Business of Healthcare

Gautam Shrikhande, MD, Chief Executive Officer of Pelvic Rehabilitation Medicine and Brian Rath, Partner, Lorient Capital join Business of Healthcare to explore the role of private equity in physician services. Physicians want to serve patients with the highest value care at the best cost while being fairly compensated.  Growth is a sign of a healthy, well-run practice. Ethical medical groups attract patients and increase revenue per patient by providing better outcomes, patient experience, and value as compared to local alternatives.  Some practices of these practices are choosing private equity to fund growth. As a source of capital, is private equity better at supporting growth?  Does a practice taking PE investment run the risk of overly aggressive patient recruitment and billing? Do private equity partners help practices engage the right patients for growth? We learn how one of these practices, PRM, partnered up with a PE firm to achieve velocity and growth.  We look at the investment hypothesis, how they find the right patients for their services, how outcomes are measured and the role PE has with physician leaders.

You may think Patient Experience is a straightforward discipline. Cathy Lee, Corporate Vice President for Patient Experience, joins BOH host Matthew Hanis to explain the lenses of a modern patient experience program and her innovations in the space.

Digital ethnography observes healthcare decision making on community message boards. These insights bring a more distinct ‘voice of the customer’ to shape marketing and service delivery. Health system marketing leader Jeff T. House and digital ethnography Dean Browell, Ph.D. join BOH host Matthew Hanis to explain how digital ethnographic research is applied and some of the surprising insights which have emerged.

Why are marketing tools, techniques and approaches so important to transforming healthcare? In his BOH interview, Zeev Neuwirth, MD says, “The field, in my estimation, that really understands what people want and need is the field of marketing.” An Atrium Health clinical executive and author of recently published Reframing healthcare - roadmap for creating disruptive change, Neuwirth describes the ‘marketing mindset’, stages systems go through embracing these techniques, the threat marketing experts Google, Amazon and CVS bring and the implications for payment reform, digital health and chronic disease management. Interview filmed in partnership with the Society for Healthcare Strategy and Market Development (SHSMD) and sponsored by MedChat. MedChat provides LiveChat, Bots and text tools for a modern digital front door www.medchatapp.com

Can health systems engage consumers digitally to improve quality, cost and satisfaction? According to Mark Jannone, Senior Director, Banner Health’s Banner Innovation Group, the answer is a solid, “Yes.” He is helping to pilot digital ED triage and chatbot tools. Jannone reports the tools achieve a 35% reduction in inappropriate ED cases with 92% triage accuracy, decrease the time patients are in the ED by about 50% and increase net promoter scores by 40%. Full interview at BOHseries.com. This Business of Healthcare interview sponsored by MedChat: improving patient access with secure LiveChat, Bots & text tools. See www.medchatapp.com.

“No outcome, no income,” says Dr. David Nash, Founding Dean Emeritus, Jefferson College of Population Health. JCPH is the nation’s first graduate school of population health. Nash describes the emergence of the population health movement, why fixing the US healthcare system is so important for our economy and our society, and concrete interventions such as going at risk with supply chain partners such as pharma. See YouTube for video highlights and Full video interview  

Karen L. Smith MD, FAAFP kept discovering opioid addiction in the families she served in her independent, rural primary care practice. With growing need and few referral options, Smith began providing medication-assisted treatment. MAT uses medication, counseling and behavioral therapies to treat substance use disorders and sustain recovery. Smith shares patient stories which led her to take on this challenge and the barriers a physician must overcome to provide MAT.

In 2016, Wilmington, NC had the highest concentration of opioid use disorder among US cities. Community leaders including regional health system chief physician executive Philip M. Brown, MD, FACS helped intervene in this public health epidemic. Brown describes the moment a national report triggered awareness of the local opioid epidemic. He and his fellow leaders undertook multi-faceted interventions to change prescribing habits, impact social determinants and, most importantly, de-stigmatize addiction.

When a med mal claim emerges from patient injury, we may debate who’s liable but we can agree something undesirable happened. Mark Reynolds leads CRICO, the Risk Management Foundation of the Harvard Medical Institutions, a captive insurance program. CRICO, in addition to serving its members’ medical professional liability insurance and other needs, also provides a comparative database with 30% of U.S. MPL claims. Reynolds shares insights from this 30+ year dataset of clinical and financial data which CRICO uses to identify & propagate root cause interventions. What insights do medical malpractice claims offer to improve the Mission & Margin of healthcare? These data are one of the richest insights into U.S. healthcare quality & safety.

Physician entrepreneur Brian Alper, MD explores shared decision making as an intervention improving patient safety, patient satisfaction and financial outcomes. John Gillean, MD, MHA, EVP & Chief Clinical Officer for CHRISTUS Health shares his perspective on the patient safety and quality implications.

CHRISTUS chief clinical officer John Gillean, MD, MHA, among his many responsibilities, guides his organization’s insurance captive to reduce operating costs and improve patient safety. While supporting the system’s core patient care mission, this lowered total system cost of risk from $100 million to $50 million. Now focused on emerging risks such as natural disaster, cyber security, active shooter and pandemic, Gillean is helping wrestle the tsunami of data created in patient care to further advance mission & margin goals.

Larry Smith and Rachel Leyko of MedStar Health explain Early Intervention, their journeys to advocacy and evidence of lowers costs and better outcomes for patients, families and clinicians.  Medical error resulting in patient injury may lead healthcare personnel to withdraw from patients and withhold information for fear of litigation.  Early Intervention is an alternative approach in which physicians and health system staff quickly acknowledge an injury has occurred.  By providing immediate assistance (without accepting blame) when not clearly at fault, patients are more collaborative than adversarial, and prompt medical care lessens future harm.

Becky Gernon, MD of Blue Cross and Blue Shield of Kansas City and Peggy DeCarlis, recently retired from New Directions Behavioral Health, report on integrating behavioral health into primary care clinics and their recently published results showing 10.8% population health cost savings. Deployed through Blue KC's Spira Care Clinics, the project also showed reduction in physician burnout which Gernon attributes in part to the integrated behavioral health clinicians helping with medically complex patients.

Medical professional liability insurance premiums may rise and cyber security may become a factor.  Leading MPL underwriting expert Nat Cross, Beazley Group’s Healthcare Leader, forecasts premium trends and explains the drivers.  Cyber security may be an emerging MPL risk as internet-connected biomedical devices such as infusion pumps become subject to cyber-attacks.  Compliance and information security expert Jon Moore explains this emerging MPL risk. Interview underwriters include Cayman International Insurance, host of the Cayman Captive Forum, Clearwater, a provider of cyber risk management solutions, and EBSCO Health, an evidence-based provider of clinical decision support solutions.

Michelle Johns, Chief Risk Officer of IU Health and Bob Chaput, Executive Chairman of Clearwater discuss their innovative work benchmarking risk within and between large health systems.  They also explore why insurance captives have become so strategically important to patient safety innovation. 

Mike Hakimian explains a hardening market in medical malpractice insurance.  He describes current conditions and evidence suggesting premiums will rise. Brian Alper, MD describes patient decision aids which could elevate patient satisfaction and relieve some pressure insurance premiums by reducing the likelihood of claims. Recorded at the Cayman Captive Forum hosted by the Insurance Managers Association of Cayman.    

Dr. Jim Stefansic of Raiven Healthcare describes how payers and providers can use artificial intelligence algorithms to optimize treatment plans, medical spending and patient outcomes. Raiven’s AI algorithms, based on a large patient database from Centerstone and AI technology from Indiana University, assists providers in making treatment decisions and then uses resulting patient outcomes in a continuous learning cycle.

Wilmington Health CEO Jeff James describes how they help large employers achieve better cost and quality in self-funded employee health plans.  Recorded as part of a series underwritten by the North Carolina Medical Group Management Association and Mako Medical Laboratories.

Mako Medical Laboratories Founder & CEO Chad Price describes how his company came to serving physicians and take on LabCorp and Quest in the $75 billion lab services industry. MGMA members may receive CEU credit by watching, listening or reading the full interview.

Therapist and psychotherapy practice owner Staci Connolly recently deployed a digital diagnostic tool for patients.  She anticipates the tool will accelerate diagnosis and measure patient progress in treatment, providing data she believes insurers will soon require.  Connolly also founded The Digital Education Project to educate families on the healthy use of digital devices.  Underwriters New Directions Behavioral Health, Foothold Technology, VPAC Clinical and Raiven Healthcare made this interview possible.

Mandy Cohen, MD, MPH, North Carolina Sec. of the Department of Health and Human Services, joins BOH host Matthew Hanis for a live interview in front of 200 NC physician practice leaders. That same day, bids were due for the conversion of 1.6 million NC Medicaid beneficiaries to managed care. Previously, Cohen helped resuscitate the federal ACA insurance exchange platform healthcare.gov and helped innovate federal alternative payment models such as bundle payments and MSSP accountable care organizations.

Cigna behavioral health leader William Lopez, MD, CPE describe efforts to prove better access to behavioral health services reduces total medical spending in commercial populations. The team is helping physician practices integrate behavioral health services in a financially-sustainable manner.

David C. Guth, Jr., Co-Founder & CEO of Centerstone and Marlowe Greenberg, MPP, Founder & CEO of Foothold Technology join BOH host Matthew E. Hanis to discuss driving better patient outcomes through data integration across behavioral, social and medical services.

David B. Nash, MD, MBA is founding dean of the Jefferson College of Population Health, one of the first programs granting Master and Doctoral degrees in population health topics. Interview explores the value of population health graduate programs and advancing population health or, as Nash says, “Shut off the faucet, instead of mopping up the floor.”

Cardiologist and Tryon Medical Partners CEO Dale Owen, MD led 88 physicians in separating their practice from a large health system.  He joins Business of Healthcare host Matthew E. Hanis to discuss why he and his partners sought to return to independent practice, his vision for taking on population health risk and the tactical challenges standing up a 75,000-patient practice in weeks.

Learn the most important traits being nurtured in future healthcare leaders by organizations leading the transformation of healthcare.  “Anyone going into healthcare leadership should know that we should be putting ourselves out of business,” shares Kevin Mahoney of Penn Medicine.  “As we work with clients on mitigating risk, on how GE Healthcare can share in that risk, our leadership approach helps us cross the chasm of trust a little bit faster,” reflects Joe Gasque of GE Healthcare.  

Gary Filerman, Ph.D., influential researcher and long-time advocate for formalized healthcare management education, argues the US middle class will ultimately vote for universal healthcare coverage as a means to lower out-of-pocket costs and waste. This would lead to massive disruption in the current healthcare sector and an enormous set of moral and ethical decisions for emerging healthcare leaders. 

Dr. Lloyd Sederer, a Professor, Columbia Public Health School, medical journalist, book/film/TV reviewer and the Chief Medical Officer for the $4 billion New York State Office of Mental Health advocates for his approach to the addiction and mental health crisis in our country. Sederer’s public health approach is described in his recently published book, The Addiction Solution: Treating Our Dependence on Opioids and Other Drugs. Sederer joined BOH host Matthew Hanis during NATCON18.

The diagnostic laboratory industry is undergoing major change and innovation.  Lab business expert Andy Olen (Siemens Healthineers) joins Business of Healthcare host Matthew Hanis to discuss current trends and the emerging ‘fee-for-value’ lab business model.  He also discusses his new book, The Trilogy of Yes, in which he observes that great sales people apply ‘Communication, Connection, and Cooperation’ across cultures to generate ‘win-win’ results.

 Guests Joe Wilkins (Atlantic Health) and Joe Gasque (GE Healthcare) share the leadership characteristics and innovations supporting the Healthy Communities movement, an effort to target persistent barriers to people living the healthiest life possible wherever they live.  Both organizations have proven commitment to this effort through formal innovation programs and through the traits they seek and nurture in emerging healthcare leaders.

Shelly Buck (WellSpan Health) and Joe Gasque (GE Healthcare) discuss ways they nurture inclusiveness in emerging leaders.  As healthcare continues to rapidly evolve, inclusiveness is critical for emerging leaders.  Inclusive leadership seeks not so much to guard against discrimination as it does to harness differences in age, culture, origin, and experience as competitive advantage.  This interview was made possible by GE Healthcare, the Commission on the Accreditation of Healthcare Management Education, Saint Louis University, and the Jefferson College of Population Health.

Captive insurance is an alternative to commercial insurance for professional liability, property, workers comp, etc.  In addition to self-insuring risks, Captives also invest to reduce losses. Providers now use captives for other risks such as employee health plans and managed care risk.  Guests explore why Cyber risk may be suited for captives. Rebecca Cady, Esp., BSN Vice President and Chief Risk Officer for Children’s National Health System Bob Chaput, CISSP, HCISSP, CRISC, CIPP/US Founder & Chairman of Clearwater

“I never set out to work in addictions, but I lost my best friend to a heroin overdose,” shares Omar Manejwala, MD in his BOH interview. That tragedy ultimately led Manejwala to his current role as Senior Vice President and Chief Medical Officer of Catasys, Inc. which he describes as “solving the hidden problem of untreated behavioral health conditions.” Manejwala describes his journey and the Catasys proven value proposition for health plans. Catasys has accumulated evidence proving efficacy.  The marketplace has responded positively with five of the top 8 health plans already utilizing their capabilities

As health systems take on more ‘fee-for-value’ arrangements, their strategic suppliers may share the risk.  Joe Gasque, a senior leader from GE Healthcare North America, shares GE’s shared risk arrangements in their journey to be a “leading provider of outcomes” and impact on hiring and training field team members.  Brad Ansley, Founder and Director of SPI Health, returns to talk about preparing sales team members and others for this new value-driven paradigm.

Scott Green (Netsmart) and Tom Petrizzo (Tri-County Mental Health Services) to learn about emerging outcomes, and innovation, from Certified Community Behavioral Health Clinics (CCBHC) pilots.

Digital is disrupting pharmaceutical companies at their very core: product development and commercial operations.  We explore this with two leaders deep in the thick of transforming this key healthcare segment . . . 10% of the overall healthcare spend in the US . . . as digital innovation destroys and recreates the industry.

Digital is changing almost every aspect of healthcare including pharmaceutical manufacturing and distribution.  Join Daniel J. Gandor, Director of Digital Innovation for Takeda Pharmaceuticals U.S.A., Inc. and Brad Ansley, Director of SPI Health as they look at the ways digital is changing pharma and the impact on commercial functions.

“No outcome, no income,” says Dr. David Nash, founding dean of the nation’s first graduate school of population health. He joins Brad Ansley of SPI Health to explore the emergence of population health and the implications for healthcare suppliers.  They cover the buyer’s perspective on changing health system needs, shared-risk contracting and new selling dynamics.

Empathy for the patient, helping providers improve efficiency, adjusting to new buying paradigms . . . the work and competencies of a sales representative is undergoing just as radical change as other stakeholders.  But do we even need salespeople in healthcare?  Is the portion of healthcare dollars spent on sales wasteful or productive? What drives a sales person and how can healthcare leaders ensure their organizations get the most value from these passionate contributors?  Filmed at eyeforpharma Philadelphia 2018  #efpphilly   @eyeforpharma

TouchCare, an employee/patient advocacy service and Namely, an HR automation and insurance brokerage firm, are in the business of helping employers maximize employee happiness. What is employee happiness, how is it measured, and what value does it create? 

Patrick J. Kennedy, former U.S. Representative (D - RI) and Founder of the Kennedy Forum, describes treating his own addiction as “an acute episodic situation”.  Son of Senator Edward “Ted” Kennedy and nephew of John F. Kennedy, he led sponsorship of the Mental Health Parity & Addiction Equity Act of 2008.  He now focuses his attention advocating for brain disease and uniting the mental health community. 

Chuck Stokes was a key voice in ACHE prioritizing patient safety. Medical error has now risen to be the third leading cause of death in the United States: the equivalent of a fully loaded 737 airplane crashing every 7 hours.   While the business case for patient safety is compelling in a fee-for-service world, the journey to fee-for-value will better align incentives. Stokes believes the journey to value requires emerging healthcare leaders to have innovation skills to address three systemic challenges: individual lifestyle accountability (such as Memorial Hermann’s policy of not hiring smokers), health system waste and ethical end-of-life care. See www.BOHSeries.com for more information    

David A. Olson, FACHE was named Chairman of the American College of Healthcare Executives during its recent Congress in Chicago.  The organization acts as an affinity group and credentialing body for its more than 40,000 members. With its members leading one third of the $3.6 trillion US healthcare industry, ACHE has a profound impact on how healthcare delivery changes in our country.  Olson speaks about the highs and lows of his career, ACHE’s strategic goal of improving patient safety, and the challenges a health system faces when taking on ‘fee-for-value’ risk. Visit www.BOHSeries.com for more information

Becky Havlisch (Banner Health) and Bob Chaput (Clearwater) lead their respective organization’s search for better cyber risk management.  Havlisch has an unusual title: vice president of business health.  That title reflects her organization’s innovative approach to cyber risk.  Chaput describes why the 2009 HITECH Act led to the explosion of healthcare-related cyberattacks.  He describes a vision of ongoing risk and compliance gap assessment as a method to optimize OpEx and CapEx spent on cyber risk.  Along the way, we learn the difference between cyber risk and cyber security, lessons from Banner’s 2016 breach, and the role of the Audit Committee of the Board. Guests: Rebecca Havlisch, RN, JD, Vice President, Business Health, Banner Health Bob Chaput, MA, CISSP, HCISSP, CRISC, CIPP Chief Executive Officer Clearwater Compliance