BROADCASTS.com

Encore! EP397: The Minefield That Is a PBM Contract and Also Some Advice for EBCs Who Are Taking Money Under the Table, With Paul Holmes

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EP444: Two State Healthcare Laws Often Dont Go as Planned: CON and COPA, With Ann Kempski

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EP443: Let Us Never Pay the First Bill in Honor of Marshall Allen

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EP442: A Short Rumination on Saving Money, Except Not Saving Money. Oncology Side Effect Management as a Case Study, With Andreas Mang

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EP441: Tables Get Turned. This Is Me Interviewed by Abby Burns From Radio Advisory About What Is Value

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EP440: What Is the Optimal Size for a Medical Practice? With David Muhlestein, PhD, JD

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EP439: Fixing the Generic Drug Pricing Problem, Where Patients Pay More When They Use Their Insurance, With Luke Slindee, PharmD

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EP438: Recognizing Cognitive Dissonance and Thinking About How to Overcome It When in the Belly of the Beast, With John Lee, MD

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EP437: The Most Powerful Committee No One Ever Heard of and Their Role in Primary Care and Mental Health Struggles, With Brian Klepper, PhD

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EP436: Lets Talk About TPA and Health Plan Inertia Instead of Jumbo Employer Inertia, With Elizabeth Mitchell

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Encore! EP363: How to Cut Healthcare Admin Burden in Half, With David Scheinker, PhD

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EP435: Optimized Pharmacy Benefits Are Required if You Want to Do or Buy Value-Based Care, With Dan Mendelson

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EP434: 5 Surprises About Bundled Payments, With Benjamin Schwartz, MD, MBA

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EP433: The Mystery of the Weekly Claims Wire: What Are Plan Sponsors Actually Paying For Each Week? With Justin Leader

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Encore! EP391: A Case Study for Anyone Trying to Level Up Primary Care That Im Gonna Call How Margin Shoves Mission Off the Bus, With Scott Conard, MD

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Encore! EP297: A Driver of Patient Engagement and Clinician Team Success That Is Almost Always Overlooked, With Jerry Durham

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EP432: The Knifepoint Intersection of Margin and Mission and the Peril of Cutting Clinical Waste, With Kate Wolin, ScD

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EP431: How Accountability for Outcomes Works in the Real World With Kenny Cole, MD

\\xb7\\xa0\\xa0\\xa0\\xa0\\xa0 Eric Gallagher, CEO, Ochsner Health Network

\\xb7\\xa0\\xa0\\xa0\\xa0\\xa0 Leah Binder, CEO, The Leapfrog Group

\\xb7\\xa0\\xa0\\xa0\\xa0\\xa0 Anisha Sood, Chief Financial & Strategy Officer, First Choice Health

Follow along with the experts through the ro3 March Healthcare Classic at https://ro3.com/healthcare-classic/.

You can learn more at Ochsner Health. You can also follow Dr. Cole on LinkedIn.

Kenny Cole, MD, began his role as System VP, Clinical Improvement, for Ochsner Health in New Orleans in September 2019. He is a practicing primary care internist with advanced degrees from LSU Health Sciences Center and Dartmouth, as well as executive training from Harvard Business School. Prior to joining Ochsner Health, Dr. Cole was the chief clinical transformation officer for Baton Rouge General Medical Center, where he designed, developed, and implemented a completely reimagined multidisciplinary team-based model of primary care that focused on aligning clinical with financial outcomes. His current work at Ochsner Health built on that prior foundation to design and help develop Ochsner 65 Plus, a group of redesigned primary care clinics focused on the needs of older adults.

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07:38 Is there an optimal care pathway where there might be a lot of treatment variability?

11:01 Why doesn\\u2019t Dr. Cole like the terms \\u201cnoncompliant\\u201d and \\u201cnonadherent\\u201d?

11:45 EP412 with Robert Pearl, MD.

13:50 Why is it important to start with the end in mind?

17:20 How do you scale clinical excellence?

20:21 EP315 with Bob Matthews.

21:15 EP242 with Marty Makary, MD.

23:49 Why is it important simply to demonstrate what\\u2019s possible for better health outcomes?

24:58 EP427 with Rik Renard.

26:10 How do we reinvent the business model of healthcare?

27:50 EP415 with Rob Andrews.

30:06 EP391 with Scott Conard, MD.

38:37 Dr. Cole is published in various healthcare journals; check out his most recent article.

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You can learn more at Ochsner Health. You can also follow Dr. Cole on LinkedIn.

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Kenny Cole, MD, discusses #accountability for #healthoutcomes on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation

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Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Barbara Wachsman, Luke Slindee, Julie Selesnick, Rik Renard, AJ Loiacono (Encore! EP379), Nina Lathia, Marshall Allen, Stacey Richter (INBW39), Peter Hayes, Joey Dizenhouse

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Listed in: Health

EP430: Advice for Digital Health Vendors Selling to Employers, With Barbara Wachsman

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EP429: Following the Dollar Through Pharmacy Acronyms Like WAC, AWP, and NADAC, With Luke Slindee, PharmD

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EP428: Do-It-Now Advice From the J&J and the DOL v BCBS Lawsuits, With Julie Selesnick

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EP427: How Do Digital Health Vendors Deliver Patient Outcomes and Experiences? With Rik Renard

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Encore! EP379: How Much Money, Really, Are Employee Benefit Consultants and/or Brokers Making From Plan Sponsors? With AJ Loiacono

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EP426: Cost Containment Versus Value-based Drug Purchasing, With Nina Lathia, RPh, MSc, PhD

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EP425: Three Ways for Regular Clinical Practices to Take Cash When Its Cheaper for a Patient Than Using Their Insurance, With Marshall Allen

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INBW39: The Narcissism of Small Differences Is a Really Must-Know Concept When Attempting to Fix the Healthcare Industry

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EP424: Five Things for Hospital System Execs to Get Real About in 2024, With Peter Hayes

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EP423: Maximizers and the the Drugs Arent Covered Schemes Employers Use to Save Money (or Not) on Pharmacy Benefits, With Joey Dizenhouse

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EP422: Some Indie Pharmacy Upshots That Surprised Meand I Thought I Was Pretty in the Know, With Benjamin Jolley, PharmD

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Encore! EP392: When Patient Journeys Dont Fit in the EHR, With Emily Kagan Trenchard

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Encore! EP372: Step One for Employers and UnionsGet Your Data, With Cora Opsahl

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EP421: Wildly Improving Outcomes When the Patient Is, for Reals, in the CenterFor Maternity and Beyond, With Jodilyn Owen

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EP420: Paying Cash for Generic DrugsSome Finer Points That Had Totally Gone Over My Head, With Ge Bai, PhD, CPA

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EP419: The Financialization of Health Benefits for Boards of Directors and C-Suites of Self-Insured Employers, With Andreas Mang

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Encore! EP381: For Reals, Becoming Customer-centric, Transforming, or Innovating at a Very Large Organization, With Karen Root

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EP418: Mark Cuban With Some Advice for CEOs and CFOs of Self-insured Employers, With Mark Cuban and Ferrin Williams, PharmD, MBA, From Scripta

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Encore! EP385: Morgan Health and the 5 Things Self-insured Employers Should Do Right Now, With Dan Mendelson

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EP417: 5 Kinds of Payer and Provider Collaborations and 5 Must-Haves for Said Collaborations to Work, With Josh Berlin, JD

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EP416: Why Should Med Schools Teach the Business of Medicine? With Adam Brown, MD, MBA

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EP415: Some Jumbo Employers Buying Better Healthcare Outcomes While Saving 15% on Total Cost of Care, With Rob Andrews

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EP414: An IRL How-To for Delivering Better Care and Getting Paid for ItA Value-Based Case Study, With Justina Lehman

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EP413: The Intersection of Healthcare Waste, Value-Based Care, and the Potential Rising Power of PCPs, With Will Shrank, MD

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EP411: Getting Paid (or Paying) for New Innovations Used in Hospitals as Part of a Procedure or a DRGAlso Bloodstream Infections and Dialysis, With Secretary David Shulkin, MD, and Erin Mistry

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Encore! EP361: The Gap in Closing Care Gaps, With Carly Eckert, MD, PhD(c), MPH

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EP412: Leadership of the Art and Science of Medicine, With Robert Pearl, MD

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Are Physicians (and the Rest of Us, Nothing for Nothing) Knights, Knaves, and/or Pawns? With Larry Bauer, MSW, MEdSummer Shorts 8

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Why Do Actuarial Risk Horizons Really Matter for Anybody Trying to Improve Patient Outcomes? With Keith Passwater and JR ClarkSummer Shorts 7

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Should You Not Give Employees the Benefit Design They Think They Want? With Lauren VelaSummer Shorts 6

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Payers Trying to Differentiate Themselves by Working With Provider Organizations ... or Not, With Jacob Asher, MDSummer Shorts 5

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Supergroups, Super ACOs, and Ochsners Value-Based Care Journey, With Eric GallagherSummer Shorts 4

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EP410: The Imperative and a 201-Level Financial How-To for Payers and Provider Organizations to Collaborate to Help CKD Patients and Others With Chronic Conditions, With Dan Serrano

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EP409: 3 Really Cool Innovative Primary Care Bright Spots and a Few Notes for Policymakers and Payers, With Larry Bauer, MSW, MEd

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Does Advanced Primary Care Reduce Access for Patients? With Vivek Garg, MD, MBASummer Shorts 3

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What Happens When Someone Tries to Un-transform a Transformed PCP Practice? With Scott Conard, MDSummer Shorts 2

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How Come There Arent More Hospital Antitrust Cases? With Brennan BilberrySummer Shorts 1

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INBW38: What Im Up to Right Now, Big RHV Plans for the SummerAlso Doug Pohl, Justina Lehman, and Dr. Amy Scanlan

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Encore! EP365: The Real Deal With PBM Contracts and Drug Rebates, With Scott Haas

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EP408: Whos Suing Who? An Overview of Healthcare Legal Goings-on, With Chris Deacon

b.\\xa0\\xa0\\xa0 Mass Laborers vs Blue Cross Blue Shield

c.\\xa0\\xa0\\xa0\\xa0 Member vs Cigna

2. Carrier vs Hospital (upcoding) and Hospital vs Carrier (underpayment)

a.\\xa0\\xa0\\xa0 United vs TeamHealth

b.\\xa0\\xa0\\xa0 TeamHealth vs United

3. Taxing Authority vs Nonprofit Hospitals

a.\\xa0\\xa0\\xa0 Tower Health line of cases in Pennsylvania

b.\\xa0\\xa0\\xa0 Pittsburgh vs UPMC

This episode itself is a little on the longer side\\u2014and I didn\\u2019t want to edit too many of Chris\\u2019s words of wisdom\\u2014so I\\u2019m gonna make this a little bit shorter, this intro.

But just one point that I\\u2019ll make, and this is about the first category of legal activity wherein self-insured employers mostly try to pass the \\u201cwho is actually the fiduciary\\u201d hot potato to carriers, ASOs (administrative services only), and TPAs (third-party administrators). And the carriers, ASOs, and TPAs are like, \\u201cIt ain\\u2019t us.\\u201d Moving forward here, I\\u2019m just gonna say carriers as a catchall for carriers, ASOs, and TPAs to save myself a mouthful.

But bottom line on this topic, I just want to underscore something that Chris makes clear later on in the show: Plan sponsors (ie, self-insured employers) are the fiduciary, the sole fiduciary, at least according to the carriers who are getting sued right now. This is the position that you can see them taking in every lawsuit that I have seen. What the carriers say also, as a follow-on, is that if there is any contractual language between the carrier and the employer that violates the CAA (Consolidated Appropriations Act) or any other regulations, it is or was the employer\\u2019s responsibility to not sign the contract.

It\\u2019s not the carrier\\u2019s responsibility to point out that there\\u2019s stuff in their own contract that\\u2019s in violation for the employer to sign.\\xa0And this includes contracts that don\\u2019t give self-insured employers the right to their own data, which is pretty much a rate critical for any and all CAA compliance.

As Justin Leader wrote the other day in reference to the bricklayer case, \\u201cTo get to the point of filing the suit, there was a solid 2 years of failed negotiations [for the bricklayers to get their own claims] data.\\u201d

Two years trying to get claims data that is necessary for a fiduciary to have from a carrier who is saying essentially, \\u201cGood luck with that. You\\u2019re the ones that signed our contract.\\u201d

Here\\u2019s one of Chris Deacon\\u2019s latest LinkedIn posts about this topic.

And here\\u2019s another one from Jeff Hogan that was interesting.

Also, here\\u2019s the link to the earlier episode with Chris (EP342), where we dive into the deep end on the topic of the CAA, which was signed into law at the beginning of 2022 and states that self-insured employers have certain rights and responsibilities based on their role as the fiduciary of their health plan.

For more on the Member vs Cigna case, check out the encore episode with Dawn Cornelis (Encore! EP285).

The show with Vikas Saini, MD, and Judith Garber, MPP (EP394) comes up where we talked about hospitals and their charitable giving.

And lastly, I mention the show with Suhas Gondi, MD, MBA (EP404) about who is on the board of directors of hospitals, big nonprofit hospitals in particular.

My guest in this healthcare podcast, Chris Deacon, is a lawyer by training. She ran the state health plan for the state of New Jersey, which covered about 820,000 public-sector lives. She now has an independent consulting firm, VerSan Consulting.

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You can learn more at versanconsulting.com and connect with Chris on LinkedIn.
You can also email her at cdeacon@versanconsulting.com.

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Chris Deacon has a deep understanding of the fiduciary role health plan administrators hold and should be leveraging in order to drive value for their plan sponsors and members. An attorney by training, Deacon formed VerSan Consulting, LLC, in order to educate and engage employers to be more prudent purchasers of healthcare. From creative procurement methodologies and demanding contracts to population health initiatives and primary care investment, Deacon believes that large employer-sponsored health plans have not only an opportunity but an obligation to drive healthcare transformation that delivers value for the market.

Prior to founding VerSan Consulting, Deacon ran one of the largest health plans in the country for the New Jersey Department of Treasury, which covered over 820,000 public-sector lives, including state employees, teachers, and uniformed professionals. During her tenure, Deacon was credited with helping the state save over $3 billion through a number of initiatives, including enhanced oversight, payment integrity programs, procurement strategy, and strict accountability for the vendors with which the state engaged. Deacon has also served as a deputy attorney general and then special counsel to Governor Christie where she oversaw the Department of Banking and Insurance, Economic Development Authority, and Treasury. She holds a JD from Rutgers Law School and bachelor\\u2019s degree in international affairs from The George Washington University.

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04:47 What does the current legal landscape look like, and how does it bode for the future?

07:24 \\u201cWe need to catch the legal framework up with the current reality.\\u201d

19:53 How is this first circuit decision affecting who might be found liable in future cases?

21:38 What happened in the Member vs Cigna case?

24:49 Are we heading in the direction of the employer having fiduciary responsibility?

25:47 What\\u2019s happening in the Carrier vs Hospital cases?

28:49 Who\\u2019s really paying the price for the current business practices being examined in court?

30:00 What\\u2019s happened in the Tower cases?

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You can learn more at versanconsulting.com and connect with Chris on LinkedIn.
You can also email her at cdeacon@versanconsulting.com.

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@VerSan_cdeacon discusses current legal affairs in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #hcmkg #healthcarepricing #pricetransparency #healthcarefinance

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Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Dr Vivek Garg, Lauren Vela, Dale Folwell (Encore! EP249), Eric Gallagher, Dr Suhas Gondi, Dr Rachel Reid, Dr Amy Scanlan, Peter J. Neumann, Stacey Richter (EP400), Dawn Cornelis (Encore! EP285)

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Listed in: Health

EP407: Considering Comprehensive Primary Care at Humana, With Vivek Garg, MD, MBA

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EP406: The Inertia Show: 5 Excellent Reasons for the Why With the Inertia in Benefits Departments, With Lauren Vela

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Encore! EP249: The War on Financial Toxicity in North Carolina as a Case Study Everybody Should Be Keeping Their Eye On, With Dale Folwell, North Carolina State Treasurer

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EP405: What Else Physicians Trying to Clinically Integrate in the Real World Really Need to Know, With Eric Gallagher

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EP404: What Now? Whos on the Board of Those Big Hospitals? With Suhas Gondi, MD, MBA

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EP403: The Mix & Match With the How Doctors Get Paid, With Rachel Reid, MD, MS

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EP402: What Physicians Trying to Clinically Integrate Care in the Real World Need to Know, With Amy Scanlan, MD

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EP401: The Most Interesting Questions About the IRA Drug Price Negotiations, With Peter J. Neumann, ScD

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EP400: My Manifesto, Part 2: Where the Rubber Hits the Road

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Encore! EP285: Who Is Auditing These Healthcare Bills? Also, That Cigna Lawsuit, With Dawn Cornelis, Cofounder and Director of Transparency at ClaimInformatics

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EP399: My Manifesto, Part 1: The Relentless Health Value Tribe, I Salute You.

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EP398: Why Is the Commercial Payer Marketplace in California Completely Boring? With Jacob Asher, MD

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EP397: The Minefield That Is a PBM Contract and Also Some Advice for EBCs Who Are Taking Money Under the Table, With Paul Holmes

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EP396: How to Answer This Question: Will Humira Biosimilars Reduce Drug Spend? With Anna Hyde

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Encore! EP293: Game Theory Gone Wild: Co-pay Cards, Co-pay Accumulators, and Co-pay Maximizers, With Dea Belazi, PharmD, MPH, President and CEO of AscellaHealth

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EP395: Consolidated Hospital Systems and Cunning Anticompetitive Contracts, With Brennan Bilberry

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EP394: Spoiler Alert: It Is Counterintuitive Which Hospitals Offer the Most Charity Care, With Vikas Saini, MD, and Judith Garber

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EP393: How Do You Know if a Practice or a CIN (Clinically Integrated Network) Is Actually Clinically Integrated? With David Muhlestein, PhD, JD

\\xb7\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0 Step 2: Assess the needs of your patient population and focus on things where your capacity meets the needs of the population that you serve in the most impactful way.

\\xb7\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0 Step 3: Take the outcome of step 2\\u2014which is basically whatcha gonna do to fix the most consequential problems that your patients have\\u2014and identify the processes by which you will do this.

\\xb7\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0 Step 4: Do not boil the ocean. Start with a subset of patients and figure out the exact plan to do better to manage that population\\u2014easier said than done, of course. (Betsy Seals, by the way said something along these exact same lines in the shows giving advice to Medicare Advantage plans. And Karen Root [EP381] also alludes to something similar as she talks about how to socialize innovation. So clearly, this advice can be universalized.)

You can learn more by emailing David at dmuhlestein@healthmanagement.com and by connecting with him on LinkedIn.

David Muhlestein, PhD, JD, is chief research and innovation officer for Health Management Associates (HMA). He is responsible for the firm\\u2019s self-directed research and supports strategic planning and innovation.

David\\u2019s research and expertise center on healthcare payment and delivery transformation, understanding healthcare markets, and evaluating how the broader healthcare system is changing. He is a self-identified data nerd and regularly speaks and writes about healthcare system evolution.

David joined HMA via its acquisition of Leavitt Partners in 2021, where he was the chief strategy and chief research officer.

Additionally, David is a visiting policy fellow at the Margolis Center for Health Policy at Duke University, adjunct assistant professor at The Ohio State University College of Public Health, and a visiting fellow at the Accountable Care Learning Collaborative. He previously served as adjunct assistant professor of The Dartmouth Institute (TDI) at the Geisel School of Medicine at Dartmouth College.

David earned his PhD in health services management and policy, JD, MHA, and MS from The Ohio State University and a BA from Brigham Young University.

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07:57 What does it mean to be clinically integrated?

10:23 How does changing practice patterns count as becoming clinically integrated?

11:11 How do you change the delivery of care to get better outcomes?

12:05 What does it mean to see better outcomes when becoming clinically integrated?

14:46 EP176 with Dr. Robert Pearl.

17:42 \\u201cTheir structure is dictating what they are going to prioritize.\\u201d

19:02 \\u201cHow do you care for the patients that have yet to come and see you?\\u201d

20:16 EP391 with Scott Conard, MD.

22:38 \\u201cWhen you\\u2019re integrated, you realize you\\u2019re not alone.\\u201d

25:50 Why does clinically integrating require a significant mindset change?

28:55 What does this country need to do from a policy perspective for this change?

30:24 EP326 with Rishi Wadhera, MD, MPP.

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You can learn more by emailing David at dmuhlestein@healthmanagement.com and by connecting with him on LinkedIn.

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@DavidMuhlestein of @HMAConsultants discusses #integratedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth

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Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Nikhil Krishnan (Encore! EP355), Emily Kagan Trenchard,\\xa0Dr Scott Conard,\\xa0Gloria Sachdev and Chris Skisak, Mike Thompson, Dr Rishi Wadhera (Encore! EP326), Ge Bai (Encore! EP356), Dave Dierk and Stacey Richter (INBW37), Merrill Goozner, Betsy Seals (EP387), Stacey Richter (INBW36), Dr Eric Bricker (Encore! EP351), Al Lewis, Dan Mendelson, Wendell Potter, Nick Stefanizzi, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375)

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Listed in: Health

Encore! EP355: The 5 Business Models for Digital Health Companies, With Nikhil Krishnan

Listed in: Health

EP392: When Patient Journeys Dont Fit in the EHR System, With Emily Kagan Trenchard From Northwell Health

Listed in: Health

EP391: Lessons for Private Equity and Others Trying to Do Right by PCPs and Their Patients, With Scott Conard, MD

Listed in: Health

EP390: What Legislators Need to Know About Hospital Prices, With Gloria Sachdev, PharmD, and Chris Skisak, PhD

Listed in: Health

EP389: The Clapback When Hospitals Cannot Constrain Their Own Prices, With Mike Thompson

Listed in: Health

Encore! EP326: The Unfortunate News About HRRP, With Insight Into How to Fix It, With Rishi Wadhera, MD, MPP

Listed in: Health

Encore! EP356: PBMs React to GoodRx, Mark Cuban, and Amazon Pharmacy, With Ge Bai, PhD, CPA

Listed in: Health

INBW37: Harnessing the Miracle of the Commons to Improve the Patient Journey Nationwide, A Conversation With Dave Dierk, Co-President of Aventria Health Group

Listed in: Health

EP388: Merrill Goozner on the Future of Healthcare and Glide Paths to Get There

Listed in: Health

EP387: Medicare Advantage Trends and How Medicare Advantage Plans Will or Will Not Succeed, With Betsy Seals, CEO and Cofounder of Rebellis Group

Listed in: Health

INBW36: Will Healthcare Stakeholders Who Dont Collaborate Wind Up With a Business Problem?

Listed in: Health

Encore! EP351: Everybody in the Healthcare Industry Getting Up in Everyone Elses Business, With Eric Bricker, MD

Listed in: Health

EP386: What You Need to Know About ER Bills Post the No Surprises Act, With Al Lewis

Listed in: Health

EP385: Morgan Health and the 5 Things Self-insured Employers Should Do Right Now, With Dan Mendelson

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EP384: How Shareholders Impact Payer Behavior, Exactly and Specifically, With Wendell Potter

Listed in: Health

EP383: Direct Contracting as a Health System Business Strategy, With Nick Stefanizzi

Listed in: Health

Encore! EP335: Why Private Equity Is Willing to Pay $55,000 per Patient to Primary Care Start-ups, With Brian Klepper, PhD

Listed in: Health

EP382: Pharma Conflicts of Interest and the Anti-Kickback Statute, With Aaron Mitchell, MD, MPH

Listed in: Health

EP381: For Reals, Becoming Customer-centric, Transforming, or Innovating at a Very Large Organization, With Karen Root

Listed in: Health

EP380: 7 Big Reasons Medicare Drug Price Negotiation Actually Happened This Time AroundWhat Changed? With Mark Miller, PhD

Mark E. Miller, PhD, leads Arnold Ventures\\u2019 work to lower the cost and improve the value of healthcare. He has more than 30 years of experience developing and implementing health policy, including prior positions as the executive director of the Medicare Payment Advisory Commission, assistant director of Health and Human Resources at the Congressional Budget Office, deputy director of health plans at the Centers for Medicare and Medicaid Services, health financing branch chief at the Office of Management and Budget, and senior research associate at the Urban Institute.

04:45 Why did Medicare\\u2019s ability to negotiate on drug pricing happen now?
06:35 What\\u2019s different about the drug market today that allowed Medicare to gain the ability to negotiate drug pricing?
12:08 How has innovation played into drug price negotiations?
12:40 \\u201cIf you limit profits, you can end up limiting innovation.\\u201d
14:03 Why was the distinction between more drugs and innovative drugs important to changing the landscape of the drug market?
15:49 More versus new and future versus now in the drug market.
19:59 \\u201cAs the landscape was shifting, Pharma didn\\u2019t shift with it.\\u201d
23:00 How did voters change the landscape in drug pricing?
24:39 \\u201cPharma did not have exclusive control over the patients\\u2019 voice.\\u201d
29:59 \\u201cThe industry would largely like to just stick with the patents that they have.\\u201d
30:16 \\u201cOf course, it\\u2019s competition that ultimately drives innovation.\\u201d
31:30 \\u201cThis is an exquisitely complicated market.\\u201d

You can learn more at arnoldventures.org. \\xa0

@MarkMiller_DC discusses #medicare #drugprices on our #healthcarepodcast. #healthcare #podcast

Why did Medicare\\u2019s ability to negotiate on drug pricing happen now? @MarkMiller_DC discusses #medicare #drugprices on our #healthcarepodcast. #healthcare #podcast

What\\u2019s different about the drug market today that allowed Medicare to gain the ability to negotiate drug pricing? @MarkMiller_DC discusses #medicare #drugprices on our #healthcarepodcast. #healthcare #podcast

How has innovation played into drug price negotiations? @MarkMiller_DC discusses #medicare #drugprices on our #healthcarepodcast. #healthcare #podcast

\\u201cIf you limit profits, you can end up limiting innovation.\\u201d @MarkMiller_DC discusses #medicare #drugprices on our #healthcarepodcast. #healthcare #podcast

Why was the distinction between more drugs and innovative drugs important to changing the landscape of the drug market? @MarkMiller_DC discusses #medicare #drugprices on our #healthcarepodcast. #healthcare #podcast

More versus new and future versus now in the drug market. @MarkMiller_DC discusses #medicare #drugprices on our #healthcarepodcast. #healthcare #podcast

\\u201cAs the landscape was shifting, Pharma didn\\u2019t shift with it.\\u201d @MarkMiller_DC discusses #medicare #drugprices on our #healthcarepodcast. #healthcare #podcast

How did voters change the landscape in drug pricing? @MarkMiller_DC discusses #medicare #drugprices on our #healthcarepodcast. #healthcare #podcast

\\u201cPharma did not have exclusive control over the patients\\u2019 voice.\\u201d @MarkMiller_DC discusses #medicare #drugprices on our #healthcarepodcast. #healthcare #podcast

\\u201cThe industry would largely like to just stick with the patents that they have.\\u201d @MarkMiller_DC discusses #medicare #drugprices on our #healthcarepodcast. #healthcare #podcast

\\u201cOf course, it\\u2019s competition that ultimately drives innovation.\\u201d @MarkMiller_DC discusses #medicare #drugprices on our #healthcarepodcast. #healthcare #podcast

\\u201cThis is an exquisitely complicated market.\\u201d @MarkMiller_DC discusses #medicare #drugprices on our #healthcarepodcast. #healthcare #podcast

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Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins

\\xa0

Listed in: Health

EP379: How Much Money, Really, Are Employee Benefit Consultants and/or Brokers Making From Plan Sponsors? With AJ Loiacono

Anthony J. \\u201cAJ\\u201d Loiacono is the co-founder and CEO of Capital Rx, one of the fastest-growing health technology companies in America. He has over 20 years of experience in pharmacy benefits, finance, and software development. AJ\\u2019s mission is to create the first efficient market for prescription prices and provide employer groups with the highest standard of patient care. AJ has spent his career studying the pharmaceutical supply chain and producing engineering solutions that have continually redefined the pharmacy benefit industry to achieve this goal.

Prior to Capital Rx, AJ was a co-founder of Truveris, where he served for eight years as CEO, CIO, and board member, leading the company to record growth (Deloitte FAST 500 and Crain\\u2019s Fast 50). Before Truveris, AJ co-founded SMS Partners, a joint venture with Realogy (RLGY), and in 2010 exited the partnership with a buyout. In his first venture, AJ started Victrix, a pharmaceutical supply chain consultancy, and successfully sold the company to Chrysalis Solutions in 2007. AJ is a graduate of Manhattanville College, where he studied finance while playing varsity soccer and rugby.

06:03 Who can get in trouble for mismanaging employee funds?
06:31 Who can begin the cycle for annual review?
07:53 \\u201cWhen you talk about conflicts of interest, they\\u2019re everywhere.\\u201d
13:17 \\u201cYou\\u2019re paying for access.\\u201d
13:38 Why is it important to request that they disclose direct and indirect compensation?
14:08 What are the layers to these hidden fees and compensations?
18:17 What is a reasonable fee for a good plan admin?
19:32 \\u201cI think people need to step back and say, \\u2018How many different ways are they getting compensated?\\u2019\\u201d
24:57 \\u201cThe compensation is not just unreasonable, but if they were to move it, they would lose access to an entire column of revenue.\\u201d
25:13 \\u201cFor every good broker consultant, there\\u2019s a horrible individual lurking out there and it\\u2019s easy to figure out: Ask for them to disclose their fees.\\u201d
28:14 \\u201cYou can\\u2019t win if you can\\u2019t even pay the house fee to come in.\\u201d
31:42 Why do you need to ask for disclosure, and what do you need to ask specifically?
32:27 What are some of the characteristics of a good plan consultant?

You can learn more at cap-rx.com and find resources through law firms. \\xa0

AJ Loiacono of @cap_rx discusses #ebcs, #brokers, and #plansponsors on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Who can get in trouble for mismanaging employee funds? AJ Loiacono of @cap_rx discusses #ebcs, #brokers, and #plansponsors on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Who can begin the cycle for annual review? AJ Loiacono of @cap_rx discusses #ebcs, #brokers, and #plansponsors on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWhen you talk about conflicts of interest, they\\u2019re everywhere.\\u201d AJ Loiacono of @cap_rx discusses #ebcs, #brokers, and #plansponsors on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cYou\\u2019re paying for access.\\u201d AJ Loiacono of @cap_rx discusses #ebcs, #brokers, and #plansponsors on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why is it important to request that they disclose direct and indirect compensation? AJ Loiacono of @cap_rx discusses #ebcs, #brokers, and #plansponsors on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What are the layers to these hidden fees and compensations? AJ Loiacono of @cap_rx discusses #ebcs, #brokers, and #plansponsors on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What is a reasonable fee for a good plan admin? AJ Loiacono of @cap_rx discusses #ebcs, #brokers, and #plansponsors on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cI think people need to step back and say, \\u2018How many different ways are they getting compensated?\\u2019\\u201d AJ Loiacono of @cap_rx discusses #ebcs, #brokers, and #plansponsors on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThe compensation is not just unreasonable, but if they were to move it, they would lose access to an entire column of revenue.\\u201d AJ Loiacono of @cap_rx discusses #ebcs, #brokers, and #plansponsors on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cFor every good broker consultant, there\\u2019s a horrible individual lurking out there and it\\u2019s easy to figure out: Ask for them to disclose their fees.\\u201d AJ Loiacono of @cap_rx discusses #ebcs, #brokers, and #plansponsors on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cYou can\\u2019t win if you can\\u2019t even pay the house fee to come in.\\u201d AJ Loiacono of @cap_rx discusses #ebcs, #brokers, and #plansponsors on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why do you need to ask for disclosure, and what do you need to ask specifically? AJ Loiacono of @cap_rx discusses #ebcs, #brokers, and #plansponsors on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What are some of the characteristics of a good plan consultant? AJ Loiacono of @cap_rx discusses #ebcs, #brokers, and #plansponsors on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova

Listed in: Health

EP378: The Status of Telehealth Reimbursement and Other Telehealth Policy Updates, With Josh LaRosa, MPP

Josh LaRosa, MPP, is a vice president at Wynne Health Group, focusing primarily on regulatory affairs with a focus on the US Food & Drug Administration (FDA) and Centers for Medicare & Medicaid Services (CMS). His interests lie in delivery reform and innovations in payment and care delivery models. Josh also supports the firm\\u2019s Public Option Institute, which studies the emergence of public option programs at the state level.

Prior to Wynne Health Group, Josh consulted for the CMS Innovation Center, where he worked to implement, monitor, and spread learning garnered from the center\\u2019s high-profile demonstration projects, most recently including the national primary care redesign effort, Comprehensive Primary Care Plus (CPC+).

Josh holds a Master of Public Policy from the University of Virginia\\u2019s Frank Batten School of Leadership and Public Policy. He also completed his undergraduate studies at the University of Virginia, graduating cum laude with a BA in political philosophy, policy, and law.

04:09 What is the story with telehealth policy right now?
06:08 What kind of flexibilities did HHS allow with telehealth after the pandemic?
09:46 Are we still under these pandemic flexibilities for telehealth?
12:15 Why isn\\u2019t the government just making greater access to telehealth permanent?
18:24 How does telehealth lend itself to the risk of overspending when dealing with an FFS model?
21:13 Does telehealth fit into the new CMS fee schedule?
22:55 How do states factor into the future of telehealth?
24:40 What is Arizona doing specifically to improve and ensure the future of telehealth?
30:56 What\\u2019s next in store for telehealth at the congressional level?

You can learn more at wynnehealth.com or by following on Twitter and LinkedIn.\\xa0\\xa0

@josh_larosa of @WynneHealth discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What is the story with telehealth policy right now? @josh_larosa of @WynneHealth discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What kind of flexibilities did HHS allow with telehealth after the pandemic? @josh_larosa of @WynneHealth discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Are we still under these pandemic flexibilities for telehealth? @josh_larosa of @WynneHealth discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why isn\\u2019t the government just making greater access to telehealth permanent? @josh_larosa of @WynneHealth discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How does telehealth lend itself to the risk of overspending when dealing with an FFS model? @josh_larosa of @WynneHealth discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Does telehealth fit into the new CMS fee schedule? @josh_larosa of @WynneHealth discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How do states factor into the future of telehealth? @josh_larosa of @WynneHealth discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What is Arizona doing specifically to improve and ensure the future of telehealth? @josh_larosa of @WynneHealth discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What\\u2019s next in store for telehealth at the congressional level? @josh_larosa of @WynneHealth discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai

\\xa0

Listed in: Health

INBW35: Collaboration Between Healthcare Providers, Payers, and Others Is Required to Improve Chronic Care Patient Outcomes

Each week on Relentless Health Value, Stacey uses her voice and thought leadership to provide insights for healthcare industry decision makers trying to do the right thing. Each show features expert guests who break down the twists and tricks in the medical field to help improve outcomes and lower costs across the care continuum. Relentless Health Value is a top 100 podcast on iTunes in the medicine category and reaches tens of thousands of engaged listeners across the healthcare industry.

In addition to hosting Relentless Health Value, Stacey is co-president of QC-Health, a benefit corporation finding cost-effective ways to improve the health of Americans. She is also co-president of Aventria Health Group, a consultancy working with clients who endeavor to form collaborations with payers, providers, Pharma, employer organizations, or patient advocacy groups.

01:41 What are the two major patient challenges in chronic patient care that can only be solved by collaboration?
01:56 What is the \\u201ccare gap\\u201d problem?
03:19 \\u201cCrappy prior auth processes create care gaps.\\u201d
03:25 EP361 with Carly Eckert, MD. \\xa0
04:00 How do you eliminate care gaps proactively?
06:46 EP358 with Wayne Jenkins. \\xa0
08:21 What is one way to make healthcare more affordable?
09:49 Why aren\\u2019t more healthcare entities collaborating?
10:04 EP366 with Kevin Schulman, MD. \\xa0
11:13 EP374 with Dave Chase.\\xa0
11:18 EP372 with Cora Opsahl. \\xa0
11:22 EP367 with Doug Hetherington. \\xa0
11:25 Upcoming episode with Nick Stefanizzi.
12:00 EP364 with David Muhlestein, PhD, JD. \\xa0

For more information, go to aventriahealth.com. \\xa0

Our host, Stacey Richter, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast

What are the two major patient challenges in chronic patient care that can only be solved by collaboration? Our host, Stacey Richter, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast

What is the \\u201ccare gap\\u201d problem? Our host, Stacey Richter, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast

\\u201cCrappy prior auth processes create care gaps.\\u201d Our host, Stacey Richter, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast

How do you eliminate care gaps proactively? Our host, Stacey Richter, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast

What is one way to make healthcare more affordable? Our host, Stacey Richter, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast

Why aren\\u2019t more healthcare entities collaborating? Our host, Stacey Richter, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan

\\xa0

\\xa0

Listed in: Health

Encore! EP295: The Not Entirely New but Definitely Improved Way to Measure Primary Care, With Rebecca Etz, PhD

Listed in: Health

Encore! EP337: A Patient-First Specialty Pharmacy, Not a Money-First Specialty Pharmacy, With Olivia Webb

Olivia Webb is a healthcare strategist and writer. She publishes the newsletter Acute Condition, as well as working on other content across the healthcare and biotech ecosystem. She previously worked at Massachusetts General Hospital and Advisory Board Company.

04:43 Why did Olivia start thinking about a patient-centric specialty pharmacy?
06:05 \\u201cThere\\u2019s really no layer on top of it to make it look nice.\\u201d
06:55 \\u201cYou\\u2019re kind of dealing with this vertical stack that doesn\\u2019t really deal with patients frequently.\\u201d
07:07 Is the specialty model more patient friendly or less?
07:39 What would a patient-centric specialty pharmacy look like?
08:29 \\u201cThere\\u2019s a lot of fragmentation; there\\u2019s a lot of friction.\\u201d
08:42 What\\u2019s unique to specialty pharmacy prescriptions?
11:09 Why can infusion centers be a high-drama place?
12:44 What\\u2019s \\u201cthe question\\u201d around specialty pharmacy?
13:11 Who has the vested interest in ensuring patients take their medications correctly in specialty pharmacy?
15:08 \\u201cIt\\u2019s really just a unique area of healthcare where the people that I think of as the good guys and the bad guys completely flips.\\u201d
16:34 Why might the time be ripe for disruption in the specialty pharmacy area?
20:26 \\u201cThere\\u2019s no one with a clear incentive to cap the prices.\\u201d
20:39 What are the barriers in specialty pharmacy?
21:01 \\u201cThe patient just isn\\u2019t at the center, the financial incentive, in any direction.\\u201d
29:44 \\u201cI think people who are designing these things need to see how patients are actually doing it.\\u201d
30:13 \\u201cI think there\\u2019s a lot of money here; I think this market is going to only increase in size.\\u201d
30:32 \\u201cI think you need scale.\\u201d
30:42 AEE15 with David Carmouche, MD, of Ochsner. \\xa0

You can learn more at acutecondition.com.\\xa0

@OliviaWebbC of the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why did Olivia start thinking about a patient-centric specialty pharmacy? @OliviaWebbC of the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThere\\u2019s really no layer on top of it to make it look nice.\\u201d @OliviaWebbC of the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cYou\\u2019re kind of dealing with this vertical stack that doesn\\u2019t really deal with patients frequently.\\u201d @OliviaWebbC of the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Is the specialty model more patient friendly or less? @OliviaWebbC of the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What would a patient-centric specialty pharmacy look like? @OliviaWebbC of the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThere\\u2019s a lot of fragmentation; there\\u2019s a lot of friction.\\u201d @OliviaWebbC of the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What\\u2019s unique to specialty pharmacy prescriptions? @OliviaWebbC of the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why can infusion centers be a high-drama place? @OliviaWebbC of the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What\\u2019s \\u201cthe question\\u201d around specialty pharmacy? @OliviaWebbC of the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why might the time be ripe for disruption in the specialty pharmacy area? @OliviaWebbC of the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIt\\u2019s really just a unique area of healthcare where the people that I think of as the good guys and the bad guys completely flips.\\u201d @OliviaWebbC of the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThe patient just isn\\u2019t at the center, the financial incentive, in any direction.\\u201d @OliviaWebbC of the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cI think people who are designing these things need to see how patients are actually doing it.\\u201d @OliviaWebbC of the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cI think there\\u2019s a lot of money here; I think this market is going to only increase in size.\\u201d @OliviaWebbC of the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353)

\\xa0

Listed in: Health

EP377: Specialty Pharmacy, PBM, Hospital, Employer, and Pharma Strategic Maneuvering, With Mike Baldzicki, CRCM

Michael J. Baldzicki, CRCM, is chief brand officer (CBO) at AscellaHealth. As CBO, Mike supports the AscellaHealth Family of Companies comprehensive business strategy to increase brand awareness, boost perceived value, and improve lines of services in the marketplace. He is responsible for oversight of their Family of Companies based on sales and marketing to finance, client services, and specialty pharmacy strategies throughout the organization that drive strategic business initiatives. Within his roles, he enhances the success of the strategic projects and applies business development, contract negotiations, network advancement, and marketing and outreach strategies that cultivate opportunities for AscellaHealth and their Family of Companies.

With more than 24 years of experience, Mike held roles in senior executive management within the specialty pharmacy supply group, pharmaceutical and biotech industry of managed markets, group purchasing organizations, specialty wholesale, and integrated delivery networks. He assumed roles within the pharmaceutical organization such as Bristol Myers Squibb, Enzon BioTech, Novo Nordisk, Baxter BioScience, as well as roles within the distribution channel of AmerisourceBergen specialty groups, BioMatrix Specialty and Infusion Rx, Diplomat/BioRx Specialty Pharmacy, CareCentrix Medical Infusion, Asembia GPO, Axelacare Infusion, to other manufacturer and specialty pharmacy home infusion companies.

Mike is active in the biotech community and is council advisor of the Council of Strategic Healthcare Advisors (CSHA), an advisor/faculty member of the Academy of Managed Care Pharmacy (AMCP) for Specialty Pharmacy Advisory Group & Biosimilars Partnership Forum, NCPDP Specialty Pharmacy Stakeholder Action Group, Self-insured Institute of America (SIIA) advisor, National Alliance of Healthcare Purchaser Coalitions, and was 2014 Editorial Board Member for Specialty Pharmacy Times.

Mike holds a bachelor\\u2019s degree in business management and a Certificate in Clinical Research Compliance and Management (CRCM). He has completed programs in leadership development at Harvard University, Brooks Group, Miller Heiman Account Management, and MD Anderson Center Cancer Courses.

04:27 Is it a conflict of incentives to worry about the cost of million-dollar pharmaceuticals?
06:24 \\u201cReally, does it make sense to carve up my specialty pharmacy benefit \\u2026 away from my typical PBM model?\\u201d
06:48 What\\u2019s the trend line with moving away from the big PBMs?
07:20 Specialty pharmacy episodes.
07:53 How does a small PBM contract with Pharma?
08:34 EP365 with Scott Haas.
10:15 EP337 with Olivia Webb.
11:32 \\u201cWe\\u2019re still lacking the overall insight to data.\\u201d
12:15 \\u201cWhen you have insight and good data, then you can start really driving the plan language and cover requirements.\\u201d
13:07 \\u201cIt is a frustrating game because \\u2026 the large PBMs that have traditionally managed an employer\\u2019s spend \\u2026 doesn\\u2019t give them the data that\\u2019s needed.\\u201d
13:48 What\\u2019s going on with outcomes-based contracts?
14:16 What\\u2019s the importance of aligning reimbursement around value instead of volume?
14:57 \\u201cThe issue is, how real is the data?\\u201d
19:24 EP370 with Erik Davis and Autumn Yongchu.
20:36 Are hospital-based specialty pharmacies teaming up with big PBMs?
22:01 \\u201cIt\\u2019s market ownership.\\u201d
29:17 EP369 with Keith Hartman, RPh.
30:43 \\u201cThese are real scenarios that are happening in the self-insured planned sponsor market.\\u201d
30:59 \\u201cEmployers really should start recognizing organizations that take more of an integrated and thoughtful approach.\\u201d

You can learn more at ascellahealth.com.\\xa0\\xa0

Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast

Is it a conflict of incentives to worry about the cost of million-dollar pharmaceuticals? Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast

\\u201cReally, does it make sense to carve up my specialty pharmacy benefit \\u2026 away from my typical PBM model?\\u201d Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast

What\\u2019s the trend line with moving away from the big PBMs? Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast

How does a small PBM contract with Pharma? Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast

\\u201cWe\\u2019re still lacking the overall insight to data.\\u201d Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast

\\u201cWhen you have insight and good data, then you can start really driving the plan language and cover requirements.\\u201d Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast

\\u201cIt is a frustrating game because \\u2026 the large PBMs that have traditionally managed an employer\\u2019s spend \\u2026 doesn\\u2019t give them the data that\\u2019s needed.\\u201d Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast

What\\u2019s going on with outcomes-based contracts? Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast

What\\u2019s the importance of aligning reimbursement around value instead of volume? Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast

\\u201cThe issue is, how real is the data?\\u201d Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast

Are hospital-based specialty pharmacies teaming up with big PBMs? Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast

\\u201cIt\\u2019s market ownership.\\u201d Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast

\\u201cThese are real scenarios that are happening in the self-insured planned sponsor market.\\u201d Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast

\\u201cEmployers really should start recognizing organizations that take more of an integrated and thoughtful approach.\\u201d Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352)

\\xa0

Listed in: Health

EP376: InteroperabilityWhos Who and Doing What? With Lisa Bari, MBA, MPH

Lisa Bari, MBA, MPH, is the inaugural CEO of Civitas Networks for Health, a national nonprofit member- and mission-driven organization that was previously known as the Network for Regional Health Improvement and the Strategic Health Information Exchange Collaborative. Civitas counts over 100 multi-stakeholder-governed regional health improvement collaboratives and health information exchanges as members and creates national opportunities for education and community building between its members, policy makers, and business partners. Their upcoming conference (August 21-24, 2022, in San Antonio or via livestream) focuses on the theme of data collaboratives and information exchanges creating the critical infrastructure for health equity. Previously, Lisa was the health IT and interoperability lead at the CMS Innovation Center, working on primary care innovation model policy, and additionally has a background in health IT marketing and strategy. She holds an MBA from Purdue University and a Master of Public Health in health policy from the Harvard TH Chan School of Public Health and serves on the boards of directors of HealthCare Access Maryland and the Zorya Foundation.\\xa0

06:30 How does value-based care depend on interoperability?
07:38 Why is it really important to exchange information at the right time with the right purpose?
08:00 What is one of the easiest low-hanging fruit to achieve in value-based care?
09:42 What are the four kinds of companies getting into the interoperability space?
11:51 \\u201cAs we know, there\\u2019s sort of technical interoperability \\u2026 and then there\\u2019s semantic interoperability.\\u201d
12:59 Where are we right now with EHR basic interoperability?
15:33 Who should ACOs hire to get the right data at the right time?
17:00 Why is it important to delineate the different types of HIE?
22:09 What can ACOs assure with interoperability?
22:59 Is the demand among ACOs for interoperability there?
24:04 \\u201cIf you\\u2019re in value-based care, you better care about what\\u2019s happening outside of the healthcare setting.\\u201d
24:36 EP108 with Chris Klomp.
26:25 \\u201cEvery couple of years, someone talks about creating the ultimate database to rule them all. \\u2026 It hasn\\u2019t happened yet, and I don\\u2019t think it\\u2019s going to happen.\\u201d
26:56 \\u201cThe difficult thing about healthcare data \\u2026 interoperability \\u2026 is an organizational and a governance problem.\\u201d
28:49 \\u201cYou\\u2019ve gotta start with the incentives \\u2026 and then you do have to say \\u2026 \\u2018We are not gonna hoard any more data.\\u2019\\u201d
29:10 What is TEFCA, and how does it fit into this interoperability conversation?
32:17 \\u201cI think partners are trying to solve for value and outcomes.\\u201d

You can learn more at civitasforhealth.org.\\xa0

@lisabari of @civitas4health discusses #interoperability on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How does value-based care depend on interoperability? @lisabari of @civitas4health discusses #interoperability on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why is it really important to exchange information at the right time with the right purpose? @lisabari of @civitas4health discusses #interoperability on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What is one of the easiest low-hanging fruit to achieve in value-based care? @lisabari of @civitas4health discusses #interoperability on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What are the four kinds of companies getting into the interoperability space? @lisabari of @civitas4health discusses #interoperability on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cAs we know, there\\u2019s sort of technical interoperability \\u2026 and then there\\u2019s semantic interoperability.\\u201d @lisabari of @civitas4health discusses #interoperability on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Where are we right now with EHR basic interoperability? @lisabari of @civitas4health discusses #interoperability on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Who should ACOs hire to get the right data at the right time? @lisabari of @civitas4health discusses #interoperability on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why is it important to delineate the different types of HIE? @lisabari of @civitas4health discusses #interoperability on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What can ACOs assure with interoperability? @lisabari of @civitas4health discusses #interoperability on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Is the demand among ACOs for interoperability there? @lisabari of @civitas4health discusses #interoperability on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIf you\\u2019re in value-based care, you better care about what\\u2019s happening outside of the healthcare setting.\\u201d @lisabari of @civitas4health discusses #interoperability on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cEvery couple of years, someone talks about creating the ultimate database to rule them all. \\u2026 It hasn\\u2019t happened yet, and I don\\u2019t think it\\u2019s going to happen.\\u201d @lisabari of @civitas4health discusses #interoperability on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThe difficult thing about healthcare data \\u2026 interoperability \\u2026 is an organizational and a governance problem.\\u201d @lisabari of @civitas4health discusses #interoperability on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cYou\\u2019ve gotta start with the incentives \\u2026 and then you do have to say \\u2026 \\u2018We are not gonna hoard any more data.\\u2019\\u201d @lisabari of @civitas4health discusses #interoperability on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What is TEFCA, and how does it fit into this interoperability conversation? @lisabari of @civitas4health discusses #interoperability on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cI think partners are trying to solve for value and outcomes.\\u201d @lisabari of @civitas4health discusses #interoperability on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker

Listed in: Health

EP375: Medicare Advantage Plans in the Hot Seat, With Betsy Seals, CEO and Cofounder of Rebellis Group

Betsy Seals is the CEO and cofounder of Rebellis Group, a consulting firm established to provide advisory and hands-on services to Medicare Advantage Organizations (MAOs) and their subcontractors. Betsy is a nationally recognized leader in the managed care industry with over 20 years of experience.

Betsy brings to the table a solid mix of leadership and business acumen, as well as regulatory and strategic knowledge within the managed care landscape. Betsy\\u2019s expertise is focused in the areas of mergers and acquisitions, compliance, sales and marketing, strategy, supplemental benefit landscape, innovative benefit design that address social determinants of health, and health plan operations.

Prior to founding Rebellis Group, Betsy served as the chief consulting officer for Gorman Health Group (GHG). In this role, Betsy managed the Medicare consulting practice, including implementation of strategic initiatives, development of new practice areas, and oversight of day-to-day consulting operations.

Prior to her role as chief consulting officer, Betsy served as senior vice president, compliance operations, where she assisted MAOs and Part D sponsors to attain and maintain compliance with the Centers for Medicare & Medicaid Services (CMS) regulations and guidance by conducting risk assessments, preparing organizations for CMS audits, performing mock CMS audits, and creating and implementing internal and delegated entity oversight programs.

Before joining GHG, Betsy worked for MAOs, where she served in customer service and compliance with responsibility for creation and implementation of oversight programs, CMS audit preparation, implementation of internal corrective action plans, and the day-to-day management of compliance operations. Betsy has also worked as a CMS subcontractor to conduct CMS Compliance Program audits.

08:15 What\\u2019s happening with sales and marketing in the healthcare industry?
11:04 What\\u2019s happening with the focus on recouping improper payments?
13:32 \\u201cWhen you look at the fundamentals of it, these are federal dollars. And what we\\u2019re talking about is federal dollars that were paid when they should not have been paid.\\u201d
15:39 Are improper claim payments an administrative problem, or something more intentional?
16:20 \\u201cThe health plan has a responsibility to catch those issues.\\u201d
20:10 What are specialty pharmacy prescriptions being scrutinized for?
22:12 \\u201cIf this is where CMS is headed \\u2026 the health plan should\\u2019ve already been doing this.\\u201d
23:58 Why do you see a bigger focus on social determinants of health?
25:54 Do these health plan audits actually have any teeth?
27:01 What is the biggest penalty a health plan can face from an audit?
29:57 \\u201cNavigating the Medicare program \\u2026 was near to impossible. I know the program, and even for me, it was hours and hours and hours and hours on the phone.\\u201d

You can learn more at rebellisgroup.com.\\xa0\\xa0

@betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What\\u2019s happening with sales and marketing in the healthcare industry? @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What\\u2019s happening with the focus on recouping improper payments? @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWhen you look at the fundamentals of it, these are federal dollars. And what we\\u2019re talking about is federal dollars that were paid when they should not have been paid.\\u201d @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Are improper claim payments an administrative problem, or something more intentional? @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThe health plan has a responsibility to catch those issues.\\u201d @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What are specialty pharmacy prescriptions being scrutinized for? @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIf this is where CMS is headed \\u2026 the health plan should\\u2019ve already been doing this.\\u201d @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why do you see a bigger focus on social determinants of health? @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Do these health plan audits actually have any teeth? @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What is the biggest penalty a health plan can face from an audit? @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cNavigating the Medicare program \\u2026 was near to impossible. I know the program, and even for me, it was hours and hours and hours and hours on the phone.\\u201d @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento

\\xa0

Listed in: Health

EP374: How to Grade a Health Plan and a Few Validated Success Stories, With Dave Chase, Cofounder of Health Rosetta

Dave Chase leads the mission for Health Rosetta, which is to empower community-owned health plans (COHPs) with the vision of COHPs everywhere. Health Rosetta\\u2019s purpose is creating and reinvesting the Health Rosetta Dividend (ie, redeploying the currently wasted $1.5 trillion in healthcare to a higher and better use\\u2014the social determinants of health such as income, better food, etc).

Health Rosetta makes health plans local, organic, and sustainable transforming health plans from the number one driver of inflation, poverty, and bankruptcy to drivers of well-being and wealth.

Health Rosetta ends the 30-year heist of stolen income from the working middle class. Health Rosetta plans have restored the American Dream for tens of thousands of people, giving them raises/bonuses and healthcare they can access without fear of bankruptcy. Individuals that had sky-high deductibles and co-pays no longer have that as a barrier (typically they are $0). School districts that once couldn\\u2019t give teachers raises or had to have school levies to pay for music, art, and sports programs now have the funds (due to healthcare savings) to pay teachers more, have bigger class sizes, avoid cutting extracurricular programs, and more\\u2014all while giving teachers much better care outcomes.

Health Rosetta\\u2019s Plan Grader^\\u2122 assesses the 40 most important attributes of a health plan \\u201cprescribing\\u201d proven strategies to transition into local, sustainable, world-class health plans.

Health Rosetta community\\u2019s transparency set a new industry standard and became the law of the land due to changes in laws that represent the largest change in employee health benefits since 1943.

Through best-selling books, writing for various media outlets, TED Talk, and TV/film, Dave has reached over 10 million people with the goal of engaging, equipping, and empowering a broad grassroots movement designed to restore hope, health, and well-being to our communities. Dave received the Health Value Awards\\u2019 Lifetime Achievement for Health Benefits Innovation at the World Health Care Congress.

Prior to Health Rosetta, Dave cofounded Avado, which was acquired by and integrated into WebMD/Medscape, and founded Microsoft\\u2019s $3-billion, 28,000-partner healthcare ecosystem.

Outside of work, Dave coaches the next generation of leaders as a high school track and cross-country coach of state champion teams and individuals. Dave was a PAC-12 800 meter and 4\\xd7400 competitor. Most importantly, devotion to faith, family, and friends underpin a desire to be a servant leader to the five million lives (and growing) stewarded through the Health Rosetta community.

06:57 Why did Dave Chase start Health Rosetta?
07:42 EP312 with Douglas Eby, MD, MPH, CPE.
07:51 How does Health Rosetta deem which health plans are succeeding?
11:07 What are the most important areas and factors for grading health plans?
11:22 EP365 with Scott Haas.
11:38 \\u201cThat $1.5 trillion of waste, how is that possible? Well, it\\u2019s all codified in the contracts.\\u201d
12:18 \\u201cYou can\\u2019t manage what you can\\u2019t measure.\\u201d
16:59 \\u201cWhat could be more disruptive than 30 years of wage gains stolen by the status quo health plans?\\u201d
17:39 \\u201cThis is the last major area to modernize inside of corporate America.\\u201d
18:15 \\u201cThis is not small dollars; there\\u2019s a tremendous opportunity.\\u201d
19:04 \\u201cGo back to PBM. That\\u2019s the first thing that starts to get at the care delivery side.\\u201d
21:52 \\u201cCan we even call it primary care if you can\\u2019t get in to that doc for weeks?\\u201d
25:03 Where does Health Rosetta get their data to assess health plans?
27:00 Who are these self-insured employers, typically?
29:48 \\u201c3.5% [is] where the market flips.\\u201d
31:57 EP367 with Doug Hetherington.
32:03 EP350 with Katy Talento.
33:13 \\u201cWe like to fetishize big in this country.\\u201d

You can learn more at healthrosetta.org or by emailing Dave at dave@healthrosetta.org.\\xa0\\xa0

@chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why did Dave Chase start Health Rosetta? @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

How does Health Rosetta deem which health plans are succeeding? @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

What are the most important areas and factors for grading health plans? @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThat $1.5 trillion of waste, how is that possible? Well, it\\u2019s all codified in the contracts.\\u201d @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cYou can\\u2019t manage what you can\\u2019t measure.\\u201d @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWhat could be more disruptive than 30 years of wage gains stolen by the status quo health plans?\\u201d @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThis is the last major area to modernize inside of corporate America.\\u201d @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThis is not small dollars; there\\u2019s a tremendous opportunity.\\u201d @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cGo back to PBM. That\\u2019s the first thing that starts to get at the care delivery side.\\u201d @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cCan we even call it primary care if you can\\u2019t get in to that doc for weeks?\\u201d @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

Where does Health Rosetta get their data to assess health plans? @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

Who are these self-insured employers, typically? @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201c3.5% [is] where the market flips.\\u201d @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWe like to fetishize big in this country.\\u201d @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33)

\\xa0

Listed in: Health

EP373: How to Kick a Big Hospital Out of Your Network, With Cora Opsahl

Cora Opsahl is the director of the 32BJ Health Fund, a self-funded plan that provides affordable, comprehensive, and innovative health coverage to 200,000 union members and their families. During her time at the Health Fund, Cora has led the implementation of multiple benefit changes: removing NewYork-Presbyterian Hospital System and physicians from the network, transitioning to a new pharmacy vendor and pharmacy group purchasing coalition, and implementing an expanded Centers of Excellence program administered by Mount Sinai Hospital System. These efforts are projected to save over $35 million in 2022. Prior to joining the 32BJ Health Fund, Cora spent 12 years with Express Scripts, a pharmacy benefit manager. During her time there, she held a variety of roles, including Medicare Part D, strategy and acquisitions, operations, and account management.

07:02 What motivated the decision for 32BJ to cut NewYork-Presbyterian out of their network?
09:14 How did 32BJ compare their spending at each hospital in their network?
13:01 \\u201cWe cannot be sustainable as a health fund \\u2026 without really tackling the challenge of hospital prices.\\u201d
13:38 \\u201cIt is one of the challenges as a self-funded plan that, even having this data, there\\u2019s not a lot we can do with it.\\u201d
16:10 What is 32BJ Health Fund\\u2019s maternity program?
19:34 What is the HEAL Act, and why did 32BJ Health Fund support it?
21:39 \\u201cFor us, we just don\\u2019t feel it\\u2019s right that anyone gets to dictate our benefit.\\u201d
22:43 EP368 with Ashleigh Gunter.
23:34 Why did 32BJ Health Fund reprice their claims using Medicare rates?
24:58 \\u201cIt really goes to show you how high the commercial prices are in comparison to Medicare.\\u201d
25:52 EP366 with Kevin Schulman, MD. \\xa0

You can learn more at 32bjhealthfundinsights.org.\\xa0

@CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What motivated the decision for 32BJ to cut NewYork-Presbyterian out of their network? @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How did 32BJ compare their spending at each hospital in their network? @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWe cannot be sustainable as a health fund \\u2026 without really tackling the challenge of hospital prices.\\u201d @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIt is one of the challenges as a self-funded plan that, even having this data, there\\u2019s not a lot we can do with it.\\u201d @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What is 32BJ Health Fund\\u2019s maternity program? @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What is the HEAL Act, and why did 32BJ Health Fund support it? @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cFor us, we just don\\u2019t feel it\\u2019s right that anyone gets to dictate our benefit.\\u201d @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why did 32BJ Health Fund reprice their claims using Medicare rates? @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIt really goes to show you how high the commercial prices are in comparison to Medicare.\\u201d @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32)

Listed in: Health

EP372: Step One for Employers and UnionsGet Your Data, With Cora Opsahl

Cora Opsahl is the director of the 32BJ Health Fund, a self-funded plan that provides affordable, comprehensive, and innovative health coverage to 200,000 union members and their families. During her time at the Health Fund, Cora has led the implementation of multiple benefit changes: removing NewYork-Presbyterian Hospital System and physicians from the network, transitioning to a new pharmacy vendor and pharmacy group purchasing coalition, and implementing an expanded Centers of Excellence program administered by Mount Sinai Hospital System. These efforts are projected to save over $35 million in 2022. Prior to joining the 32BJ Health Fund, Cora spent 12 years with Express Scripts, a pharmacy benefit manager. During her time there, she held a variety of roles, including Medicare Part D, strategy and acquisitions, operations, and account management.

08:55 How much data does 32BJ Health Fund have, where do they get it, and how do they use it?
10:56 How did 32BJ Health Fund successfully demand their data from 100% of their vendors?
11:45 \\u201cWe feel it\\u2019s really important that we own this information ourselves.\\u201d
12:08 \\u201cIt always concerns me\\u2014if a vendor doesn\\u2019t want to give you the information, what are they hiding?\\u201d
12:34 \\u201cIt\\u2019s not just getting the data; it\\u2019s then using the data.\\u201d
15:44 \\u201cWithout data, you\\u2019re really just taking a guess; and guesses are never gonna get you where you need to go.\\u201d
17:23 EP285 with Dawn Cornelis.
17:42 Is the cost of creating a data analytics team worth the cost savings of those data discoveries?
21:07 \\u201cThe use of data has really built our knowledge.\\u201d
22:55 \\u201cIt\\u2019s really important to us that as we make benefit decisions, we\\u2019re doing it smartly.\\u201d
27:34 EP358 with Wayne Jenkins, MD.
27:42 How is 32BJ Health Fund making their data knowledge actionable?
30:14 \\u201cIf we can figure out how to make telehealth accessible \\u2026 there may be an opportunity for telehealth \\u2026 to upset some of these \\u2026 monopoly systems or low-choice options.\\u201d
32:25 \\u201cIt\\u2019s really easy to think that we can solve this problem through benefit design \\u2026 but in the end \\u2026 it\\u2019s the price.\\u201d

You can learn more at 32bjhealthfundinsights.org.\\xa0

@CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How much data does 32BJ Health Fund have, where do they get it, and how do they use it? @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How did 32BJ Health Fund successfully demand their data from 100% of their vendors? @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWe feel it\\u2019s really important that we own this information ourselves.\\u201d @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIt always concerns me\\u2014if a vendor doesn\\u2019t want to give you the information, what are they hiding?\\u201d @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIt\\u2019s not just getting the data; it\\u2019s then using the data.\\u201d @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWithout data, you\\u2019re really just taking a guess; and guesses are never gonna get you where you need to go.\\u201d @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Is the cost of creating a data analytics team worth the cost savings of those data discoveries? @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThe use of data has really built our knowledge.\\u201d @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIt\\u2019s really important to us that as we make benefit decisions, we\\u2019re doing it smartly.\\u201d @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How is 32BJ Health Fund making their data knowledge actionable? @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIf we can figure out how to make telehealth accessible \\u2026 there may be an opportunity for telehealth \\u2026 to upset some of these \\u2026 monopoly systems or low-choice options.\\u201d @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIt\\u2019s really easy to think that we can solve this problem through benefit design \\u2026 but in the end \\u2026 it\\u2019s the price.\\u201d @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294)

\\xa0

Listed in: Health

Encore! EP308: How Financial Toxicity Wreaks Havoc on Value-Based Payment Success, With Mark Fendrick, MD

A. Mark Fendrick, MD, is a professor of internal medicine in the School of Medicine and a professor of health management and policy in the School of Public Health at the University of Michigan. Dr. Fendrick received a bachelor\\u2019s degree in economics and chemistry from the University of Pennsylvania and his medical degree from Harvard Medical School. He completed his residency in internal medicine at the University of Pennsylvania, where he was a fellow in the Robert Wood Johnson Foundation Clinical Scholars Program.

Dr. Fendrick conceptualized and coined the term Value-Based Insurance Design (V-BID) and currently directs the V-BID Center at the University of Michigan (vbidcenter.org), the leading advocate for development, implementation, and evaluation of innovative health benefit plans. His research focuses on how clinician payment and consumer engagement initiatives impact access to care, quality of care, and healthcare costs. Dr. Fendrick has authored over 250 articles and book chapters and has received numerous awards for the creation and implementation of value-based insurance design. His perspective and understanding of clinical and economic issues have fostered collaborations with numerous government agencies, health plans, professional societies, and healthcare companies. \\xa0

Dr. Fendrick is an elected member of the National Academy of Medicine (formerly IOM), serves on the Medicare Coverage Advisory Committee, and has been invited to present testimony before the US Senate Committee on Health, Education, Labor and Pensions; the US House of Representatives Ways and Means Subcommittee on Health; and the US Senate Committee on Armed Services Subcommittee on Personnel.

05:00 Is back surgery high-value care?
05:51 If care is patient to patient, how is high-value care decided upon?
06:40 \\u201cFlintstones delivery: We have to move from the sledgehammer to the scalpel.\\u201d
11:14 \\u201cAlmost all of the services that we recommend to reduce cost sharing \\u2026 do not save money.\\u201d
12:30 \\u201cI didn\\u2019t go to medical school to learn how to save people money.\\u201d
17:03 \\u201cWhen a patient and their clinician agree \\u2026 the patient should be able to get that [service] easily, and the clinician should be paid generously.\\u201d
18:01 \\u201cWhen patients and providers are aligned, they do much better.\\u201d
19:59 What services are deemed high value, and what services should be pre-deductible?
21:50 \\u201cAre primary care visits high value? \\u2026 The answer is, it depends.\\u201d
25:55 What are V-BID\\u2019s core pillars to address value-based care?
28:04 How does Dr. Fendrick\\u2019s method of value-based care and reimbursement actually enable better consumerism?
29:51 What do providers think about changing reimbursement on low-value and high-value care?
30:58 \\u201cWe have incentives that are run amok.\\u201d
32:12 EP176 with Dr. Robert Pearl.
32:49 \\u201cIt\\u2019s all about incentives.\\u201d
33:43 \\u201cYou do have the funding; you just have to have the courage.\\u201d

You can learn more at vbidcenter.org. There\\u2019s also a great newsletter you can sign up for there.

Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth

If care is patient to patient, how is high-value care decided upon? Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth

\\u201cFlintstones delivery: We have to move from the sledgehammer to the scalpel.\\u201d Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth

\\u201cAlmost all of the services that we recommend to reduce cost sharing \\u2026 do not save money.\\u201d Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth

\\u201cI didn\\u2019t go to medical school to learn how to save people money.\\u201d Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth

\\u201cWhen patients and providers are aligned, they do much better.\\u201d Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth

\\u201cAre primary care visits high value? \\u2026 The answer is, it depends.\\u201d Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth

\\u201cWe have incentives that are run amok.\\u201d Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth

\\u201cYou do have the funding; you just have to have the courage.\\u201d Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble

\\xa0

Listed in: Health

EP371: Buy and Bill vs Pharmacy BaggingWhich Is Better for a Plan Sponsor and Patients? With Erik Davis and Autumn Yongchu

Erik Davis, AAI, CIC, CRM, is senior vice president and principal consultant, managed care and analytics, at USI Insurance Services. He has over 30 years of experience in the insurance and risk management industry. Erik works to create an environment that supports the healthcare risk management goals of an organization while maintaining focus on compliance and financial accountability. He is instrumental in vendor negotiations, data benchmarking, population health strategies, claims analysis, recommendations in plan design, and communication strategies.

In this capacity, Erik has been involved with development of rates, payment structures, and recommendations of changes in processes, policies, and procedures. He has a broad understanding of contract analysis, evaluating risk, auditing for correct payment, and structuring of excess loss and pharmacy programs.

Erik\\u2019s experience extends from overall employee benefits consulting to workers\\u2019 compensation, as well as managed care organizations in Medicaid, Medicare, and commercial contractual risk arrangements.

Erik earned his bachelor\\u2019s degree in economics from Oregon State University. He holds Accredited Advisor in Insurance (AAI), Certified Insurance Counselor (CIC), and Certified Risk Manager (CRM) designations.

Autumn Yongchu is a healthcare operational risk consultant at USI Insurance Services. Autumn works with multiple database platforms to examine data for trends and abnormalities. Using investigative querying, medical coding analysis, and report development, she provides resources that help identify cost control opportunities and assists organizations in strategic business decisions regarding the management of healthcare risks.

Autumn analyzes and interprets healthcare utilization data, allowing the development of initiatives regarding claim and risk management. This includes identifying fiscal and clinical strategies and providing necessary information to develop, design, and implement management initiatives. Autumn also analyzes trends, assists with insurance underwriting, and adjudicates stop-loss claims.

Autumn has an in-depth knowledge of Medicaid and Medicare billing guidelines and payment methodologies.

Prior to joining USI, Autumn was a claims auditor and trainer for a managed care organization which serviced over 100,000 commercial, Medicaid, and Medicare lives. Her responsibilities included contract analysis, claims adjudication, ensuring accurate payment, and identifying and recouping errors.

04:45 Can you actually save money by carving out specialty infused drugs and making them a pharmacy benefit?
06:28 How can plan sponsors use white bagging as leverage to reduce costs from markups?
06:47 Does white bagging save money compared to buy and bill?
07:42 \\u201cYou also need to understand that with some of these drugs, you\\u2019re dealing with very vulnerable people.\\u201d\\u2014Erik
08:41 EP369 with Keith Hartman, RPh.
11:10 \\u201cWhen your insurance carrier is married to your PBM, it doesn\\u2019t matter where the money goes.\\u201d\\u2014Autumn
11:33 EP365 with Scott Haas.
12:00 \\u201cYou need to have a collective understanding of every variable \\u2026 when you\\u2019re making those \\u2026 decisions.\\u201d\\u2014Erik
14:53 How can comparison shopping save plan sponsors money when it comes to specialty infusion costs?
16:51 How can comparison shopping be a vicious circle in the wrong setting for plan sponsors?
18:43 \\u201cThat\\u2019s part of the problem: It\\u2019s not just the plan sponsor not being educated enough; it\\u2019s also the consultant \\u2026 that they believe is supposed to be that isn\\u2019t.\\u201d\\u2014Erik
19:03 How has transparency been used by healthcare systems to keep buyers\\u2019 eyes off the ball?
26:55 \\u201cIt is very case by case, but it comes down to your risk appetite.\\u201d\\u2014Autumn
28:19 \\u201cIt\\u2019s something that you have to, as a plan sponsor, really continue to monitor throughout the plan year.\\u201d\\u2014Autumn
28:38 \\u201cThe more you know, the better equipped you\\u2019re gonna be.\\u201d\\u2014Autumn
29:27 What can employers who are feeling aggressive do?
31:19 \\u201cThe dollars circle, whether people realize it or not.\\u201d\\u2014Autumn

You can learn more by connecting with Erik and Autumn on LinkedIn or by emailing them at erik.davis@usi.com and autumn.yongchu@usi.com.\\xa0\\xa0

Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma

Can you actually save money by carving out specialty infused drugs and making them a pharmacy benefit? Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma

How can plan sponsors use white bagging as leverage to reduce costs from markups? Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma

Does white bagging save money compared to buy and bill? Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma

\\u201cYou also need to understand that with some of these drugs, you\\u2019re dealing with very vulnerable people.\\u201d Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma

\\u201cWhen your insurance carrier is married to your PBM, it doesn\\u2019t matter where the money goes.\\u201d Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma

\\u201cYou need to have a collective understanding of every variable \\u2026 when you\\u2019re making those \\u2026 decisions.\\u201d Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma

How can comparison shopping save plan sponsors money when it comes to specialty infusion costs? Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma

How can comparison shopping be a vicious circle in the wrong setting for plan sponsors? Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma

\\u201cThat\\u2019s part of the problem: It\\u2019s not just the plan sponsor not being educated enough; it\\u2019s also the consultant \\u2026 that they believe is supposed to be that isn\\u2019t.\\u201d Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma

How has transparency been used by healthcare systems to keep buyers\\u2019 eyes off the ball? Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma

\\u201cIt is very case by case, but it comes down to your risk appetite.\\u201d Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma

\\u201cIt\\u2019s something that you have to, as a plan sponsor, really continue to monitor throughout the plan year.\\u201d Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma

\\u201cThe more you know, the better equipped you\\u2019re gonna be.\\u201d Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma

What can employers who are feeling aggressive do? Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma

\\u201cThe dollars circle, whether people realize it or not.\\u201d Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger

\\xa0

Listed in: Health

EP370: How Do Some Health Systems Manage to Charge 6x the Cost of a Specialty Pharmacy Med to Infuse It? With Erik Davis and Autumn Yongchu

Erik Davis, AAI, CIC, CRM, is senior vice president and principal consultant, managed care and analytics, at USI Insurance Services. He has over 30 years of experience in the insurance and risk management industry. Erik works to create an environment that supports the healthcare risk management goals of an organization while maintaining focus on compliance and financial accountability. He is instrumental in vendor negotiations, data benchmarking, population health strategies, claims analysis, recommendations in plan design, and communication strategies.

In this capacity, Erik has been involved with development of rates, payment structures, and recommendations of changes in processes, policies, and procedures. He has a broad understanding of contract analysis, evaluating risk, auditing for correct payment, and structuring of excess loss and pharmacy programs.

Erik\\u2019s experience extends from overall employee benefits consulting to workers\\u2019 compensation, as well as managed care organizations in Medicaid, Medicare, and commercial contractual risk arrangements.

Erik earned his bachelor\\u2019s degree in economics from Oregon State University. He holds Accredited Advisor in Insurance (AAI), Certified Insurance Counselor (CIC), and Certified Risk Manager (CRM) designations.

Autumn Yongchu is a healthcare operational risk consultant at USI Insurance Services. Autumn works with multiple database platforms to examine data for trends and abnormalities. Using investigative querying, medical coding analysis, and report development, she provides resources that help identify cost control opportunities and assists organizations in strategic business decisions regarding the management of healthcare risks.

Autumn analyzes and interprets healthcare utilization data, allowing the development of initiatives regarding claim and risk management. This includes identifying fiscal and clinical strategies and providing necessary information to develop, design, and implement management initiatives. Autumn also analyzes trends, assists with insurance underwriting, and adjudicates stop-loss claims.

Autumn has an in-depth knowledge of Medicaid and Medicare billing guidelines and payment methodologies.

Prior to joining USI, Autumn was a claims auditor and trainer for a managed care organization which serviced over 100,000 commercial, Medicaid, and Medicare lives. Her responsibilities included contract analysis, claims adjudication, ensuring accurate payment, and identifying and recouping errors.

07:33 How do hospitals maximize inpatient bills?
08:05 How can hospitals upcode on specialty pharmacy products?
09:44 \\u201cIt\\u2019s really not uncommon to be overbilled and overcharged.\\u201d\\u2014Autumn
11:11 Why do marked up bill charges actually affect the price commercial payers pay?
12:49 \\u201cIf your payer\\u2019s not double-checking \\u2026 how do you know that fraud\\u2019s happening?\\u201d\\u2014Autumn
12:52 \\u201cIf the payer doesn\\u2019t have the detail to validate what that drug actually is, then are they really checking?\\u201d\\u2014Autumn
13:33 Why is it so hard to verify what you\\u2019re actually paying for on a hospital bill?
16:28 How do hospitals maximize profit with outpatients?
17:12 \\u201cReally it comes down to contracts and how [the] contracts are written.\\u201d\\u2014Autumn
21:54 \\u201cThere are \\u2026 silos within healthcare, and none of them actually talk to each other.\\u201d\\u2014Autumn
24:56 \\u201cThere are these rules out there, but there are also big loopholes out there.\\u201d\\u2014Autumn
26:13 How can hospitals maximize payments for Medicare patients on drugs that have been out for a while?
29:30 \\u201cWe just have a tendency to assume \\u2026 that Medicare has a rate for everything, and Medicare doesn\\u2019t.\\u201d\\u2014Autumn
30:32: EP369 with Keith Hartman, RPh. \\xa0

You can learn more by connecting with Erik and Autumn on LinkedIn or by emailing them at erik.davis@usi.com and autumn.yongchu@usi.com.\\xa0\\xa0

Erik Davis and Autumn Yongchu discuss #specialtypharma billing in #healthsystems on our #healthcarepodcast. #healthcare #podcast #hospitalsystems

How do hospitals maximize inpatient bills? Erik Davis and Autumn Yongchu discuss #specialtypharma billing in #healthsystems on our #healthcarepodcast. #healthcare #podcast #hospitalsystems

How can hospitals upcode on specialty pharmacy products? Erik Davis and Autumn Yongchu discuss #specialtypharma billing in #healthsystems on our #healthcarepodcast. #healthcare #podcast #hospitalsystems

\\u201cIt\\u2019s really not uncommon to be overbilled and overcharged.\\u201d Erik Davis and Autumn Yongchu discuss #specialtypharma billing in #healthsystems on our #healthcarepodcast. #healthcare #podcast #hospitalsystems

Why do marked up bill charges actually affect the price commercial payers pay? Erik Davis and Autumn Yongchu discuss #specialtypharma billing in #healthsystems on our #healthcarepodcast. #healthcare #podcast #hospitalsystems

\\u201cIf your payer\\u2019s not double-checking \\u2026 how do you know that fraud\\u2019s happening?\\u201d Erik Davis and Autumn Yongchu discuss #specialtypharma billing in #healthsystems on our #healthcarepodcast. #healthcare #podcast #hospitalsystems

\\u201cIf the payer doesn\\u2019t have the detail to validate what that drug actually is, then are they really checking?\\u201d Erik Davis and Autumn Yongchu discuss #specialtypharma billing in #healthsystems on our #healthcarepodcast. #healthcare #podcast #hospitalsystems

Why is it so hard to verify what you\\u2019re actually paying for on a hospital bill? Erik Davis and Autumn Yongchu discuss #specialtypharma billing in #healthsystems on our #healthcarepodcast. #healthcare #podcast #hospitalsystems

How do hospitals maximize profit with outpatients? Erik Davis and Autumn Yongchu discuss #specialtypharma billing in #healthsystems on our #healthcarepodcast. #healthcare #podcast #hospitalsystems

\\u201cReally it comes down to contracts and how [the] contracts are written.\\u201d Erik Davis and Autumn Yongchu discuss #specialtypharma billing in #healthsystems on our #healthcarepodcast. #healthcare #podcast #hospitalsystems

\\u201cThere are \\u2026 silos within healthcare, and none of them actually talk to each other.\\u201d Erik Davis and Autumn Yongchu discuss #specialtypharma billing in #healthsystems on our #healthcarepodcast. #healthcare #podcast #hospitalsystems

\\u201cThere are these rules out there, but there are also big loopholes out there.\\u201d Erik Davis and Autumn Yongchu discuss #specialtypharma billing in #healthsystems on our #healthcarepodcast. #healthcare #podcast #hospitalsystems

How can hospitals maximize payments for Medicare patients on drugs that have been out for a while? Erik Davis and Autumn Yongchu discuss #specialtypharma billing in #healthsystems on our #healthcarepodcast. #healthcare #podcast #hospitalsystems

\\u201cWe just have a tendency to assume \\u2026 that Medicare has a rate for everything, and Medicare doesn\\u2019t.\\u201d Erik Davis and Autumn Yongchu discuss #specialtypharma billing in #healthsystems on our #healthcarepodcast. #healthcare #podcast #hospitalsystems

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong

\\xa0

\\xa0

Listed in: Health

EP369: Whats Up With Specialty Pharmacy Bagging? With Keith Hartman, RPh

Keith P. Hartman, RPh, is chief executive officer of ContinuumRx and an experienced operating entrepreneur and pharmacy business owner spanning two decades. Keith founded and grew a chain of retail pharmacies, a compounding pharmacy, and two specialty pharmacies along with a long-term care pharmacy. All were built and grown under the guise of operational excellence and produced great results. Some were sold, while others he still owns and provides limited strategic guidance as a member of the board of directors.

Keith graduated from the University of the Sciences with a degree in pharmacy. Today he is still involved mentoring future pharmacists and pharmacy owners.

08:09 What kinds of patients and/or drugs is the concept of bagging relevant to?
08:53 What is brown bagging, and what are the issues with it?
10:28 What is white bagging, and how is it different from brown bagging?
11:30 Who are the key players in pharma bagging?
12:25 Why does a PBM want a specialty drug to go through them?
12:49 From the physician\\u2019s perspective, why is buy and bill ideal?
16:46 How does white bagging impact patient clinical care?
22:12 Encore! EP216 with Chris Sloan.
23:05 What are the two main reasons patients might not continue their therapy?
23:29 \\u201cWe\\u2019ve got to leave some authority with our prescribers to be able to make a clinical decision of what\\u2019s best for that \\u2026 patient.\\u201d
24:41 What is clear bagging?
26:51 How does a hospital specialty pharmacy get in network with a PBM?
28:57 What is gold bagging?
30:11 \\u201cOutlook really needs to be what\\u2019s best for the patient.\\u201d
32:10 EP337 with Olivia Webb. \\xa0

You can learn more at continuumrx.com.\\xa0\\xa0

Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma

What kinds of patients and/or drugs is the concept of bagging relevant to? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma

What is brown bagging, and what are the issues with it? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma

What is white bagging, and how is it different from brown bagging? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma

Who are the key players in pharma bagging? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma

Why does a PBM want a specialty drug to go through them? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma

From the physician\\u2019s perspective, why is buy and bill ideal? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma

How does white bagging impact patient clinical care? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma

What are the two main reasons patients might not continue their therapy? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma

\\u201cWe\\u2019ve got to leave some authority with our prescribers to be able to make a clinical decision of what\\u2019s best for that \\u2026 patient.\\u201d Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma

What is clear bagging? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma

How does a hospital specialty pharmacy get in network with a PBM? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma

What is gold bagging? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma

\\u201cOutlook really needs to be what\\u2019s best for the patient.\\u201d Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider

\\xa0

Listed in: Health

Encore! EP282: Do You Know How Much Cancer Centers Get Paid to Put Patients on Drugs? With Aaron Mitchell, MD, MPH

Aaron Mitchell, MD, MPH, is a practicing medical oncologist and health services researcher. He is an assistant attending at Memorial Sloan Kettering Cancer Center in the department of epidemiology and biostatistics. His research focuses on understanding how the financial incentives in the healthcare system affect physician practice patterns and care delivery to cancer patients. He cares for patients with prostate and bladder cancer.

\\xa0

04:34 Following the drug and following the dollar.
04:56 The \\u201cbuy and bill\\u201d system.
05:43 The perverse and problematic incentives of the system.
08:38 \\u201cIt creates the incentive for us to gravitate toward the more expensive drug.\\u201d
08:42 The hesitancy to address the financial toxicity of drugs for patients.
09:53 Why the only person losing in this situation is the patient.
10:51 The financial impact from the patient perspective.
13:57 Are patients realizing this impact?
14:42 Solving the problem of oncology drug choice.
16:45 Reimbursement reform.
18:24 Capitated systems and incrementalist impacts to reimbursement reform, and what these look like.
23:30 Are we at a tipping point?
23:51 \\u201cThe current system \\u2026 works too well for too many people.\\u201d
25:01 Who isn\\u2019t well served by the current system.
25:32 Who has to lead the charge for change.
28:28 Large oncology providers vs small oncology providers in the buy and bill system.

\\xa0

You can learn more at drugpricinglab.org. You can also connect with Dr. Mitchell on Twitter at @TheWonkologist.\\xa0\\xa0

Check out our #healthcarepodcast with @TheWonkologist of @sloan_kettering as he discusses #oncology #drugpricing and #reimbursement. #healthcare #podcast #digitalhealth

Following the drug and following the dollar. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth

The \\u201cbuy and bill\\u201d system. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth

The perverse and problematic incentives of the system. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth

\\u201cIt creates the incentive for us to gravitate toward the more expensive drug.\\u201d @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth

Why is there hesitancy to address the financial toxicity of drug pricing for patients? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth

Why the patient is the only one that loses. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth

What\\u2019s the financial impact from the patient perspective? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth

Are patients realizing this financial impact? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth

Solving the problem of oncology drug choice. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth

What should reimbursement reform look like? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth

\\u201cThe current system \\u2026 works too well for too many people.\\u201d @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth

Who has to lead the charge for change? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth

Large oncology providers vs small oncology providers in the buy and bill system. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes

\\xa0

Listed in: Health

INBW34: The Absence of Collaboration Between Healthcare Stakeholders: What It Means

Each week on Relentless Health Value, Stacey uses her voice and thought leadership to provide insights for healthcare industry decision makers trying to do the right thing. Each show features expert guests who break down the twists and tricks in the medical field to help improve outcomes and lower costs across the care continuum. Relentless Health Value is a top 100 podcast on iTunes in the medicine category and reaches tens of thousands of engaged listeners across the healthcare industry.

In addition to hosting Relentless Health Value, Stacey is co-president of QC-Health, a benefit corporation finding cost-effective ways to improve the health of Americans. She is also co-president of Aventria Health Group, a consultancy working with clients who endeavor to form collaborations with payers, providers, Pharma, employer organizations, or patient advocacy groups.

03:07 How do we improve care, especially for chronic care patients?
03:18 What are two important contributors to patient outcomes?
03:40 EP361 with Carly Eckert, MD.
03:56 \\u201cWe know that financial toxicity is clinical toxicity.\\u201d
04:09 EP358 with Wayne Jenkins, MD.
06:05 Why can\\u2019t parties across the healthcare industry seem to collaborate?
08:05 EP366 with Kevin Schulman, MD.
08:07 EP365 with Scott Haas.
08:10 Upcoming episode with Autumn Yongchu and Erik Davis.
08:34 \\u201cI would say that a lack of collaboration is a symptom.\\u201d
10:10 There\\u2019s lots of evidence that interoperability has been solved. It\\u2019s been solved for years.
10:37 Upcoming episode with Cora Opsahl.
10:46 EP349 with Lisa Trumble.
10:53 EP354 with Shawn Rhodes.
10:57 EP324 with Nicole Bradberry and Kelly Conroy.
11:04 Upcoming episode with Dave Chase.
11:19 EP367 with Doug Hetherington.
11:25 EP350 with Katy Talento.
11:28 EP294 with Steve Schutzer, MD.
11:50 EP277 with Eric Weaver, DHA, MHA.
13:00 What are the three kinds of collaboration in healthcare?
13:23 Do collaborators need to have equal status in a collaboration?
13:57 \\u201cCare can be improved at the population level, at the community level \\u2026 at the disease or the condition level.\\u201d
15:10 How is stakeholder prejudice holding healthcare back?
15:42 EP356 with Ge Bai, PhD, CPA.
16:55 \\u201cOutcomes-based contracts \\u2026 we need to figure out how to operationalize them.\\u201d
17:08 \\u201cColluding and conflict of interest is not cost neutral.\\u201d
17:30 EP364 with David Muhlestein, PhD, JD. \\xa0

For more information, go to aventriahealth.com. \\xa0

Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab

How do we improve care, especially for chronic care patients? Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab

What are two important contributors to patient outcomes? Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab

\\u201cWe know that financial toxicity is clinical toxicity.\\u201d Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab

Why can\\u2019t parties across the healthcare industry seem to collaborate? Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab

\\u201cI would say that a lack of collaboration is a symptom.\\u201d Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab

There\\u2019s lots of evidence that interoperability has been solved. It\\u2019s been solved for years. Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab

What are the three kinds of collaboration in healthcare? Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab

Do collaborators need to have equal status in a collaboration? Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab

\\u201cCare can be improved at the population level, at the community level \\u2026 at the disease or the condition level.\\u201d Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab

How is stakeholder prejudice holding healthcare back? Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab

\\u201cOutcomes-based contracts \\u2026 we need to figure out how to operationalize them.\\u201d Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab

\\u201cColluding and conflict of interest is not cost neutral.\\u201d Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms

\\xa0

Listed in: Health

EP368: How to Successfully Roll Out New Benefit Designs to Employees and New Care Delivery Models at a Provider Organization, With Ashleigh Gunter

Ashleigh Gunter, president of Translucent Healthcare Consulting, combines her experience, an understanding of organizational culture, and a practical mindset to meet her clients\\u2019 needs. With over 30 years of management consulting experience, Ashleigh has deep expertise in advising in the dramatically changing healthcare market.

Ashleigh specializes in helping her clients drive change within their health plans, resulting in increased employee engagement, improved human resources experience, and reduced cost for both the employer and the employee. She believes in challenging the status quo by creating direct relationships between employers and providers.

Ashleigh has been a key contributor to several community-owned health plans in states from Washington to Virginia and has been credited with being key to employee participation and support of the plans.

In working for Andersen Consulting/Accenture, Deloitte Consulting, and The Gunter Group, Ashleigh has provided advice and consulting support to Fortune 100 C-suite executives over her career. She has an MBA with a focus in strategic management and organizational change from the University of Texas at Austin and a bachelor\\u2019s degree in business administration from the University of Denver with a concentration in finance.

07:46 How does change management go wrong in healthcare?
08:27 \\u201cCommunication [of change] in and of itself isn\\u2019t change management.\\u201d
10:03 What is change management?
11:06 What does great leadership look like in change management?
12:29 \\u201cLeadership sets the tone.\\u201d
12:38 What makes change management so hard?
13:27 \\u201cWhat\\u2019s the company reason to make this change happen?\\u201d
15:57 What are change champions, and why do you need to create them when changing your benefit plan?
19:18 Why is it important to overcommunicate change?
22:46 Why is it important to measure your successes and communicate those after a change?
24:14 How does change management work on the provider organization side?
28:53 \\u201cYou want to ensure you are educating the operational folks.\\u201d

You can learn more at translucenthc.com.\\xa0

Ashleigh Gunter of Translucent Healthcare Consulting discusses #benefitdesign and #deliverymodels on our #healthcarepodcast. #healthcare #podcast

How does change management go wrong in healthcare? Ashleigh Gunter of Translucent Healthcare Consulting discusses #benefitdesign and #deliverymodels on our #healthcarepodcast. #healthcare #podcast

\\u201cCommunication [of change] in and of itself isn\\u2019t change management.\\u201d Ashleigh Gunter of Translucent Healthcare Consulting discusses #benefitdesign and #deliverymodels on our #healthcarepodcast. #healthcare #podcast

What is change management? Ashleigh Gunter of Translucent Healthcare Consulting discusses #benefitdesign and #deliverymodels on our #healthcarepodcast. #healthcare #podcast

What does great leadership look like in change management? Ashleigh Gunter of Translucent Healthcare Consulting discusses #benefitdesign and #deliverymodels on our #healthcarepodcast. #healthcare #podcast

\\u201cLeadership sets the tone.\\u201d Ashleigh Gunter of Translucent Healthcare Consulting discusses #benefitdesign and #deliverymodels on our #healthcarepodcast. #healthcare #podcast

What makes change management so hard? Ashleigh Gunter of Translucent Healthcare Consulting discusses #benefitdesign and #deliverymodels on our #healthcarepodcast. #healthcare #podcast

\\u201cWhat\\u2019s the company reason to make this change happen?\\u201d Ashleigh Gunter of Translucent Healthcare Consulting discusses #benefitdesign and #deliverymodels on our #healthcarepodcast. #healthcare #podcast

What are change champions, and why do you need to create them when changing your benefit plan? Ashleigh Gunter of Translucent Healthcare Consulting discusses #benefitdesign and #deliverymodels on our #healthcarepodcast. #healthcare #podcast

Why is it important to overcommunicate change? Ashleigh Gunter of Translucent Healthcare Consulting discusses #benefitdesign and #deliverymodels on our #healthcarepodcast. #healthcare #podcast

Why is it important to measure your successes and communicate those after a change? Ashleigh Gunter of Translucent Healthcare Consulting discusses #benefitdesign and #deliverymodels on our #healthcarepodcast. #healthcare #podcast

How does change management work on the provider organization side? Ashleigh Gunter of Translucent Healthcare Consulting discusses #benefitdesign and #deliverymodels on our #healthcarepodcast. #healthcare #podcast

\\u201cYou want to ensure you are educating the operational folks.\\u201d Ashleigh Gunter of Translucent Healthcare Consulting discusses #benefitdesign and #deliverymodels on our #healthcarepodcast. #healthcare #podcast

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby

\\xa0

Listed in: Health

EP367: Why Would a Hospital Direct Contract With an Employer Looking to Pay Less? With Doug Hetherington

Doug Hetherington is a health plan visionary, innovator, and program architect who believes providers are the key to sustainable and meaningful healthcare in our communities.

Midway through his 20-year tenure as a benefit advisor, Doug began innovating around self-funding, captives, reference-based pricing (RBP), and population management in search of viable solutions that gave his employer clients control over cost and plan design. His creativity and tenacity for change drove his development of several first-of-their-kind innovations, including RB EmCap, a national access captive program for RBP employers.

Doug founded Health2Business (H2B) in 2019 after successful proof of concept that better healthcare results when employers, providers, and health systems work together at the local level through direct contracts.

Tackling one aspect of our broken healthcare system, H2B solves for how we access and pay for care. While establishing scalable direct contracts with some of the largest flagship health systems in the country, Doug realized that in order to truly decapitalize healthcare, direct contracts need to be transparent, open, and free for employers of all sizes to access. By establishing H2B\\u2019s independent, agnostic, and collaborative direct contract administrative platform infrastructure, Doug has created an entirely new vendor class known as direct contract administration.

An optimist by nature, Doug truly believes that the more we work together, the faster we can restore value to our healthcare system and create a sustainable mutual benefit for provider, employer, and employee/member stakeholders.

05:38 Why are health systems interested in direct contracting?
09:43 EP308 with Mark Fendrick, MD.
10:06 What are the essentials for direct contracting between a health system and an employer or payer?
11:16 What are the three categories of open direct contracting agreements?
12:44 EP350 with Katy Talento.
12:59 EP363 with David Scheinker, PhD.
14:43 What direction do we need to be moving to solve the cost problems in healthcare?
18:10 \\u201cWhat does a value-based model begin to look like?\\u201d
20:31 What is one of the inherent benefits of a direct contracting environment?
21:01 What data should we actually be capturing?
25:01 \\u201cSometimes you really begin to wonder, why is there such a high level of misalignment?\\u201d
25:16 How much can an employer save, on average, with a direct contract?
26:33 What are healthcare costs going up by per year?
26:50 \\u201cWe pay for these insurance plans \\u2026 and yet what you\\u2019re paying for that and how they\\u2019re assessing the risk is not \\u2026 in line with the actual cost of care.\\u201d
30:20 \\u201cI would say that \\u2026 consolidation \\u2026 is one of the reasons why we\\u2019re \\u2026 seeing more movement towards direct contracting.\\u201d

You can learn more at health2business.com and connect with Doug on LinkedIn.\\xa0

You can also learn how to engage in direct contracts from Doug\\u2019s presentation, \\u201cBeyond the Direct Contract.\\u201d

Doug Hetherington of @MyH2B discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why are health systems interested in direct contracting? Doug Hetherington of @MyH2B discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What are the essentials for direct contracting between a health system and an employer or payer? Doug Hetherington of @MyH2B discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What are the three categories of open direct contracting agreements? Doug Hetherington of @MyH2B discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What direction do we need to be moving to solve the cost problems in healthcare? Doug Hetherington of @MyH2B discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWhat does a value-based model begin to look like?\\u201d Doug Hetherington of @MyH2B discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What is one of the inherent benefits of a direct contracting environment? Doug Hetherington of @MyH2B discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What data should we actually be capturing? Doug Hetherington of @MyH2B discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cSometimes you really begin to wonder, why is there such a high level of misalignment?\\u201d Doug Hetherington of @MyH2B discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How much can an employer save, on average, with a direct contract? Doug Hetherington of @MyH2B discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What are healthcare costs going up by per year? Doug Hetherington of @MyH2B discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWe pay for these insurance plans \\u2026 and yet what you\\u2019re paying for that and how they\\u2019re assessing the risk is not \\u2026 in line with the actual cost of care.\\u201d Doug Hetherington of @MyH2B discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cI would say that \\u2026 consolidation \\u2026 is one of the reasons why we\\u2019re \\u2026 seeing more movement towards direct contracting.\\u201d Doug Hetherington of @MyH2B discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343)

\\xa0

Listed in: Health

EP366: An In-Depth Dissection of Our Dysfunctional Healthcare Benefits Market, With Kevin Schulman, MD

Kevin Schulman, MD, is a professor of medicine for the Clinical Excellence Research Center (CERC) at the Stanford University School of Medicine and, by courtesy, professor of operations, information, and technology at Stanford\\u2019s Graduate School of Business. He is the faculty director of Stanford\\u2019s new applied master degree program, the master of science in clinical informatics management program. His research focuses on broad, system challenges in the healthcare market, looking for ways to better understand hidden costs throughout the system. He then works to develop innovative solutions to deliver great care at lower cost.

07:13 Why have commercial insurers become price-takers?
10:04 How does a health plan get bigger profits?
10:40 \\u201cAt the core at this, Wall Street rewards predictable performance; and the predictable performance \\u2026 is great if healthcare costs go up.\\u201d
11:00 What does it mean to have a \\u201cdysfunctional equilibrium\\u201d in healthcare?
12:05 What\\u2019s really changed in healthcare in the last 20 years that\\u2019s caused this increase in healthcare pricing?
12:47 Commercial price versus Medicare: Do hospitals really need to cost shift?
15:51 How is value-based care really going to work?
17:43 \\u201cIt\\u2019s not A or B; it\\u2019s a dysfunctional market.\\u201d
17:57 \\u201cLittle changes in volume or incentives is not going to change the underlying dynamics.\\u201d
24:32 \\u201cI think it\\u2019s an open question whether this model is really serving the American public.\\u201d
29:25 \\u201cIt\\u2019s a really important time for us to think about, how do we create a different trajectory?\\u201d

You can learn more by visiting Dr. Schulman\\u2019s profile page and connect with him on LinkedIn.

@kevin_schulman discusses #healthcarebenefits on our #healthcarepodcast. #healthcare #podcast #benefitsmarket

Why have commercial insurers become price-takers? @kevin_schulman discusses #healthcarebenefits on our #healthcarepodcast. #healthcare #podcast #benefitsmarket

How does a health plan get bigger profits? @kevin_schulman discusses #healthcarebenefits on our #healthcarepodcast. #healthcare #podcast #benefitsmarket

\\u201cAt the core at this, Wall Street rewards predictable performance; and predictable performance \\u2026 is great if healthcare costs go up.\\u201d @kevin_schulman discusses #healthcarebenefits on our #healthcarepodcast. #healthcare #podcast #benefitsmarket

What does it mean to have a \\u201cdysfunctional equilibrium\\u201d in healthcare? @kevin_schulman discusses #healthcarebenefits on our #healthcarepodcast. #healthcare #podcast #benefitsmarket

What\\u2019s really changed in healthcare in the last 20 years that\\u2019s caused this increase in healthcare pricing? @kevin_schulman discusses #healthcarebenefits on our #healthcarepodcast. #healthcare #podcast #benefitsmarket

Commercial price versus Medicare: Do hospitals really need to cost shift? @kevin_schulman discusses #healthcarebenefits on our #healthcarepodcast. #healthcare #podcast #benefitsmarket

How is value-based care really going to work? @kevin_schulman discusses #healthcarebenefits on our #healthcarepodcast. #healthcare #podcast #benefitsmarket

\\u201cIt\\u2019s not A or B; it\\u2019s a dysfunctional market.\\u201d @kevin_schulman discusses #healthcarebenefits on our #healthcarepodcast. #healthcare #podcast #benefitsmarket

\\u201cLittle changes in volume or incentives is not going to change the underlying dynamics.\\u201d @kevin_schulman discusses #healthcarebenefits on our #healthcarepodcast. #healthcare #podcast #benefitsmarket

\\u201cI think it\\u2019s an open question whether this model is really serving the American public.\\u201d @kevin_schulman discusses #healthcarebenefits on our #healthcarepodcast. #healthcare #podcast #benefitsmarket

\\u201cIt\\u2019s a really important time for us to think about, how do we create a different trajectory?\\u201d @kevin_schulman discusses #healthcarebenefits on our #healthcarepodcast. #healthcare #podcast #benefitsmarket

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon

\\xa0

\\xa0

Listed in: Health

EP365: The Real Deal With PBM Contracts and Drug Rebates, With Scott Haas

Scott Haas has over 38 years of employee benefits experience. His background includes the development and validation of care management programs; prescription benefit management solutions; provider network evaluation, valuation, and negotiation; and underwriting.

Scott started and operationalized a third-party administrator (TPA) and a pharmacy benefit manager platform from scratch. He has worked in the arena of alternative funding for most of his career. Scott\\u2019s primary focus is in the area of alternative delivery and financing of healthcare other than fee for service, along with prescription benefit and healthcare risk management consulting.

Scott has held officer-level positions within Blues plans and TPAs as vice president of sales and marketing, vice president of underwriting, and president. Scott has also served as a trustee for both union and non-union health and welfare and pension plans.

Scott frequently shares his consulting expertise speaking at national events hosted by organizations such as Health Rosetta, the International Foundation of Employee Benefits, the Health and Welfare Plan Management Conference, the Western Pension and Benefits Conference, and the Self-Insurance Institute of America (SIIA). Scott has authored and coauthored articles on various topics over his career.

Scott earned his bachelor\\u2019s degree in business administration and economics from the University of Nebraska at Kearney. Scott also holds Chartered Life Underwriter (CLU) and Registered Health Underwriter (RHU) designations.

10:29 What\\u2019s the major flaw with the buyer-seller relationship between plan sponsors and PBMs?
12:04 What are the five things that need to be considered in order to get a fair price from a PBM?
13:16 Why does using average wholesale price cause problems for plan sponsors?
15:05 What does it mean to put the network risk on the PBM?
17:10 What\\u2019s happening with drugs moving from specialty brand to specialty generic?
19:14 \\u201cA generic is a generic; in our world, it\\u2019s binary.\\u201d
23:31 \\u201cThe term 100% of rebates is really irrelevant.\\u201d
23:54 What does it mean to have a minimum guarantee in drug rebates?
26:39 \\u201cWhen you do a line-item assessment \\u2026 is it producing an optimal result in comparison to competitively achieved \\u2026 pricing for generics \\u2026 and for specialty?\\u201d
27:52 \\u201cPlan sponsors need to grow a backbone.\\u201d
28:36 EP342 with Christin Deacon.
29:05 Why do you need to understand your consultant\\u2019s process as a plan sponsor?
29:30 Why do you need to understand formulary exclusions as a plan sponsor?
29:41 Why is it important to create a more equal PBM contract?
30:52 \\u201cRebates inure to the benefit of the plan sponsor; they don\\u2019t necessarily benefit the consumer.\\u201d
31:45 What does Scott do at USI?

You can learn more at usi.com or by emailing Scott at scott.haas@usi.com.\\xa0

Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast

What\\u2019s the major flaw with the buyer-seller relationship between plan sponsors and PBMs? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast

What are the five things that need to be considered in order to get a fair price from a PBM? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast

Why does using average wholesale price cause problems for plan sponsors? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast

What does it mean to put the network risk on the PBM? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast

What\\u2019s happening with drugs moving from specialty brand to specialty generic? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast

\\u201cA generic is a generic; in our world, it\\u2019s binary.\\u201d Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast

\\u201cThe term 100% of rebates is really irrelevant.\\u201d Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast

What does it mean to have a minimum guarantee in drug rebates? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast

\\u201cWhen you do a line-item assessment \\u2026 is it producing an optimal result in comparison to competitively achieved \\u2026 pricing for generics \\u2026 and for specialty?\\u201d Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast

\\u201cPlan sponsors need to grow a backbone.\\u201d Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast

Why do you need to understand your consultant\\u2019s process as a plan sponsor? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast

Why do you need to understand formulary exclusions as a plan sponsor? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast

Why is it important to create a more equal PBM contract? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast

\\u201cRebates inure to the benefit of the plan sponsor; they don\\u2019t necessarily benefit the consumer.\\u201d Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell

\\xa0

Listed in: Health

EP364: A Way to Think About Transforming the Healthcare Industry, With David Muhlestein, PhD, JD

David Muhlestein, PhD, JD, is chief research and innovation officer for Health Management Associates (HMA). He is responsible for the firm\\u2019s self-directed research and supports strategic planning and innovation.

David\\u2019s research and expertise center on healthcare payment and delivery transformation, understanding healthcare markets, and evaluating how the broader healthcare system is changing. He is a self-identified data nerd and regularly speaks and writes about healthcare system evolution.

David joined HMA via its acquisition of Leavitt Partners in 2021, where he was the chief strategy and chief research officer.

Additionally, David is a visiting policy fellow at the Margolis Center for Health Policy at Duke University, adjunct assistant professor at The Ohio State University College of Public Health, and a visiting fellow at the Accountable Care Learning Collaborative. He previously served as adjunct assistant professor of The Dartmouth Institute (TDI) at the Geisel School of Medicine at Dartmouth College.

David earned his PhD in health services management and policy, JD, MHA, and MS from The Ohio State University and a BA from Brigham Young University.

07:38 Is it an issue for the healthcare industry that it is one of the largest employers in the country?
08:42 \\u201cI think that we need to figure out what is an appropriate amount to spend on healthcare and get to that level.\\u201d
09:01 How do we not decrease the amount of healthcare we\\u2019re receiving while paying less for that healthcare?
10:11 What are the two ways we can look at decreasing healthcare spend?
15:39 \\u201cI think that a regional approach may happen.\\u201d
16:56 \\u201cWhen somebody takes less, others are going to follow them.\\u201d
17:33 Who is really paying in our current healthcare system?
19:47 \\u201cAny sort of a model that you start with influences everything else that you do.\\u201d
20:09 What\\u2019s the common challenge David Muhlestein sees in value-based care systems?
23:21 \\u201cThere are countless things that you can do to improve the current system today.\\u201d
27:25 What are the three options for building up better healthcare?
28:19 David\\u2019s advice for healthcare executives.
33:22 \\u201cTo really lower the total cost of \\u2026 healthcare, it\\u2019s a 30-year process.\\u201d

You can learn more at healthmanagement.com. \\xa0

@DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Is it an issue for the healthcare industry that it is one of the largest employers in the country? @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cI think that we need to figure out what is an appropriate amount to spend on healthcare and get to that level.\\u201d @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How do we not decrease the amount of healthcare we\\u2019re receiving while paying less for that healthcare? @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What are the two ways we can look at decreasing healthcare spend? @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cI think that a regional approach may happen.\\u201d @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWhen somebody takes less, others are going to follow them.\\u201d @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Who is really paying in our current healthcare system? @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cAny sort of a model that you start with influences everything else that you do.\\u201d @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What\\u2019s the common challenge David Muhlestein sees in value-based care systems? @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThere are countless things that you can do to improve the current system today.\\u201d @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cTo really lower the total cost of \\u2026 healthcare, it\\u2019s a 30-year process.\\u201d @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley

\\xa0

Listed in: Health

EP363: How to Cut the Healthcare Administrative Burden in Half, With David Scheinker, PhD

David Scheinker, PhD, started his career as a research mathematician and switched to healthcare operations to work on an interdisciplinary team and have a more immediate impact. He is a clinical associate professor of pediatrics, the executive director of systems design and collaborative research at the Stanford Lucile Packard Children\\u2019s Hospital, and a member of the Clinical Excellence Research Center (CERC) at Stanford University. He founded and directs SURF Stanford Medicine, which brings together students and faculty from the university with physicians, nurses, and administrators from the hospitals. He studies clinical care delivery, hospital operations, sensor-based and algorithm-enabled telemedicine, the socioeconomic factors that shape healthcare, and policy.

07:23 What\\u2019s the quantitative administrative cost in an average transaction?
07:49 What\\u2019s the quantitative administrative cost in a healthcare transaction?
08:43 What does the healthcare billing and administration cost add to the US\\u2019s overall healthcare spend?
09:38 Is it possible to cut billing and administrative costs in healthcare?
11:01 \\u201cIn some ways, the problem for healthcare should be simpler.\\u201d
12:14 What does the complexity of the current system look like in a doctor\\u2019s office?
15:26 How did David go about studying healthcare administrative costs?
18:17 \\u201cIt doesn\\u2019t have to be simple; it should be standardized.\\u201d
21:41 What would be the pushback on standardizing contracts in healthcare?
22:35 Why is it possible to gain more value by losing customization in contracts?
24:11 \\u201cNever let a good crisis go to waste.\\u201d
24:33 \\u201cIt\\u2019s much easier in healthcare to build something new than to change something that exists.\\u201d
27:39 What benefits does telemedicine have to cutting administrative costs?
29:09 What is another significant benefit of using standardized contracts?
30:17 Why haven\\u2019t standardized contracts become a common thing in the current healthcare system?

You can learn more by connecting with David on LinkedIn and following him on Twitter. \\xa0

@David_Scheinker of @SURFStanfordMed discusses administrative burden on our #healthcarepodcast. #healthcare #podcast #healthcarecosts

What\\u2019s the quantitative administrative cost in an average transaction? @David_Scheinker of @SURFStanfordMed discusses administrative burden on our #healthcarepodcast. #healthcare #podcast #healthcarecosts

What\\u2019s the quantitative administrative cost in a healthcare transaction? @David_Scheinker of @SURFStanfordMed discusses administrative burden on our #healthcarepodcast. #healthcare #podcast #healthcarecosts

What does the healthcare billing and administration cost add to the US\\u2019s overall healthcare spend? @David_Scheinker of @SURFStanfordMed discusses administrative burden on our #healthcarepodcast. #healthcare #podcast #healthcarecosts

Is it possible to cut billing and administrative costs in healthcare? @David_Scheinker of @SURFStanfordMed discusses administrative burden on our #healthcarepodcast. #healthcare #podcast #healthcarecosts

\\u201cIn some ways, the problem for healthcare should be simpler.\\u201d @David_Scheinker of @SURFStanfordMed discusses administrative burden on our #healthcarepodcast. #healthcare #podcast #healthcarecosts

What does the complexity of the current system look like in a doctor\\u2019s office? @David_Scheinker of @SURFStanfordMed discusses administrative burden on our #healthcarepodcast. #healthcare #podcast #healthcarecosts

How did David go about studying healthcare administrative costs? @David_Scheinker of @SURFStanfordMed discusses administrative burden on our #healthcarepodcast. #healthcare #podcast #healthcarecosts

\\u201cIt doesn\\u2019t have to be simple; it should be standardized.\\u201d @David_Scheinker of @SURFStanfordMed discusses administrative burden on our #healthcarepodcast. #healthcare #podcast #healthcarecosts

What would be the pushback on standardizing contracts in healthcare? @David_Scheinker of @SURFStanfordMed discusses administrative burden on our #healthcarepodcast. #healthcare #podcast #healthcarecosts

Why is it possible to gain more value by losing customization in contracts? @David_Scheinker of @SURFStanfordMed discusses administrative burden on our #healthcarepodcast. #healthcare #podcast #healthcarecosts

\\u201cNever let a good crisis go to waste.\\u201d @David_Scheinker of @SURFStanfordMed discusses administrative burden on our #healthcarepodcast. #healthcare #podcast #healthcarecosts

\\u201cIt\\u2019s much easier in healthcare to build something new than to change something that exists.\\u201d @David_Scheinker of @SURFStanfordMed discusses administrative burden on our #healthcarepodcast. #healthcare #podcast #healthcarecosts

What benefits does telemedicine have to cutting administrative cost? @David_Scheinker of @SURFStanfordMed discusses administrative burden on our #healthcarepodcast. #healthcare #podcast #healthcarecosts

What is another significant benefit of using standardized contracts? @David_Scheinker of @SURFStanfordMed discusses administrative burden on our #healthcarepodcast. #healthcare #podcast #healthcarecosts

Why haven\\u2019t standardized contracts become a common thing in the current healthcare system? @David_Scheinker of @SURFStanfordMed discusses administrative burden on our #healthcarepodcast. #healthcare #podcast #healthcarecosts

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17)

\\xa0

Listed in: Health

EP362: A CFO Talks About a Hybrid Business Model, With Ali Ucar

Ali Ucar is CFO of Care Solutions Group with a diverse background in finance, operations, and strategic planning. Ali has been instrumental in designing and implementing programs targeted at reducing costs to insurance companies, hospitals, and nursing homes.

Ali played the lead role in the acquisition and integration of a distressed, near-bankrupt mobile physician practice in 2015. The integration included implementation of operating and restructuring initiatives to improve competitive positioning and financial performance.

As part of the mobile clinician service and to improve access to care while minimizing the financial impact of the pandemic, Ali launched the statewide telehealth program in 2020.

Additionally, to address the needs of a chronically ill and high-risk patient population, Ali has assisted in the launch of the Transitional and Chronic Care Management Programs to assist families and patients with the required coordination of care in the home. Providing this connectivity to a dedicated, single-contact point provided through a registered nurse has been a major factor in reducing hospitalizations, readmissions, and emergency room visits.

Ali also has secured contracts with commercial insurance companies for implementation of Chronic Care Management programs as well as program outreach initiatives targeted at engaging and communicating with moderate- to high-risk members.

His work also includes project management expertise gained while leading projects with a chain of skilled nursing facilities targeted at managing the needs of discharged patients and for projects initiated by Blue Cross Blue Shield, Ford Motor Company, and multiple start-ups.

The development and expansion of Care Solutions Group\\u2019s comprehensive medical management programs traverse across multiple healthcare systems and settings that include private homes, group homes, independent living communities, assisted living, and skilled nursing facilities.

07:45 How do Care Solutions\\u2019 telehealth programs do payments?
08:57 EP320 with Christian Milaster and EP357 with Liliana Petrova.
09:33 \\u201cAs you go deeper into it, you\\u2019re coupling that telehealth with transitional care, chronic care; you can also address \\u2026 health equity issues in \\u2026 areas which may be difficult to reach.\\u201d
10:02 As a CFO, how is Ali Ucar involved in the telehealth strategy development?
11:26 How have Care Solutions\\u2019 telehealth programs become sustainable?
13:02 Why would it make financial sense for Care Solutions to continue their telehealth programs?
15:13 EP354 with Shawn Rhodes.
18:55 How does the work that Care Solutions\\u2019 telehealth programs do benefit customers?
21:50 Does Care Solutions have a proactive strategy to building out their telehealth programs?
24:34 How do Care Solutions\\u2019 telehealth programs add value to provider organizations?
26:33 \\u201cIt\\u2019s basically refining your practice. That\\u2019s the way I look at it.\\u201d
27:58 How does Ali Ucar, as a CFO, evaluate the success of his telehealth programs?
30:09 \\u201cI think the most frustrating thing from a patient standpoint may be if they don\\u2019t have those needs addressed quickly.\\u201d

You can learn more at caresolutionsusa.com or by emailing Ali at ali@caresolutionsusa.com.\\xa0

Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How do Care Solutions\\u2019 #telehealth programs do payments? Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cAs you go deeper into it, you\\u2019re coupling that telehealth with transitional care, chronic care; you can also address \\u2026 health equity issues in \\u2026 areas which may be difficult to reach.\\u201d Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth

As a CFO, how is Ali Ucar involved in the telehealth strategy development? Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How have Care Solutions\\u2019 telehealth programs become sustainable? Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why would it make financial sense for Care Solutions to continue their telehealth programs? Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How does the work that Care Solutions\\u2019 telehealth programs do benefit customers? Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Does Care Solutions have a proactive strategy to building out their telehealth programs? Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How do Care Solutions\\u2019 telehealth programs add value to provider organizations? Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIt\\u2019s basically refining your practice. That\\u2019s the way I look at it.\\u201d Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How does Ali Ucar, as a CFO, evaluate the success of his telehealth programs? Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cI think the most frustrating thing from a patient standpoint may be if they don\\u2019t have those needs addressed quickly.\\u201d Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\xa0

Listed in: Health

EP361: The Gap in Closing Care Gaps, With Carly Eckert, MD

Carly Eckert, MD, MPH, is a product leader at Olive AI, the automation company creating the internet of healthcare. As a trained physician, epidemiologist, and informatician, Dr. Eckert brings a tremendous amount of clinical experience and relevant healthcare industry knowledge to her work. In her role, Dr. Eckert combines her expertise, data understanding, and deep passion to impact healthcare for all patients. Prior to her role at Olive, Dr. Eckert led product for multiple AI start-ups with a particular interest in socially responsible technology and community impact.

06:59 What is the true goal in making population health successful?
07:26 How does the clinical pathway need to manifest in population health?
08:00 How do we get a nonfragmented state of care?
08:25 What is the best model of care?
10:08 \\u201cIdentifying and addressing care gaps is an important element of population health.\\u201d
13:01 Closing care gaps vs creating a nonfragmented system of care.
17:11 \\u201cI think you have to take small steps with people.\\u201d
18:18 \\u201cThere\\u2019s a lot of power in peer support.\\u201d
18:52 Why should provider organizations connect with peer groups?
20:39 \\u201cThe key is that it\\u2019s not going to be the same for everybody.\\u201d
24:43 Why is diversity of the workforce key to closing care gaps?
25:07 EP322 with Monica Lypson, MD, MHPE.
25:11 EP347 with Ian Tong, MD.
30:09 Where can providers improve transparency to help close care gaps?

You can learn more at oliveai.com.

You can also connect with Dr. Eckert on LinkedIn and follow her on Twitter.\\xa0\\xa0

@md_carly discusses #caregaps in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare #vbc

What is the true goal in making #populationhealth successful? @md_carly discusses #caregaps in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare #vbc

How does the clinical pathway need to manifest in #populationhealth? @md_carly discusses #caregaps in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare #vbc

How do we get a nonfragmented state of care? @md_carly discusses #caregaps in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare #vbc

What is the best model of care? @md_carly discusses #caregaps in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare #vbc

\\u201cIdentifying and addressing care gaps is an important element of #populationhealth.\\u201d @md_carly discusses #caregaps in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare #vbc

Closing care gaps vs creating a nonfragmented system of care. @md_carly discusses #caregaps in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare #vbc

\\u201cI think you have to take small steps with people.\\u201d @md_carly discusses #caregaps in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare #vbc

\\u201cThere\\u2019s a lot of power in peer support.\\u201d @md_carly discusses #caregaps in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare #vbc

Why should provider organizations connect with peer groups? @md_carly discusses #caregaps in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare #vbc

\\u201cThe key is that it\\u2019s not going to be the same for everybody.\\u201d @md_carly discusses #caregaps in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare #vbc

Why is diversity of the workforce key to closing care gaps? @md_carly discusses #caregaps in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare #vbc

Where can providers improve transparency to help close care gaps? @md_carly discusses #caregaps in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare #vbc

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Jeb Dunkelberger (EP360), Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King

Listed in: Health

EP360: How to Deliver Value-Based Care That Meets Value-Based Payment Objectives, With Jeb Dunkelberger

Jeb Dunkelberger, MSc, MHCI, currently serves as CEO of Sutter Health | Aetna (SH|A), a commercial insurance plan serving Northern California. The health plan aims to combine the value of retail, provider, and payer via its partnerships with CVS, Sutter Health, and Aetna. Prior to SH|A, Jeb led growth for two bay-area healthcare start-ups: Cricket Health and Notable Health. Jeb has also held executive roles at Highmark, McKesson, and EY. Jeb holds healthcare-related degrees from Virginia Tech, The London School of Economics, Cornell University, and University of Pennsylvania.

08:36 What must a provider organization consider operationally when incorporating value-based care and value-based payments?
09:44 How can you use perverse incentives to encourage people to do the right thing?
12:25 How should clinical workflows operate to incorporate value-based care?
14:10 \\u201cHow do you align patients?\\u201d
15:52 How should the EHR operate to maximize value-based workflow?
16:52 Why is taking action on claims data and clinical data together important?
20:26 \\u201cHave they actually solved the last mile of integrations?\\u201d
21:15 \\u201cChanging the behavior of a provider is an absolute art and science.\\u201d
22:57 \\u201cWe have to do more.\\u201d
27:09 \\u201cThat administrative headache \\u2026 doesn\\u2019t just end with the insurer.\\u201d

You can learn more at sutterhealthaetna.com.\\xa0\\xa0

You can also connect with Jeb on LinkedIn and follow him on Twitter.\\xa0\\xa0

@Jeb_Dunk discusses #valuebased #clinicalworkflows in this week\\u2019s #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs

What must a provider organization consider operationally when incorporating value-based care and value-based payments? @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week\\u2019s #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs

How can you use perverse incentives to encourage people to do the right thing? @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week\\u2019s #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs

How should clinical workflows operate to incorporate value-based care? @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week\\u2019s #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs

\\u201cHow do you align patients?\\u201d @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week\\u2019s #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs

How should the EHR operate to maximize value-based workflow? @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week\\u2019s #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs

Why is taking action on claims data and clinical data together important? @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week\\u2019s #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs

\\u201cHave they actually solved the last mile of integrations?\\u201d @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week\\u2019s #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs

\\u201cChanging the behavior of a provider is an absolute art and science.\\u201d @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week\\u2019s #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs

\\u201cWe have to do more.\\u201d @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week\\u2019s #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs

\\u201cThat administrative headache \\u2026 doesn\\u2019t just end with the insurer.\\u201d @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week\\u2019s #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Dan O\\u2019Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb

\\xa0

Listed in: Health

EP359: Value-Based PaymentsYou Get What You Pay For, With Dan ONeill

Daniel O\\u2019Neill, MA, MS, currently serves as chief commercial officer for Pine Park Health, a value-based primary care group that delivers on-site care in senior living communities. Prior to that, Dan was a health policy fellow at the National Academy of Medicine, working primarily in the US Senate on legislation focused on surprise billing, anti-competitive contracting practices in the commercial market, and price transparency. Dan has also worked as a senior vice president with Change Healthcare and as an advisor to venture-stage healthcare services and technology firms. At Pine Park, Dan is responsible for risk-based contracting with IPAs and insurers and for the group\\u2019s participation in CMS value-based care models, including direct contracting. Dan\\u2019s research is available in NEJM Catalyst and on the Health Affairs blog, and he holds graduate degrees from Johns Hopkins University and Stanford University. \\xa0

05:06 What is the spectrum of value-based contracts?
07:24 Why don\\u2019t value-based contracts at the organizational level always trickle down to the provider level?
11:25 What are the two things that need to happen to drive outcomes in value-based healthcare?
15:24 How do insurers play into improving value-based contracts?
19:46 \\u201cThere\\u2019s a strong case to actually clamp down on prices.\\u201d
23:47 \\u201cRight now, we\\u2019re still in a place where if you want to do something other than fee for service \\u2026 you have to fight like hell.\\u201d
24:03 What\\u2019s the first step to making value-based contracts more accessible?
24:27 What\\u2019s the second step to making value-based contracts accessible?
25:23 Why are the incentives to change American healthcare pretty weak?
27:10 \\u201cOrganizational change is just exceedingly difficult.\\u201d
28:45 What should you do if you want to start pushing organizations toward value-based contracts?
32:42 EP351 with Eric Bricker, MD.\\xa0

You can learn more at dponeill.com or connect with Dan on LinkedIn.

@dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth

What is the spectrum of value-based contracts? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth

Why don\\u2019t value-based contracts at the organizational level always trickle down to the provider level? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth

What are the two things that need to happen to drive outcomes in value-based healthcare? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth

How do insurers play into improving value-based contracts? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth

\\u201cThere\\u2019s a strong case to actually clamp down on prices.\\u201d @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth

\\u201cRight now, we\\u2019re still in a place where if you want to do something other than fee for service \\u2026 you have to fight like hell.\\u201d @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth

What\\u2019s the first step to making value-based contracts more accessible? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth

What\\u2019s the second step to making value-based contracts accessible? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth

Why are the incentives to change American healthcare pretty weak? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth

\\u201cOrganizational change is just exceedingly difficult.\\u201d @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth

What should you do if you want to start pushing organizations toward value-based contracts? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber

\\xa0

Listed in: Health

EP358: How Health Insurance Plan Design Can Lead to Patients Sacrificing Needed Care, Their Mental Health, and (Sometimes) Buying Groceries, With Wayne Jenkins, MD

Wayne Jenkins, MD, is the chief medical officer at Centivo. He is an accomplished physician and executive with a proven track record of patient-centered, revenue-driven results. Over the course of his career, he has consistently transformed large, complex healthcare systems into market leaders that deliver quality and value in a dynamically changing environment.

Prior to Centivo, he was the chief clinical officer for population health at Vanderbilt University Medical Center, where he provided clinical oversight of value-based care delivery and completed the formation of Medicare accountable care organizations (ACOs). Before his time at Vanderbilt University Medical Center, he served as the senior vice president and chief strategy officer of Orlando Health, as well as president of Orlando Health Physician Partners. Previously, Wayne was the chief of radiation oncology and then subsequently the medical director for the Florida affiliate of M.D. Anderson Cancer Center, a subsidiary of Orlando Health, Inc.

Wayne holds a bachelor\\u2019s degree from the University of Tennessee, an MD from Vanderbilt University School of Medicine, and a master\\u2019s of health policy and administration from Johns Hopkins University. He is board certified in radiation oncology and was recognized in Best Doctors in America annually from 1994 to 2015. He has published 18 scientific articles and is often sought out to speak at state and national conferences.

05:23 How is financial toxicity in healthcare affecting patients?
07:02 How do we define a \\u201cnormal\\u201d deductible in today\\u2019s healthcare?
08:14 What\\u2019s the point of having a deductible? What does a plan gain from a high deductible?
10:43 How does the cost of a patient\\u2019s deductible correlate with their use of their health insurance?
12:51 EP308 with Mark Fendrick, MD.
15:18 How is health insurance actually sometimes reducing patients\\u2019 health?
16:24 What is the defining characteristic of those who are more adversely affected by high deductibles?
17:04 Why should CFOs consider plans with lower deductibles for their employees?
18:26 \\u201cAre there other ways to approach this in a marketplace, to get more value for what you\\u2019re paying for so this problem can be addressed?\\u201d
21:56 How should employers contemplate health plans moving forward?
22:24 \\u201cHaving the health plan choice gives more financial viability in addition to that open access.\\u201d
22:58 \\u201cIn some sense, [that] can be a zero-sum game. Do you get it in the premium, or is it paid in the higher deductible?\\u201d
23:45 \\u201cI think there are value choices in the market that may help negate some of the problems that we were just discussing.\\u201d
25:33 \\u201cI think conventional wisdom may be left over from the \\u201990s.\\u201d
26:49 Why does building these narrow networks have to be a science?
28:38 Does a narrow network adversely affect mental health?
32:20 \\u201cNarrow and excellent is not a bad choice for people.\\u201d

You can learn more at centivo.com.\\xa0

Wayne Jenkins, MD, of @Centivo_Health discusses health insurance plan design on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts

How is financial toxicity in healthcare affecting patients? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts

How do we define a \\u201cnormal\\u201d deductible in today\\u2019s healthcare? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts

What\\u2019s the point of having a deductible? What does a plan gain from a high deductible? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts

How does the cost of a patient\\u2019s deductible correlate with their use of their health insurance? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts

How is health insurance actually sometimes reducing patients\\u2019 health? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts

What is the defining characteristic of those who are more adversely affected by high deductibles? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts

Why should CFOs consider plans with lower deductibles for their employees? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts

\\u201cAre there other ways to approach this in a marketplace, to get more value for what you\\u2019re paying for so this problem can be addressed?\\u201d Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts

How should employers contemplate health plans moving forward? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts

\\u201cHaving the health plan choice gives more financial viability in addition to that open access.\\u201d Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts

\\u201cIn some sense, [that] can be a zero-sum game. Do you get it in the premium, or is it paid in the higher deductible?\\u201d Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts

\\u201cI think there are value choices in the market that may help negate some of the problems that we were just discussing.\\u201d Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts

\\u201cI think conventional wisdom may be left over from the \\u201990s.\\u201d Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts

Why does building these narrow networks have to be a science? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts

Does a narrow network adversely affect mental health? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts

\\u201cNarrow and excellent is not a bad choice for people.\\u201d Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30)

\\xa0

Listed in: Health

EP357: Standing Up Telehealth That Actually Advances Providers Core Business, With Liliana Petrova

Liliana Petrova, CCXP, is a visionary and a proven leader in the field of customer experience and innovation. She pioneered a new customer-centric culture, energizing the more than 15,000 JetBlue employees with her vision. She has been recognized for her JFK Lobby redesign and facial recognition program with awards from Future Travel Experience and Popular Science.

Liliana is committed to creating seamless, successful experiences for customers and delivering greater value for brands. In 2019, she founded an international customer experience consulting firm that helps brands improve their customer experience. The Petrova Experience focuses on three pillars of customer experience: organizational culture that inspires employees to be brand ambassadors, design and implementation of customer centric journeys, and technology implementations with customer experience value in mind.

06:59 Who should be on the telehealth board to incorporate telehealth successfully?
08:44 What is the population that you\\u2019re serving, and how does telehealth serve that population?
09:45 \\u201cWhen they think of this as a project versus a program or a strategic imperative, then there is no business case.\\u201d
11:49 \\u201cHow do you integrate telehealth in your core business?\\u201d
12:32 What does a CIO need to do to be best equipped to serve their organization?
14:05 Why are CIOs and CFOs naturally in conflict these days?
15:30 Why is it important to have a physician be an ambassador for telehealth implementation?
17:05 Why is it important to utilize patient feedback properly?
18:37 Why must the patient own their own health?
20:29 \\u201cThe key is, if you start at the strategic level with cross-functional leaders, then the working team will also be cross-functional.\\u201d
21:49 \\u201cYou won\\u2019t have a successful telehealth experience if you don\\u2019t think through the end-to-end experience.\\u201d
21:55 EP332 with Tony DiGioia, MD.
23:40 Who is the digital navigator in implementing telehealth?
24:55 What is a digital navigator, and how does it show up in the telehealth journey?
30:55 Why is it important to have continuous growth in telehealth?

You can learn more at thepetrovaexperience.com or join the patient NODE group by emailing Liliana at liliana@thepetrovaexperience.com.

@LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Who should be on the telehealth board to incorporate telehealth successfully? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What is the population that you\\u2019re serving, and how does telehealth serve that population? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWhen they think of this as a project versus a program or a strategic imperative, then there is no business case.\\u201d @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cHow do you integrate telehealth in your core business?\\u201d @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What does a CIO need to do to be best equipped to serve their organization? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why is it important to have a physician be an ambassador for telehealth implementation? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why is it important to utilize patient feedback properly? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why must the patient own their own health? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThe key is, if you start at the strategic level with cross-functional leaders, then the working team will also be cross-functional.\\u201d @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cYou won\\u2019t have a successful telehealth experience if you don\\u2019t think through the end-to-end experience.\\u201d @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Who is the digital navigator in implementing telehealth? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What is a digital navigator, and how does it show up in the telehealth journey? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why is it important to have continuous growth in telehealth? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16)

\\xa0

Listed in: Health

EP356: PBMs React to GoodRx, Mark Cuban, and Amazon Pharmacy, With Ge Bai, PhD, CPA

Ge Bai, PhD, CPA, is professor of accounting at the Johns Hopkins Carey Business School and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. She is an expert on healthcare pricing, policy, and management. Dr. Bai has testified before the House Ways and Means Committee, written for the Wall Street Journal, and published her studies in leading academic journals such as the New England Journal of Medicine, JAMA, JAMA Internal Medicine, Annals of Internal Medicine, and Health Affairs. Her work has been widely featured on ABC, CBS, NBC, Fox News, CNN, and NPR and in the Los Angeles Times, New York Times, Wall Street Journal, Washington Post, and other media outlets and used in government regulations and congressional testimonies.

08:45 What is ESI doing by automatically applying discounts to generic drugs?
10:00 Why are PBMs losing money when consumers don\\u2019t use their benefit?
10:46 \\u201cGoodRx disrupted the ongoing game.\\u201d
11:04 How are PBMs using the Amazon discount card to discourage their patients from moving away from using their benefits?
12:13 Amazon pricing versus GoodRx pricing.
12:50 How much money is a PBM really making?
14:00 EP344 with Steven Quimby, MD.
14:29 EP334 with Sunita Desai, PhD.
14:43 How is future fear playing into the PBM business model?
16:55 Is there a negative consequence to subtracting from the bottom line in a PBM model?
17:50 \\u201cI think to have strong PBMs does not mean necessarily bad things for patients.\\u201d
19:39 What happens if everyone uses Amazon for drugs?
22:40 If every PBM gets their own discount cards, what will happen?
25:38 \\u201cWe are actually witnessing a potential sea change.\\u201d
26:25 How do cost-plus pharmacies factor into the current market?
29:16 Is a profit shortfall inevitable?
29:35 \\u201cPBMs have to give a slice of their profit back to consumers. That\\u2019s just reality.\\u201d
30:11 Can anything be done on the PBM side to generate a higher margin in the generic space?
31:41 \\u201cNaive plan sponsors are a big problem.\\u201d

You can learn more on Ge\\u2019s Web site at Johns Hopkins University. You can also connect with her on LinkedIn.

@GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

What is ESI doing by automatically applying discounts to generic drugs? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

Why are PBMs losing money when consumers don\\u2019t use their benefit? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

\\u201cGoodRx disrupted the ongoing game.\\u201d @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

How are PBMs using the Amazon discount card to discourage their patients from moving away from using their benefits? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

Amazon pricing versus GoodRx pricing. @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

How much money is a PBM really making? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

How is future fear playing into the PBM business model? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

Is there a negative consequence to subtracting from the bottom line in a PBM model? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

\\u201cI think to have strong PBMs does not mean necessarily bad things for patients.\\u201d @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

What happens if everyone uses Amazon for drugs? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

If every PBM gets their own discount cards, what will happen? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

\\u201cWe are actually witnessing a potential sea change.\\u201d @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

How do cost-plus pharmacies factor into the current market? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

Is a profit shortfall inevitable? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

\\u201cPBMs have to give a slice of their profit back to consumers. That\\u2019s just reality.\\u201d @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

Can anything be done on the PBM side to generate a higher margin in the generic space? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

\\u201cNaive plan sponsors are a big problem.\\u201d @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335)

\\xa0

Listed in: Health

EP355: The 5 Business Models of Digital Health Companies, With Nikhil Krishnan

Nikhil Krishnan is the founder/thinkboi at Out-Of-Pocket, where he\\u2019s trying to make the business of healthcare more easily understandable and (hopefully) entertaining. He runs a newsletter (yes, yet another one) and an online healthcare community and does some digital health investing on the side. He\\u2019s \\u201cextremely online,\\u201d and you can find him firing off obscure healthcare memes plus the occasional insight on Twitter at @nikillinit. \\xa0

\\xa0

05:31 What are the different models of digital health?
07:17 What are the different motives for cash-pay digital health models?
13:08 \\u201cOne of healthcare\\u2019s original sins is that every solution deployed has been a custom solution for the end user.\\u201d
13:31 How willing will these companies be to share their data with third parties?
17:20 \\u201cI don\\u2019t think selling tech to large incumbents is going to move the needle.\\u201d
20:27 \\u201cThese companies, most of them are actually getting extra money for the more expensive stuff.\\u201d
22:11 How did joint-venture digital health business models come about?
25:50 Why do you see partnerships more on the payer/provider side?
26:41 Who are the old-school digital health companies that could be considered incumbents?
28:48 Why do so many digital health start-ups have a hard time pinpointing who will pay for their services?
31:22 \\u201cThe ability to go through the idea maze is way faster now.\\u201d
34:08 \\u201cThe field is wide open to help teach people how healthcare works.\\u201d

You can learn more at outofpocket.health and with Nikhil\\u2019s upcoming course.\\xa0

@nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast

What are the different models of digital health? @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast

What are the different motives for cash pay digital health models? @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast

\\u201cOne of healthcare\\u2019s original sins is that every solution deployed has been a custom solution for the end user.\\u201d @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast

How willing will these companies be to share their data with third parties? @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast

\\u201cI don\\u2019t think selling tech to large incumbents is going to move the needle.\\u201d @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast

\\u201cThese companies, most of them are actually getting extra money for the more expensive stuff.\\u201d @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast

How did joint-venture digital health business models come about? @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast

Why do you see partnerships more on the payer/provider side? @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast

Who are the old-school digital health companies that could be considered incumbents? @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast

Why do so many digital health start-ups have a hard time pinpointing who will pay for their services? @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast

\\u201cThe ability to go through the idea maze is way faster now.\\u201d @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast

\\u201cThe field is wide open to help teach people how healthcare works.\\u201d @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai

\\xa0

Listed in: Health

EP354: 7 Vital Success Factors to Stand Up a CIN (Clinically Integrated Network), With Shawn Rhodes

Shawn Rhodes serves as regional vice president at Caravan Health, a services and technology company that helps hospitals and physicians who care for underserved population succeed in value-based care. Shawn collaborates with clients to develop tailored population health strategies and support their efforts to deliver the highest-quality, patient-focused care at the lowest cost.

Prior to Caravan Health, Shawn served as the director of clinical integration for a clinically integrated network, Med Center Health Partners, where he oversaw value-based agreements (commercial, Medicare Advantage, Medicaid, BPCI, and employer health plans) with various payers along with ACO activities and quality improvement initiatives within the network.

Before his work in value-based care, Shawn served as director of education and organizational development at Baptist Health Hardin, focusing on leadership development and cultural change through Studer Group initiatives.

The early part of Shawn\\u2019s career was spent in industrial equipment design and progressed into the automotive manufacturing industry working with Toyota and Honda on quality and process improvement. He then transitioned to the healthcare industry where he worked for eight years as a consultant specializing in coaching and mentoring hospitals to achieve improved quality, efficiency, and financial performance through process improvement, LEAN techniques, and reengineering.

Shawn has a bachelor\\u2019s degree in mechanical engineering and a master\\u2019s degree in business administration from Western Kentucky University. He resides in Bowling Green, Kentucky.

08:08 What are the seven parameters to consider when standing up a CIN?
08:25 \\u201cCulture trumps strategy.\\u201d
09:10 \\u201cCommunication and education are key components to starting that \\u2026 process.\\u201d
09:26 \\u201cHow do you get the information to the right person at the right time and the right place?\\u201d
09:36 What does interoperability need to look like in a CIN?
10:29 How do organizations communicate with the patient in a CIN?
11:07 Can a clinically integrated network work if it\\u2019s not patient-centric?
11:37 EP332 with Tony DiGioia, MD.
11:49 What\\u2019s a must-have for a clinically integrated network to be successful?
13:41 \\u201cWhat does that data mean?\\u201d
15:34 EP315 with Bob Matthews.
15:52 \\u201cYou really need a go-to person.\\u201d
18:57 \\u201cThe thing with team-based care is, you also have to have team-based accountability.\\u201d
20:54 \\u201cYou\\u2019ve got to build some infrastructure around what you want to do.\\u201d
24:37 \\u201cAlignment is not an easy task by any means.\\u201d
25:15 \\u201cThere has to be a group decision-making process.\\u201d
25:34 EP343 with David Carmouche, MD.
25:41 EP341 with Gary Campbell.
26:18 How do you define leadership?
27:49 \\u201cStart small, get some successes, and it will build as you go.\\u201d

You can learn more at caravanhealth.com or connect with Shawn on LinkedIn. \\xa0

Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork

What are the seven parameters to consider when standing up a CIN? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork

\\u201cCulture trumps strategy.\\u201d Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork

\\u201cCommunication and education are key components to starting that \\u2026 process.\\u201d Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork

\\u201cHow do you get the information to the right person at the right time and the right place?\\u201d Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork

What does interoperability need to look like in a CIN? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork

How do organizations communicate with the patient in a CIN? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork

Can a clinically integrated network work if it\\u2019s not patient-centric? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork

What\\u2019s a must-have for a clinically integrated network to be successful? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork

\\u201cWhat does that data mean?\\u201d Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork

\\u201cYou really need a go-to person.\\u201d Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork

\\u201cThe thing with team-based care is, you also have to have team-based accountability.\\u201d Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork

\\u201cYou\\u2019ve got to build some infrastructure around what you want to do.\\u201d Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork

\\u201cAlignment is not an easy task by any means.\\u201d Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork

\\u201cThere has to be a group decision-making process.\\u201d Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork

How do you define leadership? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork

\\u201cStart small, get some successes, and it will build as you go.\\u201d Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333)

Listed in: Health

EP353: What You Need to Know About Specialty Pharmacy Formularies and Rebating, With Pramod John, PhD

Listed in: Health

EP352: Some Big Actionable Surprises About the Efficacy and Effectiveness of Specialty Pharmaceuticals, With Pramod John, PhD

Pramod John, PhD, is the team leader of VIVIO, a public benefit corporation whose mission is to ensure that drugs work in the real world for the people on them and that their costs reflect the value provided. VIVIO\\u2019s model has improved health outcomes and generated 35% to 40% savings on drug acquisition costs. It accomplishes this by answering three simple questions: (1) Is this the right drug? (2) Is it a fair price? and (3) Is it working for the patient?

Before VIVIO, Pramod was founder of Oration PBC (acquired by PokitDok), which gave consumers control over their drug purchasing by capturing the prescription in the physician\\u2019s office and providing real-time pricing options and automatic routing capabilities. Pramod was also vice president of strategy and innovation at McKesson, the world\\u2019s largest healthcare company. At McKesson, Pramod helped develop solutions that leveraged advanced technologies and business process improvements to optimize healthcare delivery systems, infrastructure, and supply chains.

Earlier, Pramod founded and served as CEO of PacketMotion, Inc, a venture-funded startup in the enterprise network information and policy management industry. VMware later acquired the company. In addition, Pramod founded netExaminer.com, a managed-vulnerability assessment company acquired by SonicWALL.

Pramod earned his PhD in electrical engineering from the University of Illinois at Urbana-Champaign. He serves on the board of Wycliffe USA. He also serves on the advisory board of Folia Water and as a mentor at StartX.

05:34 What does a good response mean in pharmaceutical products?
06:06 \\u201cDifferent people get different utility out of something.\\u201d
06:31 Why doesn\\u2019t efficacy mean what you think it means in terms of pharmaceutical products?
08:40 What is the difference between efficacy and effectiveness in Pharma?
09:10 Why aren\\u2019t drugs\\u2019 major side effects factored into a drug\\u2019s efficacy and effectiveness?
10:14 \\u201cWhat\\u2019s the benefit of this versus what\\u2019s the harm in this?\\u201d
13:35 \\u201cClearly as consumers, we all feel that we\\u2019re special. But what about physicians?\\u201d
14:14 \\u201cThe benefit itself\\u2014what does it have to be?\\u201d
15:18 EP334 with Sunita Desai, PhD.
17:11 \\u201cWe tend to think of things as a binary distribution\\u2014it works or it doesn\\u2019t.\\u201d
18:22 \\u201cThe default choice that we start with is often the wrong one.\\u201d
20:54 \\u201cIt doesn\\u2019t matter why if we can\\u2019t fix the reason.\\u201d
22:02 \\u201cAt some point, the question becomes, \\u2018Do we have any information?\\u2019\\u201d
22:36 Why do other developed countries pay less for their drugs?
24:21 How do we end up with crappy drugs on the market that don\\u2019t really move the dial?
25:57 EP303 with Anna Kaltenboeck.
27:22 \\u201cWe can build a better system. And that\\u2019s what we do every day.\\u201d

You can learn more at viviohealth.com or by emailing Pramod at pramod@viviohealth.com. \\xa0

Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs

What does a good response mean in pharmaceutical products? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs

\\u201cDifferent people get different utility out of something.\\u201d Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs

Why doesn\\u2019t efficacy mean what you think it means in terms of pharmaceutical products? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs

What is the difference between efficacy and effectiveness in Pharma? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs

Why aren\\u2019t drugs\\u2019 major side effects factored into a drug\\u2019s efficacy and effectiveness? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs

\\u201cWhat\\u2019s the benefit of this versus what\\u2019s the harm in this?\\u201d Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs

\\u201cClearly as consumers, we all feel that we\\u2019re special. But what about physicians?\\u201d Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs

\\u201cThe benefit itself\\u2014what does it have to be?\\u201d Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs

\\u201cWe tend to think of things as a binary distribution\\u2014it works or it doesn\\u2019t.\\u201d Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs

\\u201cThe default choice that we start with is often the wrong one.\\u201d Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs

\\u201cIt doesn\\u2019t matter why if we can\\u2019t fix the reason.\\u201d Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs

\\u201cAt some point, the question becomes, \\u2018Do we have any information?\\u2019\\u201d Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs

Why do other developed countries pay less for their drugs? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs

How do we end up with crappy drugs on the market that don\\u2019t really move the dial? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis

Listed in: Health

EP351: Everybody in the Healthcare Industry Getting Up in Everyone Elses Business, With Eric Bricker, MD, From AHealthcareZ

Eric Bricker, MD, is an internal medicine physician and former cofounder and chief medical officer of Compass Professional Health Services. Compass is a healthcare navigation service that grew to 2000+ clients, including T-Mobile, Southwest Airlines, and Chili\\u2019s/Maggiano\\u2019s restaurants. Compass was acquired by Alight Solutions in July 2018. Alight is a 10,000-person employee benefits and HR outsourcing company that separated from Aon in 2017.

Dr. Bricker has since started AHealthcareZ.com, with 170+ healthcare finance videos with approximately 90,000 views per month across all platforms. He is also the author of Healthcare Money Campfire Stories.\\xa0

06:30 What is this \\u201cmegatrend\\u201d happening in healthcare right now?
07:52 How has consolidation changed the healthcare landscape?
10:22 What is vertical integration within healthcare?
11:48 Why doesn\\u2019t inorganic growth benefit patients?
13:33 \\u201cWhat is best for the patient does not necessarily make the most money.\\u201d
14:43 \\u201cIt\\u2019s not that it\\u2019s above the law \\u2026 it is just intentionally obscured.\\u201d
18:58 \\u201cHealthcare is glacial. It is slow.\\u201d
23:23 \\u201cThe largest source of healthcare costs is hospitals.\\u201d
25:48 EP330 with John Marchica.
29:17 \\u201cWhat have the historical priorities been of the administrators of those hospitals?\\u201d
29:32 \\u201cEvery hospital CFO knows that they need sick people.\\u201d
30:18 EP343 with David Carmouche.
30:59 \\u201cThe payment change has to come first.\\u201d
32:17 \\u201cThe money wins.\\u201d
34:12 \\u201cYou\\u2019ve got to put the financial incentives in place \\u2026 to make people actually behave the way that they should.\\u201d

You can connect with Dr. Bricker on Twitter at @DrEricB and on LinkedIn.

@DrEricB discusses #healthcare\\u2019s changing landscape on our #healthcarepodcast. #podcast #digitalhealth

What is this \\u201cmegatrend\\u201d happening in healthcare right now? @DrEricB discusses #healthcare\\u2019s changing landscape on our #healthcarepodcast. #podcast #digitalhealth

How has consolidation changed the healthcare landscape? @DrEricB discusses #healthcare\\u2019s changing landscape on our #healthcarepodcast. #podcast #digitalhealth

What is vertical integration within healthcare? @DrEricB discusses #healthcare\\u2019s changing landscape on our #healthcarepodcast. #podcast #digitalhealth

Why doesn\\u2019t inorganic growth benefit patients? @DrEricB discusses #healthcare\\u2019s changing landscape on our #healthcarepodcast. #podcast #digitalhealth

\\u201cWhat is best for the patient does not necessarily make the most money.\\u201d @DrEricB discusses #healthcare\\u2019s changing landscape on our #healthcarepodcast. #podcast #digitalhealth

\\u201cIt\\u2019s not that it\\u2019s above the law \\u2026 it is just intentionally obscured.\\u201d @DrEricB discusses #healthcare\\u2019s changing landscape on our #healthcarepodcast. #podcast #digitalhealth

\\u201cHealthcare is glacial. It is slow.\\u201d @DrEricB discusses #healthcare\\u2019s changing landscape on our #healthcarepodcast. #podcast #digitalhealth

\\u201cThe largest source of healthcare costs is hospitals.\\u201d @DrEricB discusses #healthcare\\u2019s changing landscape on our #healthcarepodcast. #podcast #digitalhealth

\\u201cWhat have the historical priorities been of the administrators of those hospitals?\\u201d @DrEricB discusses #healthcare\\u2019s changing landscape on our #healthcarepodcast. #podcast #digitalhealth

\\u201cEvery hospital CFO knows that they need sick people.\\u201d @DrEricB discusses #healthcare\\u2019s changing landscape on our #healthcarepodcast. #podcast #digitalhealth

\\u201cThe payment change has to come first.\\u201d @DrEricB discusses #healthcare\\u2019s changing landscape on our #healthcarepodcast. #podcast #digitalhealth

\\u201cThe money wins.\\u201d @DrEricB discusses #healthcare\\u2019s changing landscape on our #healthcarepodcast. #podcast #digitalhealth

\\u201cYou\\u2019ve got to put the financial incentives in place \\u2026 to make people actually behave the way that they should.\\u201d @DrEricB discusses #healthcare\\u2019s changing landscape on our #healthcarepodcast. #podcast #digitalhealth

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica

\\xa0

Listed in: Health

EP350: Employers Direct Contracting With Hospitals, in Real Life, With Katy Talento

Katy Talento is an infectious disease epidemiologist, a veteran health policy advisor, and healthcare consultant. She is CEO of AllBetter Health, an insurgent benefits advisory firm building innovative health plans for employers that are free of misaligned financial incentives. Katy served as the health policy lead in the White House on the Domestic Policy Council where her portfolio included public health issues such as eliminating domestic HIV/AIDS, ending secret healthcare prices, lowering prescription drug prices, expanding health IT interoperability, combating the opioids and other drug addiction crisis, and promoting bioethics in the life sciences. Katy has appeared on or been published in a number of media outlets, including CNN, Sky News, Newsmax, The New York Times, The Hill, The Morning Consult, RealClearPolitics, and others.

Prior to her White House appointment, Katy served five U.S. Senators over a 15-year period, including as top health advisor and manager of legislative staff and oversight investigators. She also worked in the private sector helping multinational energy companies protect their global workforce from infectious diseases and on the research faculty at Georgetown University Medical School.

Katy served as the director of speechwriting for the Republican National Committee and has written a number of published opinion pieces, Web copy, and video scripts. She spent two years as a Catholic nun and has worked with the poorest of the poor from East Africa to industrial Russia and inner-city America. Katy received a master of science degree in infectious disease epidemiology from the Harvard School of Public Health and an undergraduate degree in sociology from the University of Virginia.

05:21 Why are employers direct contracting?
06:37 \\u201cWhen you directly contract \\u2026 you don\\u2019t have to chase patients.\\u201d
07:43 Why the growing 501(r) movement is making direct contracting more enticing.
10:16 \\u201cThey\\u2019re going to be giving better rates, whether they want to or not.\\u201d
11:46 \\u201cI think it\\u2019s the future hospitals want, too.\\u201d
12:58 What is the primary driver of increased healthcare costs?
14:56 \\u201cThe fixed costs that the hospitals \\u2026 have may not be so fixed.\\u201d
15:08 \\u201cA hospital should not be a freestanding profit center. \\u2026 The hospital is a failure of healthcare. It alone should not be profitable.\\u201d
15:35 \\u201cWe have the system we have, but why do we have to live with it? We don\\u2019t have to.\\u201d
17:15 What\\u2019s step 1 of direct contracting?
24:12 What\\u2019s the TPA\\u2019s role in direct contracting?
25:21 What\\u2019s the repricer\\u2019s role in direct contracting?
33:28 \\u201cI think the thing that makes all this work is having a benefits advisor that knows how to do all this.\\u201d

You can learn more at allbetter.health or contact Katy directly at katy@allbetter.health.

@KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth

Why are employers direct contracting? @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth

\\u201cWhen you directly contract \\u2026 you don\\u2019t have to chase patients.\\u201d @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth

Why the growing 501(r) movement is making direct contracting more enticing. @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth

\\u201cThey\\u2019re going to be giving better rates, whether they want to or not.\\u201d @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth

\\u201cI think it\\u2019s the future hospitals want, too.\\u201d @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth

What is the primary driver of increased healthcare costs? @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth

\\u201cThe fixed costs that the hospitals \\u2026 have may not be so fixed.\\u201d @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth

\\u201cA hospital should not be a freestanding profit center. \\u2026 The hospital is a failure of healthcare. It alone should not be profitable.\\u201d @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth

\\u201cWe have the system we have, but why do we have to live with it? We don\\u2019t have to.\\u201d @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth

What\\u2019s step 1 of direct contracting? @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth

What\\u2019s the TPA\\u2019s role in direct contracting? @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth

What\\u2019s the repricer\\u2019s role in direct contracting? @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth

\\u201cI think the thing that makes all this work is having a benefits advisor that knows how to do all this.\\u201d @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly

Listed in: Health

INBW33: Thank You, and a Few Thoughts

Each week on Relentless Health Value, Stacey uses her voice and thought leadership to provide insights for healthcare industry decision makers trying to do the right thing. Each show features expert guests who break down the twists and tricks in the medical field to help improve outcomes and lower costs across the care continuum. Relentless Health Value is a top 100 podcast on iTunes in the medicine category and reaches tens of thousands of engaged listeners across the healthcare industry.

In addition to hosting Relentless Health Value, Stacey is co-president of QC-Health, a benefit corporation finding cost-effective ways to improve the health of Americans. She is also co-president of Aventria Health Group, a consultancy working with clients who endeavor to form collaborations with payers, providers, Pharma, employer organizations, or patient advocacy groups.

03:36 Thank you to our listeners and the feedback you\\u2019ve given the show over the years.
05:10 \\u201cGood and bad is a matter of extremes.\\u201d
06:20 Thank you to Dr. Steve Schutzer, Dr. George Mathews, Dr. Ge Bai, Troy Larsgard, Dr. Hugh Sims, Vinay Eaton, Dr. Brian Decker, Jeff Hogan, Peter Hayes, Dr. Aaron Mitchell, Parker Edman, Andre Wenker, Doug Aldeen, Cristy Gupton, LynAnn Henderson, Chad Jackson, and Darrell Moon.
07:27 Thank you to our iTunes reviewers.
07:47 If you haven\\u2019t given us a review yet, please do here.
08:01 Thank you to Malfoxley, Jopo1234, and Teresa O\\u2019Keefe for your 2021 reviews.
08:19 Thank you to Dr. Nadia Chaudhri, who sadly died this past year of ovarian cancer but who did so much to advance the awareness of ovarian cancer and pursue better outcomes and better patient care. Look through her Twitter feed.
08:39 Thank you to Brian Klepper, who is a great writer but also runs what might be the largest Listserv for those on the innovative self-insured employer side of healthcare. What I most admire about Brian is his ability and dedication to fact-based and productive debate. Brian is featured on several RHV episodes this past year. You can check them out here: EP335 and AEE16.
09:09 I\\u2019d also like to thank Dr. Eric Bricker for his series called AHealthcareZ. Dr. Bricker is a guest on an episode coming up that I\\u2019m so looking forward to publishing.
09:45 Thanks to these writers for taking the time and effort to put out such worthwhile content: Brendan Keeler, Kevin O\\u2019Leary, Nikhil Krishnan, Olivia Webb, Joe Connolly, Christian Milaster (Telehealth Tuesday), Gist Healthcare daily/weekly newsletter and podcast, John Marchica\\u2019s newsletter and podcast, and Merrill Goozner.
10:10 If you don\\u2019t already, I\\u2019d also recommend following these individuals on LinkedIn: Darren Fogarty, Leon Wisniewski, and Christin Deacon (listen to Christin\\u2019s episode about the CAA this past fall).
10:26 David Contorno and Emma Fox, thanks so much for all of your work motivating collaboration and inspiring self-insured employers to wield the power they possess in meaningful ways. There\\u2019s a symposium coming up that anyone interested should check out.
10:42 I appreciate and periodically check out Julie Yoo from Andreessen Horowitz\\u2019s collection of resources on a Google doc.
10:55 Thanks to Rohan Siddhanti and Ezequiel Halac for organizing events in NYC.
11:03 People often ask me for podcast recommendations, so here\\u2019s a few I listen to regularly: John Lynn\\u2019s podcasts,\\xa0Creating a New Healthcare with Dr. Zeev Neuwirth, Race to Value with Eric Weaver, Radio Advisory, Gist Healthcare Daily, The #HCBiz Show! with Don Lee, and Primary Care Cures with Ron Barshop (I was on the show released Thanksgiving week). There\\u2019s also the Pharmacy Podcast Network.
11:42 Also thanks to the following publications who have given us press credentials and passes to conferences: STAT News, NODE.Health, HealthIMPACT, and JAMA.
12:03 Lastly, we have a tip jar on our Web site which we don\\u2019t really publicize. I say this to emphasize that those who choose to donate are just simply kind and gracious individuals: Alex Dou, Linda Garcia, James Farley, Arthur Berens, Lois Drapin, James Cheairs, Robert Matthews, Lois Niland, Teresa O\\u2019Keefe, Richard Klasco, Hugh Sims, Matt Warhaftig, Meredith Fried, Chad Jackson, Vidar Jorgensen, and Brandon Weber.
12:38 Thank you ALL for your continued leadership in improving healthcare.
12:42 Christin Deacon has said, \\u201cWhat we need more of in the healthcare industry are leaders who are willing to take on legacy institutions and their lobbyists, in both public and private discourse. We need leaders that are willing to take on an industry that makes up about 20% of our GDP and is willing to go on record stating that the goal is not just to curb growth but, rather, stop it and rebuild this whole thing better for patients.\\u201d

For more information, go to aventriahealth.com.

From all of us at Relentless Health Value, THANK YOU for your listenership and support. Our host, Stacey, shares highlights and resources from this past year on our latest #healthcarepodcast. #healthcare #podcast #digitalhealth

Did you know you can review our #podcast? https://relentlesshealthvalue.com/4-steps-rate-review-podcast-itunes/ Our host, Stacey, shares highlights and resources from this past year on our latest #healthcarepodcast. #healthcare #digitalhealth

In memory of @DrNadiaChaudhri, check out her Twitter feed for info on better #patientoutcomes and care. Our host, Stacey, shares highlights and resources from this past year on our latest #healthcarepodcast. #healthcare #digitalhealth

Check out @DrEricB\\u2019s AHealthcareZ for in-depth industry information. Our host, Stacey, shares highlights and resources from this past year on our latest #healthcarepodcast. #healthcare #digitalhealth

Thanks to @healthbjk, @olearykm, @nikillinit, @OliviaWebbC, @JConnol, @GistHealthcare, @DarwinHealth, @_GoozNews, and @HealthChrism for putting out great content. Our host, Stacey, shares highlights and resources from this past year on our latest #healthcarepodcast. #healthcare #digitalhealth

We appreciate and recommend following @julesyoo for more #healthcareinsights. Our host, Stacey, shares highlights and resources from this past year on our latest #healthcarepodcast. #healthcare #digitalhealth

Thanks to @RSiddhanti and @halac_ezequiel for their event organizing in NYC. Our host, Stacey, shares highlights and resources from this past year on our latest #healthcarepodcast. #healthcare #digitalhealth

We love #podcasts! Check out some of Stacey\\u2019s recs in our show notes, including @techguy, @ZeevNeuwirth, @Eric_S_Weaver, @raemwoods, @Alexolgin, @The_HCBiz, @RonBarshop, and @PharmacyPodcast. #healthcare #healthcarepodcast

Thanks to the following #healthcarepublications as well: @statnews, @HITHealthIMPACT, @JAMA_current, and @nodehealthorg.

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen

\\xa0

Listed in: Health

INBW32: The Ultimate Impact of Telehealth: A Thought Experiment

Each week on Relentless Health Value, Stacey uses her voice and thought leadership to provide insights for healthcare industry decision makers trying to do the right thing. Each show features expert guests who break down the twists and tricks in the medical field to help improve outcomes and lower costs across the care continuum. Relentless Health Value is a top 100 podcast on iTunes in the medicine category and reaches tens of thousands of engaged listeners across the healthcare industry.

In addition to hosting Relentless Health Value, Stacey is co-president of QC-Health, a benefit corporation finding cost-effective ways to improve the health of Americans. She is also co-president of Aventria Health Group, a consultancy working with clients who endeavor to form collaborations with payers, providers, Pharma, employer organizations, or patient advocacy groups.

02:30 Should provider organizations be getting rid of telehealth?
02:40 EP330 with John Marchica.
04:36 EP349 with Lisa Trumble.
05:07 Should telehealth be viewed as a threat?
05:40 \\u201cVirtual is a \\u2018head in the bed at the hospital\\u2019 demand destroyer.\\u201d
06:45 \\u201c\\u2018Virtual\\u2019 is the scapegoat.\\u201d
07:42 Patients/Consumers: Is in person really better?
10:42 EP338 with Nikki King; EP347 with Ian Tong, MD; EP320 with Christian Milaster; and EP302 with Blake McKinney, MD.
11:06 How one VP of finance justifies a facility fee for a telehealth visit.
11:54 Do patients actually act like consumers in the digital age?
12:12 Why are virtual-first entities steering patients to clinically integrated networks?
13:08 How is telehealth changing healthcare costs?
14:21 \\u201cIt adds up to telehealth being inexorable. It\\u2019s a done deal. It\\u2019s not a trend.\\u201d
15:17 \\u201cIf telehealth is a leading indicator, anybody in the care delivery business who isn\\u2019t \\u2026 trying to figure out how to make telehealth work in their core business is gonna find themselves \\u2026 in a very problematic position.\\u201d
16:50 \\u201cWhen will tele-whatever become an existential problem for laggard traditional provider organizations?\\u201d

For more information, go to aventriahealth.com.

Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Should provider organizations be getting rid of telehealth? Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Should telehealth be viewed as a threat? Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cVirtual is a \\u2018head in the bed at the hospital\\u2019 demand destroyer.\\u201d Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201c\\u2018Virtual\\u2019 is the scapegoat.\\u201d Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Patients/Consumers: Is in person really better? Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Do patients actually act like consumers in the digital age? Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why are virtual-first entities steering patients to clinically integrated networks? Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How is telehealth changing healthcare costs? Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIt adds up to telehealth being inexorable. It\\u2019s a done deal. It\\u2019s not a trend.\\u201d Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIf telehealth is a leading indicator, anybody in the care delivery business who isn\\u2019t \\u2026 trying to figure out how to make telehealth work in their core business is gonna find themselves \\u2026 in a very problematic position.\\u201d Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWhen will tele-whatever become an existential problem for laggard traditional provider organizations?\\u201d Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye

\\xa0

Listed in: Health

Encore! EP294: Building a Center of Excellence: A Playbook for Physician Entrepreneurs, With Steve Schutzer, MD

Steven F. Schutzer, MD, graduated with honors from Union College and the University of Virginia School of Medicine. Following a surgical internship at the University of Rochester, he served as lieutenant in the Medical Corps of the United States Navy. After his tour of duty, Dr. Schutzer did his general surgical training at the University of Rochester and then completed his orthopedic residency at the University of Connecticut. He was then a fellow in adult hip and reconstructive surgery at the Massachusetts General Hospital, after which he entered practice in Hartford, Connecticut.

Dr. Schutzer is a founding member and medical director of the Connecticut Joint Replacement Institute (CJRI), a Center of Excellence at Saint Francis Hospital in Hartford, where he served as medical director between 2007 and 2021. He is currently the physician executive for the orthopedic service line at Trinity Health of New England. He is on the staff of Saint Francis Hospital and a member of Advanced Orthopedics New England.

In 2014, Dr. Schutzer and two colleagues, Ms. Steph Kelly and Ms. Maureen Geary, launched a consulting company, Novel Healthcare Solutions, whose mission is to establish effective and trusting business relationships between physicians and hospital partners\\u2014and then create orthopedic Centers of Excellence.

Dr. Schutzer is also vice president and co-founder of Upswing Health, a health technology start-up whose charge is to help 10 million lives alleviate suffering from musculoskeletal pain by the end of 2023.

04:52 Why would competitive physician groups gang together?
09:02 \\u201cEven if you never \\u2026 bundle, going through the implementation process \\u2026 will yield incredible unrecognized value.\\u201d
10:19 \\u201cIt demands an end-to-end care redesign process.\\u201d
11:40 \\u201cThe value of a COE is really unquestionable.\\u201d
11:48 \\u201cFor every dollar saved [in a COE], two-thirds was in the quality side, and one-third was in the price point.\\u201d
14:38 Slide deck discussing the definition of a COE and its seven building blocks.
15:06 \\u201cI\\u2019m talking about business relationships between the physicians \\u2026 these are the most fundamental [relationships].\\u201d
16:24 \\u201cIt is all about trust.\\u201d
16:49 What is the most central issue as to why a COE does well or fails?
17:26 \\u201cIt\\u2019s not just data. It has to be actionable data because physicians naturally don\\u2019t trust data.\\u201d
22:55 \\u201cEmployers are definitely taking note to patient-reported outcomes.\\u201d
23:38 What is the seventh element that is necessary for a COE, and what is fundamental to that element?
24:28 Where will fee-for-service doctors be in 2 to 3 years?
25:46 \\u201cThe only way that we can accrue the value that we deserve is through these types of relationships.\\u201d
26:12 \\u201cThe supreme motivator is opportunity.\\u201d
28:03 How do physicians and providers begin a transformation of the marketplace they\\u2019re in?
28:38 \\u201cWhat they need from us is product. They need products to disrupt the status quo.\\u201d
31:27 \\u201cThe problem is that there are vendors who are working at the margin.\\u201d

You can contact Dr. Schutzer at steve.schutzer@gmail.com and learn more at the Novel Healthcare Solutions website.\\xa0\\xa0

@SSchutzer of @THOfNewEngland discusses #centersofexcellence on this week\\u2019s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

Why would competitive physician groups gang together? @SSchutzer of @THOfNewEngland discusses #centersofexcellence on this week\\u2019s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

\\u201cIt demands an end-to-end care redesign process.\\u201d @SSchutzer of @THOfNewEngland discusses #centersofexcellence on this week\\u2019s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

\\u201cThe value of a COE is really unquestionable.\\u201d @SSchutzer of @THOfNewEngland discusses #centersofexcellence on this week\\u2019s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

\\u201cIt\\u2019s not just data. It has to be actionable data because physicians naturally don\\u2019t trust data.\\u201d @SSchutzer of @THOfNewEngland discusses #centersofexcellence on this week\\u2019s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

\\u201cEmployers are definitely taking note to patient-reported outcomes.\\u201d @SSchutzer of @THOfNewEngland discusses #centersofexcellence on this week\\u2019s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

Where will fee-for-service doctors be in 2 to 3 years? @SSchutzer of @THOfNewEngland discusses #centersofexcellence on this week\\u2019s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

How do physicians and providers begin a transformation of the marketplace they\\u2019re in? @SSchutzer of @THOfNewEngland discusses #centersofexcellence on this week\\u2019s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried

Listed in: Health

EP349: How Integrated Is a Clinically Integrated Network, Actually? With Lisa Trumble

Lisa M. Trumble, MBA, president and CEO of SoNE HEALTH, has had a career showcased by successes in generating strong clinical and financial operating results for healthcare organizations. She has 30+ years\\u2019 experience at integrated delivery systems and physician organizations. Prior to joining SoNE HEALTH, Lisa served as senior vice president of accountable care at Cambridge Health Alliance (CHA); the scope of her responsibility included systemwide duties for accountable care and population health management, incorporating payer contracting, financial medical economics, regulatory compliance, and administrative and clinical programming. Under her leadership, the organization realized significant improvements in clinical and financial outcomes.

Lisa joined CHA from Berkshire Health Systems, where she served as vice president of physician services and executive director of the Berkshire Health Systems Physicians Organization. She was instrumental in transforming physician operation, restructuring provider employment agreements and provider compensation plans, and enhancing patient satisfaction. Prior to Berkshire Health Systems, she served as the vice president of finance and operations at the Cambridge Health Alliance Physician Organization, where she achieved similar outcomes.

Previously, Lisa was administrative director for anesthesia and surgery services lines at North Shore Medical Center and chief financial officer of North Shore\\u2019s Physicians Organization, a subsidiary of North Shore Medical Center. Additionally, she held positions in operations and finance at Commonwealth Health Management Service and Independent Physicians Association. Lisa holds a bachelor\\u2019s degree in business administration from North Adams State College and a master\\u2019s degree in business administration and healthcare finance from Western New England University.

06:20 Why do accountability and integration go hand in hand?
08:56 \\u201cAggregation just for the point of aggregation doesn\\u2019t necessarily produce better outcomes.\\u201d
09:18 What questions should we be asking when considering aggregation?
09:45 Does aggregation equal integration?
11:42 What exactly is a clinically integrated network?
12:26 What is the intention of a clinically integrated network?
13:22 Are all CINs ACOs? Are all ACOs CINs?
17:22 What entities make up a clinically integrated network?
19:26 \\u201cWe want providers that are able to generate the outcomes that we\\u2019re expecting.\\u201d
20:44 \\u201cThere is a lot of work that goes into data integration.\\u201d
23:14 What is a hybrid CIN model?
25:22 Encore! EP206\\xa0with Ashok Subramanian.
26:53 \\u201cEveryone is sitting around the table proactively.\\u201d\\u2014Stacey
29:37 What kind of structure could move the Medicare market quickly?

You can learn more at sonehealthcare.com.\\xa0\\xa0

Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

Why do accountability and integration go hand in hand? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

\\u201cAggregation just for the point of aggregation doesn\\u2019t necessarily produce better outcomes.\\u201d Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

What questions should we be asking when considering aggregation? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

Does aggregation equal integration? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

What exactly is a clinically integrated network? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

What is the intention of a clinically integrated network? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

Are all CINs ACOs? Are all ACOs CINs? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

What entities make up a clinically integrated network? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

\\u201cWe want providers that are able to generate the outcomes that we\\u2019re expecting.\\u201d Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

\\u201cThere is a lot of work that goes into data integration.\\u201d Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

What is a hybrid CIN model? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

\\u201cEveryone is sitting around the table proactively.\\u201d Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

What kind of structure could move the Medicare market quickly? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera

Listed in: Health

EP348: Your Burning Questions About Payviders Answered! With Jeb Dunkelberger

Jeb Dunkelberger, MSc, MHCI, currently serves as CEO of Sutter Health | Aetna (SH|A), a commercial insurance plan serving Northern California. The health plan aims to combine the value of retail, provider, and payer via its partnerships with CVS, Sutter Health, and Aetna. Prior to SH|A, Jeb led growth for two bay-area healthcare start-ups: Cricket Health and Notable Health. Jeb has also held executive roles at Highmark, McKesson, and EY. Jeb holds healthcare-related degrees from Virginia Tech, The London School of Economics, Cornell University, and University of Pennsylvania.

03:58 What all does Sutter Health | Aetna entail?
04:31 What does it mean to be a \\u201cperformance network\\u201d?
04:48 What does it mean to be a payvider?
06:35 How common are payviders?
07:31 \\u201cWe are writing direct risk.\\u201d
09:21 How does the fully insured product work?
12:30 \\u201cYou want to hold their feet to the fire, from a value-based perspective.\\u201d
12:42 What\\u2019s the incentive for providers to partner with payers?
15:25 \\u201cIt\\u2019s just math. It\\u2019s the amount of lives times the amount of utilization multiplied by your unit costs.\\u201d
20:58 \\u201cYou have to have a day of reckoning, and that only comes from financial incentives creating that gateway out.\\u201d
24:55 How do we think about reform and taking money out of the healthcare system?
26:58 \\u201cWe also have to talk about repurposing the workforce.\\u201d
27:27 \\u201cWe need to upskill our workforce.\\u201d
30:14 \\u201cCan a health system survive as the largest employer, year over year, if they give unit cost concessions, year over year? \\u2026 The answer is no.\\u201d

You can learn more at sutterhealthaetna.com.\\xa0\\xa0

You can also connect with Jeb on LinkedIn and follow him on Twitter.\\xa0\\xa0

@Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What all does Sutter Health | Aetna entail? @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What does it mean to be a \\u201cperformance network\\u201d? @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What does it mean to be a payvider? @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How common are payviders? @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWe are writing direct risk.\\u201d @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How does the fully insured product work? @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cYou want to hold their feet to the fire, from a value-based perspective.\\u201d @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What\\u2019s the incentive for providers to partner with payers? @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIt\\u2019s just math. It\\u2019s the amount of lives times the amount of utilization multiplied by your unit costs.\\u201d @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cYou have to have a day of reckoning, and that only comes from financial incentives creating that gateway out.\\u201d @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWe also have to talk about repurposing the workforce.\\u201d @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWe need to upskill our workforce.\\u201d @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cCan a health system survive as the largest employer, year over year, if they give unit cost concessions, year over year? \\u2026 The answer is no.\\u201d @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham

Listed in: Health

EP347: Rolling Out Healthcare Initiatives That Actually Get Uptake With the Populations You Aim to Serve, With Ian Tong, MD, About the Black Community Innovation Coalition

Ian Tong, MD, is chief medical officer at Included Health (formerly Doctor On Demand and Grand Rounds Health). In this role, Ian leads all clinical care delivery, including clinical products and service lines, clinical quality, and practice performance of the clinical staff.

Prior to Doctor On Demand, Ian held leadership roles including chief resident of Stanford Internal Medicine and co-medical director of the Arbor Free Clinic. He also founded and was medical director of The Health Resource Initiative for Veterans Everywhere (THRIVE), honored with the Award for Outstanding Achievement in Service to Homeless Veterans in 2008 by the US Secretary of Veterans Affairs.

A national collegiate champion in rugby at the University of California at Berkeley, Ian was named to the All-American Team in 1994. He graduated from Berkeley with a bachelor\\u2019s degree in English, then earned his medical degree from The University of Chicago Pritzker School of Medicine. He completed residency and chief residency at Stanford Hospital and Clinics and is currently a clinical assistant professor (affiliated) at Stanford University Medical School. He is board certified in internal medicine.

Ian has dedicated his career to improving equity in, and access to, high-quality care. He lives in the San Francisco Bay area.

04:33 What is the Black Community Innovation Coalition?
05:06 Who are the partners behind the Black Community Innovation Coalition?
06:23 How is the Black Community Innovation Coalition focusing on patients?
08:05 \\u201cIf you take a one-size-fits-all approach to your employees, that is not going to be adequate or complete.\\u201d
08:56 How the Black Community Innovation Coalition is incorporating engagement into its core foundation.
13:18 \\u201cThere\\u2019s a great deal of hesitancy around engaging care, and there\\u2019s a high level of avoidance.\\u201d
15:26 EP338 with Nikki King, DHA.
16:34 \\u201cThe technology is not making that experience worse. It\\u2019s a bad experience, and it\\u2019s broken already.\\u201d
23:27 \\u201cI feel very strongly that everyone should probably have a virtual primary care clinician.\\u201d
27:20 EP295 with Rebecca Etz, PhD.
28:15 \\u201cWe really want to pay attention to that encounter being the best encounter possible because that \\u2026 might be the only chance you get to engage that patient.\\u201d
29:00 Why is virtual care important for self-insured employers?
32:08 \\u201cWe cannot afford to have low-value encounters.\\u201d

You can learn more by checking out the Implicit Bias Test, the CDC REACH site, and includedhealth.com.\\xa0

@Driantong discusses the Black Community Innovation Coalition on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth

What is the Black Community Innovation Coalition? @Driantong discusses community health initiatives on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth

Who are the partners behind the Black Community Innovation Coalition? @Driantong discusses community health initiatives on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth

How is the Black Community Innovation Coalition focusing on patients? @Driantong discusses on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth

\\u201cIf you take a one-size-fits-all approach to your employees, that is not going to be adequate or complete.\\u201d @Driantong discusses the Black Community Innovation Coalition on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth

\\u201cThe technology is not making that experience worse. It\\u2019s a bad experience, and it\\u2019s broken already.\\u201d @Driantong discusses the Black Community Innovation Coalition on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth

\\u201cI feel very strongly that everyone should probably have a virtual primary care clinician.\\u201d @Driantong discusses the Black Community Innovation Coalition on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth

\\u201cWe really want to pay attention to that encounter being the best encounter possible because that \\u2026 might be the only chance you get to engage that patient.\\u201d @Driantong discusses the Black Community Innovation Coalition on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth

Why is virtual care important for self-insured employers? @Driantong discusses the Black Community Innovation Coalition on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth

\\u201cWe cannot afford to have low-value encounters.\\u201d @Driantong discusses the Black Community Innovation Coalition on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy

Listed in: Health

Encore! EP288: The Big Three PBMs Spinning Up GPOsWhat? With Mike Schneider

Mike Schneider is an experienced healthcare executive with over 20 years of experience in the pharmaceutical manufacturer, pharmacy benefit manager, and payer side of healthcare. He previously spent 9 years at CVS Caremark, where he was a director of industry relations with responsibility for trade strategy development, rebate negotiations, and contract execution for CVS Caremark\\u2019s own Medicare Part D plans and that of its clients. He held a similar position at Universal American (UA) before it was acquired by CVS Health, where he also negotiated UA\\u2019s commercial business. Mike has held various sales and market access roles with pharmaceutical manufacturers with increasing responsibility. Before entering healthcare, Mike began his career as a researcher at the Procter & Gamble Company in Cincinnati, where he worked on hair care product formulation development focusing on the key markets of China and Japan, and then moved on to work in drug development. Mike holds a BS degree from the University of Illinois and an MBA from the University of Akron.

02:48 What does a GPO add to a PBM?
05:23 Rebates vs driving more revenue.
10:39 PBMs vs safe harbors.
12:25 The net impact on the commercial side.
14:07 PBMs vs pharmaceutical manufacturers.
14:54 How the \\u201cBig Three\\u201d PBMs compete with each other, and how employers would choose between them.
15:56 What the net-net is here.
18:06 How PBMs are shifting their models.
20:42 How GPOs may be making things even less transparent.
21:31 \\u201cThe PBM world as a whole is not very transparent.\\u201d
25:00 \\u201cOne of the biggest beneficiaries of this whole rebate [system] is the government.\\u201d
25:46 \\u201cThe question is, \\u2018Who\\u2019s paying those costs?\\u2019\\u201d
26:02 EP216 with Chris Sloan.
27:00 A better way to move money from Pharma to employers and plan sponsors.
28:04 \\u201cPut your money where your mouth is.\\u201d

You can learn more by connecting with Mike on LinkedIn.\\xa0

Check out our newest #healthcarepodcast with Mike Schneider as he discusses #PBMs and #GPOs. #healthcare #podcast #digitalhealth #healthcarefinance #pharma

What does a GPO add to a PBM? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma

Rebates vs driving more revenue. Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma

PBMs vs safe harbors. Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma

What is the net impact on the commercial side? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma

PBMs vs pharmaceutical manufacturers. Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma

How do the \\u201cBig Three\\u201d PBMs compete with each other? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma

How do #employers choose between the \\u201cBig Three\\u201d PBMs? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma

What\\u2019s the net-net here? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma

How are PBMs shifting their revenue models? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma

How are GPOs making things even less transparent? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma

\\u201cThe PBM world as a whole is not very transparent.\\u201d Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma

\\u201cOne of the biggest beneficiaries of this whole rebate [system] is the government.\\u201d Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma

\\u201cThe question is, \\u2018Who\\u2019s paying those costs?\\u2019\\u201d Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma

A better way to move money from Pharma to employers and plan sponsors. Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma

\\u201cPut your money where your mouth is.\\u201d Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis

Listed in: Health

EP346: How Did Health Systems Get Addicted to the Inflated Prices They Charge Employers and Some Patients? 2021 Update, With Peter Hayes, President and CEO of the Healthcare Purchaser Alliance of Maine

Peter Hayes is president and CEO of the Healthcare Purchaser Alliance of Maine and formerly a principal of Healthcare Solutions and director of associate health and wellness at Hannaford Supermarkets. He has been in innovative, strategic benefit design for the past 20+ years. During the past several years, Hannaford has received numerous national awards in recognition of the company\\u2019s commitment to working collaboratively with healthcare providers and vendors in delivering health benefits that are focused on value (high-quality efficient care). Hannaford Supermarkets has been successful in this arena by focusing on innovative solutions for patient advocacy, chronic disease management, and health promotion programs. Hannaford was recognized by receiving the National Business Group on Health Platinum Award for the health promotion and wellness programs three years in a row. These programs, along with healthcare delivery strategies, contributed to a flat trend line over five years.

Peter has also been involved in healthcare reform leadership roles on both the national and regional levels with organizations like the Center for Health Innovation, Care Focused Purchasing, and Leapfrog. He\\u2019s also cofounder of the Maine Health Management Coalition (now Healthcare Purchaser Alliance of Maine) and has been appointed by two different Maine Governors to serve on Health Care Reform Commissions to recommend public policies to improve the access and affordability of healthcare for Maine citizens.

07:51 Who are the commercial payers?
08:48 Are hospitals actually losing money on Medicare and Medicaid?
11:26 Is cost inversely connected to quality when it comes to hospital care?
13:46 \\u201cA lot of hospitals don\\u2019t do cost accounting.\\u201d
13:59 If hospitals don\\u2019t know their costs, how does Medicare know their costs?
15:52 \\u201cIn the hospital financial world \\u2026 they start the budget upside down.\\u201d
18:48 \\u201cThere\\u2019s plenty of accountability to spread around for where we are.\\u201d
20:30 Do employers have any options in the current health system situation?
21:39 \\u201cIf this market\\u2019s going to change, purchasers have to step up and start demanding more accountability, more transparency.\\u201d
26:21 How is the new transparency legislation impacting plan sponsors and employers?
29:41 EP342 with Christin Deacon.
32:38 \\u201cI think the whole dialogue around how we pay for hospital services is going to really change.\\u201d
32:45 What is Peter\\u2019s advice to employers?

You can learn more at purchaseralliance.org. \\xa0

@pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Who are the commercial payers? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Are hospitals actually losing money on Medicare and Medicaid? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Is cost inversely connected to quality when it comes to hospital care? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cA lot of hospitals don\\u2019t do cost accounting.\\u201d @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

If hospitals don\\u2019t know their costs, how does Medicare know their costs? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIn the hospital financial world \\u2026 they start the budget upside down.\\u201d @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThere\\u2019s plenty of accountability to spread around for where we are.\\u201d @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Do employers have any options in the current health system situation? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIf this market\\u2019s going to change, purchasers have to step up and start demanding more accountability, more transparency.\\u201d @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How is the new transparency legislation impacting plan sponsors and employers? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cI think the whole dialogue around how we pay for hospital services is going to really change.\\u201d @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim

Listed in: Health

EP345: Can Pharma Imagine How Our Health System Will Look in the Future? With Paul Simms

Paul Simms is known as the \\u201cpharma provocateur\\u201d for his efforts to realize the unfulfilled potential of the life sciences industry. His journey started in 2003 with eyeforpharma, an organization which he quickly grew into the pharmaceutical industry\\u2019s most influential and largest event organizer, acquired by Reuters in 2019. He has since set up a think tank and consultancy called Impatient Health. Paul counts the industry\\u2019s CEOs and innovators amongst his friends and is a regular speaker, host, author, and commentator.

\\xa0

05:04 \\u201cWe\\u2019re at that catalyst point where we could go one way or the other.\\u201d
05:39 How can the analogy of Web 1.0 vs Web 2.0 be applied to the future of healthcare business models?
07:06 \\u201cPeople need to improve their awareness at the very least as to a new generation of companies coming forward.\\u201d
08:31 \\u201cWhat now is the new business model that can exist in that world?\\u201d
09:07 Is there a stage pre-agility that will allow pharma companies to pivot to future markets?
12:08 What are the new ways to think about things in the future of healthcare business?
14:09 \\u201cThe mind boggles at what is possible but is not yet being achieved.\\u201d
16:11 Why could prices falling actually spark more innovation?
16:49 EP300 with Bruce Rector, MD.
21:36 \\u201cIt\\u2019s these companies that have this data-driven consumer relationship that I think are very interesting.\\u201d
25:16 \\u201cI just think that it\\u2019s a mindset change first.\\u201d
25:38 \\u201cI\\u2019m not here to be right or wrong. I\\u2019m just here to enable the conversation.\\u201d
25:56 \\u201cWhat I find is that companies make significant efforts and that they don\\u2019t quite gain the same traction as quickly as they might like to.\\u201d
26:20 \\u201cIt seems to be this great impatience that companies can turn around these non-medicine initiatives more quickly.\\u201d
29:42 \\u201cIt seems to me that the pharmaceutical industry\\u2019s reaction to the pandemic has been, \\u2018We need to double down.\\u2019\\u201d

You can learn more by connecting with Paul on LinkedIn.

@xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth

\\u201cWe\\u2019re at that catalyst point where we could go one way or the other.\\u201d @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth

\\u201cPeople need to improve their awareness at the very least as to a new generation of companies coming forward.\\u201d @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth

\\u201cWhat now is the new business model that can exist in that world?\\u201d @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth

Is there a stage pre-agility that will allow pharma companies to pivot to future markets? @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth

What are the new ways to think about things in the future of healthcare business? @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth

\\u201cThe mind boggles at what is possible but is not yet being achieved.\\u201d @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth

Why could prices falling actually spark more innovation? @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth

\\u201cIt\\u2019s these companies that have this data-driven consumer relationship that I think are very interesting.\\u201d @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth

\\u201cI just think that it\\u2019s a mindset change first.\\u201d @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth

\\u201cI\\u2019m not here to be right or wrong. I\\u2019m just here to enable the conversation.\\u201d @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth

\\u201cWhat I find is that companies make significant efforts and that they don\\u2019t quite gain the same traction as quickly as they might like to.\\u201d @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth

\\u201cIt seems to be this great impatience that companies can turn around these non-medicine initiatives more quickly.\\u201d @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth

\\u201cIt seems to me that the pharmaceutical industry\\u2019s reaction to the pandemic has been, \\u2018We need to double down.\\u2019\\u201d @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson

Listed in: Health

EP344: The High Cost of Generic Drugs, With Steven Quimby, MD

Steven Quimby, MD, is a physician who has worked in academic medicine at the Mayo Clinic and in private practice. He has been involved in drug treatment studies, including major pharmaceutical trials, and maintained an active interest in the interface of corporate business, pharmacy, and medicine for over 50 years.

Dr. Quimby is concerned escalating prices for generic drugs, which fill 90% of our prescriptions, threaten access to needed medications and patients going without treatment risk worsening of their medical conditions and further costs. Too often controversies over high new drug prices and the funding of new drug development and innovation obscure addressable problems in the generic drug supply and financing chain.

05:54 What are the current lawsuits involved in the generic drug space right now?
06:52 How is price fixing happening in the generic drug space?
07:58 \\u201cIf I was the major payer for drugs \\u2026 I\\u2019d want to know answers.\\u201d
08:06 What\\u2019s the scale on new and generic drugs?
09:02 What\\u2019s the problem with using price tools for generic drugs?
10:22 \\u201cI think right now, virtually everyone should be checking [those sites vs] their insurance price.\\u201d
10:47 Are payers paying too much for generic drugs?
11:53 Who are these generic manufacturers?
12:10 \\u201cThey\\u2019re distinctly different corporations than those that we have called Big Pharma.\\u201d
13:55 Why is it important to have adequate numbers of manufacturers for generic drugs?
17:03 \\u201cWe just can\\u2019t get legitimate acquisition and then sale prices of the actual drugs.\\u201d
17:17 \\u201cThe industry\\u2019s opaque to all of these things.\\u201d
19:39 \\u201cThe prices that patients are getting at the prescription counter are so high that some studies say a third of them or more are walking away without buying the drug.\\u201d
20:02 AEE13 with Ge Bai, PhD, CPA, on the GoodRx model.
20:50 EP241 with Vinay Patel.
22:05 What and who should be on formulary?
26:24 \\u201cIf they\\u2019d give us the numbers, we could see when it happens.\\u201d
28:58 How can we overcome the challenges of these high generic drug costs?
30:38 EP284 with Carm Huntress.
30:46 EP334 with Sunita Desai, PhD. \\xa0
31:26 \\u201cHow can we judge value when we don\\u2019t know price?\\u201d

You can learn more by reading Dr. Quimby\\u2019s book Billions in Your Generic Drugs. \\xa0

You can also reach Dr. Quimby on Twitter and LinkedIn.\\xa0

@QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing

How is price fixing happening in the generic drug space? @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing

\\u201cIf I was the major payer for drugs \\u2026 I\\u2019d want to know answers.\\u201d @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing

What\\u2019s the problem with using price tools for generic drugs? @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing

Are payers paying too much for generic drugs? @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing

\\u201cThey\\u2019re distinctly different corporations than those that we have called Big Pharma.\\u201d @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing

Why is it important to have adequate numbers of manufacturers for generic drugs? @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing

\\u201cWe just can\\u2019t get legitimate acquisition and then sale prices of the actual drugs.\\u201d @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing

\\u201cThe industry\\u2019s opaque to all of these things.\\u201d @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing

\\u201cThe prices that patients are getting at the prescription counter are so high that some studies say a third of them or more are walking away without buying the drug.\\u201d @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing

\\u201cIf they\\u2019d give us the numbers, we could see when it happens.\\u201d @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing

\\u201cHow can we judge value when we don\\u2019t know price?\\u201d @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco

Listed in: Health

EP343: What Provider Leadership Teams Need to Know to Operationalize Value-Based Care, With David Carmouche, MD

David Carmouche, MD, views healthcare from three distinct perspectives: as a physician provider, an executive for an insurance company, and as a leader in a health system. Specifically, he built a large, multidisciplinary internal medicine and preventive cardiology practice in Louisiana; served as the chief medical officer for Blue Cross Blue Shield of Louisiana; and has a triad of responsibilities with Ochsner Health, the largest nonprofit academic healthcare system in the Gulf South. He was promoted to serve as executive vice president of value-based care and network operations in addition to his duties as president of the Ochsner Health Network and executive director of the Ochsner Accountable Care Network.

He is known as an expert in value-based care. He led one of the top 15 performing accountable care organizations in the United States, managing billions in care spend and generating millions in year-over-year shared savings.

Dr. Carmouche earned a bachelor\\u2019s degree from Tulane University and a medical degree from Louisiana State University School of Medicine in New Orleans. He completed his residency in internal medicine at the University of Alabama at Birmingham.

06:31 How do you operationally deal with conflicting FFS and VBC processes?
07:23 \\u201cIt\\u2019s pretty clear in Medicare that our strategy in the future \\u2026 is one of value.\\u201d
11:31 \\u201cI think a bigger challenge, though, is that in many markets, there are just no opportunities to have experienced value-based care.\\u201d
13:18 \\u201cHow do we engage in collaborative relationships that would allow us to move into value?\\u201d
14:01 \\u201cNo one wants to rush through their day in a series of seven-minute visits.\\u201d
15:53 \\u201cIn a fee-for-service environment \\u2026 you\\u2019re forced to bring people into the office to create an encounter who don\\u2019t necessarily need to be there.\\u201d
19:22 \\u201cWe haven\\u2019t really changed how we select and train physicians \\u2026 in the last hundred years.\\u201d
20:32 \\u201cWe, as physicians, were taught to be accountable for outcomes; and we create probably an unnecessary and unfair burden on ourselves.\\u201d
21:30 \\u201cIn the value-based care world, a physician does have to recast themselves as part of a team.\\u201d
22:30 \\u201cIt is an enormous cultural shift \\u2026 but ultimately, it\\u2019s one that the facts \\u2026 mandate.\\u201d
26:58 \\u201cYou have to have a compelling vision and belief that value-based care offers benefits to all of the actors in the healthcare ecosystem.\\u201d
27:24 \\u201cYou have to be able to communicate effectively across sectors.\\u201d
27:43 \\u201cYou have to have courage.\\u201d
28:29 What are the leadership skills required to make value-based care work?

You can learn more by visiting Dr. Carmouche\\u2019s LinkedIn page or by reading From Competition to Collaboration by Tracy Duberman and Robert Sachs.\\xa0

@CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare

How do you operationally deal with conflicting FFS and VBC processes? @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare

\\u201cIt\\u2019s pretty clear in Medicare that our strategy in the future \\u2026 is one of value.\\u201d @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare

\\u201cI think a bigger challenge, though, is that in many markets, there are just no opportunities to have experienced value-based care.\\u201d @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare

\\u201cHow do we engage in collaborative relationships that would allow us to move into value?\\u201d @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare

\\u201cNo one wants to rush through their day in a series of seven-minute visits.\\u201d @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare

\\u201cIn a fee-for-service environment \\u2026 you\\u2019re forced to bring people into the office to create an encounter who don\\u2019t necessarily need to be there.\\u201d @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare

\\u201cWe haven\\u2019t really changed how we select and train physicians \\u2026 in the last hundred years.\\u201d @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare

\\u201cWe, as physicians, were taught to be accountable for outcomes; and we create probably an unnecessary and unfair burden on ourselves.\\u201d @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare

\\u201cIn the value-based care world, a physician does have to recast themselves as part of a team.\\u201d @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare

\\u201cIt is an enormous cultural shift \\u2026 but ultimately, it\\u2019s one that the facts \\u2026 mandate.\\u201d @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare

\\u201cYou have to have a compelling vision and belief that value-based care offers benefits to all of the actors in the healthcare ecosystem.\\u201d @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare

\\u201cYou have to be able to communicate effectively across all platforms.\\u201d @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare

What are the leadership skills required to make value-based care work? @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15)

Listed in: Health

EP342: How the Consolidated Appropriations Act (CAA) and ERISA Fiduciary Requirements Are an Anchor for Self-insured Employers to Navigate the Complexity of Healthcare, With Christin Deacon

Christin Deacon is a healthcare thought leader who brings with her a wealth of experience in both public and private sector. Driven by her passion to change the healthcare system to truly benefit patients and payers, she focuses on bringing solutions and agency to self-funded and government-sponsored health plans.

\\xa0

\\xa0

04:10 What is ERISA, and what does it stand for?
05:40 What is a fiduciary obligation for an employer?
08:18 \\u201cWe\\u2019re now at a point of spending 17.7% of our GDP on healthcare costs.\\u201d
09:39 \\u201cYou absolutely have the keys to \\u2026 controlling that spend.\\u201d
13:35 \\u201cYou have to own your data.\\u201d
15:04 \\u201cIf you don\\u2019t have your claims data, how do you know you\\u2019re paying reasonable fees?\\u201d
15:31 \\u201cIf your carrier is telling you, \\u2018Oh, HIPAA \\u2026 you can\\u2019t look at your data,\\u2019 you need to pull out that red BS card.\\u201d
16:25 How do employers navigate carriers refusing to share claims data?
21:36 \\u201cIt has only as much teeth as the self-funded employer is \\u2026 willing to learn about it and \\u2026 willing to push back.\\u201d
22:22 \\u201cThis is not aspirational; this is an absolute floor.\\u201d
24:11 \\u201cWhat does value mean?\\u201d
27:41 \\u201cBecome familiar with HIPAA beyond just the privacy piece.\\u201d
29:30 \\u201cAt the end of the day, it\\u2019s about people.\\u201d
29:38 \\u201cIf you\\u2019re not paying reasonable fees, you\\u2019re using plan assets to enrich others.\\u201d
32:21 \\u201cThe self-insured market \\u2026 they hold the keys to unlocking value. And they\\u2019re holding them; they just have to use them.\\u201d
34:10 Marshall Allen\\u2019s new book.

You can learn more by emailing Christin at cdeacon@4chealthsolutions.com. You can also connect with her on LinkedIn.

@deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What is ERISA, and what does it stand for? @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What is a fiduciary obligation for an employer? @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWe\\u2019re now at a point of spending 17.7% of our GDP on healthcare costs.\\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cYou absolutely have the keys to \\u2026 controlling that spend.\\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cYou have to own your data.\\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIf you don\\u2019t have your claims data, how do you know you\\u2019re paying reasonable fees?\\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIf your carrier is telling you, \\u2018Oh, HIPAA \\u2026 you can\\u2019t look at your data,\\u2019 you need to pull out that red BS card.\\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How do employers navigate carriers refusing to share claims data? @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIt has only as much teeth as the self-funded employer is \\u2026 willing to learn about it and \\u2026 willing to push back.\\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThis is not aspirational; this is an absolute floor.\\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWhat does value mean?\\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cBecome familiar with HIPAA beyond just the privacy piece.\\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cAt the end of the day, it\\u2019s about people.\\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIf you\\u2019re not paying reasonable fees, you\\u2019re using plan assets to enrich others.\\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThe self-insured market \\u2026 they hold the keys to unlocking value. And they\\u2019re holding them; they just have to use them.\\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster

Listed in: Health

EP341: How to Cut Administrative Waste AND Attract and Retain Doctors and Nurses, With Gary Campbell

Gary Campbell is the founder and owner of Impact2Lead, LLC, and the CEO of Johnson Health Center (JHC), where he has enjoyed a career centered on leading for-profit/not-for-profit organizations and helping to unleash potential in others along the way.

In 2011, he left Bayer and came to JHC; and in 2013, he launched Impact2Lead to provide transformation-consulting services to other firms across the United States.

Since joining JHC, the center has enjoyed unprecedented success and growth by transforming the culture using his Impact Leadership model and becoming the first Federally Qualified Health Center to be recognized as an Employer of Choice by Employer of Choice International, Inc. The health center has achieved multiple workplace and community awards since that time and has enjoyed exponential growth during his seven years as the CEO.

Gary currently speaks and consults nationally on leadership, workplace strategies, and motivational topics.

05:15 Why is there no opportunity to cost shift in an FQHC?
05:46 What happens when an FQHC is operating inefficiently?
06:12 \\u201cHave you workflowed it out? \\u2026 You can overstaff yourself in a way that your cost per patient goes way up.\\u201d
06:37 Why is taking a lean approach not an excuse to cut staff?
08:05 \\u201cThe nurses are linchpins to everything.\\u201d
09:05 How does standardizing care lead to personalization of care?
10:28 \\u201cOur clinical teams see that we care.\\u201d
10:48 \\u201cIf you don\\u2019t have a vision for where you want to be two and three years down the road, you\\u2019re struggling.\\u201d
11:03 \\u201cI want everybody to understand, What is their why?\\u201d
20:10 \\u201cThey don\\u2019t teach leadership in most medical schools.\\u201d\\u2014Dr. Robert Pearl
21:19 \\u201cGet to know these clinicians \\u2026 sincerely.\\u201d
23:11 \\u201cFrom a core values perspective, you can make every single decision \\u2026 on core values.\\u201d
23:35 \\u201cWe always start with those values. \\u2026 They\\u2019re embedded in everything we do.\\u201d
24:16 \\u201cYou have to project plan things out that you want.\\u201d
25:09 How does an FQHC or private practices that are patient-oriented attract talent?
30:45 \\u201cFirst and foremost, be visible.\\u201d

You can learn more at impact2lead.com.\\xa0

@Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why is there no opportunity to cost shift in an FQHC? @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What happens when an FQHC is operating inefficiently? @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cHave you workflowed it out? \\u2026 You can overstaff yourself in a way that your cost per patient goes way up.\\u201d @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why is taking a lean approach not an excuse to cut staff? @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThe nurses are linchpins to everything.\\u201d @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How does standardizing care lead to personalization of care? @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cOur clinical teams see that we care.\\u201d @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cI want everybody to understand, What is their why?\\u201d @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cGet to know these clinicians \\u2026 sincerely.\\u201d @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cWe always start with those values. \\u2026 They\\u2019re embedded in everything we do.\\u201d @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cYou have to project plan things out that you want.\\u201d @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How does an FQHC or private practices that are patient-oriented attract talent? @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cFirst and foremost, be visible.\\u201d @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell

Listed in: Health

EP340: How Digital Front Doors Can Enable Value-Based Care, With Kristin Begley

Kristin Begley, PharmD, is a proven leader in the healthcare space with 20 years of experience in health information technology and the pharmaceutical supply chain, focusing on innovative solutions and software. She currently serves as the chief commercial officer of Wildflower Health, a modular digital-enablement care company that activates women and their families within the healthcare ecosystem.

Wildflower\\u2019s software, hardware, and humanware amplify and personalize available resources to women, breaking down silos of care between payers and clinicians while fueling the shift from fee-for-service to value-based care. Wildflower supports the whole person by helping clinicians address both clinical and social determinants of health needs and empowering women to confidently navigate and access care for the family.\\xa0

Kristin is a founding member of All Tru Health, a consulting organization dedicated to improving quality and lowering healthcare costs for Americans, with an emphasis on emerging technology and high-value clinical care. She also served as the chief commercial officer at EmpiRx Health, a pharmacy care manager with a model rooted in payer alignment through at-risk management and concierge service.

Prior to that, Kristin was the chief pharmacy officer of Truveris, a healthcare technology company that sheds light on the inner workings of the pharmaceutical supply chain, serving all segments, including consumers. She also led Hewitt\\u2019s national pharmacy practice, where she managed Rx benefit strategy for Fortune 500 employers. Kristin holds a doctor of pharmacy degree from Samford University.

04:20 What do we mean by \\u201cdigital front door\\u201d in healthcare?
05:27 \\u201cIn healthcare, the next generation of digital front door is connecting all those stakeholders that try to help patients stay healthier.\\u201d
06:20 \\u201cWhat we\\u2019re trying to migrate to is \\u2026 walk into any front door.\\u201d
07:24 Why is engagement the hardest part?
10:24 \\u201cAre they digital providers \\u2026 or are they healthcare providers?\\u201d
12:25 \\u201cWhen we live in a capitalistic healthcare system, we all have a price tag on our head.\\u201d
14:01 \\u201cHow will providers and payers ever be successful in value-based care if we don\\u2019t have activated, educated, motivated patients?\\u201d
16:36 \\u201cI don\\u2019t know how \\u2026 we succeed in value-based care without having \\u2026 personalized content for everyone.\\u201d
18:24 \\u201cWhat does a consumer want?\\u201d
26:52 How does Wildflower Health achieve their value-based care network effect?
29:54 What do stakeholders want relative to value-based care?

You can learn more at wildflowerhealth.com. \\xa0

Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare

What do we mean by \\u201cdigital front door\\u201d in healthcare? Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare

\\u201cIn healthcare, the next generation of digital front door is connecting all those stakeholders that try to help patients stay healthier.\\u201d Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare

\\u201cWhat we\\u2019re trying to migrate to is \\u2026 walk into any front door.\\u201d Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare

Why is engagement the hardest part? Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare

\\u201cAre they digital providers \\u2026 or are they healthcare providers?\\u201d Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare

\\u201cWhen we live in a capitalistic healthcare system, we all have a price tag on our head.\\u201d Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare

\\u201cHow will providers and payers ever be successful in value-based care if we don\\u2019t have activated, educated, motivated patients?\\u201d Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare

\\u201cI don\\u2019t know how \\u2026 we succeed in value-based care without having \\u2026 personalized content for everyone.\\u201d Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare

\\u201cWhat does a consumer want?\\u201d Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare

What do stakeholders want relative to value-based care? Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard

\\xa0

Listed in: Health

AEE17: Employers and Reference-Based PricingDavid Contornos Latest Thinking

David Contorno is founder of E Powered Benefits. As a native of New York, David began his career in the insurance industry at the age of 14 and has since become a leading expert in the realm of employee benefits over the last 22 years.

David was Benefits Selling magazine\\u2019s 2015 Broker of the Year, and in March 2016, Forbes deemed him \\u201cone of America\\u2019s most innovative benefits leaders.\\u201d More recently, he received the 2017 Leadership Award at ASCEND, the annual conference of The Association for Insurance Leadership, which recognizes those whose leadership in support of improving the value and performance of employee benefits has significantly advanced the industry.

David is a member of the board of directors for both the Charlotte Association of Health Underwriters and HealthReach Community Clinic. He served on the NC Insurance Commissioners Life and Health Agent Advisory Committee, as well as participated in the Technical Advisory Group that helped with the market reforms required under the Affordable Care Act in North Carolina. He is a longtime member of the Lake Norman and South Iredell Chambers of Commerce as well as the National, North Carolina, New York, and Long Island Associations of Health Underwriters. David contributes to numerous publications, including Forbes, Benefits Selling magazine, Business Leader magazine, and Insurance Thought Leadership.

David is committed to giving back to his community and actively participates in the membership drive for the United Way, assisting the local chapter of Habitat for Humanity, and supporting The Dove House Child Advocacy Center. When he is not working, he enjoys boating and traveling.

01:37 What does good reference-based pricing look like?
01:57 What is the pricing methodology that 97% of healthcare is using?
04:25 How has E Powered Benefits minimized the noise around reference-based pricing?
04:55 \\u201cYou\\u2019re getting what we view as balance bills all the time.\\u201d
06:47 \\u201cWhat very few people really recognize is that hospitals have multiple revenue streams.\\u201d
07:36 \\u201cWhich is the highest price? The answer is, commercial.\\u201d

You can learn more at epoweredbenefits.com. You can also connect with David on LinkedIn. \\xa0

@dcontorno discusses #employers and #referencebasedpricing on our #healthcarepodcast. #healthcare #podcast

What does good reference-based pricing look like? @dcontorno discusses #employers and #referencebasedpricing on our #healthcarepodcast. #healthcare #podcast

What is the pricing methodology that 97% of healthcare is using? @dcontorno discusses #employers and #referencebasedpricing on our #healthcarepodcast. #healthcare #podcast

How has E Powered Benefits minimized the noise around reference-based pricing? @dcontorno discusses #employers and #referencebasedpricing on our #healthcarepodcast. #healthcare #podcast

\\u201cYou\\u2019re getting what we view as balance bills all the time.\\u201d @dcontorno discusses #employers and #referencebasedpricing on our #healthcarepodcast. #healthcare #podcast

\\u201cWhat very few people really recognize is that hospitals have multiple revenue streams.\\u201d @dcontorno discusses #employers and #referencebasedpricing on our #healthcarepodcast. #healthcare #podcast

\\u201cWhich is the highest price? The answer is, commercial.\\u201d @dcontorno discusses #employers and #referencebasedpricing on our #healthcarepodcast. #healthcare #podcast

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard, Josh LaRosa

\\xa0

Listed in: Health

EP339: Helping Employers Navigate the Perilous Medical-Industrial Complex, With David Contorno

David Contorno is founder of E Powered Benefits. As a native of New York, David began his career in the insurance industry at the age of 14 and has since become a leading expert in the realm of employee benefits over the last 22 years.

David was Benefits Selling magazine\\u2019s 2015 Broker of the Year, and in March 2016, Forbes deemed him \\u201cone of America\\u2019s most innovative benefits leaders.\\u201d More recently, he received the 2017 Leadership Award at ASCEND, the annual conference of The Association for Insurance Leadership, which recognizes those whose leadership in support of improving the value and performance of employee benefits has significantly advanced the industry.

David is a member of the board of directors for both the Charlotte Association of Health Underwriters and HealthReach Community Clinic. He served on the NC Insurance Commissioners Life and Health Agent Advisory Committee, as well as participated in the Technical Advisory Group that helped with the market reforms required under the Affordable Care Act in North Carolina. He is a longtime member of the Lake Norman and South Iredell Chambers of Commerce as well as the National, North Carolina, New York, and Long Island Associations of Health Underwriters. David contributes to numerous publications, including Forbes, Benefits Selling magazine, Business Leader magazine, and Insurance Thought Leadership.

David is committed to giving back to his community and actively participates in the membership drive for the United Way, assisting the local chapter of Habitat for Humanity, and supporting The Dove House Child Advocacy Center. When he is not working, he enjoys boating and traveling.

04:20 How do you ensure better care for patients?
05:10 \\u201cWhat\\u2019s required to correct those things is not really a massive degree of intellect or even innovation.\\u201d
05:38 What\\u2019s the road map for self-insured employers who want to take control of their healthcare costs?
10:06 \\u201cHigher costs equal more profit and more revenue.\\u201d
14:03 \\u201cThe problem with devalued primary care is \\u2026 that most people pass over the primary care provider and go right to the specialist.\\u201d
19:41 \\u201cEvery employer should have every broker sign a compensation disclosure form.\\u201d
20:06 \\u201cIf you think there\\u2019s perverse incentives on the medical side \\u2026 it gets even worse on the pharmacy side.\\u201d
21:01 What changes do employers find when they follow the road map to taking control of their healthcare costs?
21:44 \\u201cIt\\u2019s not uncommon for us to reduce total healthcare spend for an employer by between 20% and 40% at the end of the first year.\\u201d
22:09 \\u201cI can\\u2019t change [the] outcome without changing the path you walked to get there.\\u201d
22:41 \\u201cGoing self-funded is where the journey starts, not where it ends.\\u201d
24:47 \\u201cIf most employers truly understood how badly these carriers and health systems are taking advantage of them \\u2026 [it\\u2019s almost like] Stockholm syndrome.\\u201d
27:09 \\u201cThe only legitimate fear that employers should have is, How do they message these changes \\u2026 to the employees?\\u201d
29:21 \\u201cThis has to happen, and if it doesn\\u2019t happen, the system\\u2019s going to break and \\u2026 be picked up by entities that are, I think, only going to make the situation worse.\\u201d

You can learn more at epoweredbenefits.com. You can also connect with David on LinkedIn. \\xa0

@dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits

How do you ensure better care for patients? @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits

\\u201cWhat\\u2019s required to correct those things is not really a massive degree of intellect or even innovation.\\u201d @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits

What\\u2019s the road map for self-insured employers who want to take control of their healthcare costs? @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits

\\u201cHigher costs equal more profit and more revenue.\\u201d @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits

\\u201cThe problem with devalued primary care is \\u2026 that most people pass over the primary care provider and go right to the specialist.\\u201d @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits

\\u201cEvery employer should have every broker sign a compensation disclosure form.\\u201d @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits

\\u201cIf you think there\\u2019s perverse incentives on the medical side \\u2026 it gets even worse on the pharmacy side.\\u201d @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits

What changes do employers find when they follow the road map to taking control of their healthcare costs? @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits

\\u201cIt\\u2019s not uncommon for us to reduce total healthcare spend for an employer by between 20% and 40% at the end of the first year.\\u201d @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits

\\u201cI can\\u2019t change [the] outcome without changing the path you walked to get there.\\u201d @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits

\\u201cGoing self-funded is where the journey starts, not where it ends.\\u201d @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits

\\u201cIf most employers truly understood how badly these carriers and health systems are taking advantage of them \\u2026 [it\\u2019s almost like] Stockholm syndrome.\\u201d @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits

\\u201cThe only legitimate fear that employers should have is, How do they message these changes \\u2026 to the employees?\\u201d @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits

\\u201cThis has to happen, and if it doesn\\u2019t happen, the system\\u2019s going to break and \\u2026 be picked up by entities that are, I think, only going to make the situation worse.\\u201d @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard, Josh LaRosa, Dr David Carmouche (EP316)

Listed in: Health

EP338: Ideas to Meet Rural Healthcares Tough Challenges, With Nikki King, DHA

Nikki King, MHSA, DHA, was born and raised in the coalfields of Southeastern Kentucky. Prior to working in the healthcare industry, she worked for the Center of Business and Economic Research studying models of sustainability in rural communities with a single economic engine. She has been working at Margaret Mary Health since 2015, occupying roles in clinical statistics, as well as currently managing the behavioral health and addiction services department. In addition to her role at Margaret Mary, Nikki completed her DHA at the Medical University of South Carolina and her MHSA from Xavier University. She currently serves on the Indiana Rural Health Association\\u2019s Board of Directors, the American Hospital Association\\u2019s Opioid Stewardship Advisory Group, and the National Rural Health Association\\u2019s Policy Congress and Government Action Committee, and as the Board Chair of Rural Health Leadership Radio Board of Directors.

05:57 How dire is the rural hospital situation right now?
06:18 How could freestanding ERs be a potential solution for rural hospitals?
08:21 What are other potential rural health access solutions?
09:25 Why is broadband a roadblock to telehealth as a solution for rural health access?
14:06 The \\u201chot potato\\u201d of nurse practitioners in the healthcare world.
15:05 \\u201cThe number of residencies for physicians each year is not increasing, but the population \\u2026 is increasing.\\u201d
19:06 EP312 with Douglas Eby, MD, MPH, CPE, of the Nuka System of Care.
20:41 What\\u2019s the issue with maternity care in rural America?
22:53 \\u201cAs healthcare becomes more and more specialized, [the] ability to treat high-risk cases is better, but access gets worse.\\u201d
26:50 How is mental health care affected in rural communities?
27:23 \\u201cRural communities are trying very hard to hang on to what they have.\\u201d
28:49 \\u201cWhen you look at the one market plan that\\u2019s available in a rural community, you probably can\\u2019t afford it.\\u201d
30:39 What\\u2019s the single biggest challenge to moving to a model that incentivizes keeping people healthy?
31:33 \\u201cThe easiest low-hanging fruit \\u2026 is having national Medicaid and have that put under the same hood as Medicare.\\u201d

You can learn more by emailing Nikki at king.nikki2014@gmail.com.

You can also connect with her on LinkedIn and follow her on Twitter. \\xa0

@NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth

How dire is the rural hospital situation right now? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth

How could freestanding ERs be a potential solution for rural hospitals? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth

What are other potential rural health access solutions? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth

Why is broadband a roadblock to telehealth as a solution for rural health access? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth

The \\u201chot potato\\u201d of nurse practitioners in the healthcare world. @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth

\\u201cThe number of residencies for physicians each year is not increasing, but the population \\u2026 is increasing.\\u201d @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth

What\\u2019s the issue with maternity care in rural America? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth

\\u201cAs healthcare becomes more and more specialized, [the] ability to treat high-risk cases is better, but access gets worse.\\u201d @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth

How is mental health care affected in rural communities? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth

\\u201cRural communities are trying very hard to hang on to what they have.\\u201d @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth

\\u201cWhen you look at the one market plan that\\u2019s available in a rural community, you probably can\\u2019t afford it.\\u201d @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth

What\\u2019s the single biggest challenge to moving to a model that incentivizes keeping people healthy? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth

\\u201cThe easiest low-hanging fruit \\u2026 is having national Medicaid and have that put under the same hood as Medicare.\\u201d @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard, Josh LaRosa, Dr David Carmouche (EP316), Bob Matthews

Listed in: Health

EP337: A Patient-First Specialty Pharmacy, Not a Money-First Specialty Pharmacy, With Olivia Webb

Olivia Webb, PharmD, is a healthcare strategist and writer. She publishes the weekly healthcare newsletter Acute Condition, in addition to writing freelance pieces. She also works as a senior communications manager at the specialty care start-up Thirty Madison. In the past, Olivia has worked on healthcare policy and hospital consulting at Economic Liberties, Massachusetts General Hospital, and Advisory Board Company.

\\xa0

04:11 Why did Olivia start thinking about a patient-centric specialty pharmacy?
05:33 \\u201cThere\\u2019s really no layer on top of it to make it look nice.\\u201d
06:23 \\u201cYou\\u2019re kind of dealing with this vertical stack that doesn\\u2019t really deal with patients frequently.\\u201d
06:35 Is the specialty model more patient friendly or less?
07:08 What would a patient-centric specialty pharmacy look like?
07:58 \\u201cThere\\u2019s a lot of fragmentation; there\\u2019s a lot of friction.\\u201d
08:11 What\\u2019s unique to specialty pharmacy prescriptions?
10:38 Why can infusion centers be a high-drama place?
12:15 What\\u2019s \\u201cthe question\\u201d around specialty pharmacy?
12:42 Who has the vested interest in ensuring patients take their medications correctly in specialty pharmacy?
14:39 \\u201cIt\\u2019s really just a unique area of healthcare where the people that I think of as the good guys and the bad guys completely flips.\\u201d
16:05 Why might the time be ripe for disruption in the specialty pharmacy area?
19:56 \\u201cThere\\u2019s no one with a clear incentive to cap the prices.\\u201d
20:09 What are the barriers in specialty pharmacy?
20:31 \\u201cThe patient just isn\\u2019t at the center, the financial incentive, in any direction.\\u201d
29:22 \\u201cI think people who are designing these things need to see how patients are actually doing it.\\u201d
29:50 \\u201cI think there\\u2019s a lot of money here; I think this market is going to only increase in size.\\u201d
30:10 \\u201cI think you need scale.\\u201d
30:20 AEE15 with David Carmouche, MD, of Ochsner.

You can learn more at acutecondition.com. \\xa0

@OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why did Olivia start thinking about a patient-centric specialty pharmacy? @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThere\\u2019s really no layer on top of it to make it look nice.\\u201d @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cYou\\u2019re kind of dealing with this vertical stack that doesn\\u2019t really deal with patients frequently.\\u201d @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Is the specialty model more patient friendly or less? @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What would a patient-centric specialty pharmacy look like? @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThere\\u2019s a lot of fragmentation; there\\u2019s a lot of friction.\\u201d @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What\\u2019s unique to specialty pharmacy prescriptions? @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why can infusion centers be a high-drama place? @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What\\u2019s \\u201cthe question\\u201d around specialty pharmacy? @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why might the time be ripe for disruption in the specialty pharmacy area? @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIt\\u2019s really just a unique area of healthcare where the people that I think of as the good guys and the bad guys completely flips.\\u201d @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThe patient just isn\\u2019t at the center, the financial incentive, in any direction.\\u201d @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cI think people who are designing these things need to see how patients are actually doing it.\\u201d @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cI think there\\u2019s a lot of money here; I think this market is going to only increase in size.\\u201d @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye,\\xa0Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard, Josh LaRosa, Dr David Carmouche (EP316), Bob Matthews, Dr Douglas Eby (AEE14)

Listed in: Health

EP336: The Barbarians at the GateWho Are They and How Do They Cause Trouble for the Healthcare Industry Status Quo? With Brandon Weber

Brandon Weber is the cofounder and CEO at Nava, a modern benefits brokerage on a mission to provide high-quality, affordable access to healthcare to all Americans. By melding cutting-edge tech solutions with deep industry expertise, Nava aims to fix healthcare, one benefits plan at a time.

Prior to Nava, Brandon cofounded VTS, a tech-driven leasing and asset management platform that transformed the commercial real estate marketplace. Trusted by over 45,000 brokers and asset managers around the globe, it\\u2019s now used in over 50% of all office buildings in the United States and is consistently ranked one of New York\\u2019s best places to work.

Outside of work, he enjoys retreating into nature and is passionate about backcountry skiing, mountaineering, and trail running.

04:13 What does it mean to have \\u201cbarbarians at the gate\\u201d of healthcare?
05:32 What is the overly complex gate to healthcare?
07:28 \\u201cNo one can make the argument that we\\u2019ve seen this before.\\u201d
08:37 Are the \\u201cbarbarians\\u201d in healthcare going to expand the system that already exists?
09:25 What is the number one pain point in healthcare?
13:25 \\u201cTypically, the innovation doesn\\u2019t come from the incumbents.\\u201d
17:16 \\u201cWe were actually just blown away by the amount of innovation that is already happening \\u2026 [in] care delivery.\\u201d
17:58 \\u201cThe future is actually here; it\\u2019s just not evenly distributed.\\u201d
18:08 Why is there a need for a distribution layer in healthcare?
20:57 \\u201cEveryone is vying to be that one app in the pocket that acts as the aggregator, the hub, the steering point.\\u201d
26:32 \\u201cIf you build it, they will come \\u2026 that is absolutely not true in [healthcare].\\u201d
29:46 \\u201cThe benefits broker is likely the most underappreciated stakeholder in the healthcare industry.\\u201d

You can learn more at nava.io or by visiting their LinkedIn page.

@BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation

What does it mean to have \\u201cbarbarians at the gate\\u201d of healthcare? @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation

What is the overly complex gate to healthcare? @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation

\\u201cNo one can make the argument that we\\u2019ve seen this before.\\u201d @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation

Are the \\u201cbarbarians\\u201d in healthcare going to expand the system that already exists? @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation

\\u201cTypically, the innovation doesn\\u2019t come from the incumbents.\\u201d @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation

What is the number one pain point in healthcare? @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation

\\u201cWe were actually just blown away by the amount of innovation that is already happening \\u2026 [in] care delivery.\\u201d @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation

\\u201cThe future is actually here; it\\u2019s just not evenly distributed.\\u201d @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation

Why is there a need for a distribution layer in healthcare? @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation

\\u201cEveryone is vying to be that one app in the pocket that acts as the aggregator, the hub, the steering point.\\u201d @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation

\\u201cIf you build it, they will come \\u2026 that is absolutely not true in [healthcare].\\u201d @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation

\\u201cThe benefits broker is likely the most underappreciated stakeholder in the healthcare industry.\\u201d @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard, Josh LaRosa, Dr David Carmouche (EP316), Bob Matthews, Dr Douglas Eby (AEE14), Dr Sheldon Weiss

\\xa0

Listed in: Health

INBW30: A Hot Take on Healthcare Stakeholders Not Collaborating

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.

\\xa0

00:12 What\\u2019s Stacey\\u2019s hot take on collaboration in healthcare?
00:43 Why is collaboration so vital, and how does fragmentation play into that?
01:38 \\u201cTo fix American healthcare, we need to fix fragmentation.\\u201d
03:23 \\u201cNobody gets to be holier than thou.\\u201d
04:38 What is the bottom line on collaboration in healthcare?
05:20 What\\u2019s the difference between collaboration and collusion?
05:35 \\u201cMore is not usually better.\\u201d

For more information, go to aventriahealth.com. \\xa0

Our host, Stacey Richter, discusses her hot take on #healthcarecollaboration in our #healthcarepodcast. #healthcare #podcast #collaboration #digitalhealth

Why is collaboration so vital, and how does fragmentation play into that? Our host, Stacey Richter, discusses her hot take on #healthcarecollaboration in our #healthcarepodcast. #healthcare #podcast #collaboration #digitalhealth

\\u201cTo fix American healthcare, we need to fix fragmentation.\\u201d Our host, Stacey Richter, discusses her hot take on #healthcarecollaboration in our #healthcarepodcast. #healthcare #podcast #collaboration #digitalhealth

\\u201cNobody gets to be holier than thou.\\u201d Our host, Stacey Richter, discusses her hot take on #healthcarecollaboration in our #healthcarepodcast. #healthcare #podcast #collaboration #digitalhealth

What is the bottom line on collaboration in healthcare? Our host, Stacey Richter, discusses her hot take on #healthcarecollaboration in our #healthcarepodcast. #healthcare #podcast #collaboration #digitalhealth

What\\u2019s the difference between collaboration and collusion? Our host, Stacey Richter, discusses her hot take on #healthcarecollaboration in our #healthcarepodcast. #healthcare #podcast #collaboration #digitalhealth

\\u201cMore is not usually better.\\u201d Our host, Stacey Richter, discusses her hot take on #healthcarecollaboration in our #healthcarepodcast. #healthcare #podcast #collaboration #digitalhealth

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard, Josh LaRosa, Dr David Carmouche (EP316), Bob Matthews, Dr Douglas Eby (AEE14), Dr Sheldon Weiss, Dan Strause and Drew Leatherberry

Listed in: Health

AEE16: The Destruction of Primary CareA Short History, With Brian Klepper, PhD

Brian Klepper, PhD, is a healthcare analyst, commentator, and entrepreneur. He is a Principal of Healthcare Performance Inc, a healthcare strategy and business development practice, and CEO/Principal of Worksite Health Advisors, a benefits consultancy focused on linking high-performance/high-impact healthcare organizations with purchasers. He founded and moderates a popular professional healthcare Listserv, Healthcare Hackers, which is a discussion forum on healthcare high performance and value and which has about 850 participating benefits managers, benefits advisors, and innovative vendors.

An active author and speaker, Dr. Klepper has provided healthcare commentary to CBS Evening News, the Wall Street Journal, the New York Times, and the Washington Post. He has published widely in healthcare trade and academic publications and in newspapers nationally.

Brian is a regular contributor to Employee Benefit News, the Health Affairs Blog, The Health Care Blog, The Doctor Weighs In, Kevin MD, and other expert healthcare blogs. He is a reviewer for Health Affairs and The Journal of Ambulatory Care Management.

He is an advisor to the Lundberg Institute and to several for-profit healthcare organizations.

In his spare time, Brian is an offshore sailor.

01:00 What is the RUC?
03:18 What is the goal of the specialists in the RUC?
04:32 Why health plans and not health systems?
06:55 \\u201cAll this time, the hospital community was waging war against the HMO community.\\u201d
07:59 \\u201cThe incentives that have been at play have been very formidable.\\u201d
08:23 \\u201cPrimary care has developed a reputation for being the easy specialty \\u2026 and it\\u2019s just not so.\\u201d

You can learn more by emailing Brian at bklepper@worksitehealthadvisors.com.

@bklepper1 discusses #primarycare on our #anexpertexplains #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

What is the RUC? @bklepper1 discusses #primarycare on our #anexpertexplains #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

What is the goal of the specialists in the RUC? @bklepper1 discusses #primarycare on our #anexpertexplains #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

Why health plans and not health systems? @bklepper1 discusses #primarycare on our #anexpertexplains #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

\\u201cAll this time, the hospital community was waging war against the HMO community.\\u201d @bklepper1 discusses #primarycare on our #anexpertexplains #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

\\u201cThe incentives that have been at play have been very formidable.\\u201d @bklepper1 discusses #primarycare on our #anexpertexplains #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

\\u201cPrimary care has developed a reputation for being the easy specialty \\u2026 and it\\u2019s just not so.\\u201d @bklepper1 discusses #primarycare on our #anexpertexplains #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard, Josh LaRosa, Dr David Carmouche (EP316), Bob Matthews, Dr Douglas Eby (AEE14), Dr Sheldon Weiss, Dan Strause and Drew Leatherberry, Dr Douglas Eby (EP312)

Listed in: Health

EP335: Why Is Private Equity Willing to Pay $55,000 per Patient to Primary Care Start-ups? With Brian Klepper, PhD

Brian Klepper, PhD, is a healthcare analyst, commentator, and entrepreneur. He is a Principal of Healthcare Performance Inc, a healthcare strategy and business development practice, and CEO/Principal of Worksite Health Advisors, a benefits consultancy focused on linking high-performance/high-impact healthcare organizations with purchasers. He founded and moderates a popular professional healthcare Listserv, Healthcare Hackers, which is a discussion forum on healthcare high performance and value and which has about 850 participating benefits managers, benefits advisors, and innovative vendors.

An active author and speaker, Dr. Klepper has provided healthcare commentary to CBS Evening News, the Wall Street Journal, the New York Times, and the Washington Post. He has published widely in healthcare trade and academic publications and in newspapers nationally.

Brian is a regular contributor to Employee Benefit News, the Health Affairs Blog, The Health Care Blog, The Doctor Weighs In, Kevin MD, and other expert healthcare blogs. He is a reviewer for Health Affairs and The Journal of Ambulatory Care Management.

He is an advisor to the Lundberg Institute and to several for-profit healthcare organizations.

In his spare time, Brian is an offshore sailor.

05:10 Is the HMO model of primary care a good model?
07:48 \\u201cIndustrialized medicine is exciting.\\u201d
08:59 What does primary care have the opportunity to do?
09:21 \\u201cThe problem that goes along with that is that now immense amounts of money are being infused into primary care organizations.\\u201d
10:15 Where does direct primary care and advanced primary care fit into this model?
13:35 \\u201cAt the end of the day, what primary care really needs to be about is \\u2026 the management of life issues as well.\\u201d
14:05 EP295 with Rebecca Etz, PhD.
14:19 \\u201cBetter relationships quantifiably translate to better care.\\u201d
21:48 \\u201cAlmost nobody in healthcare wants any of this to happen.\\u201d
23:58 Why the huge amounts of money being invested into primary care is actually a big problem.
28:11 \\u201cWe should be able to get wildly better health outcomes for about 40% to 45% of the money that we\\u2019re currently spending.\\u201d

You can learn more by emailing Brian at bklepper@worksitehealthadvisors.com.

@bklepper1 discusses #primarycare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

Is the HMO model of primary care a good model? @bklepper1 discusses #primarycare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

\\u201cIndustrialized medicine is exciting.\\u201d @bklepper1 discusses #primarycare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

What does primary care have the opportunity to do? @bklepper1 discusses #primarycare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

\\u201cThe problem that goes along with that is that now immense amounts of money are being infused into primary care organizations.\\u201d @bklepper1 discusses #primarycare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

Where does direct primary care and advanced primary care fit into this model? @bklepper1 discusses #primarycare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

\\u201cAt the end of the day, what primary care really needs to be about is \\u2026 the management of life issues as well.\\u201d @bklepper1 discusses #primarycare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

\\u201cBetter relationships quantifiably translate to better care.\\u201d @bklepper1 discusses #primarycare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

\\u201cAlmost nobody in healthcare wants any of this to happen.\\u201d @bklepper1 discusses #primarycare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

Why the huge amounts of money being invested into primary care is actually a big problem. @bklepper1 discusses #primarycare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

\\u201cWe should be able to get wildly better health outcomes for about 40% to 45% of the money that we\\u2019re currently spending.\\u201d @bklepper1 discusses #primarycare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pcp

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard, Josh LaRosa, Dr David Carmouche (EP316), Bob Matthews, Dr. Douglas Eby (AEE14), Dr Sheldon Weiss, Dan Strause and Drew Leatherberry, Dr Douglas Eby (EP312), Ge Bai

\\xa0

Listed in: Health

EP334: Do Consumers Ditch High-Cost Providers After Shopping With Price Transparency Tools? With Sunita Desai, PhD

Listed in: Health

EP333: Actually Using Care Plans in the Real World, With (in Order of Appearance) Jeff Hogan, Darrell Moon, Dr. Grace Terrell, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy

Jeffrey Hogan is the northeast regional manager for Rogers Benefit Group, a national benefits marketing and consulting firm. Jeff has been with Rogers Benefit Group for 30 years. Additionally, Jeff operates a consulting firm, Upside Health Advisors, where he provides expert witness services on health care\\u2013related litigation, is a consultant to payers and large provider groups for product development and launch, and is a resource to employers desirous of implementing strategies to manage their health spend. Jeff is focused on health care payment reform, health policy, care coordination, value-based health care, health care quality, and precision medicine.

Jeff regularly appears on national forums focused on moving to value-based health care and is actively working to promote health care\\u2013related transparency measures in the market. He serves as the group\\u2019s liaison to the National Alliance of Healthcare Purchaser Coalitions. Jeff is the regional leader for The Leapfrog Group. He is also one of the coordinators of Connecticut\\u2019s Moving to Value Alliance.

Darrell Moon founded Orriant in 1996 to change the dynamics of health care and give employers some control over the ever-increasing costs of the health care benefits they offer their employees. Darrell believed that engaging individuals in the management of their own health was a key that had to be inserted back into the economic equation of health care. Darrell received both his bachelor\\u2019s degree in finance and his master\\u2019s degree in healthcare administration from Brigham Young University. As the CEO, COO, or CFO, Darrell managed medical and psychiatric hospitals throughout the country for over 10 years prior to creating Orriant. He also has more than a decade of experience managing insurance and managed care products. Darrell is a Forbes leadership contributor.

Grace E. Terrell, MD, MMM, is CEO of Eventus WholeHealth, a company focused on integrated value-based behavioral medicine and primary care in the long-term care space. She is a national thought leader in health care innovation and delivery system reform and a serial entrepreneur in population health outcomes driven through patient care model design, clinical and information integration, and value-based payment models. She is the former CEO of Cornerstone Health Care, one of the first medical groups to make the \\u201cmove to value\\u201d by lowering the cost of care and improving its quality for the sickest, most vulnerable patients; the founding CEO of CHESS, a population health management company; and the former CEO of Envision Genomics, a company focused on the integration of precision medicine technology into population health frameworks for patients with rare and undiagnosed diseases. Dr. Terrell currently serves on the US Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee and the board of the AMGA (American Medical Group Association), is a founding member of the Oliver Wyman Health Innovation Center, and is the coauthor of Value-Based Healthcare and Payment Models.

Rich Klasco, MD, FACEP, has focused throughout his career on rendering evidence-based medicine operational\\u2014that is, making the right thing the easy thing to do. He has pursued this goal in academia, in industry, in policy, and in the press.

In addition to publishing extensively in both peer-reviewed journals such as JAMA and lay publications such as The New York Times, Dr. Klasco has taught at leading academic medical centers, including Harvard, Stanford, Mayo, and the University of California, San Francisco; served on the executive committee of Brigham and Women\\u2019s Hospital Center for Patient Safety Research and Practice; testified before the United States Congress on evidence-based practices; and won CMS (Centers for Medicare & Medicaid Services) approval for an officially designated compendium of evidence-based oncologic drug information. Dr. Klasco previously served as chief medical officer and editor-in-chief for the Thomson Reuters group of health care companies, where he had editorial responsibility for companies including Micromedex, the Physicians\\u2019 Desk Reference (PDR), and the United States Pharmacopoeia (USP) Drug Information.

For the past 15 years, Dr. Klasco has served as chief medical officer for Motive Medical Intelligence, where he provides clinical leadership for the development and deployment of solutions that quantitative assess physician performance for payers, providers, and patients, and integrate scientific knowledge into workflow systems where it can be accessed and applied in real-time.

Dr. Klasco received his medical degree from Harvard Medical School. He completed his internship and residency in internal medicine at Brigham and Women\\u2019s Hospital, and he completed his residency in emergency medicine at the Denver Health Residency in Emergency Medicine, where he served as chief resident.

Nicole Bradberry is the founder and chief of growth and innovation officer for MIND 24-7. MIND 24-7 runs mental health crisis centers with a focus on immediate access, quality care, and the understanding that mental health and substance abuse drive significant health cost. She is also the founder of ValueH Network, which aggregates high-performing value-based care network providers in order to enable the best performance in new innovate contracts. In addition, she is currently the chief executive officer and chairman of the board of the Florida Association of ACOs (FLAACOs). FLAACOs is the premier professional organization for accountable care organizations (ACOs) throughout Florida which provides education and collaboration in the fee for value health care space.

Nicole spent 16 years leading operations and information technology programs for UnitedHealth Group and Cigna HealthCare. While there, she served as business lead for the technology transformation of the country\\u2019s largest dental and vision services company, led the national deployment of health care quality and affordability programs, and was responsible for the successful integration of many major health plans.

Nicole holds a bachelor\\u2019s degree in statistics from the University of Florida. She has been recognized for her personal and professional achievements many times, recently as the nation\\u2019s Outstanding Midmarket IT Leader of the Year and one of the Business Journal\\u2019s \\u201cWomen of Influence.\\u201d She is often found on the speaker faculty for health care conferences focused on ACOs, population health, and value-based care. She is passionate about changing health care and enabling physicians to provide high-quality, cost-effective, and consumer-focused care.

Kelly A. Conroy is director of Pinnacle Healthcare Consulting and brings more than 30 years of health care finance, management, and leadership experience with significant experience in value-based care. As a leader in the field, she\\u2019d contributed through multiple start-up health care companies with a leading-edge focus on advancements in care delivery and alignment.

Kelly started the first Medicare ACO in the country, which delivered nearly $40 million in savings in its first year and has gone on to manage some of the most profitable ACOs in the country. She is now sought after as a senior advisor and consultant, having developed a reputation as one of the most experienced and effective ACO professionals in the country. As a true catalyst driving the shift in health care culture toward physician leadership, her understanding and strategic vision are unmatched, along with her comprehension of the latest government-proposed valued-based agreements.

From starting health care organizations to serving in multiple senior executive leadership roles, Kelly is a seasoned executive with a career record of negotiating and increasing revenues through new product offerings while optimizing efficiency and productivity in the medical field.

02:10 Jeff Hogan (EP309) talks about the consequences of when there\\u2019s a disconnect between what the patient thinks is happening and what is actually happening in a care plan.
03:48 EP315 with Bob Matthews.
03:58 Merrill Goozner\\u2019s perspective on successful population health.
04:55 Why did Darrell Moon (EP305) give up being a hospital administrator because of care plans?
08:02 \\u201cIt\\u2019s a myth that population medicine \\u2026 and precision medicine are incompatible or opposites.\\u201d\\u2014Dr. Grace Terrell (EP319)
11:28 Dr. Rich Klasco (EP321) explains \\u201cnoncognitive\\u201d medicine and why it bogs physicians down.
14:45 What is at the core of appropriateness for care?
16:33 \\u201cYou start to bring that data to the physician, and it really does open their eyes.\\u201d\\u2014Nicole Bradberry (EP324)
16:51 Nicole Bradberry and Kelly Conroy (EP324) discuss how to really change the way physicians work.

You can listen to full episodes and learn more about this week\\u2019s guests at relentlesshealthvalue.com.\\xa0

Jeff Hogan, Darrell Moon, @gracet22, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy discuss #careplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

What are the consequences when there\\u2019s a disconnect between what the patient thinks is happening, and what is actually happening in a care plan? Jeff Hogan, Darrell Moon, @gracet22, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy discuss #careplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

Why did Darrell Moon give up being a hospital administrator because of care plans? Jeff Hogan, Darrell Moon, @gracet22, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy discuss #careplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIt\\u2019s a myth that population medicine \\u2026 and precision medicine are incompatible or opposites.\\u201d Jeff Hogan, Darrell Moon, @gracet22, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy discuss #careplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

What is \\u201cnoncognitive\\u201d medicine, and why does it bog physicians down? Jeff Hogan, Darrell Moon, @gracet22, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy discuss #careplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

What is at the core of appropriateness for care? Jeff Hogan, Darrell Moon, @gracet22, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy discuss #careplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cYou start to bring that data to the physician, and it really does open their eyes.\\u201d Jeff Hogan, Darrell Moon, @gracet22, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy discuss #careplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

How do you really change the way physicians work? Jeff Hogan, Darrell Moon, @gracet22, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy discuss #careplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\xa0

Recent past interviews:

Click a guest\\u2019s name for their latest RHV episode!

Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard, Josh LaRosa, Dr David Carmouche (EP316), Bob Matthews, Dr Douglas Eby (AEE14), Dr Sheldon Weiss, Dan Strause and Drew Leatherberry, Dr Douglas Eby (EP312), Ge Bai, Sumit Nagpal, Dr Vikas Saini and Shannon Brownlee

Listed in: Health

EP332: A New OS for Provider OrganizationsThe Patient-Centered Value System (PCVS), With Tony DiGioia, MD

Listed in: Health

EP331: Employers Buyer Beware! Six Tricks Wellness and Point-solution Vendors Use to Overstate Their Results, With Al Lewis, Cofounder and CEO of Quizzify

Al Lewis wears multiple hats, both professionally and also to cover his bald spot.

Hat #1: Employee Health Literacy. He is the founder and \\u201cquizmeister-in-chief\\u201d of Quizzify, whose mission is to help companies teach their employees to utilize health care services appropriately, using a format best described as \\u201cJeopardy meets Choosing Wisely meets Comedy Central.\\u201d Quizzify is the only vendor authorized to display the Harvard Medical School \\u201cVeritas\\u201d shield and has received excellent reviews from users.

Quizzify is also well known for its surprise billing \\u201cPrevent Consent\\u201d solution, which was recently featured in the New York Times. It can be taped to an insurance card, used as a stand-alone card, or downloaded into your Apple Wallet. Starting in 2022, use of this language prevents forced arbitration under the Surprise Billing Act and instead allows payment of 2x Medicare for non-elective care.\\xa0

His quiz-specific background includes authorship of the best-selling Newsweek Presents the Ultimate Trivia Game, which Games magazine lauded as having the best questions of any trivia game; hosting two quiz shows on Boston network affiliates; and appearing on Jeopardy.

Hat #2: Outcomes Measurement. As an author, his critically acclaimed category best-selling book on outcomes measurement, Why Nobody Believes the Numbers, chronicling and exposing the innumeracy of the health management field, was named digital health book of the year in Forbes.\\xa0Cracking Health Costs, written in conjunction with Walmart alum Tom Emerick, was also a trade best seller.

He was the cofounder of the World Health Care Congress\\u2019s Validation Institute.

His expertise in outcomes measurement got him named one of the unsung heroes changing health care forever.\\xa0

He graduated Phi Beta Kappa with honors from Harvard, where he taught economics as well. He also graduated from Harvard Law School, albeit with no honors that time\\u2014other than winning their annual trivia contest, of course.

04:49 Are brokers going to have to become more transparent about where their money is coming from?
07:33 Are carriers transparent?
08:09 What\\u2019s the goal of the Validation Institute?
08:55 \\u201cYou either get a true statement put up or learn what you have to do in order to get a true statement put up.\\u201d
11:18 How is Regression to the Mean (RTM) used in a flawed way?
16:32 \\u201cIf you do wellness for employees instead of to employees, the people who want the wellness will be able to access it.\\u201d
21:13 What is plausibility testing?
23:17 What about actuaries and validation?
23:40 \\u201cThat\\u2019s one of the reasons the Validation Institute exists, is because actuaries are easily corrupted.\\u201d
25:18 What is a prime example of population health economics?
26:20 What does it mean to overstate engagement?
27:15 \\u201cHow often did you use this and was it useful?\\u201d
28:55 \\u201cAre you validated by the Validation Institute, and if not, why not?\\u201d

You can learn more at the Validation Institute.

You can connect with Al by emailing al@quizzify.com, visiting the website at quizzify.com, on LinkedIn, or on Twitter at @quizzify and @whynobodybeliev.\\xa0

@whynobodybeliev of @quizzify discusses #wellnessvendors and #pointsolutionvendors on our #healthcarepodcast. #healthcare #podcast #employerhealthcare #digitalhealth

Are brokers going to have to become more transparent about where their money is coming from? @whynobodybeliev of @quizzify discusses #wellnessvendors and #pointsolutionvendors on our #healthcarepodcast. #healthcare #podcast #employerhealthcare #digitalhealth

Are carriers transparent? @whynobodybeliev of @quizzify discusses #wellnessvendors and #pointsolutionvendors on our #healthcarepodcast. #healthcare #podcast #employerhealthcare #digitalhealth

What\\u2019s the goal of the Validation Institute? @whynobodybeliev of @quizzify discusses #wellnessvendors and #pointsolutionvendors on our #healthcarepodcast. #healthcare #podcast #employerhealthcare #digitalhealth

\\u201cYou either get a true statement put up or learn what you have to do in order to get a true statement put up.\\u201d @whynobodybeliev of @quizzify discusses #wellnessvendors and #pointsolutionvendors on our #healthcarepodcast. #healthcare #podcast #employerhealthcare #digitalhealth

How is Regression to the Mean (RTM) used in a flawed way? @whynobodybeliev of @quizzify discusses #wellnessvendors and #pointsolutionvendors on our #healthcarepodcast. #healthcare #podcast #employerhealthcare #digitalhealth

\\u201cIf you do wellness for employees instead of to employees, the people who want the wellness will be able to access it.\\u201d @whynobodybeliev of @quizzify discusses #wellnessvendors and #pointsolutionvendors on our #healthcarepodcast. #healthcare #podcast #employerhealthcare #digitalhealth

What is plausibility testing? @whynobodybeliev of @quizzify discusses #wellnessvendors and #pointsolutionvendors on our #healthcarepodcast. #healthcare #podcast #employerhealthcare #digitalhealth

What about actuaries and validation? @whynobodybeliev of @quizzify discusses #wellnessvendors and #pointsolutionvendors on our #healthcarepodcast. #healthcare #podcast #employerhealthcare #digitalhealth

\\u201cThat\\u2019s one of the reasons the Validation Institute exists, is because actuaries are easily corrupted.\\u201d @whynobodybeliev of @quizzify discusses #wellnessvendors and #pointsolutionvendors on our #healthcarepodcast. #healthcare #podcast #employerhealthcare #digitalhealth

What is a prime example of population health economics? @whynobodybeliev of @quizzify discusses #wellnessvendors and #pointsolutionvendors on our #healthcarepodcast. #healthcare #podcast #employerhealthcare #digitalhealth

\\u201cHow often did you use this and was it useful?\\u201d @whynobodybeliev of @quizzify discusses #wellnessvendors and #pointsolutionvendors on our #healthcarepodcast. #healthcare #podcast #employerhealthcare #digitalhealth

\\u201cAre you validated by the Validation Institute, and if not, why not?\\u201d @whynobodybeliev of @quizzify discusses #wellnessvendors and #pointsolutionvendors on our #healthcarepodcast. #healthcare #podcast #employerhealthcare #digitalhealth

Listed in: Health

EP330: What Is Going On Over at Health Systems? With John Marchica, CEO at Darwin Research Group

John Marchica is a veteran health care strategist and CEO of Darwin Research Group, a health care market intelligence firm specializing in health care delivery systems. He\\u2019s a two-time health care entrepreneur, and his first company, FaxWatch, was listed twice on the Inc. 500 list of fastest-growing American companies. John is the author of The Accountable Organization and has advised senior management on strategy and organizational change for more than a decade.

John did his undergraduate work in economics at Knox College, has an MBA and MA in public policy from the University of Chicago, and completed his PhD coursework at The Dartmouth Institute. He is a faculty associate in the WP Carey School of Business and the College of Health Solutions at Arizona State University and is an active member of the American College of Healthcare Executives.

03:50 What were John\\u2019s top three health system findings during COVID?
05:24 What is priority for integrated delivery network health systems right now?
08:57 Why do health systems have a renewed focus in primary care?
10:07 How did infusion centers manage throughout the pandemic?
13:58 \\u201cIt\\u2019s not just in cancer, people not getting screened and being diagnosed; it\\u2019s in other areas as well.\\u201d
14:17 Which of these telemedicine changes are permanent?
19:39 \\u201cA visit is a visit \\u2026 so why would you reimburse at a lower rate?\\u201d
19:57 \\u201cTelemedicine \\u2026 is, by its nature, more efficient \\u2026 and they should be able to figure out how to make money.\\u201d
27:17 What are health system plans that own their specialty pharmacy groups doing right now?
29:57 What does Darwin Research Group focus on?

You can learn more at darwinresearch.com or by emailing John at jm@darwinresearch.com. You can also listen to the podcast Health Care Rounds wherever you listen to podcasts.

@johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

What were John\\u2019s top three health system findings during COVID? @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

What is priority for integrated delivery network health systems right now? @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

Why do health systems have a renewed focus in primary care? @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

How did infusion centers manage throughout the pandemic? @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

\\u201cIt\\u2019s not just in cancer, people not getting screened and being diagnosed; it\\u2019s in other areas as well.\\u201d @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

Which of these telemedicine changes are permanent? @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

\\u201cA visit is a visit \\u2026 so why would you reimburse at a lower rate?\\u201d @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

\\u201cTelemedicine \\u2026 is, by its nature, more efficient \\u2026 and they should be able to figure out how to make money.\\u201d @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

What are health system plans that own their specialty pharmacy groups doing right now? @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

Listed in: Health

EP329: Virtual-First Health Care SolutionsTheir Promise and a Few Outstanding Questions, With Joe Connolly From Visana Health

Joe Connolly is the founder and CEO of Visana Health, a virtual-first women\\u2019s specialty care clinic focused on high-cost chronic gynecologic conditions like endometriosis. Visana works with payers and self-funded employers to improve access to best-practice women\\u2019s health care. Joe also writes a popular blog consisting of long-form, in-depth analyses on the burgeoning virtual-first care industry. Prior to Visana, Joe led digital health and strategy efforts at Boston Scientific, a large medical device company.\\xa0

05:01 What does it mean to be virtual first?
05:50 \\u201cIt\\u2019s meeting people where they are and where they want care to be delivered. It does not mean virtual only.\\u201d
07:01 How do payers and purchasers know that a virtual-first program is available to them?
07:34 \\u201cWe need to come up with new ways to increase engagement with these services.\\u201d
10:59 Will virtual care replace in-person care?
15:01 What needs to happen in order to have an empathetic care delivery?
18:06 How should employers try to wade through the virtual health space?
19:41 What\\u2019s the value in administration within virtual care?
20:27 How does virtual care affect the relationship of the patient with their PCP?
22:05 What does physician abrasion mean?
25:31 What do virtual-first providers need to make sure they\\u2019re doing?
27:16 \\u201cThere is the possibility for perverse incentives, and it\\u2019s up to the virtual-first space to make sure that we don\\u2019t give in to those perverse incentives.\\u201d
28:28 Who is Visana and what do they do?

You can learn more at visanahealth.com or by emailing Joe directly at joe@visanahealth.com.\\xa0

@JConnol of @VisanaHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

What does it mean to be virtual first? @JConnol of @VisanaHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

\\u201cIt\\u2019s meeting people where they are and where they want care to be delivered. It does not mean virtual only.\\u201d @JConnol of @VisanaHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

How do payers and purchasers know that a virtual-first program is available to them? @JConnol of @VisanaHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

\\u201cWe need to come up with new ways to increase engagement with these services.\\u201d @JConnol of @VisanaHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

Will virtual care replace in-person care? @JConnol of @VisanaHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

What needs to happen in order to have an empathetic care delivery? @JConnol of @VisanaHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

How does virtual care affect the relationship of the patient with their PCP? @JConnol of @VisanaHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

\\u201cThere is the possibility for perverse incentives, and it\\u2019s up to the virtual-first space to make sure that we don\\u2019t give in to those perverse incentives.\\u201d @JConnol of @VisanaHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

Listed in: Health

EP328: An Interview Specifically for Health Care Executives, With Marshall Allen, Author of the Best Seller Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win

Marshall Allen investigates why we pay so much for health care in the United States and get so little in return. He is the author of the new book, Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win. He is also the founder of Allen Health Academy, which produces a curriculum of short on-demand videos to equip and empower employees to navigate the health care system. Marshall has investigated the health care industry for 15 years, including a decade at ProPublica. He has also spent a decade as an educator at the Craig Newmark Graduate School of Journalism at The City University of New York. His work has been honored with many journalism awards, including some of the top business reporting honors, the Harvard Kennedy School\\u2019s Goldsmith Prize for Investigative Reporting, and twice as a finalist for the Pulitzer Prize. Before he was in journalism, Marshall spent 5 years in full-time ministry, including 3 years in Nairobi, Kenya. He has a master\\u2019s degree in theology.\\xa0

03:35 What\\u2019s the point of view that Marshall is coming from with his investigative reporting?
04:06 \\u201cHow does this affect the people who are paying for it and the people who are undergoing the care?\\u201d
04:58 \\u201cThere\\u2019s a lot of good people working within this very messed up system.\\u201d
05:12 Why are patients considered outsiders in the health care system?
05:55 \\u201cWhat\\u2019s happened in health care is that the stakeholders treat each other more as the customer.\\u201d
07:54 What is upcoding?
11:27 \\u201cThese are schemes that have been created within the industry to increase revenue.\\u201d
11:56 \\u201cThis system is not set up for the benefit of the patient.\\u201d
12:22 \\u201cOn the financial side, the industry is actually oppressing the American people.\\u201d
12:39 Can a critical mass of patients force health systems to become more accountable?
16:02 \\u201cWe have been expected to pay whatever aggregate sum is thrown at us.\\u201d
17:09 Why have patients been so passive toward this crooked health care system so far?
18:04 \\u201cThey\\u2019re violating the trust of the American people when they don\\u2019t treat us fairly.\\u201d
19:28 \\u201cIt\\u2019s totally legal to do that, [but] is it ethical?\\u201d
20:11 What\\u2019s the difference between making a profit and profiteering?
21:43 \\u201cIt\\u2019s hard to argue against your own paycheck.\\u201d
29:57 \\u201cThe things that matter most to people are their health and their money.\\u201d
33:51 What are the first-order and second-order consequences of what\\u2019s happening in health care right now, and which of these consequences will actually drive change?
34:56 \\u201cWhen you tell the truth about what\\u2019s going on \\u2026 they become so ashamed \\u2026 that they change their behavior.\\u201d
36:10 \\u201cThe patient \\u2026 is not their most important customer.\\u201d
39:03 \\u201cThe sleeping giant is the employers.\\u201d

You can find Marshall\\u2019s book, Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win, anywhere that books are sold.

@marshall_allen, author of \\u201cNever Pay the First Bill,\\u201d discusses #financialtoxicity in the #healthcaresystem on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystem

\\u201cHow does this affect the people who are paying for it and the people who are undergoing the care?\\u201d @marshall_allen, author of \\u201cNever Pay the First Bill,\\u201d discusses #financialtoxicity in the #healthcaresystem on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystem

\\u201cThere\\u2019s a lot of good people working within this very messed up system.\\u201d @marshall_allen, author of \\u201cNever Pay the First Bill,\\u201d discusses #financialtoxicity in the #healthcaresystem on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystem

Why are patients considered outsiders in the health care system? @marshall_allen, author of \\u201cNever Pay the First Bill,\\u201d discusses #financialtoxicity in the #healthcaresystem on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystem

\\u201cThese are schemes that have been created within the industry to increase revenue.\\u201d @marshall_allen, author of \\u201cNever Pay the First Bill,\\u201d discusses #financialtoxicity in the #healthcaresystem on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystem

\\u201cThis system is not set up for the benefit of the patient.\\u201d @marshall_allen, author of \\u201cNever Pay the First Bill,\\u201d discusses #financialtoxicity in the #healthcaresystem on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystem

\\u201cOn the financial side, the industry is actually oppressing the American people.\\u201d @marshall_allen, author of \\u201cNever Pay the First Bill,\\u201d discusses #financialtoxicity in the #healthcaresystem on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystem

Can a critical mass of patients force health systems to become more accountable? @marshall_allen, author of \\u201cNever Pay the First Bill,\\u201d discusses #financialtoxicity in the #healthcaresystem on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystem

Why have patients been so passive toward this crooked health care system so far? @marshall_allen, author of \\u201cNever Pay the First Bill,\\u201d discusses #financialtoxicity in the #healthcaresystem on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystem

\\u201cThey\\u2019re violating the trust of the American people when they don\\u2019t treat us fairly.\\u201d @marshall_allen, author of \\u201cNever Pay the First Bill,\\u201d discusses #financialtoxicity in the #healthcaresystem on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystem

\\u201cIt\\u2019s totally legal to do that, [but] is it ethical?\\u201d @marshall_allen, author of \\u201cNever Pay the First Bill,\\u201d discusses #financialtoxicity in the #healthcaresystem on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystem

What\\u2019s the difference between making a profit and profiteering? @marshall_allen, author of \\u201cNever Pay the First Bill,\\u201d discusses #financialtoxicity in the #healthcaresystem on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystem

\\u201cIt\\u2019s hard to argue against your own paycheck.\\u201d @marshall_allen, author of \\u201cNever Pay the First Bill,\\u201d discusses #financialtoxicity in the #healthcaresystem on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystem

\\u201cThe things that matter most to people are their health and their money.\\u201d @marshall_allen, author of \\u201cNever Pay the First Bill,\\u201d discusses #financialtoxicity in the #healthcaresystem on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystem

\\u201cThe sleeping giant is the employers.\\u201d @marshall_allen, author of \\u201cNever Pay the First Bill,\\u201d discusses #financialtoxicity in the #healthcaresystem on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystem

Listed in: Health

ENCORE! EP263: The Start-up Who Won Medicares AI Contest, Beating Out IBM, Deloitte, and MayoA Conversation With Andrew Eye

Andrew Eye\\u2019s executive and entrepreneurial experience spans over 20 years in business to consumer and business to business for start-ups and Fortune 500 companies. Andrew founded and sold three technology companies and today is the CEO and founder of ClosedLoop.ai.

In 2012, Andrew cofounded the mobile software company Boxer. Boxer developed mobile productivity software for individuals and large corporations. Boxer\\u2019s flagship email product was downloaded by millions of users and received significant industry praise for its exceptional user interface, including a 2015 Webby Nomination as one of the top 5 productivity applications in the world. Boxer was purchased by VMWare (one of the top 10 largest software companies in the world) in 2015.

Prior to Boxer, Andrew cofounded the cybersecurity firm Ciphent in 2007. Ciphent grew to nearly 100 employees with 1000 customers by 2010 before being acquired by Accuvant (now Optiv). With a three-year growth rate of 8900%, Ciphent was recognized by Inc. magazine as the 16th fastest-growing private company in the United States. During his tenure as SVP of services at Accuvant, Andrew oversaw a $50-million, 200-person organization and was responsible for doubling revenues in 18 months.

Andrew also served as CEO of Bodkin Consulting Group, where he worked with Fortune 500 brands and technology companies to define their interactive marketing strategies. Andrew began his career as a software architect working with NASA, i2 technologies, and the US Marine Corps.

Andrew graduated summa cum laude from Virginia Tech with a degree in management information technology. Andrew lives in Austin, Texas.

04:34 What exactly predictive analytics is.
05:05 The use cases of predictive analytics value.
07:23 The oversimplification of how people think about risk.
09:03 \\u201cDid you have an impact or not?\\u201d
09:17 The public scorecard for predictive analytics.
13:59 \\u201cExplainability is a real hot topic in artificial intelligence, specifically in health care.\\u201d
15:24 Data shaming\\u2014what\\u2019s wrong with it, and why incomplete data are still important.
17:34 The possibilities that machine learning allows for in patient care in health care.
23:45 \\u201cOur health care system can\\u2019t afford for that level of inefficiency.\\u201d
24:57 \\u201cIt\\u2019s not a question of if; it\\u2019s a question of when.\\u201d
26:04 The diminishing returns of interoperability and more data for machine learning.
29:21 \\u201cYou\\u2019re running your business today, and whatever data you\\u2019re using to run your business \\u2026 you can use it to provide better patient care.\\u201d
30:01 Andrew\\u2019s advice: Get started now.

You can learn more at closedloop.ai or by following Andrew (@andreweye) on Twitter.\\xa0

Check out our newest #healthcarepodcast with @andreweye of @ClosedLoopai as he discusses #populationhealth and #artificialintelligence. #healthcare #podcast #ai #pophealth #digitalhealth

What is #predictiveanalytics value to health care? @andreweye of @ClosedLoopai discusses. #healthcarepodcast #populationhealth #podcast #ai #pophealth #digitalhealth #artificialintelligence

Oversimplifying risk. @andreweye of @ClosedLoopai discusses. #healthcarepodcast #populationhealth #podcast #ai #pophealth #digitalhealth #artificialintelligence

\\u201cDid you have an impact or not?\\u201d @andreweye of @ClosedLoopai discusses. #healthcarepodcast #populationhealth #podcast #ai #pophealth #digitalhealth #artificialintelligence

\\u201cExplainability is a real hot topic in artificial intelligence, specifically in health care.\\u201d @andreweye of @ClosedLoopai discusses. #healthcarepodcast #populationhealth #podcast #ai #pophealth #digitalhealth #artificialintelligence

What is data shaming, and why is it an issue? @andreweye of @ClosedLoopai discusses. #healthcarepodcast #populationhealth #podcast #ai #pophealth #digitalhealth #artificialintelligence

#Machinelearning in #patientcare. @andreweye of @ClosedLoopai discusses. #healthcarepodcast #populationhealth #podcast #ai #pophealth #digitalhealth #artificialintelligence

\\u201cOur health care system can\\u2019t afford for that level of inefficiency.\\u201d @andreweye of @ClosedLoopai discusses. #healthcarepodcast #populationhealth #podcast #ai #pophealth #digitalhealth #artificialintelligence

\\u201cIt\\u2019s not a question of if; it\\u2019s a question of when.\\u201d @andreweye of @ClosedLoopai discusses. #healthcarepodcast #populationhealth #podcast #ai #pophealth #digitalhealth #artificialintelligence

\\u201cYou\\u2019re running your business today, and whatever data you\\u2019re using to run your business \\u2026 you can use it to provide better patient care.\\u201d @andreweye of @ClosedLoopai discusses. #healthcarepodcast #populationhealth #podcast #ai #pophealth #digitalhealth #artificialintelligence

Listed in: Health

EP327: Pharma Hooking Up With Start-ups, With Naomi Fried, PhD, About PharmStarsTM

Naomi Fried, PhD, is the founder and CEO of PharmStars, the first and only pharma-focused accelerator for digital health start-ups, dedicated to driving digital health adoption to improve patient outcomes. PharmStars understands and addresses the challenges that Pharma and start-ups face when seeking to collaborate. Its PharmaU^\\u2122 program supports its digital health start-ups and pharma members seeking to \\u201cbridge the gap,\\u201d leading to greater success and faster adoption of \\u201cbeyond the molecule\\u201d solutions for patients. PharmStars provides education and mentoring to digital health start-ups seeking engagement with pharma and biotech firms. Its pharma members are committed to working with its graduating start-ups. Applications for participation in the first cohort are due July 21, 2021.

Dr. Fried is also the co-founder and managing partner of Ambit Health Ventures, an early-stage venture capital fund focused on digital health investments. Previously, she was the CEO of the consulting firm Health Innovation Strategies, VP of innovation and external partnerships at Biogen, the first chief innovation officer at Boston Children\\u2019s Hospital, and the first VP of innovation and advanced technology at Kaiser Permanente. She advises and serves on the boards of digital health start-ups.

03:42 What does the pharma\\u2013start-up gap look like?
05:49 Why is it hard to navigate Big Pharma when trying to partner with start-ups?
09:53 \\u201cA lot of what contributes to that pharma\\u2013start-up gap is a lack of understanding.\\u201d
10:05 What\\u2019s the best way to navigate the pharma\\u2013start-up partnership?
10:55 \\u201cThere\\u2019s not a clear path as to who should be engaged from the pharma side, because the value proposition wasn\\u2019t well articulated.\\u201d
12:27 \\u201cEven if \\u2026 the product is better, if it\\u2019s such an uphill battle to get them through the hoops and to work with them, they may not be the partner of choice.\\u201d
13:45 Why are start-ups surprised at who all is involved with the decision-making process on the pharma side?
15:51 Where might start-ups run into regulatory oversight compliance issues?
20:41 \\u201cSetting expectations and talking early on \\u2026 really, just understanding on both sides \\u2026 they have to meet each other and work around these requirements.\\u201d
22:02 \\u201cStart-ups really are under financial pressure.\\u201d
26:33 \\u201cPharma has a lot to offer digital health start-ups.\\u201d
27:40 Is Pharma any good at selling something to a provider?
29:22 What do start-ups need to keep in mind when pitching to Pharma?
30:35 \\u201cUnderstanding Pharma\\u2019s needs, how they work, what they will pay for is so important for start-ups.\\u201d

You can learn more about PharmStars at pharmstars.com.

@NaomiFried of @AmbitHealth discusses @PharmStars on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

What does the pharma\\u2013start-up gap look like? @NaomiFried of @AmbitHealth discusses @PharmStars on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

Why is it hard to navigate Big Pharma when trying to partner with start-ups? @NaomiFried of @AmbitHealth discusses @PharmStars on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

\\u201cA lot of what contributes to that pharma\\u2013start-up gap is a lack of understanding.\\u201d @NaomiFried of @AmbitHealth discusses @PharmStars on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

What\\u2019s the best way to navigate the pharma\\u2013start-up partnership? @NaomiFried of @AmbitHealth discusses @PharmStars on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

\\u201cEven if \\u2026 the product is better, if it\\u2019s such an uphill battle to get them through the hoops and to work with them, they may not be the partner of choice.\\u201d @NaomiFried of @AmbitHealth discusses @PharmStars on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

\\u201cStart-ups really are under financial pressure.\\u201d @NaomiFried of @AmbitHealth discusses @PharmStars on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

\\u201cPharma has a lot to offer digital health start-ups.\\u201d @NaomiFried of @AmbitHealth discusses @PharmStars on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

What do start-ups need to keep in mind when pitching to Pharma? @NaomiFried of @AmbitHealth discusses @PharmStars on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

\\u201cUnderstanding Pharma\\u2019s needs, how they work, what they will pay for is so important for start-ups.\\u201d @NaomiFried of @AmbitHealth discusses @PharmStars on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

Listed in: Health

EP326: The Unfortunate News About HRRP, With Insights on How to Fix It, With Rishi Wadhera, MD, MPP

Rishi K. Wadhera, MD, MPP, MPhil, is an assistant professor of medicine at Harvard Medical School, a cardiologist at Beth Israel Deaconess Medical Center (BIDMC), and the associate program director of the cardiovascular medicine fellowship at BIDMC. He is also health policy and equity researcher at the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology.

Dr. Wadhera received his MD from the Mayo Clinic School of Medicine as well as an MPhil in public health as a Gates Cambridge Scholar from the University of Cambridge. He completed his internal medicine residency and cardiovascular medicine fellowship at Brigham and Women\\u2019s Hospital in Boston. During this time, he also received a master\\u2019s in public policy (MPP) at the Harvard Kennedy School of Government, with a focus on health policy.

Dr. Wadhera\\u2019s research spans questions related to health care access, quality, and disparities, as well as understanding how local, state, and national policy initiatives impact care delivery, health equity, and outcomes. Dr. Wadhera has published more than 80 articles to date, and he receives research support from the National Heart, Lung, and Blood Institute (NHLBI) and the National Institutes of Health (NIH).

03:10 What was the Hospital Readmissions Reduction Program intended to do?
05:05 Why did the Centers for Medicare & Medicaid (CMS) think some readmissions were preventable?
05:46 \\u201cThe spirit of the Hospital Readmissions Reduction Program was to incentivize hospitals to improve \\u2026 discharge planning, transitions of care, and post-discharge follow-up and care.\\u201d
06:54 How has research in the last few years changed the thoughts on the effectiveness of the Hospital Readmissions Reduction Program?
08:14 \\u201cThe 30-day readmission measure\\u2014it\\u2019s an incomplete measure.\\u201d
12:12 \\u201cI think patients \\u2026 are smart, and they know what\\u2019s going on.\\u201d
14:01 \\u201cWhat\\u2019s happening is, we\\u2019re just increasing the number of times they need to come back to the ER within that 30-day period.\\u201d
14:22 \\u201cThe weird thing about the HRRP is that when it evaluates hospitals\\u2019 30-day readmission rates, it\\u2019s a yes-no phenomenon.\\u201d
15:30 \\u201cWhat CMS does is, it risk adjusts \\u2026 and that is what we should be doing.\\u201d
19:16 \\u201cThis program has been incredibly regressive.\\u201d
19:51 \\u201cPoverty, neighborhood disadvantage, housing instability\\u2014these factors are out of hospitals\\u2019 control.\\u201d
22:56 \\u201cBlunt policies like this that are rolled out nationally probably elicit mixed behavioral responses.\\u201d
23:12 \\u201cIt just makes no sense to take resources away from hospitals.\\u201d
25:22 What\\u2019s the way to improve quality of care globally?
27:19 \\u201cCMS\\u2019s approach to improving quality of care has really anchored \\u2026 [that] to payment.\\u201d
27:49 \\u201cIt\\u2019s time for us to rethink what our approach to quality improvement should be.\\u201d
31:28 \\u201cPolicy makers have an obligation to rigorously test the impact of these types of policies before they roll them out nationally.\\u201d
34:05 Can you scale health care nationally?

You can learn more at Dr. Rishi\\u2019s Harvard Catalyst profile and the Beth Israel Deaconess Medical Center Web site.

@rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission

What was the Hospital Readmissions Reduction Program intended to do? @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission

Why did CMS think some readmissions were preventable? @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission

\\u201cThe spirit of the Hospital Readmissions Reduction Program was to incentivize hospitals to improve \\u2026 discharge planning, transitions of care, and post-discharge follow-up and care.\\u201d @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission

How has research in the last few years changed the thoughts on the effectiveness of the Hospital Readmissions Reduction Program? @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission

\\u201cThe 30-day readmission measure\\u2014it\\u2019s an incomplete measure.\\u201d @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission

\\u201cWhat CMS does is, it risk adjusts \\u2026 and that is what we should be doing.\\u201d @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission

\\u201cBlunt policies like this that are rolled out nationally probably elicit mixed behavioral responses.\\u201d @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission

\\u201cIt just makes no sense to take resources away from hospitals.\\u201d @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission

What\\u2019s the way to improve quality of care globally? @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission

\\u201cIt\\u2019s time for us to rethink what our approach to quality improvement should be.\\u201d @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission

Can you scale health care nationally? @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission

Listed in: Health

EP325: The Show in Which Dr. Mai Pham Disagrees With Three of My Value-Based Care Premises

Hoangmai (Mai) H. Pham, MD, MPH, is a general internist and national health policy leader. She was vice president, provider alignment solutions, at Anthem, Inc., responsible for value-based care initiatives at the country\\u2019s second-largest health insurance company. Prior to Anthem, Dr. Pham served as chief innovation officer at the Centers for Medicare & Medicaid Services, where she was a founding official, and the architect of Medicare\\u2019s foundational programs on accountable care organizations and primary care. She was co-director of research at the Center for Studying Health System Change and has published extensively on provider payment policy and its intersection with health disparities, quality performance, provider behavior, and market trends. Dr. Pham serves on numerous advisory bodies, including the National Advisory Council for the Agency on Healthcare Research and Quality, the Maryland Primary Care Program, and the National Business Group on Health, and was a member of the Board Executive Committee at the Health Care Transformation Task Force. Dr. Pham earned her bachelor\\u2019s degree from Harvard University, her MD from Temple University, and her MPH from Johns Hopkins University, where she was also a Robert Wood Johnson Clinical Scholar.

04:22 What are the nuances within the promises of value-based care?
05:34 \\u201cFor the first 10 years of \\u2026 value-based care, it was right in order to generate momentum and get as much participation as possible.\\u201d
06:41 \\u201cWhen you leave yourself open to tackling prices, now you open up a whole world of possibilities in terms of how you could redirect sources.\\u201d
08:00 \\u201cNot all providers are the same.\\u201d
09:24 \\u201cIt\\u2019s time to stop tracking the phenomenon and actually pay for change.\\u201d
10:29 \\u201cWe haven\\u2019t done our best to actually make the alternative to value-based payment as bad as it could be.\\u201d
12:14 What\\u2019s the path forward in value-based care, especially for specialists?
15:43 \\u201cThere has been tremendous business opportunity in Medicare Advantage, not to the benefit of the trust funds.\\u201d
17:13 \\u201cAs a citizen, I gotta ask, \\u2018How much is enough?\\u2019\\u201d
19:03 \\u201cIt\\u2019s not like we\\u2019re talking about replacing a really superlative gold standard.\\u201d
19:34 EP263 with Andrew Eye from ClosedLoop.ai.
22:02 \\u201cIt\\u2019s not just about taking dollars away from certain subsectors; it\\u2019s about reallocating some of those dollars.\\u201d
23:34 \\u201cPolicy making itself tends to be siloed.\\u201d
25:02 \\u201cThis is about paying some people in health care modestly less.\\u201d
25:35 \\u201cMost of the costs are driven by fixed costs.\\u201d
29:25 \\u201cValue-based care is not what has driven consolidation.\\u201d

You can learn more at ie-care.org.\\xa0

@HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

What are the nuances within the promises of value-based care? @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\\u201cFor the first 10 years of \\u2026 value-based care, it was right in order to generate momentum and get as much participation as possible.\\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\\u201cWhen you leave yourself open to tackling prices, now you open up a whole world of possibilities in terms of how you could redirect sources.\\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\\u201cNot all providers are the same.\\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\\u201cIt\\u2019s time to stop tracking the phenomenon and actually pay for change.\\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\\u201cWe haven\\u2019t done our best to actually make the alternative to value-based payment as bad as it could be.\\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\\u201cAs a citizen, I gotta ask, \\u2018How much is enough?\\u2019\\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\\u201cIt\\u2019s not like we\\u2019re talking about replacing a really superlative gold standard.\\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\\u201cIt\\u2019s not just about taking dollars away from certain subsectors; it\\u2019s about reallocating some of those dollars.\\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\\u201cThis is about paying some people in health care modestly less.\\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\\u201cValue-based care is not what has driven consolidation.\\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

Listed in: Health

EP324: ACOs (Accountable Care Organizations): Do They, in Fact, Improve the Quality of Care and Reduce Costs? With Nicole Bradberry and Kelly Conroy

Nicole Bradberry is the founder and chief of growth and innovation officer for MIND 24-7. MIND 24-7 runs mental health crisis centers with a focus on immediate access, quality care, and the understanding that mental health and substance abuse drive significant health cost. She is also the founder of ValueH Network, which aggregates high-performing value-based care network providers in order to enable the best performance in new innovate contracts. In addition, she is currently the chief executive officer and chairman of the board of the Florida Association of ACOs (FLAACOs). FLAACOs is the premier professional organization for accountable care organizations (ACOs) throughout Florida which provides education and collaboration in the fee for value health care space.

Nicole spent 16 years leading operations and information technology programs for UnitedHealth Group and Cigna HealthCare. While there, she served as business lead for the technology transformation of the country\\u2019s largest dental and vision services company, led the national deployment of health care quality and affordability programs, and was responsible for the successful integration of many major health plans.

Nicole holds a bachelor\\u2019s degree in statistics from the University of Florida. She has been recognized for her personal and professional achievements many times, recently as the nation\\u2019s Outstanding Midmarket IT Leader of the Year and one of the Business Journal\\u2019s \\u201cWomen of Influence.\\u201d She is often found on the speaker faculty for health care conferences focused on ACOs, population health, and value-based care. She is passionate about changing health care and enabling physicians to provide high-quality, cost-effective, and consumer-focused care.

Kelly A. Conroy is director of Pinnacle Healthcare Consulting and brings more than 30 years of health care finance, management, and leadership experience with significant experience in value-based care. As a leader in the field, she\\u2019d contributed through multiple start-up health care companies with a leading-edge focus on advancements in care delivery and alignment.

Kelly started the first Medicare ACO in the country, which delivered nearly $40 million in savings in its first year and has gone on to manage some of the most profitable ACOs in the country. She is now sought after as a senior advisor and consultant, having developed a reputation as one of the most experienced and effective ACO professionals in the country. As a true catalyst driving the shift in health care culture toward physician leadership, her understanding and strategic vision are unmatched, along with her comprehension of the latest government-proposed valued-based agreements.

From starting health care organizations to serving in multiple senior executive leadership roles, Kelly is a seasoned executive with a career record of negotiating and increasing revenues through new product offerings while optimizing efficiency and productivity in the medical field.

05:44 ACOs: What\\u2019s in it for the patient?
08:10 Is the upside of ACOs enough to justify the cost?
11:23 \\u201cYou can either keep on doing what you\\u2019re doing and end up like Blockbuster, or you can really pivot and be Netflix.\\u201d\\u2014Nicole
12:26 Why would MIPS incentivize providers to sign up for an ACO?
15:22 What are the big ACO failures?
18:27 \\u201cJust as patient engagement is a number one key success indicator, so is physician engagement.\\u201d\\u2014Kelly
19:57 \\u201cIt\\u2019s not individual benchmarks; it\\u2019s the whole ACO.\\u201d\\u2014Kelly
20:15 \\u201cHonestly, data is key to that conversation.\\u201d\\u2014Nicole
21:55 EP321 with Rich Klasco, MD.
22:14 What are the essentials for a successful ACO?
27:31 Who do you need to add to the ACO mix?
28:55 How does home health play into the ACO system?
29:33 \\u201cThe whole behavioral health\\u2014just adding in a really good care team.\\u201d\\u2014Kelly
29:48 \\u201cThere\\u2019s just a whole host of things that having all this data opens up the physician and the provider\\u2019s eyes.\\u201d\\u2014Kelly
32:56 \\u201cWe really think fee for service is the competition.\\u201d\\u2014Kelly

You can learn more at flaacos.com, valueh.com, and Pinnacle Healthcare Consulting.

You can also connect with Nicole and Kelly on LinkedIn.

Nicole Bradberry and Kelly Conroy discuss #ACOs on our #healthcarepodcast. #healthcare #podcast #digitalhealth #accountablecareorganization #ACO

ACOs: What\\u2019s in it for the patient? Nicole Bradberry and Kelly Conroy discuss #ACOs on our #healthcarepodcast. #healthcare #podcast #digitalhealth #accountablecareorganization #ACO

Is the upside of ACOs enough to justify the cost? Nicole Bradberry and Kelly Conroy discuss #ACOs on our #healthcarepodcast. #healthcare #podcast #digitalhealth #accountablecareorganization #ACO

\\u201cYou can either keep on doing what you\\u2019re doing and end up like Blockbuster, or you can really pivot and be Netflix.\\u201d Nicole Bradberry and Kelly Conroy discuss #ACOs on our #healthcarepodcast. #healthcare #podcast #digitalhealth #accountablecareorganization #ACO

Why would MIPS incentivize providers to sign up for an ACO? Nicole Bradberry and Kelly Conroy discuss #ACOs on our #healthcarepodcast. #healthcare #podcast #digitalhealth #accountablecareorganization #ACO

What are the big ACO failures? Nicole Bradberry and Kelly Conroy discuss #ACOs on our #healthcarepodcast. #healthcare #podcast #digitalhealth #accountablecareorganization #ACO

\\u201cJust as patient engagement is a number one key success indicator, so is physician engagement.\\u201d Nicole Bradberry and Kelly Conroy discuss #ACOs on our #healthcarepodcast. #healthcare #podcast #digitalhealth #accountablecareorganization #ACO

\\u201cIt\\u2019s not individual benchmarks; it\\u2019s the whole ACO.\\u201d Nicole Bradberry and Kelly Conroy discuss #ACOs on our #healthcarepodcast. #healthcare #podcast #digitalhealth #accountablecareorganization #ACO

\\u201cHonestly, data is key to that conversation.\\u201d Nicole Bradberry and Kelly Conroy discuss #ACOs on our #healthcarepodcast. #healthcare #podcast #digitalhealth #accountablecareorganization #ACO

What are the essentials for a successful ACO? Nicole Bradberry and Kelly Conroy discuss #ACOs on our #healthcarepodcast. #healthcare #podcast #digitalhealth #accountablecareorganization #ACO

Who do you need to add to the ACO mix? Nicole Bradberry and Kelly Conroy discuss #ACOs on our #healthcarepodcast. #healthcare #podcast #digitalhealth #accountablecareorganization #ACO

How does home health play into the ACO system? Nicole Bradberry and Kelly Conroy discuss #ACOs on our #healthcarepodcast. #healthcare #podcast #digitalhealth #accountablecareorganization #ACO

\\u201cThe whole behavioral health\\u2014just adding in a really good care team.\\u201d Nicole Bradberry and Kelly Conroy discuss #ACOs on our #healthcarepodcast. #healthcare #podcast #digitalhealth #accountablecareorganization #ACO

\\u201cWe really think fee for service is the competition.\\u201d Nicole Bradberry and Kelly Conroy discuss #ACOs on our #healthcarepodcast. #healthcare #podcast #digitalhealth #accountablecareorganization #ACO

Listed in: Health

Encore! EP244: A Playbook for Jumbo Employersor Providers, Consultants, Carriers, or Pharma Who Get Paid by Jumbo Employers, With Lee Lewis, Chief Strategy Officer at the Health Transformation Alliance

Lee Lewis serves as chief strategy officer and GM medical solutions for the Health Transformation Alliance. He leads efforts across over 50 large and jumbo employers and six million employees to save lives and save millions of dollars through improved health delivery, outcomes, and experience. Key initiatives in this role include new models of health benefits administration, curated provider steerage, and improved clinical delivery and outcomes.

\\xa0

Listed in: Health

EP323: A Short Take on Digital Tools Purporting to Maximize Throughput, With Arshad Rahim, MD, MBA, FACP, of Mount Sinai Health System

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 Population Health, Healthgrades, and Sg2. As the vice president, clinical integration and population health, at Mount Sinai Health System, Dr. Rahim is responsible for the 4500-provider Mount Sinai Clinically Integrated Network (CIN) and has built a team-driven practice focusing on key value-based care metrics of utilization, cost, access, and quality. He is also leading a team driving ambulatory care standardization for six key chronic conditions across Mount Sinai Health System. Dr. Rahim has a bachelor\\u2019s 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.

07:37 When does throughput negatively affect patient care?
08:55 Why does diagnostic inaccuracy become a problem with throughput?
09:27 Do population health outcomes decline with less throughput?
10:20 \\u201cThe way you can also be most financially successful is by taking care of sicker patients.\\u201d
10:53 What do patients actually want and need?
11:55 \\u201cThe emotionality in a health care interaction is always there \\u2026 [when] you\\u2019re focused on throughput, you can definitely lose the healing and calming presence.\\u201d
14:18 What do doctors need from their organizations to sustain a high level of care?
15:59 \\u201cThe actions vary across the spectrum from very supportive to not very supportive at all.\\u201d
17:02 \\u201cThere definitely is a challenge of competitive pay.\\u201d

You can connect with Dr. Rahim on LinkedIn.\\xa0

Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools and #throughput on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools

When does throughput negatively affect patient care? Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools

Why does diagnostic inaccuracy become a problem with throughput? Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools

Do population health outcomes decline with less throughput? Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools

\\u201cThe way you can also be most financially successful is by taking care of sicker patients.\\u201d Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools

What do patients actually want and need? Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools

\\u201cThe emotionality in a health care interaction is always there \\u2026 [when] you\\u2019re focused on throughput, you can definitely lose the healing and calming presence.\\u201d Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools

What do doctors need from their organizations to sustain a high level of care? Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools

\\u201cThe actions vary across the spectrum from very supportive to not very supportive at all.\\u201d Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools

\\u201cThere definitely is a challenge of competitive pay.\\u201d Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools

Listed in: Health

EP322: Cherry Picking, Lemon Dropping, and Other Learnings for Value-Based Care Models, With Monica Lypson, MD, MHPE

Monica L. Lypson, MD, MHPE, FACP, serves as a professor, vice-chair of medicine, division director of general internal medicine at The George Washington University School of Medical and Health Sciences. She will join Columbia University\\u2019s Vagelos College of Physicians and Surgeons as vice dean for medical education on June 1, 2021. Her work focuses on innovations and improvements in health professions education and assessment, health equity, workforce diversity, faculty development, medical care delivery, and provider communication skills. Dr. Lypson most recently served as director for medical and dental education for the Veterans Health Administration, where she oversaw undergraduate and graduate medical education across the nation within the Department of Veterans Affairs.

04:08 Is value-based care good for underserved communities?
05:09 \\u201cIf you create perverse incentives, you actually might make known health care disparities worse \\u2026 to meet the demands\\u2019 value.\\u201d
06:29 \\u201cThere actually might be systematic and structural ways that the health care system might say \\u2026 we\\u2019re not interested in taking care of you.\\u201d
07:12 \\u201cThe incentive to have a good outcome is not there; the incentive to have another visit is there.\\u201d
08:33 \\u201cIf you don\\u2019t have any connection in that system, even the provider trying to \\u2026 provide a good outcome might be disconnected because the system is not in place to \\u2026 connect the dots.\\u201d
08:55 \\u201cThe only indictment I have on the fee-for-service system is that it\\u2019s gotten us to where we are right now.\\u201d
09:30 What are the must-haves for a value-based system that creates the patient outcomes we need?
09:58 What is a whole health model?
10:43 EP319 with Grace Terrell, MD.
11:08 EP312 with Douglas Eby, MD, MPH, CPE.
16:25 \\u201cWe want to move money around with the accountability of the patient outcome. We want to be responsible stewards of that dollar.\\u201d
17:14 What does it mean to keep an equity framework?
20:48 Do we know the impact of independent physicians closing their offices?
25:20 What do we need to be mindful of when constructing a value-based system of care?
27:52 \\u201cThe large health care system needs their community partners at the table.\\u201d

You can connect with Dr. Lypson on LinkedIn.

@mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

Is value-based care good for underserved communities? @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

\\u201cIf you create perverse incentives, you actually might make known health care disparities worse \\u2026 to meet the demands\\u2019 value.\\u201d @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

\\u201cThere actually might be systematic and structural ways that the health care system might say \\u2026 we\\u2019re not interested in taking care of you.\\u201d @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

\\u201cThe incentive to have a good outcome is not there; the incentive to have another visit is there.\\u201d @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

\\u201cThe only indictment I have on the fee-for-service system is that it\\u2019s gotten us to where we are right now.\\u201d @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

What are the must-haves for a value-based system that creates the patient outcomes we need? @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

What is a whole health model? @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

\\u201cWe want to move money around with the accountability of the patient outcome. We want to be responsible stewards of that dollar.\\u201d @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

What does it mean to keep an equity framework? @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

What do we need to be mindful of when constructing a value-based system of care? @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

\\u201cThe large health care system needs their community partners at the table.\\u201d @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

Listed in: Health

EP321: How to Point Out Low-Value Care Without Starting a Fistfight, With Rich Klasco, MD

Rich Klasco, MD, FACEP, has focused throughout his career on rendering evidence-based medicine operational\\u2014that is, making the right thing the easy thing to do. He has pursued this goal in academia, in industry, in policy, and in the press.

In addition to publishing extensively in both peer-reviewed journals such as JAMA and lay publications such as The New York Times, Dr. Klasco has taught at leading academic medical centers, including Harvard, Stanford, Mayo, and the University of California, San Francisco; served on the executive committee of Brigham and Women\\u2019s Hospital Center for Patient Safety Research and Practice; testified before the United States Congress on evidence-based practices; and won CMS approval for an officially designated compendium of evidence-based oncologic drug information. Dr. Klasco previously served as chief medical officer and editor-in-chief for the Thomson Reuters group of health care companies, where he had editorial responsibility for companies including Micromedex, the Physicians\\u2019 Desk Reference (PDR), and the United States Pharmacopoeia (USP) Drug Information.

For the past 15 years, Dr. Klasco has served as chief medical officer for Motive Medical Intelligence, where he provides clinical leadership for the development and deployment of solutions that quantitative assess physician performance for payers, providers, and patients, and integrate scientific knowledge into workflow systems where it can be accessed and applied in real-time.

Dr. Klasco received his medical degree from Harvard Medical School. He completed his internship and residency in internal medicine at Brigham and Women\\u2019s Hospital, and he completed his residency in emergency medicine at the Denver Health Residency in Emergency Medicine, where he served as chief resident.

03:31 How do you define high-value care?
04:40 How do we define what isn\\u2019t appropriate care?
05:26 Why aren\\u2019t patients good at recognizing high-value care?
07:02 \\u201cHe was in the \\u2018more is more\\u2019 school of medicine, which is always wrong.\\u201d
11:54 Are payers good at identifying high-value care?
13:41 Why are payers so adept at understanding what high-value care really is?
15:53 \\u201cIt\\u2019s not just cost cutting; it\\u2019s utilization, optimization of resources.\\u201d
16:02 \\u201cThis is, again, an innovation of appropriateness.\\u201d
18:38 \\u201cWe have to deal with the world that we have in front of us now.\\u201d
19:55 How do we get everyone on the same page about high-value and appropriate care?
24:16 How does a team recognize the path forward for appropriate care?

You can learn more at motivemi.com. For more information and the case study, please visit motivepw.com/resources. \\xa0

Rich Klasco, MD, discusses #lowvaluecare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare #vbc

How do you define high-value care? Rich Klasco, MD, discusses #lowvaluecare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare #vbc

How do we define what isn\\u2019t appropriate care? Rich Klasco, MD, discusses #lowvaluecare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare #vbc

Why aren\\u2019t patients good at recognizing high-value care? Rich Klasco, MD, discusses #lowvaluecare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare #vbc

\\u201cHe was in the \\u2018more is more\\u2019 school of medicine, which is always wrong.\\u201d Rich Klasco, MD, discusses #lowvaluecare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare #vbc

Are payers good at identifying high-value care? Rich Klasco, MD, discusses #lowvaluecare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare #vbc

Why are payers so adept at understanding what high-value care really is? Rich Klasco, MD, discusses #lowvaluecare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare #vbc

\\u201cIt\\u2019s not just cost cutting; it\\u2019s utilization, optimization of resources.\\u201d Rich Klasco, MD, discusses #lowvaluecare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare #vbc

\\u201cThis is, again, an innovation of appropriateness.\\u201d Rich Klasco, MD, discusses #lowvaluecare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare #vbc

\\u201cWe have to deal with the world that we have in front of us now.\\u201d Rich Klasco, MD, discusses #lowvaluecare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare #vbc

How do we get everyone on the same page about high-value and appropriate care? Rich Klasco, MD, discusses #lowvaluecare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare #vbc

How does a team recognize the path forward for appropriate care? Rich Klasco, MD, discusses #lowvaluecare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare #vbc

Listed in: Health

AEE15: A Sidebar Conversation About the Importance and Challenges for Health Systems to Collaborate With Pharma Manufacturers, With David Carmouche, MD, From Ochsner, a Large Health System

David Carmouche, MD, views health care from three distinct perspectives: as a physician provider, an executive for an insurance company and as a leader in a health system. Specifically, he built a large, multidisciplinary internal medicine and preventive cardiology practice in Louisiana; served as the chief medical officer for Blue Cross Blue Shield of Louisiana; and currently has a triad of responsibilities with Ochsner Health, the largest nonprofit academic health care system in the Gulf South. He was recently promoted to serve as executive vice president of value-based care and network operations in addition to his duties as president of the Ochsner Health Network and executive director of the Ochsner Accountable Care Network.

He is known as an expert in value-based care. He led one of the top 25 performing accountable care organizations in the United States, managing billions in care spend and generating millions in year-over-year shared savings.

Dr. Carmouche earned a bachelor\\u2019s degree from Tulane University and a medical degree from Louisiana State University School of Medicine in New Orleans. He completed his residency in internal medicine at the University of Alabama at Birmingham.

01:57 Why has creating collaboration across Pharma been difficult?
03:10 \\u201cIs it better over an episode of care to add a more expensive drug \\u2026 or would we be better served using less expensive drugs?\\u201d
03:51 Why has it been difficult for health systems to execute agreements directly with pharma companies?
04:36 \\u201cThe question is really just whether or not there\\u2019s enough value that\\u2019s created to make it worth our while.\\u201d

You can learn more by visiting Dr. Carmouche\\u2019s LinkedIn page or by reading From Competition to Collaboration by Tracy Duberman and Robert Sachs.\\xa0

@CarmoucheMd discusses #healthsystem #collaboration with #pharmamanufacturers on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

Why has creating collaboration across Pharma been difficult? @CarmoucheMd discusses #healthsystem #collaboration with #pharmamanufacturers on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

\\u201cIs it better over an episode of care to add a more expensive drug \\u2026 or would we be better served using less expensive drugs?\\u201d @CarmoucheMd discusses #healthsystem #collaboration with #pharmamanufacturers on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

Why has it been difficult for health systems to execute agreements directly with pharma companies? @CarmoucheMd discusses #healthsystem #collaboration with #pharmamanufacturers on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

\\u201cThe question is really just whether or not there\\u2019s enough value that\\u2019s created to make it worth our while.\\u201d @CarmoucheMd discusses #healthsystem #collaboration with #pharmamanufacturers on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

Listed in: Health

EP320: Is Telehealth vs In-Person Care Like Some Kind of Winner-Takes-All Cage Fight? With Christian Milaster From Ingenium

Christian Milaster optimizes telehealth services for health systems and physician practices. He serves as a digital health and telehealth advisor to start-ups and established digital health companies. Christian is a master builder of digital health and telehealth programs and is the founder and president of Ingenium Digital Health Advisors, a boutique consultancy focused on enabling the effective delivery of extraordinary care through workflow optimization and the judicious use of technology.

Born, raised, and educated as an engineer in Germany, Christian started his career at IBM Global Services before joining the Mayo Clinic in Minnesota, where he worked for 12 years in various roles before launching Ingenium in 2012.

06:53 What\\u2019s the biggest mistake provider organizations are making in regard to telehealth right now
08:50 Is there a downside to not investing more in telehealth?
12:28 \\u201cThere\\u2019s no more geographic boundaries.\\u201d
15:25 What\\u2019s a provider organization\\u2019s first step in making telehealth a cornerstone of care?
17:20 Why is organizational change management essential to incorporating telehealth?
19:00 \\u201cEverybody involved in the in-person care experience needs to be involved and play a role in the virtual care experience as well.\\u201d
19:22 What does the patient flow look like for organizations that do telehealth well?
21:12 How does an organization use telehealth as a strategic tool?
23:55 \\u201cTelehealth gives us an opportunity to redesign the workflow of the care delivery experience.\\u201d
24:38 How is the provider reimbursed in telehealth?
26:29 \\u201cIt\\u2019s really about the outcomes and it\\u2019s about value-based care \\u2026 when I can just wield telemedicine \\u2026 as a clinical tool.\\u201d
28:19 \\u201cTelemedicine \\u2026 is vital for value-based care; it\\u2019s vital for better patient outcomes.\\u201d

You can learn more at ingeniumdigitalhealth.com and connect with Christian on LinkedIn.\\xa0

@HealthChrism discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #telemedicine

What\\u2019s the biggest mistake #providerorganizations are making in regard to telehealth right now? @HealthChrism discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #telemedicine

Is there a downside to not investing more in telehealth? @HealthChrism discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #telemedicine

\\u201cThere\\u2019s no more geographic boundaries.\\u201d @HealthChrism discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #telemedicine

What\\u2019s a #providerorganization\\u2019s first step in making telehealth a cornerstone of care? @HealthChrism discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #telemedicine

Why is organizational change management essential to incorporating telehealth? @HealthChrism discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #telemedicine

\\u201cEverybody involved in the in-person care experience needs to be involved and play a role in the virtual care experience as well.\\u201d @HealthChrism discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #telemedicine

What does the patient flow look like for organizations that do telehealth well? @HealthChrism discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #telemedicine

How does an organization use telehealth as a strategic tool? @HealthChrism discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #telemedicine

\\u201cTelehealth gives us an opportunity to redesign the workflow of the care delivery experience.\\u201d @HealthChrism discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #telemedicine

How is the provider reimbursed in telehealth? @HealthChrism discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #telemedicine

\\u201cTelemedicine \\u2026 is vital for value-based care; it\\u2019s vital for better patient outcomes.\\u201d @HealthChrism discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #telemedicine

Listed in: Health

EP319: How Do We Improve Outcomes in Skilled Nursing and Also Assisted Living Facilities? With Grace Terrell, MD

Grace E. Terrell, MD, MMM, is CEO of Eventus WholeHealth, a company focused on integrated value-based behavioral medicine and primary care in the long-term care space. She is a national thought leader in health care innovation and delivery system reform and a serial entrepreneur in population health outcomes driven through patient care model design, clinical and information integration, and value-based payment models. She is the former CEO of Cornerstone Health Care, one of the first medical groups to make the \\u201cmove to value\\u201d by lowering the cost of care and improving its quality for the sickest, most vulnerable patients; the founding CEO of CHESS, a population health management company; and the former CEO of Envision Genomics, a company focused on the integration of precision medicine technology into population health frameworks for patients with rare and undiagnosed diseases. Dr. Terrell currently serves on the US Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee and the board of the AMGA (American Medical Group Association), is a founding member of the Oliver Wyman Health Innovation Center, and is the coauthor of Value-Based Healthcare and Payment Models.

04:09 \\u201cThe industry itself is in a real pickle.\\u201d
04:49 What are the fiscal opportunities that a SNF might have in a value-based care model?
09:34 What\\u2019s the basic principle that needs to be true to provide the best care possible in a SNF environment?
11:05 How does whole-person care work?
15:51 \\u201cIt does require integrative care; it does require somebody \\u2026 to be steering the ship.\\u201d
18:53 \\u201cThis population doesn\\u2019t necessarily do well with the typical medications that are prescribed \\u2026 by a specialist.\\u201d
20:49 \\u201cMost of us in health care \\u2026 don\\u2019t have the opportunity to build something from the ground up. You have to work in the system that you\\u2019re in.\\u201d
23:10 \\u201cMore and more people are thinking about integrative models of care.\\u201d
27:50 \\u201cIntegrated care is very much based on \\u2026 access to information, access to communication capabilities, the ability to know what the patient wants, \\u2026 and the skills to actually provide them good care.\\u201d
29:27 \\u201cOnce you get past critical thinking and get into \\u2026 creative thinking, you\\u2019ll find that there\\u2019s just a ton of folks out there who want to be with you, who want to create with you.\\u201d

You can learn more at eventuswholehealth.com and follow Dr. Terrell on Twitter.

@gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThe industry itself is in a real pickle.\\u201d @gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What are the fiscal opportunities that a #SNF might have in a value-based care model? @gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What\\u2019s the basic principle that needs to be true to provide the best care possible in a #SNF environment? @gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How does whole-person care work? @gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cIt does require integrative care; it does require somebody \\u2026 to be steering the ship.\\u201d @gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cThis population doesn\\u2019t necessarily do well with the typical medications that are prescribed \\u2026 by a specialist.\\u201d @gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cMore and more people are thinking about integrative models of care.\\u201d @gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\\u201cOnce you get past critical thinking and get into \\u2026 creative thinking, you\\u2019ll find that there\\u2019s just a ton of folks out there who want to be with you, who want to create with you.\\u201d @gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Listed in: Health

EP318: A Primer for Pharma Looking to Collaborate With Health Systems, From the Point of View of Troy Larsgard, a Pharmaceutical Category Manager at Johns Hopkins

Troy Larsgard is a health care professional specializing in pharmacy supply chain. After working six years at Intermountain Healthcare in Salt Lake City, Utah, he joined The Johns Hopkins Health System Corporation in Baltimore, Maryland, in January 2020. One of his most rewarding career experiences is taking an active role with key stakeholders in planning for and operationalizing the COVID-19 vaccine at Johns Hopkins.

After thousands of meetings, proposals, and presentations from pharmaceutical companies, he is convinced there are better ways suppliers can work strategically with large health systems. He welcomes forward-thinking ideas and engagements to move beyond the transactional and create strategic alliances and value-added opportunities. He has put this philosophy to practice helping to remove barriers and working together with suppliers to make industry changes.

04:16 What\\u2019s the rationale behind trimming the supplier list for pharmacists?
05:35 What\\u2019s the difference between a strategic model and a tactical model?
06:49 \\u201cA lot of effort goes into developing drugs and bringing them to market, but sometimes the thought of how to interact with the health system beyond that isn\\u2019t always thought out.\\u201d
09:06 \\u201cI think there\\u2019s opportunity to be more seamless.\\u201d
10:48 \\u201cThose who inform early, often, and are transparent \\u2026 save much more face.\\u201d
11:04 What do account managers need to know about health systems and vice versa for them to work together?
14:15 How do drugs on formulary fall into these pharma/health system collaborations?
16:46 How do physicians know when a drug is on formulary?
19:32 Are downstream medical costs being assessed?
21:29 Why would a health system choose to collaborate with a pharmaceutical company in this system?
22:31 \\u201cWhat does partnership mean to you?\\u201d
26:15 \\u201cOutcomes-based contracts sometimes are called risk share, and I like to joke sometimes it\\u2019s all risk, no share.\\u201d

You can connect with Troy on LinkedIn.

Troy Larsgard of @HopkinsMedicine talks #pharmacollabs with #healthsystems on our #healthcarepodcast. #healthcare #podcast #digitalhealth #drugpricing #pharma

What\\u2019s the rationale behind trimming the supplier list for pharmacists? Troy Larsgard of @HopkinsMedicine talks #pharmacollabs with #healthsystems on our #healthcarepodcast. #healthcare #podcast #digitalhealth #drugpricing #pharma

What\\u2019s the difference between a strategic model and a tactical model? Troy Larsgard of @HopkinsMedicine talks #pharmacollabs with #healthsystems on our #healthcarepodcast. #healthcare #podcast #digitalhealth #drugpricing #pharma

\\u201cA lot of effort goes into developing drugs and bringing them to market, but sometimes the thought of how to interact with the health system beyond that isn\\u2019t always thought out.\\u201d Troy Larsgard of @HopkinsMedicine talks #pharmacollabs with #healthsystems on our #healthcarepodcast. #healthcare #podcast #digitalhealth #drugpricing #pharma

\\u201cI think there\\u2019s opportunity to be more seamless.\\u201d Troy Larsgard of @HopkinsMedicine talks #pharmacollabs with #healthsystems on our #healthcarepodcast. #healthcare #podcast #digitalhealth #drugpricing #pharma

\\u201cThose who inform early, often, and are transparent \\u2026 save much more face.\\u201d Troy Larsgard of @HopkinsMedicine talks #pharmacollabs with #healthsystems on our #healthcarepodcast. #healthcare #podcast #digitalhealth #drugpricing #pharma

Are downstream medical costs being assessed? Troy Larsgard of @HopkinsMedicine talks #pharmacollabs with #healthsystems on our #healthcarepodcast. #healthcare #podcast #digitalhealth #drugpricing #pharma

"What does partnership mean to you?" Troy Larsgard of @HopkinsMedicine talks #pharmacollabs with #healthsystems on our #healthcarepodcast. #healthcare #podcast #digitalhealth #drugpricing #pharma

Listed in: Health

EP317: Wait, the Latest Action on Drug Pricing Reform Can Be Found in the Infrastructure Bill? With Josh LaRosa, MPP, Policy Director, Wynne Health Group

Josh LaRosa, MPP, is a policy director at Wynne Health Group, focusing primarily on regulatory affairs with a focus on the US Food & Drug Administration (FDA) and Centers for Medicare & Medicaid Services (CMS). His interests lie in delivery reform and innovations in payment and care delivery models. Josh also supports the firm\\u2019s Public Option Institute, which studies the emergence of public option programs at the state level.

Prior to Wynne Health Group, Josh consulted for the CMS Innovation Center, where he worked to implement, monitor, and spread learning garnered from the center\\u2019s high-profile demonstration projects, most recently including the national primary care redesign effort, Comprehensive Primary Care Plus (CPC+).

Josh holds a Master of Public Policy from the University of Virginia\\u2019s Frank Batten School of Leadership and Public Policy. He also completed his undergraduate studies at the University of Virginia, graduating cum laude with a BA in political philosophy, policy, and law.

02:56 Where are we on drug pricing reform in legislation?
05:06 What things have the greatest potential for consideration on drug pricing reform legislation?
06:07 How is the Part D benefit design and reform shaping up?
07:55 Who is one of the largest offenders of high federal spending?
09:15 Who is going to pay in the reform of the catastrophic pricing phase?
12:04 What are inflation rebates?
15:36 \\u201cThe interesting part of the inflation rebates \\u2026 is that it not only \\u2026 had these inflation rebates as applying to \\u2026 Medicare Part D drugs but also Medicare Part B \\u2026 drugs.\\u201d
16:20 How likely is this reform?
18:43 What\\u2019s happening on the regulatory and administrative side of drug pricing?
24:23 When will we start to see what the White House intends to do about drug reform pricing?

You can learn more at wynnehealth.com or by following on Twitter and LinkedIn.\\xa0

@josh_larosa of @WynneHealth talks #drugpricingreform on our #healthcarepodcast. #healthcare #podcast #digitalhealth #drugpricing #pharma

Where are we on drug pricing reform in legislation? @josh_larosa of @WynneHealth talks #drugpricingreform on our #healthcarepodcast. #healthcare #podcast #digitalhealth #drugpricing #pharma

What things have the greatest potential for consideration on drug pricing reform legislation? @josh_larosa of @WynneHealth talks #drugpricingreform on our #healthcarepodcast. #healthcare #podcast #digitalhealth #drugpricing #pharma

How is the Part D benefit design and reform shaping up? @josh_larosa of @WynneHealth talks #drugpricingreform on our #healthcarepodcast. #healthcare #podcast #digitalhealth #drugpricing #pharma

Who is one of the largest offenders of high federal spending? @josh_larosa of @WynneHealth talks #drugpricingreform on our #healthcarepodcast. #healthcare #podcast #digitalhealth #drugpricing #pharma

Who is going to pay in the reform of the catastrophic pricing phase? @josh_larosa of @WynneHealth talks #drugpricingreform on our #healthcarepodcast. #healthcare #podcast #digitalhealth #drugpricing #pharma

What are inflation rebates? @josh_larosa of @WynneHealth talks #drugpricingreform on our #healthcarepodcast. #healthcare #podcast #digitalhealth #drugpricing #pharma

How likely is this latest drug pricing reform? @josh_larosa of @WynneHealth talks #drugpricingreform on our #healthcarepodcast. #healthcare #podcast #digitalhealth #drugpricing #pharma

What\\u2019s happening on the regulatory and administrative side of drug pricing? @josh_larosa of @WynneHealth talks #drugpricingreform on our #healthcarepodcast. #healthcare #podcast #digitalhealth #drugpricing #pharma

Listed in: Health

EP316: Unexpectedly Talking About Employers, With David Carmouche, MD, From Ochsner, a Large Health System

David Carmouche, MD, views health care from three distinct perspectives: as a physician provider, an executive for an insurance company and as a leader in a health system. Specifically, he built a large, multidisciplinary internal medicine and preventive cardiology practice in Louisiana; served as the chief medical officer for Blue Cross Blue Shield of Louisiana; and currently has a triad of responsibilities with Ochsner Health, the largest nonprofit academic health care system in the Gulf South. He was recently promoted to serve as executive vice president of value-based care and network operations in addition to his duties as president of the Ochsner Health Network and executive director of the Ochsner Accountable Care Network.

He is known as an expert in value-based care. He led one of the top 25 performing accountable care organizations in the United States, managing billions in care spend and generating millions in year-over-year shared savings.

Dr. Carmouche earned a bachelor\\u2019s degree from Tulane University and a medical degree from Louisiana State University School of Medicine in New Orleans. He completed his residency in internal medicine at the University of Alabama at Birmingham.

04:15 Who needs to be working together to create value-based success?
04:31 \\u201cI think the most important partnerships that are likely to lead to value are those between payers or purchasers \\u2026 and providers.\\u201d
04:45 What four things have to come together for meaningful value?
06:02 \\u201cWe\\u2019re focusing specifically on payer employers today. We think that\\u2019s where there\\u2019s the biggest opportunity.\\u201d
07:23 What\\u2019s the overarching reason for health systems to want to grow their commercial market share?
14:00 Is the competition moving upstream?
16:20 \\u201cIn all honesty, we\\u2019re competing for pieces of the business.\\u201d
16:23 What\\u2019s the ultimate competition?
18:36 \\u201cThere is a consumer experience that is available inside these \\u2026 collaborative efforts.\\u201d
20:53 \\u201cWe really haven\\u2019t changed the paradigm of benefit design as it comes to drugs.\\u201d

You can learn more by visiting Dr. Carmouche\\u2019s LinkedIn\\xa0page or by reading From Competition to Collaboration by Tracy Duberman and Robert Sachs.\\xa0

@CarmoucheMd talks #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystems #vbc #valuebasedcare

Who needs to be working together to create value-based success? @CarmoucheMd talks #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystems #vbc #valuebasedcare

\\u201cI think the most important partnerships that are likely to lead to value are those between payers or purchasers \\u2026 and providers.\\u201d @CarmoucheMd talks #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystems #vbc #valuebasedcare

What four things have to come together for meaningful value? @CarmoucheMd talks #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystems #vbc #valuebasedcare

\\u201cWe\\u2019re focusing specifically on payer employers today. We think that\\u2019s where there\\u2019s the biggest opportunity.\\u201d @CarmoucheMd talks #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystems #vbc #valuebasedcare

What\\u2019s the overarching reason for health systems to want to grow their commercial market share? @CarmoucheMd talks #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystems #vbc #valuebasedcare

Is the competition moving upstream? @CarmoucheMd talks #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystems #vbc #valuebasedcare

\\u201cIn all honesty, we\\u2019re competing for pieces of the business.\\u201d @CarmoucheMd talks #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystems #vbc #valuebasedcare

\\u201cThere is a consumer experience that is available inside these \\u2026 collaborative efforts.\\u201d @CarmoucheMd talks #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthsystems #vbc #valuebasedcare

\\xa0

Listed in: Health

EP315: The Very Unsexy Essential for Technology to Drive Outcomes That Nobody Talks About, With Bob Matthews

Bob Matthews is president and CEO of MediSync. Bob has led multiple medical groups over 20 years. He is Black Belt trained in the Six Sigma quality methods. The MediSync team creates sophisticated processes and AI technologies to enable physicians to achieve best-in-the-nation clinical outcomes, especially in chronic disease management.

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04:47 How do you address concerns about chronic care costs?
06:15 What are the disjunctures in the health system?
07:01 \\u201cVery few organizations today know how to do a great job in managing [chronic care].\\u201d
09:58 \\u201cSome medical group organizations \\u2026 put the pressure on, but they don\\u2019t offer much help.\\u201d
10:09 \\u201cThere\\u2019s something inherently difficult about the work, or we wouldn\\u2019t have this problem.\\u201d
10:44 What is the increasing pressure on practices to manage chronic conditions?
11:51 \\u201cWe just simply cannot afford to get the outcomes we need with the system we have.\\u201d
13:37 \\u201cThe pressure to improve outcomes is just really now starting to heat up.\\u201d
14:00 What things need to be focused on to improve outcomes?
17:32 \\u201cThe only thing you get rewarded for is speed.\\u201d
19:20 \\u201cJust because you start the journey doesn\\u2019t mean that you\\u2019re going to succeed.\\u201d
23:18 \\u201cComplexity can only be mastered with process.\\u201d
25:38 \\u201cWe do need to work on ways to help patients want to take their own medicines.\\u201d
29:21 Who is MediSync?

You can learn more at medisync.com.\\xa0

Bob Matthews of @MediSyncHealth talks #medtech on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

How do you address concerns about chronic care costs? Bob Matthews of @MediSyncHealth talks #medtech on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

\\u201cVery few organizations today know how to do a great job in managing [chronic care].\\u201d Bob Matthews of @MediSyncHealth talks #medtech on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

\\u201cSome medical group organizations \\u2026 put the pressure on, but they don\\u2019t offer much help.\\u201d Bob Matthews of @MediSyncHealth talks #medtech on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

What is the increasing pressure on practices to manage chronic conditions? Bob Matthews of @MediSyncHealth talks #medtech on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

\\u201cWe just simply cannot afford to get the outcomes we need with the system we have.\\u201d Bob Matthews of @MediSyncHealth talks #medtech on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

What things need to be focused on to improve outcomes? Bob Matthews of @MediSyncHealth talks #medtech on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

\\u201cComplexity can only be mastered with process.\\u201d Bob Matthews of @MediSyncHealth talks #medtech on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

Listed in: Health

AEE14: A Short Lesson for Self-insured Employers: Dr. Doug Eby Gives Some Advice That Everybody Should Hear Who Is Interested in Improving Outcomes and Lowering Costs, With Douglas Eby, MD, MPH, CPE

Douglas K. Eby, MD, MPH, CPE, is vice president of medical services for Southcentral Foundation\\u2019s Malcolm Baldrige Award\\u2013winning Nuka System of Care. Doug is a physician executive who has done extensive work with the Institute for Healthcare Improvement and other organizations around the Triple Aim, accountable care organizations (ACOs), patient-centered medical homes, whole system transformation, workforce, cultural competency, health disparities, and other topics. His speaking and consulting include work across the US, Canada, and portions of Europe and the South Pacific. Doug has spent more than 20 years working in support of Alaska Native leadership as they created a very innovative integrated system of care that has significantly improved health outcomes. Doug received his medical degree from the University of Cincinnati in Ohio and his master\\u2019s in public health degree from the University of Hawaii.

03:19 \\u201cThe employer is the total-cost provider.\\u201d
03:23 \\u201cThe people who don\\u2019t like us are people who are trying to make profits \\u2026 extremely high use of high-end medicine.\\u201d
03:47 \\u201cHealth care, for chronic disease management, should be provided when, where, and how the person on the receiving side wants and needs it.\\u201d
07:05 \\u201cPeople think demand is driven by \\u2026 paranoia \\u2026 but when you replace all of that by trust \\u2026 that\\u2019s a massive replacement for all of that other stuff.\\u201d

You can learn more at southcentralfoundation.com.

@deby59 of @SCFinsider discusses #selfinsuredemployers on our #AEE #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth

\\u201cThe employer is the total-cost provider.\\u201d @deby59 of @SCFinsider discusses #selfinsuredemployers on our #AEE #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth

\\u201cThe people who don\\u2019t like us are people who are trying to make profits \\u2026 extremely high use of high-end medicine.\\u201d @deby59 of @SCFinsider discusses #selfinsuredemployers on our #AEE #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth

\\u201cHealth care, for chronic disease management, should be provided when, where, and how the person on the receiving side wants and needs it.\\u201d @deby59 of @SCFinsider discusses #selfinsuredemployers on our #AEE #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth

\\u201cPeople think demand is driven by \\u2026 paranoia \\u2026 but when you replace all of that by trust \\u2026 that\\u2019s a massive replacement for all of that other stuff.\\u201d @deby59 of @SCFinsider discusses #selfinsuredemployers on our #AEE #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth

Listed in: Health

EP314: Why Do SNF (Skilled Nursing Facility) Patients Need Two Pharmacies and a PBM? Following the Kinda Long Long-term Care Pharmaceutical Supply Chain, With Sheldon Weiss, MD

Sheldon Weiss, MD, practiced OB/GYN for over 30 years and has a master\\u2019s degree in health care management from the Harvard School of Public Health. He was the chief strategy officer for Indiana University Health system for 5 years and was the chief operating officer of a long-term care pharmacy for 2 years. He now does consulting for operational efficiencies in the health care space and has founded a start-up company focused on developing a health care record interoperability solution.

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04:19 What\\u2019s the role of a wholesale pharmacy in a SNF?
04:48 What\\u2019s the connection between a wholesale pharmacy, a long-term care pharmacy, and a retail pharmacy?
07:00 Why does a SNF need two players? Why can\\u2019t a long-term pharmacy also take on the role of the wholesale pharmacy?
09:43 Why don\\u2019t long-term care pharmacies negotiate directly with PBMs?
10:02 \\u201cThe key for \\u2026 getting the best prices for medications is on volume.\\u201d
10:11 Who are these wholesale pharmacies negotiating the best prices?
11:19 \\u201cThe goal of driving health care costs down by helping out the residents is a good model.\\u201d
13:43 \\u201cUltimately the resident gets the same quality of medication, but yet it\\u2019s at a much more reasonable price.\\u201d
14:35 How does overmedication happen in the long-term care pharmacy model?
15:19 \\u201cThe lower the amount of medicines, the less the chances of someone to become overmedicated.\\u201d
17:50 \\u201cI would think that most of the time it\\u2019s subtractive.\\u201d
19:00 \\u201cThe idea in health care should be and is \\u2026 that we only prescribe medications that are necessary.\\u201d
20:26 How does aging in place impact pharmacy?
22:11 \\u201cWhen you\\u2019re aging at home, there\\u2019s no one there looking out for you like a consultant pharmacist.\\u201d
24:39 How do we make aging in place safer from a pharmacy perspective?
25:58 \\u201cPhysicians are very intelligent, but they tend to know their medications in their field.\\u201d
26:21 \\u201cAnything that increases the multidisciplinary approach model is going to benefit the patient.\\u201d
27:10 \\u201cThe cost of medicine and the outcome of medicine really don\\u2019t equate.\\u201d