The Race to Value Podcast

Today, Ashley welcomes Trista Sebastian, an expert in Early Childhood Education and a self-proclaimed nutrition guru, for an in-depth conversation about the critical role childhood nutrition plays in shaping the health and development of young minds and bodies. Together, they explore how proper nutrition during these formative years influences not only immediate behavioral patterns and academic performance but also long-term health outcomes and social equity. Trista sheds light on the profound connection between what children eat and their physical, emotional, and cognitive well-being, emphasizing the lasting effects that early dietary habits can have on adulthood. This thought-provoking discussion also examines how nutrition intersects with health equity, addressing systemic barriers and disparities that impact children's access to healthy food. Don't miss this enlightening episode that underscores why what we feed our children today determines the adults they become tomorrow. Trista Sebastian is an Early Childhood Education teacher from Cincinnati, Ohio. . Currently serving as the lead teacher at a preschool, Trista not only nurtures young minds in the classroom but also oversees the school's nutrition program, ensuring that her students have access to healthy, balanced meals. Her passion for childhood nutrition began during a deeply personal journey—her pregnancy with her daughter—which inspired her to dive deeper into the connection between nutrition and early development. Since then, Trista has dedicated herself to advocating for the importance of proper nutrition in shaping children's health, behavior, and future outcomes. Her unique blend of classroom expertise and hands-on experience with childhood nutrition makes her an invaluable voice in this vital conversation.

In today's Episode, Ashley sits down with Dr. Kim Kelly-Cortez to explore challenges nursing schools face, such as faculty shortages, limited clinical training slots, high burnout rates among current educators, and the financial barriers students encounter. We also delve into the ripple effects of these issues on healthcare, such as staffing shortages, overworked nurses, and potential impacts on patient care quality. Dr. Kimberly Kelly Cortez is the Senior Associate Dean and Director for the Prelicensure BSN program at Western Governors University. She continues to support the growth of the Prelicensure program by expanding into additional states, opening simulation centers/labs, expanding access to communities and populations in need of pathways to nursing education. Her research continues to focus on student success, programmatic excellence, Competency Based Education (CBE), and simulation. She has presented research related to NCLEX, CBE, and Diversity in BSN prelicensure programs at the NLN Education Summit, AACN Transform, and the National Nursing Workforce Conference respectively in recent years.

On today's episode, Ashley sits down with with Keith Somers.  CRO at HealthCorum.  Keith is an entrepreneur with a finance background who co-founded HealthCorum after a series of frustrating experiences navigating the healthcare system as a patient and caregiver. As CRO at HealthCorum, he leads the sales/marketing team on all market interactions while maintaining responsibility for company operations. HealthCorum is a company that provides data analytics and insights focused on the healthcare industry. They specialize in analyzing data on healthcare providers, such as hospitals and physicians, to assess their quality, efficiency, and overall value in comparison to other similar providers. HealthCorum's platform and underlying data helps healthcare organizations, insurers, and employers identify high-performing providers, reduce costs, and improve the quality of care.

Today Ashley sat down and talked with Dr. Edwin Estavez.  Edwin is the founder of the Altacair Foundation.   He Previously, served as Market President of Value Based Care at Prominence Health, a leading health care company that provides high quality, cost-effective care to diverse populations. Edwin, has over 30 years of experience in health care and higher education administration, risk management, and business development, with a PhD in Administration and an MSW. He is passionate about organizational transformation. From health care delivery and outcomes through value-based care tactics, to patient engagement programs, and care coordination models.  Join as we chat about the mission of Altacair, how he ensures the foundation stays true to its mission and vision, and the collaboration between Altacair and The Leavitt School of Health on the Accelerator Conference. Altacair Foundation:  About Us – Altacair Foundation Accelerator 2024:  https://www.eventbrite.com/e/accelerator2024-advancing-value-for-health-equity-tickets-951490021267?aff=oddtdtcreator

On today's episode of The Race to Value, Ashley sits down with her colleague and friend, Dr. Melissa McLaren to discuss the importance of DEI in Healthcare and Education, and why building inclusivity is not just a buzzword, but something that is vital for the future. Dr. McLaren is an Associate Dean and Academic Program Director at the Leavitt School of Health at Western Governors University.  She graduated with her BSN from The Ohio State University and her Doctor of Nursing Practice from the University of Minnesota. She received her master's in management and leadership and an MBA from Western Governors University. Melissa and her family have engaged with lawmakers at the local and state level, as well as the Congressional LGBTQ Equality Caucus and the US Department of Health and Human Services in support of gender-affirming care and other LGBTQIA+ rights. They have spoken at state and national conferences to educate on the importance of family support when raising a transgender child. Dr. McLaren has partnered with organizations such as the Human Rights Campaign, Welcoming Schools, PFLAG, the ACLU, TransOhio, Equality Ohio, and many others to advocate for transgender youth.  Dr. McLaren currently serves on the Human Rights Campaign Parents for Transgender Equality National Council. She is a board officer for Equality Ohio and was an inaugural board member of her local LGBTQ+ organization. She is a member of the AACN DEI Leadership Network Communications Committee. She lives in Ohio with her husband of 20 years, 19-year old twins, 2 dogs, and several entitled cats. Previous Episode: Ep 137 – Authentic Truth, Love, and Compassion: A Family's Journey in Gender-Affirming Care, with Melissa and Conner McLaren – The Race to Value Podcast™ 0:50: Defining Diversity and Inclusion 4:52 Why is diversity and inclusion so important in today's society? 9:34: How the impacts of disparities and health inequities affects absolutely everyone 13:30: How treatment of patients differs based on insurance status 21:00: Education related healthcare burdens, and how education has an impact. 24:00: How diversity enriches the learning experiences in educations settings 33:24 Stories about successful inclusive educational initiatives 38:00 Shifting policies and practices 39:30: Dr. McLaren's personal story

On today's episode of Race to Value, Ashley sits down with Mark Young, CEO of MyCHN to discuss how MyCHN launched a partnership with Wysa, an AI-driven mental health platform. We discuss how this collaboration aims to bolster the well-being and mental health of MyCHN's Crisis and Behavioral Health patients by providing them access to Wysa's innovative AI personal mental health companion at no cost. Mark Young has worked in health services since 1989 and in community health since 1998. He has a Master's in Business Administration from Trident University and a Master's in Organization Management from the University of Phoenix. Over his career of 30-plus years, Mr. Young has worked with initiatives in the Rio Grande Valley, northeast Texas, and south Texas. Projects he has developed include outreach and engagement with colonia residents, residential treatment services for pregnant women and children, a tuberculosis intervention program, multiple chemical and alcohol dependency programs, behavioral health programs, and many outreach, education, and intervention projects. Timestamps: 3:00: Discussion on how MyCHN created this partnership with WYSA and the benefits it has brought to their patients. 6:00: How this tool is used to help patients 7:30: Tools and Resources that WYSA offers 11:30: Breaking the Stigma around using AI in Healthcare 16:00: Discussion on the current state of Behavioral Health 19:00: Discussion on younger populations and if they are more likely to opt into utilizing AI for healthcare

In today's episode we chat with Geoffrey Roche, MPA. Geoffrey is the son of a nurse, future of work and education expert, diversity, equity, inclusion, and belonging advocate, champion for transforming health equity, and the host of the Ed Up Health Up podcast. His professional career includes over nine years in hospital administration as a strategic advisor to the President and CEO and department director of various departments, including Business Development and Planning, Government Affairs, Community Health, and Public Relations, for Lehigh Valley Hospital-Pocono. At Lebanon Valley College and Harrisburg University of Science and Technology he held senior leadership roles focused on strategic partnerships, organizational strategy, and business development. As Senior Vice President, Business & Workforce Development at Dignity Health Global Education, he led a diverse team focused on developing institutional relationships with leading health systems while simultaneously championing national conversations and initiatives to develop innovative diversity, equity, and inclusion solutions for the healthcare workforce. “We expected to see a drop in enrollment before the pandemic for all healthcare programs. Why did Healthcare and Education not come together to combat this?” - Geoffrey Roche “We have made bad decisions as a society when taking care of our healthcare workforce.” - Geoffrey Roche“We have five generations of people in the workforce, and this is the first time we have had this.” - Geoffrey Roche“As Leaders we need to harness the creativity and passion for all generations in the workforce.” - Geoffrey Roche 2:25: What is happening in the nursing workforce? 4:30: The Supply and Demand Gap Challenge and addressing culture in healthcare organizations. 5:30: The Gig Economy is now in healthcare, and we have to get used to this model. 8:00: Millennials in the workforce and creating a culture that allows people to be the best they can be by creating a community and culture that allows them to thrive. This means they must be valued and heard. 14:00: What do we need to do as healthcare leaders to invest in our people? 17:30: Why you need to listen to your workforce, instead of just hiring consultants. 20:30: If we do not have a healthcare workforce, it will impact education, clinical placements and preceptorships. 22:50: Apprenticeships, why they are important and why healthcare has been slow to implement them 29:27: We need to do more work in the K-12 Landscape to promote and encourage people to go into healthcare careers. It is important to learn that there are jobs in healthcare that aren't being a doctor or a nurse.

Welcome back to Race to Value! In this episode we introduce our new host, Ashley Schwartz and discuss the rebranding of the Institute for Advancing Health Value and how we are expanding our work. Today's guest is Dr. Keith Smith (M.A., Ed.D., MBA, L.M., RMHC (ret.)) serves as the Executive Dean and Senior Vice President for Michael O. Leavitt School of Health at Western Governors University. He has strategic leadership experience in the business, nonprofit, and higher education sectors. His 26-year career in higher education comprises holding faculty, dean, vice-provost, vice-president, and now senior vice-president positions, at five universities prior to coming to WGU, inclusive of leading schools of health, business and IT, and arts and sciences. He has taught courses and given presentations domestically and internationally on leadership and organizational change, higher education innovation, and personal growth and development. Smith has supervised educational programs in Europe, the Middle East, and Asia. He has played a lead role in both regional and programmatic accreditations. His teams have developed a wide spread of programs from the microcredential through doctoral levels, as well as partnerships with business, government, military, and community colleges across the nation. 0:19: Introduction to Keith Smith, SVP of WGU's Leavitt School of Health. 1:42:  Upcoming changes you can expect to see with the Institute for Advancing Health Value and it's rebrand. 2:52:  Expansion in content- we will be continuing our work in Value Based Care, but are expanding into workforce, health equity, diversity and inclusion and workforce development. 4:50:  Health Equity Convening in the Rio Grande Valley of Texas.   This is a new area of work that we are continuing to expand and explore in different areas of the United States 8:00:   Discussion of the Programs that the Leavitt School of Health currently offers. 11:40: Discussion of WGU's strategic pillars and how they will benefit the general public and the current workforce. “We want to set a greater tone out in the Healthcare Industry, in terms of thought leaderships and opportunities to partner with those in different systems, and opportunities to be a resource center for them.”  - Dr. Keith Smith “Educational Equity feeds into Health Equity.  By providing education to everyone, it opens the door for health equity and having trained, qualified and a culturally competent workforce that mirrors the diverse population that they are caring for.” – Ashley Schwartz

In this last ever episode of the Race to Value podcast, we are leaving you with inspiration for a more optimistic future in the value transformation of our country.  Sadly, this will be our last show, but we are ending it on such an incredible high point!  This week's interview brings a message of hope, compassion, and human connection balanced with the business success of value-based care within a national leading health system.= Albert Einstein once said that “Only a life lived for others is a life worthwhile” and no one better captures that spirit of servant leadership than our guest this week. Philip Eaves is the President and CEO of Ascension Seton ACO | Ascension Seton Health Alliance and the Vice President of Population Health at Ascension Texas, and he is a leader in the value movement that you should know about. In this interview we focus on change management, leadership, and the human side of healthcare economics. Overseeing the value-based care strategy and operations for one of the largest clinically integrated networks in Texas, Philip is leading the ACO to outstanding success…and transforming the lives of people along the way. Bookmarks: 01:30    The human side of healthcare economics – compassion is the currency; empathy is the language. 02:00    Introduction to Philip Eaves, President and CEO, Ascension Seton ACO and VP of Population Health, Ascension Texas 02:30    Ascension Seton ACO is the largest clinically integrated network in Texas with 3,600 providers with 300K value-based lives. 04:45    “Only a life lived for others is a life worthwhile” -- Albert Einstein 05:30    Philip shares how a humble, faith-based upbringing fueled his ambition, work ethic, and compassion as a healthcare leader. 07:30    “Healthcare is about serving others.” 08:30    Occupational medicine as a stepping stone to value-based care. 09:45    Team-based care that enables providers so they can build meaningful patient relationships. 11:00    $24M in MSSP Shared Savings for 23,000 Medicare beneficiaries to achieve a top 7% performance ranking of all ACOs in the country (#32 out of #482). 12:45    Valuable partnerships with independent practices (e.g. Austin Regional Clinic, Capital Medical Clinic). 13:00    “Physician engagement is the overall key to ACO success.” 14:00    The impact of Annual Wellness Visits (AWVs) in practice transformation. 15:00    HCC recapture for documentation accuracy as an area of educational focus. 15:45    Centralized versus Embedded Care Management. 16:30    Analytical insights to drive high risk CM interventions. 17:15    Quality campaigns to close care gaps and improve population health outcomes. 18:00    Refining a Post-Acute Care network for optimal transitional care. 18:30    An after hours program as an effective ED diversion strategy. 20:00    Change management to improve team culture and reinvent the business model for VBC. 22:00    Phillip shares his experience leading an inflection point for the ACO business. 23:30    Applying the principles of the Kübler Ross Change Curve in organizational change. 24:30    Inspiration from John Kotter (“Leading Change”) – Leadership versus Management. 25:00    Recognizing the need for change in shifting a new strategic direction. 26:00    Communicating the vision and creating short-term wins. 26:45    New initiatives: a new ACO for early adopters, Medicare Advantage risk, and Direct-to-Employer partnerships. 28:00    Financial toxicity as a driver of Direct Contracting between employers and providers in value-based care. 30:00    Employer frustration with rising medical spend and the lack of solutions from their brokers. 30:45    Designing an ACO value proposition based on employer pain points. 31:00    Leveraging network adequacy and CIN care infrastructure for commercially insured populations. 32:45    PBM transparency to reduce extreme spending on pharmacy drugs. 34:00    Forging a new partnership with Signify/CVS to suppor...

The transformation of healthcare is a seemingly insurmountable challenge, yet overcoming any obstacle in the journey begins with the belief that it is possible to win!  It's not about the magnitude of the task; it is about the collective will to prioritize the wellbeing of every person we serve in our population.  Perhaps when approached with the audacity to imagine a healthier and more equitable future for all, we'll actually get there.  And that is just what the Physicians of Southwest Washington (PSW) is realizing as they navigate a successful transition from volume to value. Our guest on the Race to Value this week is Melanie Matthews, the dynamic, creative, and innovative CEO of PSW. She leads a population health company that has been around for three decades. Melanie is not only leading their ACO and managing their progression in the adoption of full-risk Medicare Advantage delegation; she has become a nationally recognized voice for value-based health policy.  In listening to this interview, you will hear from a leader that has a real personal capacity for leadership and a clear focus on excellence. If you want to hear from someone that is at the absolute forefront of risk-based contracting and innovation, who understands the issues at a granular level, this episode with Melanie is a must-listen! Episode Bookmarks: 01:30 Introduction to Melanie Matthews and the Physicians of Southwest Washington (PSW) 04:30 PSW has evolved over the last three decades from an IPA to a diverse business that includes a national leading ACO and risk-bearing entity for MA. 06:00 "PSW is a story of independent physicians who, in a time of market consolidation, want to remain independent and focus on the patient relationship." 06:45 Achieving success in delegated risk and taking accountability for both quality and total cost of care. 07:00 The impact of MACRA on the long-term value-based care strategy of PSW. 08:30 Building an infrastructure and developing capabilities to move a value-based agenda. 09:00 Developing a business model for agility in responding to new rules ("a kayak in a sea of cruise ships") and engaging all types of physicians in the landscape. 09:30 "The value-based movement is important as the fee-for-service chassis is not realistic, has poor quality and outcomes, and rising costs." 10:00 Taking risk with physician partners and providing them with MSO services, leveraging a technical infrastructure and population health platform. 10:45 The glacial pace of scaling payment model transformation at CMS and CMMI's bold goal for 2030. 12:00 The increasing shift to home-based care delivery and the use of generative AI in reshaping care delivery. 13:00 How the flawed economic design of the fee-for-service system creates industry inertia. 14:00 Diverting to the known (i.e. fee-for-service care delivery) in times of stress is an unsustainable path forward. 15:00 Convincing the Board room on the tenets of VBC when it hasn't historically delivered on its promises. 16:00 Trends in consumer cost-shifting and the challenges of private insurers cross-subsidizing provider losses from public payers. 16:30 Unsustainable economics in employer-based healthcare and the looming insolvency of Medicare. 17:00 What does the CMMI 2030 Goal mean for future of the value movement? 18:30 An overview of the extensive services offered by PSW that empowers success in VBC. 19:30 The explosive growth of strategic transactions of physician groups and how mass consolidation is impacting the landscape. 21:00 Aligned incentives and access to a population health platform as keys to VBC success. 22:00 PE investment impacts on competition in an independent physician ecosystem. 23:00 Generational differences in the approach to the business of practicing medicine. 23:30 "Organizations that are convened with independent physicians are able to show better costs of care." (vs. employed or vertically integrated systems)

We have a broken healthcare system. Too often, individuals today experience care that is fragmented, duplicative, wasteful, and confusing.  Through value-based care, we can improve the health care experience by coordinating care, creating care teams that communicate with one another, and supporting individuals in their care journey with services that address their medical and non-medical needs. Accountable for Health is a nonpartisan national advocacy and policy analysis organization accelerating the adoption of effective accountable care. Their members are advocating for value-based care on Capitol Hill so policymakers can understand how best to move American healthcare towards a model that achieves better outcomes, improved care experiences, increased access, and lower costs. Joining us on the podcast this week is Mara McDermott, the Chief Executive Officer for Accountable for Health.  She is an accomplished healthcare executive with deep expertise in federal healthcare law and policy, including delivery system reform, physician payment and payment models. Take this opportunity to learn from a leading expert on accountable care as she translates the truth in building a bridge towards a more broad-based understanding of health value.  And make sure to tune in to Mara's special announcement about Health Care Value Week at the end of the interview so you don't miss out on important educational events occurring January 29th thru February 2nd. Episode Bookmarks: 01:30  The need for accountable care policies that create better health outcomes and patient experiences. 02:00  Introduction to Accountable for Health (A4H) and its Founder/CEO Mara McDermott, JD, MPH 03:00  Interview topics discussed (e.g. the meaning of VBC, MSSP vs. MA, MACRA 2.0, advanced APMs, integrated specialty care, Medicaid transformation, and the upcoming Health Care Value Week event). 06:00  How A4H is translating thought leadership to action in the advocacy arena. 06:30  Accountable care as the solution to fragmented, uncoordinated care. 07:00  Political turnover in D.C. has made VBC a "new" health policy solution. 07:30  Educating the Hill comes down to conveying enthusiasm for health care transformation. 08:00  Accountable for Health Members are shaping the national conversation for payment and delivery system reform. 09:00  The health policy controversy of the Global and Professional Direct Contracting model (the precursor to ACO REACH). 11:30  If Direct Contracting was the natural evolution of a series of advanced ACO options, why was there such strong criticism? 12:00  The need to overcome misunderstandings about what ACOs are trying to achieve. 13:00  Providing education to dispel the myth that ACOs can actually limit services. 14:00  How uninformed policy decisions could potentially create a catastrophic blow to the value movement. 14:45  "Accountable care is integral to care delivery system reform." 15:45  Confusion with the term "value-based care" and why it will fail unless people understand the truest aims of the movement. 17:00  The need for effective storytelling to advance care delivery transformation. 18:00  Prioritizing care experience over cost reforms (delivery innovation will address costs!) 20:00  The topline takeaways from CMS model evaluations and whether or not programs should be expanded. 21:00  What do most people think when they hear the word "value"? (the need to reframe the conversation with more precise language) 22:00  The MSSP and the Medicare Advantage programs as two distinct approaches to healthcare delivery and reimbursement. 24:00  Mara provides a brief comparison between MSSP and MA (e.g. beneficiary assignment, risk adjustment, benchmarking). 25:30  How strong relationships between MA plans and provider networks (underpinned by capitation) drive value. 26:30  Understanding provider compensation in MA value-based payment and the synergies between managing MSSP and MA populations.

The World Health Organization has declared climate change as "the greatest threat to global health in the 21st century." As our planet grapples with the accelerating impacts of climate change, it is crucial that we adopt a climate lens in the value transformation of our healthcare industry. The repercussions of climate change extend far beyond environmental shifts; they manifest in various health issues, including challenges with clean water access, increased allergens, respiratory diseases, heat induced illnesses, and the proliferation of infectious diseases. It's essential to acknowledge that while climate change affects everyone, the burden falls disproportionately on historically marginalized populations, highlighting the interconnectedness of climate impacts and social determinants of health in underserved communities. In our pursuit of delivering safe, effective, and efficient care amid the climate crisis, we as healthcare leaders also bear the responsibility to address the substantial greenhouse gas emissions generated by the sector. Accounting for nearly one fifth of the U.S. gross domestic product, the healthcare industry possesses considerable purchasing power that can be harnessed to steer the nation toward cleaner energy and a low carbon supply chain. Beyond mitigating environmental harm, embracing preventive models of care and enhancing care quality that lowers excess utilization naturally aligns with lower carbon footprints. Value-based care, therefore, can become a powerful catalyst in propelling us toward a net zero carbon future that will build a sustainable, resilient future for our planet. This week we are  interviewing Dr. Vivian Lee, a healthcare executive dedicated to the advancement of value-driven transformation in health and tackling climate change. Author of the acclaimed book,The Long Fix: Solving America's Health Care Crisis with Strategies that Work for Everyone, she is an Executive Fellow at Harvard Business School and Sr Lecturer at Harvard Med School. Prior to her Executive Fellowship at Harvard, she was the founding President of Verily Health Platforms, an Alphabet company combining a data-driven, people-first approach to precision health.  Dr. Lee is also a former health system CEO, medical school Dean and member of the National Academy of Medicine. She is regularly listed among Modern Healthcare's Most Influential Clinical Executives as well as Modern Healthcare's Most Influential People in Healthcare.   Episode Bookmarks: 01:30  The World Health Organization has declared climate change as "the greatest threat to global health in the 21st century." 02:00  Climate change burden falls disproportionately on historically marginalized populations. 02:30  The responsibility to address the substantial greenhouse gas emissions generated by the healthcare sector. 03:00  Introduction to Vivian Lee, M.D. 04:30  One in four deaths can be attributed to preventable environmental causes...and climate change is exacerbating these risks. 06:00  Climate change resilience as a lens for value-based transformation. 06:45  The irrefutable scientific evidence about the unprecedented levels of carbon dioxide in our atmosphere. 07:00  What are health care leaders going to do about this?  (The need to manage the crisis through an empowered workforce.) 08:30  Exposed vulnerabilities in our supply chain as a complication to address climate-related crises. 09:00  The healthcare industry is responsible for 8-10% of the overall carbon footprint of the country (more than twice the #2 country!) 10:00  How do we decarbonize healthcare in order to "do no harm"? 11:45  Pollution from health care–associated energy use results in an estimated 405,000 disability-adjusted life years annually (a burden comparable to that of preventable medical errors). 12:30  The strong business case for health care organizations to reduce their carbon footprint. 13:00  Tax credits offered by the Inflation Reduction Act ...

     A new era in value-based care is emerging where employers are no longer sleeping giants willing to tolerate a broken fee-for-service healthcare system. ‘Poor health' costs employers $575B in lost productivity on top of the $880B they already spend in premium dollars annually. Employers (and their employees) continued to get fleeced by unsustainable double-digit premium increases every year, with hospitals using that excess spend in commercial insurance to their subsidize losses on the public pay side. The paradigm shift to value-based purchasing is underway in employer-based health insurance; however, it will not achieve the aims of population health unless a similar transformation occurs in workforce wellbeing.      Joining us this week in the Race to Value is Dr. Richard Safeer, the Chief Medical Director of Employee Health and Well-being at Johns Hopkins Medicine, where he leads the Healthy at Hopkins employee health and well-being strategy.  Dr. Safeer is a highly influential thought leader on building a culture of health and is the author of the groundbreaking new book, “A Cure for the Common Company: A Well-Being Prescription for a Hopper, Healthier, and More Resilient Workforce.” In this interview you will hear from one of the leading experts on employee health in our country about what it takes to cultivate a healthy workforce. Episode Bookmarks: 01:30 Introduction to Richard Safeer, M.D. and “A Cure for the Common Company” 04:45 Developing a holistic view where we look at individuals as both patients and employees. 05:15 “Until we integrate a strategy that includes the workplace, we are not likely to optimize population health." 06:00 The economic and cultural imperatives for workforce well-being. 06:30 A key factor in achieving health goals is the support of people you are closest to at home and at work. 07:45 Connecting the spectrum of employee health from well-being to chronic disease. 08:30 Why have attempts at corporate wellness failed so often in the past? 09:30 “Our health and well-being are greatly influenced by the relationships we have in the workplace.” 10:00 Most employers do not fully leverage the social sciences to optimize the support of their workforce. 10:45 Innovative self-funded health insurance as a requisite component of a corporate wellness strategy. 12:30 How a company benefits from a healthy workforce. 13:45 Innovations to create access to high quality primary care and lifestyle medicine (e.g. Direct Primary Care and onsite clinics). 17:00 Employers must fully leverage all resources (e.g. data from health insurers, EAPs, collaboration with local health systems). 18:30 The 6 Building Blocks of a Wellbeing Culture. 20:45 Making it easier for employees to make healthy choices. 21:30 The influence of social climate in the workplace. 22:30 The plight of healthcare workforce burnout and moral injury. 23:45 We need supportive work environments to produce good health (not paternalism). 25:00 “Employers who demonstrate genuine care and back it up with genuine resources to support health and well-being will be the ones to attract and retain talent.” 25:30 Resiliency does not rest solely on the individual! 26:00 Employees cannot maintain mental health if their work doesn't align with education and skill set. 27:00 Social connections to team and trust in management improves resiliency. 29:00 70-80% of employees are willing to take a pay cut to get a job that better supports their mental health (see UKG study) 30:00 Balancing the need for social connection with remote work. 31:30 Referencing the new book, “Culture Shock: An Unstoppable Force is Changing How We Work and Live.” 32:00 One-size fits all decisions about onsite work doesn't make sense for all employees. 33:30 Cisco Systems as an exemplar of a workplace culture for health and well-being. 36:00 The role of technology in health is superseded in importance by the workplace, home, and community settings.

The future of health will be shaped by consumer expectations for a mobile-centric experience with personalized insights and care services.  Information is determinant of health, where people already search for health information on Google hundreds of millions of times a day. Additionally people view YouTube videos about health conditions 100 billion times globally in a year. As consumers seek information ubiquity in their online experience, health information will also become more personalized through wearables and other mobile devices. Our future in health will also be enabled by AI. Artificial Intelligence has the potential to transform the health of people on a planetary scale akin to the discovery of penicillin.  If developed boldly and responsibly, AI will be a powerful for health equity on a global scale.  It will also bring the joy back to practicing medicine by reducing cognitive burden and giving providers more time to spend with patient. In this week's episode, we explore health tech consumerism and AI enablement with Dr. Karen DeSalvo, Chief Health Officer at Google. Dr. DeSalvo is an internist and health leader working at the intersection of medicine, public health, and information technology.  She has dedicated her career to improving health outcomes for all with a focus on solutions that address all the determinants of health.  Dr. DeSalvo continues to be a powerful voice and advocate for eliminating inequities and improving the public's health.  Under her watch, Google has optimized search and YouTube to better answer common health questions, updated its consumer health wearables to function more like medical devices and built artificial intelligence products to meet industry demands. This episode covers various topics in the realm of healthcare technology innovation from consumerism, Generative AI and LLMs, health equity by design, and various initiatives underway at Google to connect and bring meaning to health information. In the interview, we also discuss the role of technology in mitigating the health impacts of climate change and addressing the epidemic of loneliness and isolation at a global level.   Episode Bookmarks: 01:30 Introduction to Karen DeSalvo, Chief Health Officer at Google. 03:30 How Google understands “information as a determinant of health.” 05:00 “We see heavy consumer orientation to the way we see our opportunity to improve the health of everyone everywhere.” 05:30 The evolution of healthcare businesses to meet people in an increasingly virtual world with ever-changing consumer expectations. 06:00 Informing health empowerment through high quality information and personalized insights. 06:30 Personal reflections from clinical practice when the flow of information was not enabled by technology automation. 07:30 Modern-day tools for patient education and personal health tracking and measurement. 08:00 The optimization of Google search results to convey trust in the provision of health information. 08:30 “The conveyance of information through trusted messengers is an important way we address information as a determinant of health.” 09:00 Patients showing up with more knowledge and power – a priority goal for Google Health. 09:30 How AI can improve health for everyone everywhere. (Karen's recent blog on the future of AI as a transformational path forward in population health.) 10:00 Leveraging AI at Google Health to advance medical research, improve accuracy and efficiency of diagnostic processes, and improve health information quality. 11:00 A future world were everyone has access to the best quality care on their phone (e.g. AI-enabled health agents combined with the human care team). 12:00 Developing health technology for the entire world. (“A billion people on the planet don't have access to primary care.”) 12:15 AI can address workforce challenges by reducing cognitive load to address burnout and filling capability and capacity gaps.

In caring for our communities, a carefully designed Care Continuum Blueprint becomes the roadmap to enhanced population health outcomes—a testament to the profound impact of integrated care and strategic coordination.  There has never been a more compelling time to adopt a system of care based on population health management. The COVID-19 pandemic revealed substantial health disparities and compels us to take action. The population is aging, and the Medicare insolvency crisis is looming. Now is the time to move away from fee-for-service care and toward an approach that prioritizes quality, outcomes, and affordability for all populations. In this week's episode, we interview Dr. Mark Angelo, a senior administrator of a large accountable care organization and a leader in population health and palliative medicine.  He is the author of the new book Caring for Our Communities: A Blueprint for Better Outcomes in Population Health, that provides tactical guidance for developing effective population health programs and explores value-based care models. Dr. Angelo is an inspirational leader to the health value movement, providing a road map for creating an equitable, outcomes-focused system, using the right resources to nurture the health of our communities. Dr. Mark Angelo currently serves as CEO and President for the Delaware Valley ACO (DVACO). In this role, he oversees clinical strategy and operations, including quality, population health pharmacy, clinical integration, care coordination, post-acute networks and practice transformation. In addition to serving patient communities as an executive with the ACO, he is a practicing palliative care doctor who continues to see patients.  DVACO has participated in the MSSP since 2014 and also works with commercial and Medicare Advantage payers in an effort to grow and expand the mission of value-based care in the Greater Philadelphia area. Episode Bookmarks: 01:30 Introduction to Delaware Valley ACO and Mark Angelo, MD, MHA, FACP. 04:30 Referencing Dr. Angelo's new book Caring for Our Communities:  A Blueprint for Better Outcomes in Population Health. 05:00 “Never doubt that a small group of thoughtful committed citizens can change the world; indeed, it is the only thing that ever has.”  -- Margaret Mead 06:00 Dr. Angelo provides his perspective on population health underpinned by his clinical practice of palliative care. 07:30 A care continuum strategy that ensures care continuity, collaborative planning, and case management for complex patients. 09:30 The post-acute care journey at DVACO that began in 2014. 10:30 The Skilled Nursing component of DVACO's post-acute care strategy. 11:30 Using claims data and real-time readmission tracing to monitor performance of SNF partners. 12:30 Graduating from a post-acute care focus to an overall care continuum strategy. 13:45 Optimizing home health to prevent avoidable hospitalizations. 14:30 How to identify suboptimal hospice care (e.g. length of stay greater than 180 days). 16:30 Home-based therapy as part of the care continuum to reduce TCOC in a frail elderly population. 18:00 An optimal zone of therapy between 12 and 32 therapy units over the course of a year. 19:00 Medicare reimbursement differentials across the different settings in a post-acute care continuum. 20:30 Building a population health playbook in post-acute care begins with SNFs. 22:00 Assessing performance data in developing a small SNF network to guide steerage decisions. 23:30 Applying the SNF assessment strategy in the vetting of preferred providers in home health and hospice. 26:00 Are partnering PAC facilities communicating with you in a meaningful way? 26:45 “Discharge planning shouldn't happen in the last 24 hours of discharge. It should be happening all along. This is an important factor when it comes to creating partnerships across the care continuum.” 28:00 DVACO (in partnership with Main Line Health) developed a palliative care program that red...

With 1 out of every 3 U.S. health care dollars emanating from Washington, the federal government is the single largest payer of health services in the United States and accounts for nearly half of all national health spending. As our country ages, these forces are accelerating, with Medicare spending alone projected to increase by 7.5% annually through 2031. Healthcare companies that depend on government revenue – or are downstream from it – must begin to view policymakers as among their most important customers. Impactful organizations that will succeed in the new era of value-based care will learn how to leverage the unparalleled value of internal advocacy.  By creating extraordinarily powerful messaging for policymakers to understand what is needed for value-based innovation, we exercise our right to form a more perfect union.  While healthcare will never be perfect, we must still strive for perfection – that is at the heart of value-based care transformation in our country! On the Race to Value this week, we interview Andrew Schwab – a value-based care leader, an intentional strategist, and a master of Washington's internal game.  He brings a bold, brash, no-holds-barred approach to government affairs by coaching and mentoring forward-thinking organizations ready to invest in their internal policy teams so they can thrive in a new era of value-based care.  Prior to establishing his own firm, Platform Government Strategies, Andrew advocated in-house on behalf of both nonprofits and private sector organizations. Most recently, Andrew established Oak Street Health's first government affairs function that put them at the center of the national value-based care conversation and contributed to their recent acquisition by CVS Health. Episode Bookmarks: 01:30 The federal government is the single largest payer of health services and accounts for nearly half of all national health spending. 02:00 Healthcare companies that depend on government revenue must begin to view policymakers as among their most important customers. 02:30 Introduction to Andrew Schwab and his public affairs consulting firm, Platform Government Strategies. 05:30 The glacial pace of the value-based care movement.  Is there truly bipartisan consensus on the aims of health value? 07:00 2030 Medicare VBC Goal (“The government is putting its thumb on the scale for value-based care.”) 08:15 The 1st Amendment right to petition government for redress of grievances (“Advocacy and lobbying are quintessentially American.”) 09:00 “Elected officials and appointed regulators in Washington D.C. and in state capitals react to a different set of incentives.” 10:00 Explosive growth of the Medicare Advantage program. 11:00 Consumer-centric innovation and higher quality of care in MA plans. 11:30 Political controversy with MA (e.g. PE-backing, overpayment concerns, risk adjustment gaming, “perverse business model”) 13:00 Critics of MA ranging from physicians and hospitals protecting the “sanctity of fee-for-service" to those leery of privatization. 13:30 The incredible popularity of MA and the research showing it has superior outcomes. 14:00 Mitigating the potential for upcoding with the new V28 risk adjustment methodology being implemented over next 3 years. 15:00 MA is paid more than Traditional Medicare, but it offers more in terms of benefits (e.g. hearing, dental, vision, population health interventions). 16:00 Private equity investment and payvider innovation (e.g. Oak Street Health, VillageMD, Centerwell, Archwell). 17:00 The importance of Patient-Reported Outcome Measures since process measures alone don't achieve patient-centeredness. 19:00 “Outcomes should be the most important metric by which we judge the health of our healthcare system.” 20:00 “We need to put providers that participate in value-based relationships at the center of advocacy pushes in Washington and in state capitals.” 21:00 If we are incentivized to keep patients healthy and out ...

The future of care is not confined by walls; it thrives in the heart of homes, where compassion meets innovation, and healing becomes a daily experience. Home-based primary care with full-risk Medicare Advantage is a transformative model that not only brings health care to the doorstep of our seniors but also places the responsibility for their well-being squarely in the hands of dedicated providers, creating a proactive and patient-centered approach to aging with dignity and comprehensive care. By making primary care easier to access for our nation's seniors, we can deliver personalized care that meets their needs; help them stay healthy and feel better; and live well with existing conditions so they can prepare for what's ahead. This week we are joined by two executive leaders from WellBe Senior Medical -- the largest and fastest growing independent home-based medical group in the country. WellBe is a global risk medical group that provides longitudinal geriatric care to underserved, frail, complex, and homebound Medicare Advantage beneficiaries. In this episode, we feature Dr. Jeffrey Kang, Chief Executive Officer and Mike Stuart, Chief Growth Officer from WellBe Senior Medical. Dr. Kang is a geriatrician with extensive experience in global risk and primary care for frail, elderly, and disabled populations.  Mike Stuart has extensive experience in fostering partnerships with health plans, health systems, and provider groups and leads commercial strategy and partnership development for WellBe Senior Medical.  In this interview you will learn about the home-based care continuum, primary care innovation, mission-driven leadership, Medicare Advantage risk, and the future of value-based primary care. Episode Bookmarks: 01:30 An overview of WellBe Senior Medical – a global risk primary care group providing longitudinal geriatric care in the home. 02:30 Introduction to Dr. Jeffrey Kang, WellBe CEO (formerly served as ChenMed President, Walgreens SVP, Cigna CMO, and CMS CMO). 03:00 Introduction to Mike Stuart, WellBe Chief Growth Officer (formerly served in executive leadership roles at Somatus and Evolent). 05:00 An overview of the home care continuum (e.g. acute, post-acute, custodial, longitudinal primary care, DME, home infusion). 08:00 How WellBe is helping patients navigate and coordinate the fragmentation of home care point solutions. 10:30 A mission to help senior patients “lead healthier meaningful lives by delivering the most complete care”. 11:30 Opportunities to make care in the home more multidisciplinary, personalized, and SDOH-responsive. 12:00 Proactive vs. Reactive Care (leveraging analytics and unique provider skillsets for population health). 13:30 The clinical persona of the “frail elderly” and why WellBe focuses on this target population. 14:30 “Everything done in a primary care office can actually be done at home.” 15:30 “Home-based primary care is the best thing to do. You get better outcomes and better patient satisfaction.” 15:45 Is it possible to deliver high quality primary care (like ChenMed or Oak Street) in the home setting? 16:30 Referencing Marcus Welby, M.D. as an example of an empathetic approach to delivering care in the home (see Season 1 Trailer) 17:00 Care Fragmentation Challenges - NEJM found that the average Medicare patient sees a median of two PCPs and five specialist physicians per year. 18:00 “Quality of Life” is more important than “Quantity of Life” (why empathy and compassion matter most in caring for frail seniors). 19:30 Patients define a good doctor by bedside manner and respect given. 20:30 How the economics of full global risk enable complete care models for seniors. 20:30 Scalable home-based primary care is a new approach in value-based care. 23:00 WellBe's results (e.g. >50% neighborhood engagement, patient satisfaction is at 95%, and MLR improvement >40% in 3yrs). 23:30 The importance of reaching a 4 Star Rating in a Medicare Advantage plan.

Many factors impact our health beyond genetics and aging.  Collectively, these are called social determinants of health and include factors such as education, housing, income, occupation, hunger, language, literacy, where we live, and access to affordable healthcare services. However, there is a gap in the current list of social determinants of health, and that is the influence of “information” or an “information ecosystem” on patients' behavior, engagement, and health outcomes. It is critical to consider “information” as another social determinant of health since it can be used to drive positive patient health outcomes.  How we deliver it, where we deliver it, and who delivers it is crucial to value-based health care transformation and patient-centeredness. So, how do we harness this idea that information can change health outcomes?  To answer this question, we have invited Debbie Welle-Powell back to the Race to Value!  As a 30-year healthcare executive veteran, value-based care thought leader, and educator, she is committed to the empowerment of change management principles to drive population health at the intersection of patient engagement and information sharing. In this episode, we discuss what is needed to empower the patient and clinician, technology-enablement and value-based payment to fine tune the delivery system, and the information ecosystem needed to drive healthy outcomes. As a companion to this podcast, make sure to read Debbie's new article on this topic.  It is available for download on the Race to Value webpage for this episode! Information as a Social Determinant of Health Episode Bookmarks: 01:30 Introduction to Debbie Welle-Powell, a healthcare executive veteran whose work focuses on delivering affordable and accessible high quality care. 02:45 Reference previous R2V episode - “Climbing the Mountain: Reaching New Heights for a Transformative Future”) 03:00 Read the companion article to this interview on the Race to Value episode website! 03:45 Debbie provides a brief update on her professional work in value-based care (and her mountain climbing adventures!) 05:30 The influence of “information" or an "information ecosystem” on patients' behavior, engagement, and health outcomes. 06:30 Should we consider information as another Social Determinant of Health (like transportation, education, housing, and food security)? 07:30 “Information only really matters if it helps patients change behaviors.  The delivery of information is crucial to empowering health outcomes.” 08:30 “The American healthcare system is not as patient-centric as it claims to be because of a failure to provide empowering information.” 09:00 The roles of clinicians and patients to improve health literacy. 10:00 Patient noncompliance – Ex: 20-30% do not pick up prescriptions, 30-40% do not follow-through on referrals. 10:45 The challenges of interpreting and addressing SDOH challenges to avoid unnecessary utilization. 12:00 The importance of the patient-provider relationship. (Eric shares insights from his healthcare trip to Cuba.) 14:30 Technology enablement and health system evolution to better address patient information needs. 15:00 Improving patient engagement through the online user journey (i.e. the digital front door). 15:45 Debbie shares a personal example from her cancer journey where the care team failed to provide adequate information. 17:00 Half of patients seeking receive misleading information when independently searching online sources. 17:30 The opportunity for clinicians to provide trusted and reliable online educational resources. 18:00 The hyper-saturation of online content (e.g. 500 hours of content uploaded to YouTube per minute!) 18:30 How the value-based care movement provides incentives for improving patient engagement. 19:30 The use of Generative AI in the clinical setting to help patients better navigate their care journey. 20:45 Merging the science of medicine with the art of informat...

A revolution is imminent in American healthcare, and “the revolution will not be televised” for passive observation.  Value-based care transformation, like any other important movement, requires the active participation of all leaders on the frontlines. However, for these leaders to make the right decisions, they need to embrace innovation in order to realize the fullest potential of generative AI and predictive analytics.  Through the reengineering of care delivery, we can achieve a more personalized, proactive, and efficient outcomes-based model that can ultimately transform population health. As we navigate this transformative journey, data will play a pivotal role in reshaping the landscape of care delivery.  And no one knows this better than Nassib Chamoun, Founder President & CEO of Health Data Analytics Institute (HDAI), our guest this week on Race to Value.  In this episode, you will hear from a leader and primary inventor of a broad-based population health data analytics platform, enabling healthcare providers to make informed decisions based on real-time information. Tune in to an informative conversation covering such topics as data aggregation, predictive analytics, digital twinning, network management, generative AI in clinical care, and future advancements in technology-enabled value-based care. Episode Bookmarks: 01:30 The Imminent “Big Data” Revolution in Value-Based Care 02:00 Introduction to Nassib Chamoun of Health Data Analytics Institute 03:00 As a teenager living in Beirut, Nassib experienced the horror of a civil war. 04:00 The inventor of Bispectral Index monitoring – a technology standard in operating rooms around the world. 05:00 Nassib discusses the pivotal moments in his life that shaped a passion for data analytics in healthcare. 07:00 80% of health information in EHRs is unstructured and entirely unusable unless converted to discrete data. 07:45 CMS provided HDAI a highly coveted Innovator's License that allows the company access to data on 100 million Medicare beneficiaries. 09:00 How Big Data drives powerful AI algorithms and predictive models in healthcare. 10:00 “If you can't measure something, you can't improve it.” 11:00 Understanding the intersection between cost, outcomes, and utilization. 11:30 Making data actionable in order to effectuate change in care delivery. 11:45 Data overload can actually lead to clinical inefficiencies if it isn't curated appropriately. 12:30 The artful curation of data to drive operational improvements at point-of-care. 14:00 The limitations of claims data in making timely clinical decisions and treatment interventions. 15:00 Interpretation of unstructured EHR data to extract potential new conditions and HCC coding opportunities. 16:00 The importance of clinical judgement in augmenting AI-based recommendations in value-based care. 17:00 Combining behavioral, psychosocial, and biometric data with the existing sciences of epidemiology and clinical medicine. 18:00 Generalized clinical use cases of AI at the point-of-care to improve costs, outcomes, and utilization. 19:00 “To be successful in value-based care, you must operationalize two separate goals: Prevention and Avoidance of Complications.” 20:30 “The goal of AI is to very simply do what a clinician does, but do it repeatedly and do it continuously for every patient in their cohort.” 21:00 How staffing limitations and an aging populations necessitates a more optimal use of technology in VBC. 22:00 In 2032, U.S. healthcare spending will reach $8 trillion (ahead of the economy of Japan) making it the third largest economy in the world! 22:45 Leveraging predictive models to drive more effective care coordination and interdisciplinary team-based care. 24:30 Patient engagement as one of the more challenging aspects of value-based care. 26:30 The integration of predictive analytics and digital twinning for individualized patient care. 28:45 Using multiple predictors to serve every comp...

Everyone needs access to quality, affordable health care regardless of health status, social need or income.  To reach this paradigm shift, healthcare leaders must evangelize within industry and communities they serve.  There is a better path forward for American health care – one that is people-centered and transformational; however, to get there we must unite the power of one at the intersection of people, policy, and politics. By listening to people's needs, jointly developing policy solutions, and partnering with others, we can ensure our health care system works for everyone. This week on the Race to Value, we bring to you Natalie Davis and Dr. Venice Haynes at the United States of Care, a nonprofit organization focused on an ambitious goal to achieve universal access to quality and affordable healthcare for all Americans. It brings together stakeholders from various backgrounds, including healthcare experts, patients, policymakers, and advocates, to develop and implement practical, bipartisan solutions to improve the healthcare system in the United States. By fostering dialogue and collaboration, conducting research, and advocating for policies that enhance access, lower costs, and improve healthcare outcomes, the organization finds common ground and works across party lines and ideological divides to address the healthcare challenges facing the nation. As CEO and Co-Founder of the United States of Care, Natalie Davis is on a mission to reshape and implement American health care policies that improves the lives of all people.  Dr. Venice Haynes, the Director of Research & Community Engagement for United States of Care, is a social and behavioral scientist focused on an overarching research agenda to address social determinants of health and health disparities in underserved populations using qualitative and community-based participatory approaches.  In this episode we talk about the tenets of patient-first care (a.k.a. value-based care) including affordability, dependability, personalization, and understandability.  We also have an in-depth conversation on the power of storytelling in health care transformation and the imperative to overcome structural barriers in the creation of health equity. Episode Bookmarks: 01:30 United States of Care, a nonprofit organization focused on an ambitious goal to achieve universal access to quality and affordable healthcare for all Americans. 02:00 Introduction to Natalie Davis, Chief Executive Officer and Co-Founder. 02:45 Introduction to Venice Haynes, PhD, Director of Research & Community Engagement. 05:00 Natalie shares her personal story that led her towards an entrepreneurial career path in health care policy transformation. 07:30 Mentorship from Andy Slavitt and his advice to get out of Washington, D.C. to make an impact on health policy. 08:30 Venice discusses how her science and public health background inspired her to lead people-centered health care change. 11:45 Inspiration from Camara Phyllis Jones, a physician, epidemiologist, and anti-racism activist who specializes in the effects of racism and social inequalities on health. 14:30 When offered an alternative, by a 4:1 margin, people favor a model that compensates providers for improving overall health, delivering superior care, and coordinating patient care. 15:30 What it means for United States of Care to be at the intersection of people, policy, and politics in health care transformation. 16:00 Research and listening to people as a way to overcome tribalism and build an agenda of reform for the whole country! 16:45 The 4 goals and 12 solutions of United States of Care to meet the needs of people across demographics and can drive collection action to build a better health care system. 18:30 “The 4 goals of United States of Care – Affordability, Dependability, Personalization, and Understandability – comprehensively cannot be done in a fee-for-service model.”

In the Race to Value, we must recognize that quality of life is the ultimate currency of healthcare, and this aim is all the more important in senior living facilities.  Transforming health outcomes for skilled nursing and senior living populations is not just a goal; it's a commitment to providing the care and dignity our elders deserve.  This week, we profile a leader in the value movement who leads a company on a mission “to improve the health, happiness, and dignity of senior living residents”. We are joined by Mark Price, CEO of Curana Health – a leader who lives by the mantra that “extreme passion” is the single most important ingredient to reform the American healthcare system. Curana Health is a provider of value-based primary care services exclusively for the senior living industry, including in nursing homes, assisted/independent living facilities, CCRC/life plan communities and affordable senior housing communities. Curana Health serves more than 1,100 senior living community partners across 30 states and participates in the MSSP ACO, ACO Reach and Medicare Advantage programs with CMS. Backed by more than $300M in venture capital funding, the organization is poised to disrupt care delivery in senior living on a meaningful scale through innovative care models and applied analytics. In this episode, you will learn about how to transform health outcomes for skilled nursing and senior living populations through extreme passion.  We cover such topics as how to leverage APMs such as MSSP and ACO REACH in the senior living setting, the performance results of Curana Health across their value-based portfolio, technology innovation, palliative care, the state of the nursing home industry, and future trends in the shift to home-based care delivery. Episode Bookmarks: 01:30 Introduction to Mark Price, CEO of Curana Health. 03:45 An estimated 27M more people are aging into the 75+ cohort through 2050, resulting in rising age and higher health acuity levels of residents moving into senior living. 05:00 Curana Health has achieved a 39% reduction in 30-day hospital readmissions and a 37% reduction in total hospital admissions among Medicare Advantage I-SNP members. 06:00 “There are many subsectors in the industry where value-based care can succeed.  The important thing is ensuring that your people have an extreme amount of passion for making it work.” 07:00 Founding story of Curana Health based on how we would want our loved ones to be cared for at the end of life. 08:45 The majority of Americans will spend some time in senior living or skilled nursing in the final years of their life. 10:00 Elite Patient Care ACO performed in the top 1% of ACOs in its first year of operation, achieving PBPY savings amount of $2,235—the highest PBPY for any first-year MSSP ACO since 2012. 11:30 Curana Health also has one of the top performing ACO REACH and risk-based MA I-SNP programs in the country. 11:45 “Our core business is not a payment model. It is a clinical model that produces health outcomes which, in turn, enables affordability as well.” 13:00 Developing a population health playbook for the senior living space. 14:00 Success in developing a level of clinical integration within a senior living facility that is now owned by the company. 15:00 MA Institutional Special Needs Plans (I-SNPs) are designed to meet the needs of people living in long-term care settings such as long-term care nursing, skilled nursing facilities, and inpatient psychiatric facilities. 16:45 Facilities are taking an ownership position of MA plans for senior living and skilled nursing residents. 17:00 Mark provides perspective on I-SNPs and how the Curana Health clinical model is achieving results to improve clinical outcomes. 18:30 Performing well by recognizing the commonality between MSSP, ACO REACH, and Medicare Advantage. 20:00 How CMS and CMMI is incorporating innovation to value-based payment models (e.g.SNF 3-Day Rule Waiver).

Connecting the health and wellbeing of patients of patients directly to the bottom line isn't just good business; it is a visionary approach that shows how healthier outcomes can actually drive healthier profitability. Continued success in demonstrating the correlation between clinical and financial outcomes will be a catalyst for generating societal wellbeing that paves the way for others to adopt value-based care.  And in doing so, we create a more sustainable and effective healthcare ecosystem. In this Race to Value, the true race isn't about speed; it is about the journey to improved outcomes. Strategic and transformational partnerships guided by an enabling vision to improve population health will ultimately create a healthcare system that we can be proud of. In this episode, you will hear from Kyle Wailes, the Chief Executive Officer and Board Member of value-based care company, Wellvana.  Kyle Wailes is someone on a mission to demonstrate how fully-capitated models in primary care, empowered by the right partnerships to create enablement, will ultimately drive patient behavior change.  Under his leadership, Wellvana is an industry-leading example of a company that is connecting the healthy outcomes of patients directly to healthier profitability. With the tools, technologies, analytics, and resources for healthcare providers to successfully and seamlessly transition to value-based care, Wellvana is getting outstanding results and growing at an exponential rate for such a young company.  This is highlighted by the recent announcement of their partnership with AdventHealth to revolutionize primary care in the state of Florida.  Don't miss this important interview to learn more about VBC enablement, high-touch primary care and clinical integration, the power of storytelling, patient behavior change, lifestyle medicine, and the current state of private equity investment in healthcare!   Episode Bookmarks: 01:30 Connecting healthy outcomes of patients to healthier profitability.  (A High-Touch Approach for High Performers) 02:00 Introduction to Kyle Wailes, Chief Executive Officer and Board Member at Wellvana. 04:00 Big Announcement -- AdventHealth partners with Wellvana to transition its Florida primary care network to VBC 05:00 Wellvana is the first value-based care enablement organization in the country to partner with a multi-state/national health system. 06:00 Kyle provides more details on how Wellvana's recently announced partnership will impact the delivery of healthcare in Florida. 06:30 “Building clinically integrated primary care networks across the country requires flexibility.” 07:00 Expanding primary care impact through interdisciplinary roles (e.g. case management, care coordination, pharmacy integration, social work, coding) 07:45 Health systems across the country are extremely distressed with expenses growing 2X as fast as Medicare payments. 09:30 “The pandemic has been an accelerant overall to drive the adoption of value-based care.” 09:45 The opportunity to reposition primary care in the health system setting, taking it from loss leader to profit center, as a strategic cornerstone for transformation. 10:00 A health system focused only on fee-for-service can lose up to $200-300K per employed PCP. 10:30 “Clinically integrated primary care networks can drive better clinical outcomes, but they can also drive profit and growth as well.” 11:00 Flexibility in growing a PCP network through either an employed or affiliated model. 11:30 Kyle's personal journey as a professional athlete, student of neuroscience, and value-based healthcare executive. 12:30 “The Story of the Chinese Farmer” – a parable that illustrates the idea that events that initially seem bad or good can lead to unexpected outcomes. 14:00 Kyle provides perspective on the highs and lows of life and how that translates to theculture at Wellvana. 15:00 Lessons learned from playing competitive sports (discipline, hard work,

Unlocking wellness and reshaping healthcare involves the profound bridge between Lifestyle Medicine and the Social Determinants of Health, a blueprint found in the wisdom of the Blue Zones. Blue Zones are regions of the world where people are known to live longer, healthier lives compared to the global average, often to 100 years of age. These areas have gained attention from researchers and health enthusiasts because they provide valuable insights into the factors that contribute to longevity and well-being.  Researchers have reverse-engineered longevity to find the common denominators and found that these Blue Zones are all places where people enjoy a diet rich in plant-based foods, regular physical activity, strong social connections and community support, and a sense of purpose or meaning in life. Given these lifestyle factors that contribute to the remarkable longevity and well-being of the people in these Blue Zones, we need to find a way to replicate them in our uniquely American society, which is often limited by modern fast-paced living, processed foods, and social structures that de-prioritize these essential elements of health and well-being. If population health success is at the intersection of Blue Zones and Lifestyle Medicine, how can drive the necessary realignment of financial incentives for value-based care? In this enlightening episode of Race to Value, we dive deep into the world of healthcare transformation with Dr. Dexter Shurney, President of the Blue Zones Well-being Institute. He is responsible for creating innovative health and well-being solutions that have broad impact. The Blue Zones Institute is a “Living Lab” to create, study, and codify best practice, including a whole-person approach to care, that can be replicated across regions and communities, including those of greatest need. In this episode, we explore the potential for wellness through the lens of Blue Zones research, discuss the impact that chronic disease has on declining U.S. life expectancy, uncover the profound connection between stress-induced inflammation and chronic disease, and address the impact of both racism and SDOH variables on health equity.  Additionally, we go deep into the tenets of lifestyle medicine and how it aligns with the broader movement value-based care. Tune in for a thought-provoking conversation that unveils the pathway to healthier lives, stronger communities, and a brighter future in healthcare!   Episode Bookmarks: 01:30 Introduction to Dr. Dexter Shurney and the wellness potential of applying Blue Zones research. 03:30 After peaking in 2014, US life expectancy has declined each subsequent year, trending far worse than peer countries. 04:00 Chronic diseases remain our nation's greatest killer, erasing more than double the years of life as all overdoses, homicides, suicides, and car accidents combined. 04:30 The death rate gap between the rich and poor has grown almost 15x faster than the income gap since 1980. 05:30 We have the answers to address declining life expectancy…but haven't put in place the right policies to solve the problem. 06:00 Referencing the new Netflix docuseries, “Live to 100:  Secrets of the Blue Zones” 06:30 People living in Blue Zones often live to be 100 and do not suffer from high rates of chronic disease. 07:00 “Blue Zones countries spend far less than the U.S. on healthcare, and their good health is driven by things others than genetics.” 07:45 “Drug overdoses, homicides, and suicides with our youth are all deaths of despair. It touches back to people being lonely and not connected to friends, family, and society.” 09:00 The common denominators of long life expectancy (plant-based diet, regular physical activity, strong social connections and community support, and a sense of purpose or meaning in life). 09:30 Finding ways to replicate Blue Zones in our uniquely American society, which is often limited by modern fast-paced living, processed foods,

Data interchange and interoperability are the keystones of a united ecosystem for value-based care, where information flows seamlessly, connecting patients, providers, and payers to drive better outcomes, lower costs, and improved patient experience. Overcoming siloed information is the key to breaking down the barriers that fragment care delivery, and in doing so, we unlock the potential for a healthier future for all. While health data interoperability has arguably become an industry buzzword over the past decade, the concept's importance for digital health transformation cannot be understated. The benefits of optimal interoperability in healthcare includes improved care coordination for patients and reduced administrative burden for healthcare payers and providers. Interoperability also supports public health surveillance and population health initiatives that are so critical to value-based care transformation. In this podcast episode, you will hear from two executives on a mission to unlock greater value in American healthcare by aggregating, normalizing, and unifying data.  Venkat Kavarthapu and Dr. Summerpal Kahlon are the Chief Executive Officer and Chief Medical Officer for Edifecs, a Best in KLAS interoperability platform that serves as the foundation for the solutions that eliminate stakeholder friction to overcome healthcare's biggest challenges. We discuss how interoperability will accelerate value-based payment adoption and help providers obtain more complete and accurate care funding for alternative payment models. We cover such topics as the future of AI, the potential for automated prior authorization, how ACO REACH will drive population health management, and the collaboration that is enabled by technology. Episode Bookmarks: 01:30 Introduction to Venkat Kavarthapu and Dr. Summerpal Kahlon and their company Edifecs that provides a leading interoperability platform. 04:00 Industry struggles to implement interoperability requirements of the CMS Interoperability and Patient Access Final Rule. 04:30 The benefits of interoperability and how it serves as a foundation for value-based care. 05:30 Venkat discusses how value-based care is the only path forward in creating a sustainable healthcare system. 06:30 The need for data to improve patient experience and quality of care. 07:00  “True value-based care can only be accelerated if information is available to all entities in all three dimensions – clinical, administrative, and financial.” 08:00 Exchanging information across organizations and between systems without friction, while ensuring privacy and security. 09:00 How data siloes create healthcare dysfunction. 10:00 Extreme data siloing increases data management costs (25-30% of total cost spent to ensure data accuracy). 10:30 Payer-provider collaboration supports value-based care but is still limited by interoperability adoption. 12:00  “Driving interoperability is not a burden on the industry, but a true competitive advantage for the industry.” 12:30 How interoperability reduces administrative burden and the cost of human capital. 13:45 “An interoperability framework can drive a meaningful dialogue, and communication is key to driving good patient outcomes.” 14:30 Summer describes how an overly-fragmented healthcare system that still relies on fax machines contributes to data inaccuracy. 16:00 Emphasizing data accuracy within an interoperability framework ensures patient safety. 16:30 How Natural Language Processing and AI can provide context and improve communication at the point-of-care. 19:00 CMS Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule 20:00 The need for fully automated Prior Authorization (PA) enabled by EDI processing, FHIR-based APIs, AI/ML, and NLP. 21:45 Electronic PA will foster payer-provider collaboration and drive clinical decision support. 23:30 PA transactions are only automated 30% of the time at present (compared to 90% or more ...

Innovation and partnership are the twin engines that propel us into a new era of healthcare. The fusion of cutting-edge technology and clinical innovation, empowered by collaborative relationships, can revolutionize primary care.  This cohesion of innovation and partnership makes primary care more accessible, effective, and patient-centered than ever before. There is no better example of primary care modernization than Central Ohio Primary Care (COPC), the largest physician-owned primary care group in the United States with over 480 physicians and 83 locations in central Ohio. Rooted in a long history of clinical excellence and a commitment to the highest ethical standards, COPC is building a new holistic model for primary care that gives physicians time to build relationships with their patients and one another. Through ACO REACH, full-risk delegated capitated Medicare Advantage Plans, and direct-to-employer value-based arrangements, they are able to engage their entire team in the innovation of their primary care model.  Furthermore, through partnerships they are able to share risk and build a pathway to sustainability in the provision of value-based care for decades to come. Joining us on the Race to Value this week is Donald Deep, M.D., the CEO of Central Ohio Primary Care.  In this episode, we discuss the modernization of primary care that is underway at COPC – including technology-enabled care efficiency, 24/7 access, care management, and post-discharge follow-up. We explore the successes of their Extensive Care Center and Comprehensive Home and Palliative Care programs.  There is also in-depth discussion on low value care, the importance of payer partnerships, direct-to-employer strategies for commercial populations, accessing capital partnerships in full-risk MA, and collaborative leadership for success in VBC. This episode is sponsored by Agilon Health, a company that partners with independent primary care practices that are leaders in their markets and helps them transition to value-based care success in the Medicare program. https://vimeo.com/870324462?share=copy Episode bookmarks: 01:30 Introduction to Donald Deep, M.D., the CEO of Central Ohio Primary Care (the largest physician-owned primary care group in the U.S.) 02:45 Referencing prior episode featuring Dr. Bill Wulf (“The Value Game”: Achieving Success with Capitated Risk and Patient-Centered Primary Care) 03:00 This week's episode is brought to you by Agilon Health 04:30 COPC has directing 2,200 employees across 90 locations covering six counties and has been on a value journey since 2010. 05:30 The modernization of primary care at COPC. 06:30 Patient care coordination that includes technology-enabled care efficiency, 24/7 access, care management, and post-discharge follow-up. 07:30 “We are responsible for the care of our patient population, even outside of the exam room.” 07:45 Empowering PCPs to spend more time with patients and engage patients and families in the care process. 08:00 Addressing prevention and SDOH requires a modernized primary care model. 08:45 Extensive Care Center (ECC): A Novel Approach to Reducing Emergency Department Visits and Observation Unit Utilization 10:00 The Extensive Care Center at COPC returns 95% of patients to the home (ER Avoidance) and prevents 2-3 hospital admissions each week. 11:00 Scaling the ECC model in co-location with Same Day Centers at COPC to provide immediate access for emergent primary care needs. 12:00 Addressing chronic disease in the extensive care center avoids unnecessary ER visits and hospitalizations. 13:30 Payer recognition of the ECC model, with high levels of patient satisfaction. 14:45 The Comprehensive Home and Palliative Care (CHPC) program at COPC provides primary and palliative care in the home setting. 15:30 Palliative care in ACOs have demonstrated reductions in 30-day readmissions, avoidable hospital admissions,

Fourteen years ago, surgeon, writer, and public health researcher, Atul Gawande wrote his landmark article, The Cost Conundrum, about the healthcare challenges of the Rio Grande Valley (RGV) of South Texas. Gawande showcased the challenges that health systems confront when dealing with public and private insurers and the paradox between high-cost treatment options and low-quality outcomes. His careful assessment of McAllen, Texas, a small city on the border, found that it had the most expensive healthcare system in the nation.  This “cost conundrum” in the Rio Grande Valley inspired President Obama to pass the Affordable Care Act and begin a national movement to value-based care. Now that ACOs have reached a critical mass in the Rio Grande Valley we must now ask ourselves “to what degree can value-based care accelerate health equity?” Value-based care is the seed from which health equity transformation can bloom, nurturing a system that values every life, cultivates well-being, and harvests a future where health disparities are but a distant memory. Health equity transformation in underserved regions (like the RGV) is not just a matter of providing medical care; it's a testament to our commitment to justice, compassion, and the recognition that the well-being of every individual, regardless of their circumstances, is a reflection of our shared humanity. Equity transformation is currently underway in the Rio Grande Valley, one of the most underserved regions in the entire United States. The RGV – a 50-mile stretch of towns that span the border of Texas and Mexico – is home to 1.4 million people (almost twice the population of El Paso), nearly 90% Hispanic, and has some of the poorest counties in the country. Issues like poverty and lack of access to healthcare burden the Valley. These factors are the leading cause of health problems like diabetes, obesity, and cervical cancer. Our guest this week is Dr. Edwin Estevez, a nationally-recognized value-based care leader and champion for health equity in the RGV.  His vision is to activate the local health ecosystem to expand access and promote inclusivity through the power of co-opetition. It involves competing organizations in the same market, working together on something that is mutually beneficial while simultaneously competing in other areas. Coopetition in healthcare is the catalyst for transformative change, where the pursuit of collective well-being transcends individual interests, and collaboration becomes the cornerstone of a healthier local ecosystem. If you want to be a part of the health equity transformation in the Rio Grande Valley, register today for Accelerator2023 on October 17th!  (Attendees can attend in-person in Mission, Texas or virtually).  More information at www.equity-accelerator.org https://vimeo.com/decibelrocks/accel?share=copy Additional Resources: WGU Aims to Transform Rio Grande Valley's Healthcare A Vision of Pioneering Co-opetition for Health Equity Episode Bookmarks: 01:20 The landmark article, “The Cost Conundrum” about the healthcare cost crisis and how it inspired a national movement to value-based care. 01:45 Obama's Favorite New Yorker Article led to the passage of the Affordable Care Act and the development of ACOs. 02:00 Edwin Estevez returns to the Race to Value!  (Episode #1 with Edwin) 02:30 The underserved region of the Rio Grande Valley (RGV) as a focal point to create a replicable convening model of equity-based co-opetition. 04:30 Advancing health equity through a community-based ecosystem – Eric and Edwin discuss their upcoming collaboration in the RGV. 05:45 “Value-based care is a platform to shape policy, redirect programs, and understand services better through the lens of health equity.” 06:00 Edwin's prior VBC success with RGV ACO, one of the earliest (and most successful) physician-led MSSP ACOs in the country. 06:30 Edwin discusses AltaCair,

The plasticity of primary care, in the new value-based era, embodies remarkable adaptability, innovation, and responsiveness to evolving community health needs. As our understanding of health and well-being expands, primary care stands as the first line of defense, ready to transform and customize its services to address the unique challenges faced by diverse populations. This flexibility allows primary care providers to pivot swiftly, whether it's in responding to public health crises, addressing disparities in healthcare access, or integrating innovative technologies into daily practice. In embracing this plasticity, primary care not only becomes a cornerstone of community health but also a powerful catalyst for positive change, driving us closer to the goal of a healthier, more equitable society. In this week's episode of the Race to Value, we are joined by R. Shawn Martin, Executive Vice President and Chief Executive Officer for the American Academy of Family Physicians. The AAFP is the medical specialty organization representing 129,600 family physicians and medical students nationwide. Shawn Martin works with the AAFP Board of Directors on the mission, strategy and vision for the AAFP and provides representation to other organizations, including medical, public, and private sectors. He is nationally recognized for his thoughtful leadership on a range of healthcare and workforce issues. While his career portfolio has focused on numerous health care and public-policy issues, he is best known for his extensive work on the development and implementation of primary care delivery and payment models. In this episode, we discuss such things as payment reforms in primary care, the industry impact of primary care consolidation, physician-led ACOs, the new Making Care Primary (MCP) payment model and the need for multipayer collaboration, health equity, rural healthcare transformation, physician workforce challenges, and the future implications of AI on the medical profession. With leadership from Shawn and his constituents throughout the primary care ecosystem, we are well-positioned for transformation in the race to value! Episode bookmarks: 01:30 The plasticity of primary care and how it can evolve to meet community health needs in the new value era. 02:30 Introduction to R. Shawn Martin, the Executive Vice President and Chief Executive Officer for the American Academy of Family Physicians. 04:45 People who have access to advanced primary care tend to have better health, receive timelier diagnoses, and get more prompt treatment when it is needed. 05:30 The U.S. spends only 5-7% of its healthcare dollars on primary care — less than half of the 14% average in Western European countries. 06:00 AAFP Advocacy Priorities:  Fighting for Family Medicine! 07:00 Shawn discusses the need for additional investment in primary care at a national level. 08:30 The misalignment of fee-for-service in the primary care setting. 09:00 “Appropriate investment in primary care, coupled with a prospective payment model, will transform both patient experience and care team performance.”   09:45 PCP Infrastructure Investments + Rapid Transition to Value-Based Care = Primary Care Transformation 10:45 Vertical integration of primary care can lead to higher prices and costs, including insurance premiums, without improving care quality or patient outcomes. 11:30 Site-of-service payment differentials create uneven playing field between independent practices and hospital-owned primary care. 12:00 Shawn's congressional testimony to the Senate Finance Committee on the “Consolidation and Corporate Ownership in Health Care” 13:00 The Medicare program created siloed benefits between hospitals and physicians, and these design flaws created incongruencies in system economics and patient health outcomes. 14:30 The inability of independent physician practices to survive on the regulatory framework of the modern healthcare system.

Democratizing access to value in healthcare through primary care enablement is the compass guiding us toward a future where health is a universal right, not a privilege, and where the promise of value-based care is accessible to all. It represents a fundamental shift in our approach to healthcare delivery. By prioritizing primary care and leveraging technology, we can extend the reach of healthcare services, making them more affordable and accessible to diverse populations. This approach emphasizes preventive care, early intervention, and patient education, reducing the burden on emergency rooms and hospital admissions. Ultimately, primary care enablement has the potential to transform the healthcare landscape, promoting healthier communities and improving the overall well-being of individuals while also making healthcare a more equitable and sustainable system for everyone. Joining us this week on the Race to Value is Michael Kopko, the CEO of Pearl Health – a company that is on a mission to democratize access to value in healthcare. More than 800 primary care providers across the country partnered with Pearl to align payments with patient health and leverage emerging data and technology to achieve better outcomes more efficiently. And earlier this year, they closed on a $75M Series B funding round to bring even more capability to the health value economy, by empowering providers to transition to a more proactive care model, enabling them with a technology solution that surfaces urgent cases before they become emergent, and rewarding them for outcomes aligned with value. This is a company that you need to know about, and it is my pleasure to have Mike on the podcast this week to discuss the challenges facing our industry and how Pearl Health is accelerating the development of innovative solutions that place providers at the center of healthcare delivery and cost management. Episode Bookmarks: 01:30 Introduction to Michael Kopko and Pearl Health -- a company that is on a mission to democratize access to value in healthcare. 03:30 After more than a decade of value-based care efforts, the U.S. still pays about twice as much for healthcare than any other country, despite underperforming in quality and outcomes. 04:00 How do we reach a critical mass with ACOs and other APMs to save the Medicare Trust Fund from insolvency by catalyzing care delivery transformation? 05:45 There is reason for optimism for healthcare in the long-term, e.g. R&D in the health sector, the steady march to value since Michael Porter coined the term in 2006. 07:00 The increasing adoption of Medicare APMs and value-based Medicare Advantage (see HCP-LAN APM Measurement Effort). 07:30 “The underlying infrastructure and operating system for healthcare is positioned well for value.” 07:45 More work needs to be done, e.g. Medicare negotiations with pharma companies to lower drug costs, further realignment of incentives. 08:00 Medicare cost growth has abated.  (See recent NYT article: “A Huge Threat to the U.S. Budget Has Receded. And No One is Sure Why.”) 08:30 The need to balance ACO Shared Savings performance over time with the democratization of data to improve population health outcomes. 09:00 “We are starting to get the highways and freeways established for data interoperability to be very proactive in creating health value.” 09:30 “Our healthcare system has so much money that with the right capability sets and incentives, we will solve any problem as long as we have the will to do so.” 10:00 Pearl has seen 10X year-over-year growth, expanding from 10 to 29 states, since its founding in November 2020. 11:00 Technology enablement requires the harmonization of the platform with the wisdom of experienced healthcare professionals. 12:30 Michael shares key learnings in his healthcare leadership journey and how that led to the founding of Pearl Health. 14:45 The realization that the missing piece of value transformation was the enablement of PC...

In the ever-evolving landscape of healthcare technology, humility is the compass that guides successful change management. It reminds us that the journey towards seamless adoption of health information technology is a collaborative one, where the wisdom of many outweighs the knowledge of one.  The humility to acknowledge one's limitations fosters an environment where collaboration and learning thrive. In the context of clinical informatics, allyship and teamwork are indispensable. Effective clinical informatics demands a diverse skill set, often spanning healthcare providers, IT specialists, and administrative personnel. Allyship within this multidisciplinary team is essential, and applied clinical informatics can be the linchpin in the transition to value-based care.  Through successful HIT implementation, leaders can illuminate the path to better outcomes, reduced costs, and patient-centered excellence. A new era for Clinical Informatics is upon us and will empower healthcare with data-driven insights, AI capabilities, virtual care at scale, and precision medicine to ensure that quality triumphs over quantity in our pursuit of healthier communities. On the Race to Value this week, we are joined by Brittany Partridge, a national thought leader on health data management and informatics.  Brittany is passionate about implementing technology that impacts clinical workflow in a positive way and increases patients' access to care. Join us for an informative discussion on Clinical Informatics, the importance of allyship to mitigate medical technology risk, the impact of Generative AI and virtual care on health system transformation, and change management best practices to lead your organization to successful healthcare innovation. Episode Bookmarks: 01:30 Introduction to Brittany Partridge, an industry leader in Virtual Care Technical Architecture and Informatics Implementations. 03:00 Recent book collaboration with Ed Marx – “Voices of Innovation:  Fulfilling the Promise of Information Technology in Healthcare” 04:30 The sub-disciplines of Health Informatics (e.g. Nursing, Pharmacy, Public Health, Biomedical, Medical, and Clinical Informatics). 06:00 AMIA: Why Informatics? -  “Informatics is the overarching field of study that pulls all these subdomains into one discipline focused on improving health and healthcare.” 06:30 Applied Clinical Informatics – the frontline of healthcare innovation with direct clinician interaction. 07:00 Early experiences in e-prescribing implementations that led to other care delivery innovations such as virtual care and remote patient monitoring. 08:00 The intersection of Clinical Informatics and VBC (ensuring tech usability to optimize care workflows for clinical quality improvement). 09:00 Best Practice Advisories (BPAs) – pop-up alerts to empower clinicians to make the best informed decisions at the point-of-care. 09:45 Leveraging technology innovations to improve patient access and affordability. 11:30 The importance of shadowing and workflow analysis as a catalyst for innovation. 13:00 How shadowing is incorporated into user validation, user design, and Lean (“Go to the Gemba”) 14:00 Simply asking clinicians to describe a workflow is insufficient in understanding the entire process. 15:00 “Get a robust current state workflow before you implement any innovation project because you need to know what you're going to be replacing.” 15:45 How virtual interactions with providers can complement provider shadowing in an embedded CI model. 16:30 Non-judgement in applied clinical informatics is required to build trust. 17:30 “The most important part of rolling out any technology project is clinician trust. They need to know that you have their best interests at heart.” 19:45 Allyship is key to reducing medical technology risk because the inclusion of diverse perspectives yields the greatest rewards. 21:30 “Fail fast and iterate” and “Perfect being the enemy of good” philosophies don'...

Crossing the Value-Based Healthcare Rubicon isn't just a journey, it's a revolution in care, where the currency is quality, and the compass is compassion. This transformation is both an economic and moral imperative, and in the alchemy of healthcare, transforming economics isn't just about numbers; it's the catalyst for transmuting care outcomes into golden results that enrich both lives and ledgers. This week you have access to two of the leading minds in value transformation. We are joined by Dr. Edward McEachern (Executive Vice President and Chief Medical Officer for PacificSource) and Jenni Gudapati (Value-Based Healthcare Program Director and Clinical Associate Professor at Boise State University). In this illuminating episode, we delve into the transformative realm of value-based healthcare with a diverse range of topics. Our insightful interview explores the value movement and its profound impact on economics and care outcomes. We unravel the intricate dynamics of care management, particularly in the context of chronic diseases, while shedding light on the crucial aspects of risk adjustment, Annual Wellness Visits, and Quality Improvement. We also investigate the concept of "Gold Carding" and the role it plays in healthcare transformation. Furthermore, we delve into higher education's pivotal role in shaping the future of healthcare value, emphasizing the essential skills that healthcare leaders of tomorrow must possess. Tune in for an enlightening discussion that navigates the evolving landscape of healthcare, economics, and leadership! This week's episode is brought to you by Edifecs – an EMR-agnostic, interoperable, and AI-enabled technology helps providers unify and utilize data for a more complete digital portrait of patient populations. The result: better clinical, financial, and compliance outcomes.  To learn how Edifecs' applications can enhance prospective risk adjustment and value-based contract performance, visit edifecs.com today. Episode Bookmarks: 01:30 Introduction Edward McEachern, M.D. and Jenni Gudapati, MBA, RN 06:50 The slow uptake of accountable care (HCP-LAN: only 20% of healthcare payments flow through Categories 3B and 4 APMs). 07:20 Provider challenges: supply chain disruptions, labor shortages, high inflation, and the end of COVID-19 relief payments. 08:20 Congressional Budget Office projects insolvency of the Medicare Trust Fund by 2026. 08:50 The economic necessity of value-based health care to reduce unnecessary spending. 09:35 “In the shadow of COVID we have crossed this Rubicon where there is a push on the current paradigms of care delivery and payment.” 10:15 Stressor #1: The retirement of the Boomer workforce will create a 14% structural deficit in accessible labor. 10:30 Stressor #2: FFS infrastructure collides with APM adoption strategies and cannot support value transformation. 11:20 Stressor #3: Shift of hospital care delivery to the outpatient and home setting. (“It is never coming back.”) 11:50 “This chronic complex system of care that takes care of people in the post-acute setting is not adequately available in most communities.” 12:20 “LAN 3B and 4 payments will only help in the context of the operational reshaping of the health delivery system.” 12:50 Value-based consumer perspective needed: 46% cannot afford out-of-pocket healthcare expenses! 13:20 Low value services that do not track to best patient outcomes. 13:50 Revenue dependency on a sick-care model of fee-for-service medicine. 14:35 “Too many health inequities exist. We need to financially incentivize providers to take care of underserved populations.” 15:20 “Healthcare is the only industry that is Yelp proof.” (the dislocation between costs and consumerism) 16:20 What if we created a well-financed and integrated SDOH health system to work alongside the sick care health system? 17:50 The power of the Annual Wellness Visit (AWV) in patient-centered care.

Now is the time to embark on a journey towards a brighter and more resilient future. As the U.S. healthcare system grapples with the aftermath of a global pandemic, we find ourselves at a pivotal crossroads. This episode delves deep into the profound changes brought about by the pandemic, examining how it has exposed vulnerabilities in our existing systems and ignited conversations about the need for transformative change. Join us as we navigate this critical juncture, exploring the shifts in healthcare, economy, and societal values that could ultimately lead us to a high-value system that prioritizes well-being and sustainability for all. Get ready to be inspired and informed as we embark on this enlightening exploration of the post-pandemic world. Joining us in the Race to Value this week is David B. Nash -- an American physician, world renowned scholar and public health expert, and Founding Dean Emeritus of the Jefferson College of Population Health. His accolades and achievements in healthcare transformation are innumerable. (The week before this interview was recorded he had received the Lifetime Achievement Award from the American Association for Physician Leadership.) Dr. Nash is also a bestselling author with his new book, “How COVID Crashed This System: A Guide to Fixing American Health Care.”  In this episode, we discuss insights from Dr. Nash's research on COVID-19's impact on the healthcare system and how this post-pandemic era can help us transition to a high value health care system.   Episode Bookmarks: 01:30 Introduction to Dr. David Nash, an American physician, world renowned scholar and public health expert, and Founding Dean Emeritus of the Jefferson College of Population Health. 03:30 Have we learned our lessons from the COVID disaster? 05:00 Dr. Nash reflects on his recent experience with Dr. Ashish Jha on the last day of service to our country as the White House COVID-19 Response Coordinator. 05:30 “The office of the presidential response to COVID is now a janitorial closet somewhere in the West Wing of the White House…it is sad.” 06:00 “1.2 million dead from COVID-19 is more than the total of all combat casualties of every war since the Revolutionary War of the United States!” 06:30 “Sadly in the history of our country, when the dying stops, the forgetting begins.” 07:00 PTSD from the pandemic with physicians and healthcare professionals, coupled with societal apathy towards COVID-19 and surging cases in China. 08:00 Medicaid Redetermination as the consequence of the end of the Public Health Emergency and how lost coverage will impact marginalized populations. 09:00 3,000+ people died from 9/11, and we are still taking our shoes off at the airport.  1.2M died from COVID-19, and it is back to business as usual. 09:30 Societal issues (e.g. structural racism, inequality) persist in our country. 10:00 What is the True North for American Healthcare really?  ($4 Trillion in spend with significant amount of low value care, declining life expectancy, low ranking in world health rankings) 10:30 Additional societal measures of a poor performing health system (alcoholism, depression, suicide, opioid abuse). 11:30 How Philadelphia is suffering an exacerbation of  pre-pandemic problems (lack of access, redlining, crime, homelessness, educational disparities). 11:45 There is a 20-year disparity in life expectancy between rich and poor communities in Philadelphia. 13:00 The persistence of health inequities and social injustice since the transatlantic slave trade. 13:30 COVID-19 blasted a searing light on social determinants of health! 14:30 “You can't have value-based care without equity.” – the costs of health inequities are in the hundreds of billions (see recent JAMA article). 15:00 Employer engagement in health equity transformation. 15:30 “The emergence of the payvider model has given value-based care additional energy.” 17:00 The evolution of medical and nursing education to improve heal...

In value-based care, true leadership emerges from the depths of the heart, where empathy, compassion, and authenticity converge to illuminate the path of positive change. Purpose-driven leadership can not only revolutionize community health but also create a ripple effect that reaches every corner of society. At the intersection of purpose, compassion, and community lies a transformation of our healthcare system with a tangible impact on the well-being of individuals, families, and neighborhoods. Now is the time for healthcare leaders to harness the power of the heart to shape a healthier and more harmonious world for all.  The heart's power of purpose knows no boundaries, for it holds the strength to heal, inspire, and connect the threads of humanity. Joining us this week on the Race to Value is Mikelle Moore, a nationally recognized health executive with more than 25 years of experience impacting communities through forward-thinking, collaboration, and leadership. Mikelle has payer, provider, business and start-up experience in healthcare having served in executive leadership at Intermountain Health, an integrated system serving an 8-state region. During her tenure at Intermountain, she served as Chief Community Health Officer and as the first female CEO of the system's flagship hospital. In addition, Mikelle has worked in contracting for a provider-owned health plan and in strategy for Mayo Clinic Arizona. As a thought leader in the space, Mikelle knows the value in moving from healthcare to health. In this week's episode, prepare to be inspired and enlightened by Mikelle's heartfelt exploration of “The Power of Purpose:  Transforming Community Health Through Leadership of the Heart.”   Episode Bookmarks: 01:30 Introduction to Mikelle Moore, a nationally-recognized VBC executive leading system change to improve population health outcomes. 03:15 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:00 Broadening the scope of care delivery in health systems to address the determinants of health through equity, impact investments, and ESG factors. 06:00 Mikelle discusses her leadership journey as an expression of authenticity and purpose to right the wrongs of a broken system. 08:00 Intermountain Health as a leading health system that is designed for a consumer-provider approach to improving health care. 09:00 Advocating for improvements in the variability of care and the reduction of wasteful healthcare utilization. 09:30 Listening to the community in the strategic planning of a hospital. 10:00 Pivoting from “sick care” to “health care.” 10:45 The realization that health disparities were far reaching beyond just the care delivered, e.g. poverty, homelessness. 11:00 “If we want to be health leaders that are making healthcare better, we have to be champions for addressing disparities in underserved and marginalized communities.” 13:00 Finding common ground with Community Benefit Organizations (CBOs). 14:00 Mikelle shares his insights on the importance of relationship-building in community partnerships. 16:00 How the principles of collective impact forged new community partnerships to address behavior health and SDOH. 17:00 Defining success by really understanding the problem and what issues get in the way (e.g. how nonmedical issues such as homeless and social isolation impact health outcomes) 19:00 Developing a system of communication and data sharing between the CBO and health system that is centered on patient needs. 20:00 The Alliance for the Determinants of Health as a vehicle to address social needs to improve health. 21:00 The impact of institutional racism on health equity. 24:00 Viewing social factors in society as a lens to view and understand racism. 25:00 “Inequities are often delivered at a subconscious level. It is our accountability to identify those disparities and build systems of care to prevent them from occurring.”

Peering into the horizon of healthcare, we unveil the vanguard of value-based care research and innovation, where data-driven insights and daring ideas converge to shape a healthier tomorrow. In the ever-evolving landscape of healthcare, trailblazing research serves as the guiding light that illuminates the path toward a value-based care revolution. By delving into the intricate dynamics of accountable care, dissecting payment models, and exploring innovative strategies, research on healthcare transformation provides the foundation upon which healthcare stakeholders can build a more equitable, efficient, and patient-centered future. This work not only dismantles traditional barriers but also empowers policymakers, providers, and patients to collectively navigate the complex journey toward a value-driven healthcare paradigm. Our guest this week on the Race to Value is none other than the esteemed David Muhlestein, PhD, JD a true trailblazer in the field of value-based care research and innovation! With a passion for accelerating the adoption of accountable care and driving meaningful change, David has dedicated his career to unraveling the complexities of the value movement by telling a story with data.  As the chief research and innovation officer at Health Management Associates (HMA), David Muhlestein's research and expertise centers on health care payment and delivery transformation, understanding health care markets, and evaluating how the broader health care system is changing. In this interview, we cover topics such as the value-based care movement and the goal of speeding the uptake of accountable care; the current growth trajectory of ACOs; payment model reforms that are taking place to advance health equity; the positioning of Medicare Advantage in the accountable care landscape; the inclusion of specialists in value-based care; multi-payer alignment to reduce administrative burdens and increase the impact of accountable care reforms; hospital and health insurer price transparency; and the new Primary Care Alternative Payment Model ("Making Care Primary").   Episode Bookmarks: 01:30 Introduction to David Muhlestein, PhD, JD – one of the nation's leading value-based care research executives. 03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:30 The glacial pace of scaling payment model transformation and CMS' goal of speeding the uptake of accountable care. 05:30 Industry challenges (e.g. supply chain disruptions, labor shortages, inflation, financial distress) that complicate value-focused investments. 07:30 The plateau of accountable care growth over the last three years in terms of total number of participating ACOs and lives covered. 08:30 The business model for value is supported by payment mechanisms, unique population health capabilities, and playbook approaches. 09:30 Who is really the customer of a health system?  (Is it the patient, the health plan, or physician practices that drive referrals?) 10:30 The capacity-focused world view of a FFS model – creating capacity for well-reimbursed services and then driving transactional patient volume. 11:00 The population health focus of VBC and how that creates conflicts within health systems optimized for fee-for-service capacity. 14:00 Changing the reality of an organizational culture dominated by FFS is increasingly more difficult in a post-pandemic economy. 15:30 Has anyone else noticed that the VBC solutions vendors at healthcare conferences are less predominant in recent years? 16:00 “When times are tough, organizations revert to the lowest common denominator that is their underlying business model.  That is the current challenge for value transformation.” 17:00 Recent stats on the growth trajectory and overall savings of Medicare ACOs over the last few years. 19:00 Average savings in the MSSP (after bonus payments) is about 1% relative to the projected benchmark.

In this thought-provoking episode, we delve into the transformative world of value-based care, exploring the multifaceted facets that are reshaping the future of healthcare. Join us as we dissect the vital components of this paradigm shift, from tackling social determinants of health and championing health equity, to seamlessly integrating behavioral health into patient care.  Discover how population health enablement is empowering communities, while bundled payments revolutionize the healthcare landscape. We'll also uncover the incredible role of technology and patient outreach, enabling unprecedented levels of personalized care and accessibility. And lastly, we navigate the critical importance of physician engagement, a driving force behind the success of value-based care. As we peer into the crystal ball, we envision the future role of hospitals, embracing change and embracing innovation. Joining us in the discussion this week are three important thought leaders in value-based care transformation: Dr. Caroline Goldzweig, Chief Medical Officer – Cedars-Sinai Medical Care Foundation Cynthia Deculus, Vice President and Chief Population Health Officer, Cedars-Sinai Dr. Michael Conseulos, Vice President Strategy, Growth, and Innovation Consulting at OptumInsight Get ready to be inspired as we illuminate the path toward a healthier, fairer, and more compassionate healthcare system. The journey starts now! This week's episode is brought to you by Edifecs – an EMR-agnostic, interoperable, and AI-enabled technology helps providers unify and utilize data for a more complete digital portrait of patient populations. The result: better clinical, financial, and compliance outcomes.  To learn how Edifecs' applications can enhance prospective risk adjustment and value-based contract performance, visit edifecs.com today.   This audio was re-purposed from a discussion that took place at the Pinnacle Value Based Care Symposium on April 24th, 2023.     Episode Bookmarks: 01:30 To learn how Edifecs' applications can enhance prospective risk adjustment and value-based contract performance, visit www.edifecs.com  today! 02:30 This we ek's episode is all about the VBC paradigm shift –from tackling SDOH and championing health equity, to seamlessly integrating behavioral health into patient care. 03:30 This week's guests are Dr. Caroline Goldzweig (Cedars Sinai Medical Foundation), Cynthia Deculus (Cedars Sinai) and Dr. Michael Consuelos (OptumInsight) 04:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:15 “The true measure of any society can be found in how it treats its most vulnerable members.”  - Mahatma Ghandi 06:45 “We are finally seeing major movement in the direction of healthcare providers addressing social determinants of health.” 09:00 “There is so much more to making people healthy than just writing a prescription.  We must begin to impact how patients are living.” 11:00 Cynthia discusses how Cedars Sinai is helping patients navigate the totality of health and social needs, especially dual eligible Medicare patients. 14:00 Patients who have a chronic disease have a three to four times higher frequency of behavioral health comorbidities. 14:30 Cedars Sinai Collaborative Care Model – an overview of how Cedars Sinai is integrating behavioral health in the primary care setting. 16:45 How Care Teams at Cedars Sinai coordinate transitions of care and prevent ED overuse for patients dealing with a behavioral health condition. 18:00 Behavioral health provider workforce challenges and the role of technology and education to fill the void in providing whole-person care. 20:00 Depression screenings in primary care and the need for more inpatient psychiatry beds in the acute care setting. 22:00 34% of all deaths from cancer could be prevented if disparities in access to care were eliminated!

There is a dynamic interplay between health economics, patient-centricity, and value assessment—an intersection that holds the key to unlocking better health outcomes, improved access to care, and sustainable healthcare systems.  With the principles of health economics guiding our decision-making processes in healthcare, we can allocate resources effectively and maximize the value delivered to patients. Patient-centricity lies at the heart of this convergence, emphasizing the importance of putting patients and their unique needs at the forefront of healthcare delivery. Despite decades of investment in patient-centered health care, decisions about access and value are typically made in the context of financial risk management, and often without the input of those who should benefit from care. In addition to a myriad of payment reform strategies, rising interest in cost-effectiveness evaluation commands a central place in the debate about how to measure and pay for high-quality, efficient, and equitable health care. This week on the Race to Value we are joined by Dr. Jason Spangler, the Chief Executive Officer for The Innovation and Value Initiative (IVI).  The IVI is a collaboration of scientists, patient organizations, payers, life sciences companies, providers and delivery systems dedicated to finding scientifically credible approaches to measuring value in healthcare.  The IVI provides the technical knowledge, resources, and collaborative learning platform that facilitate exploration and application of value-based care. In this podcast episode, you learn how partnership with patients, researchers, and industry and purchaser stakeholders can build consensus on the scope and inputs  needed for value assessment models.  Only by assessing true value in health care will we win the Race to Value!   Episode Bookmarks: 01:30 Podcast Introduction with background on Dr. Jason Spangler, the Chief Executive Officer for The Innovation and Value Initiative (IVI). 03:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:30 Creating open-source models that allow researchers and decision-makers to explore, apply, and test scientifically credible approaches to measuring value in health care. 05:30 “The IVI is a nonprofit research organization that focuses on the science and the methodology for determining value, new medical technologies, and innovations.” 06:00 Health technology assessments (HTA) typically have only included payer perspectives (not the patient perspective!) 07:30 Going beyond the academic research understanding of value assessment to reflect real world patient experience. 08:00 How is patient-informed value assessment and comparative effectiveness research used to impact health policy at a national level? 11:00 Defining “value” from a health economist perspective provides the standard equation. 11:45 What is important to patients beyond the clinical outcomes – these must be measured too! 12:30 The costs of healthcare beyond the financial domain (e.g. time, future prospects, family) forces us to deviate from the simple value equation. 12:45 The “Value Flower” – the elements of value that are important to all stakeholders (e.g. QALYs Gained, Net Cost, Productivity, Equity, Hope, Knowing, etc.) 14:00 Asking patients what is important to them in the formation of specific patient-reported outcome measures. 15:00 “We typically look at cost effectiveness in terms of patient populations and averages. This must be balanced with individual patients or smaller patient communities.” 15:45 How good are we…really…in actually listening to patients?  Fee-for-service care complexity gets in the way of meaningful connection. 17:00 Using both qualitative and quantitative data to advance patient-centered innovation. 17:30 The IVI is driving innovation in value assessment through the Open-Source Value Projectwhich is a laboratory for advancing the science and im...

In this week's episode, we embark on a journey into the realm of transforming rheumatology care with tech-driven value-based care. Autoimmune conditions affect millions of people worldwide, causing chronic inflammation, pain, and a host of complex challenges.  These patients often receive substandard care, as it takes almost 2.5 years to receive a diagnosis and patients often wait six months to receive an appointment with a rheumatologist!  This is often a neglected patient population in the movement to value-based care, but what if there was a new frontier of care that leveraged technology and a value-based approach to transform the lives of those living with autoimmune conditions? This podcast explores how a virtual specialty practice, centered on improving patient outcomes and reducing healthcare costs, is driving the transformation of rheumatology care.  We are joined today by Anuj Patel (Founder) and Dr. Elizabeth Ortiz, the CEO (Chief Medical Officer) from a new startup company called Motto Health. Anuj is a seasoned digital health innovator and operator with over 15 years of experience in the healthcare industry. And Dr. Elizabeth Ortiz is a board-certified rheumatologist with patient care experience ranging from large public medical centers to concierge practices.   Episode Bookmarks: 01:30 Where does rheumatology care intersect with the world of value transformation? 02:45 Introduction to Anuj Patel and Dr. Elizabeth Ortiz, the Founder and Chief Medical Officer respectively for Motto Health. 03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:00 The rheumatology workforce faces a deficit of physicians trained to provide high-quality care to patients with rheumatic diseases (only 0.5 rheumatologists per 100,000 people). 06:00 Chronic inflammatory conditions are very expensive to treat (e.g. the average healthcare cost for a patient with Rheumatoid Arthritis is $32k per year). 06:30 Why aren't ACOs and other Risk Bearing Entities actively addressing this patient segment like they do patients with diabetes, CHF, COPD, or even kidney disease? 06:45 The epidemiological fragmentation of chronic diseases across the care delivery landscape. 07:30 Lack of overall marketplace adaptation in rheumatology care and treatment (e.g. specialty pharmacy injectables) to the shift in value-based care. 09:00 The wide breadth of conditions in the specialty of rheumatology and how that creates a “black box” for other physicians to understand. 10:15 Patients waiting so long to see a rheumatologist that it takes, on average, 2.5 years for a patient to receive a confirmatory diagnosis! 10:30 Rheumatology provider shortage worsening (50% of adult and 32% of pediatric rheumatologists projected to retire over the next 10 years). 11:30 The window of opportunity for clinical outcomes improvement if chronic autoimmune and inflammatory diseases are diagnosed early. 12:30 Limited capacity for rheumatologists to see new patients due to long persistence of disease and the shortage of providers. 13:00 How virtual care can increase access by offloading the maintenance burden of managing a large patient panel. 13:30 Enablement of expanded geographic access through a virtual care model. 13:45 “Virtual care delivery can democratize access for patients in need of rheumatological care.” 14:00 In Texas, 213 of 254 counties in the state do not have a practicing rheumatologist leading to 5M people without access to care. 14:45 A huge opportunity in value-based rheumatological care is to tackle the exorbitant specialty drug costs for drugs like Remicaid or Humira that have an annual cost of $70k. 15:00 Mark Cuban's online pharmacy announced that it will be selling a biosimiliar of Humira for a steep discount. 15:30 Since 2016, AbbVie has raised the price of Humira 30X from $522 per syringe to $2,984 per syringe. 17:30 Biosimiliar adoption should not be over-indexed in valu...

We need to change the calculus of self-interest in health care. If the trend of unfettered greed in fee-for-service medicine continues, we will have a bleak future ahead of us. Our industry is on a ventilator, demanding another cigarette. Yet despite its moribund appearance, a few critical vital signs do offer hope. There is an opportunity to find optimism with unifying language and shared virtues to guide health care transformation. By developing a shared vernacular for value-based care, we will be able to have the meaningful conversations to reimagine care delivery. And this new language will be shaped by the evidence from leading exemplars in the value movement.  Amidst the vast wilderness of the healthcare landscape, we can find hope in these green shoots, sprouting with resilience and the promise of a brighter future. This post-pandemic era is a tremendous opportunity for value creation. Now is the time to have the conversation and be the change we want to be. The elevation of social consciousness related to health equity, transparency, and financial accountability—coupled with industry challenges related to escalating inflationary pressures, workforce shortages, lack of patient access, supply chain disruption, and weaknesses in our public health infrastructure—will provide the catalyst for a new modus operandi in American healthcare. Joining Eric Weaver on the Race to Value this week are Craig Solid and Andrew Kopolow. Together they recently co-wrote an article published by the American Journal of Medical Quality entitled, “Changing the Calculus of Self-Interest in Health Care.”  In this podcast discussion, they discuss their views about greed in healthcare and what it will take to transform our industry to a more sustainable, value-based model. “Greed has poisoned men's souls, has barricaded the world with hate, has goose-stepped us into misery and bloodshed. We have developed speed, but we have shut ourselves in. Machinery that gives abundance has left us in want. Our knowledge has made us cynical. Our cleverness, hard and unkind. We think too much and feel too little. More than machinery we need humanity. More than cleverness we need kindness and gentleness. Without these qualities, life will be violent and all will be lost…”  -- The Final Speech from “The Great Dictator” (Charlie Chaplin) Episode Bookmarks: 01:30 Referencing the recently published article, “Changing the Calculus of Self-Interest in Health Care” written by Eric, Craig, and Andrew. 01:45 Eric reads an excerpt from The Final Speech from “The Great Dictator” by Charlie Chaplin. 02:45 How is the greed of fee-for-service healthcare holding us back from our human potential? 03:00 Introduction to Craig Solid, PhD and Andrew Kopolow, MPA MSW CPHQ PMP CLSSMBB FNAHQ. 05:30 Don Berwick's JAMA article entitled, “Salve Lucrum: The Existential Threat of Greed in US Health Care” which called out our industry for the glorification of profit (Salve Lucrum) 07:30 The difficulty in addressing profit motive through value transformation when “none of us speak the same language” through a shared vernacular in healthcare. 08:30 The emotionality of Dr. Berwick's article as a recognition of the existential threat of greed in healthcare. 09:15 Hospital closures across the healthcare landscape are seen as just the normal course of business. 09:45 How can we even talk about the quality of care when people can't even access the care they need? 10:00 The oversimplification of “quality” and “value” is holding us back. 10:45 What is the solution to price gouging of prescription drugs, exploitive market consolidation, upcoding, overpaid executives, lack of transparency, and patient medical bankruptcies? 11:30 The need to align incentives in healthcare so that it does not personify greed as a primary virtue. 12:00 Optimism for socially-conscious healthcare based on Bright Spots and Green Shoots! 12:45 The exemplars of value-based health care (i.e.

Since diabetes is one of the few chronic conditions that can be very effectively managed by an individual, why are there so many people with poorly managed diabetes? Despite conventional logic, it's not that most people aren't willfully noncompliant with their diabetes care. Instead, many have extenuating socioeconomic or other circumstances that can lead to drifting away from their care plans. There is an opportunity in value-based care to engage diabetic patients more effectively through data-driven personalized care interventions.  By merging rich, non-traditional data sources such as purchase trends with foundational elements like claims and clinical services, trusted care team members can develop one-of-a-kind insights into individuals' risks and behaviors. Translating broad, extensive multiple data sets into actionable information specific to an individual holds the potential to better manage populations while simultaneously changing the trajectory for each patient living with a chronic disease. On this week's episode, we have: Richard Mackey, Chief Technology Officer at CCS, a company that transforms chronic care management by combining equipment and products with comprehensive education, monitoring, and coaching…serving more than 400 employers and more than 1,800 managed care plans nationally to support patients with diabetes.  Joining Richard on the podcast is Jean-Claude Saghbini, Chief Technology Officer at Lumeris who also serves on the advisory board for CCS. Richard and Jean-Claude address how technology-assisted disease management makes the patient experience less arduous. They also discuss how devices and digital tools such as continuous glucose monitors, insulin pumps, chatbots and smartphones can generate an enormous amount of new and unique data. The information from these additional data feeds can be used to derive valuable insights into both the individual and population levels to drive the future of personalized care. Episode Bookmarks: 01:30 Data-driven, personalized care interventions are key to effective chronic disease management. 02:00 Introduction to Richard Mackey and Jean-Claude Saghbini. 02:45 An overview of technology-assisted disease management. 04:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:00 Diabetes is such a significant problem in the United States, affecting over 37 million people, and it leads to numerous health complications. 07:00 Richard provides his perspective on the potential for aggregating disparate data sources and applying advanced analytics to transform diabetes outcomes. 08:30 How technology solutions can enhance the relationship between the care provider and the patient. 09:00 An overarching data interoperability framework is not necessarily required to leverage the power of data and technical solutions. 09:30 Jean-Claude on balancing the aims of interoperability, data normalization, and predictability in data flows with current day realities. 12:00 The importance of partnerships in driving scale in population health management through combined data feeds and biometric capabilities. 13:00 Richard expounds on the importance of partnerships in data-driven solutioning and medical device optimization for effective delivery of VBC. 14:30 Jean-Claude on how healthcare organizations can extract insights from technology to change the trajectory of disease in their patient population. 16:00 Predictive analytics can accelerate progress in understanding relationships between external factors and human biology.   17:30 Richard discusses the impact of predictive analytics to enhance the reengineering of clinical pathways to deliver personalized care to patients. 18:15 The unique opportunity to customize patient segmentation at the individual-level (versus relying just on profiling patients at the population-level). 19:45 Jean-Claude on how SDOH predictive models focused on housing instability or...

We are on an enlightening journey to transform American healthcare in the race to value. Medicare Advantage increasingly stands out as a superior vehicle for value transformation due to its ability to catalyze care delivery innovation through full-risk capitation. By promoting coordinated care and integration among healthcare providers, MA plans foster a patient-centric approach that improves overall care quality and health equity. Additionally, these plans prioritize preventive care and wellness initiatives and enable early identification and management of chronic disease, ultimately reducing healthcare costs. By incentivizing providers to prioritize outcomes over volume, Medicare Advantage is our path forward to a uniquely American healthcare system that we can be proud of. Joining us this week on the podcast is Don Crane, former CEO of America's Physicians Groups. In this episode, he shares his valuable insights and expertise on Medicare Advantage and how it will shape our future in healthcare transformation. Join us as we explore the challenges and opportunities that lie ahead for Medicare Advantage and discuss the potential impact on the healthcare landscape! Episode Bookmarks: 01:30 Introduction to Don Crane (Former President and CEO of APG) and the potential for Medicare Advantage to transform American healthcare. 03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:00 Don Crane joins the Race to Value again as returning guest. (Check out his prior episode on Primary Care Transformation!) 05:00 The explosive growth of MA and the evidence showing that MA plans deliver better economic and clinical outcomes. 06:30 How a capitation in Medicare Advantage enables population health outcomes through effective SDOH interventions. 08:00 The criticisms of Medicare Advantage from notable thought leaders Richard Gilfillan and Don Berwick. 09:30 Protection of the Medicare Trust Fund is the common point of agreement between MA proponents and opponents. 10:00 Don addresses the criticisms of risk adjustment gaming and the program's overall spend. 10:45 Is it necessarily a bad thing if MA costs more than Traditional Medicare if it provides better care outcomes and supplemental benefits? 11:30 “Spending more on Medicare Advantage makes all the sense in the world to me if it provides better outcomes and value for seniors.” 12:00 The perspective from seniors enrolled in Medicare Advantage on the appropriateness of spending for supplemental benefits. 12:30 “The astronomical growth of Medicare Advantage should be celebrated.” 13:00 The V28 HCC changes to the Risk Adjustment model for payment year 2024 will decrease the number of codes by more than 2,000 from the HCC model. 14:00 The adverse impacts of risk adjustment coding changes will increase administrative complexity and hurt seniors by reducing MA funding to the tune of $10B. 15:45 The need to evaluate both Traditional Medicare and MA to determine the best path forward. 16:30 Risk adjustment is grounded on the premise of fairness to both the payer and provider and should prevent both over- and under-payment. 17:30 “Risk adjustment is such an important ingredient in capitated payment models and provides a business case for addressing inequities in underserved communities.” 18:30 Concerns about the elimination of risk adjustment and how that will adversely affect sicker patent populations through “cherry picking” during MA enrollment. 19:30 Don compares the bad actors in MA who perform upcoding to the overpayments and overutilization that occurs in Traditional Medicare. 20:00 Is the potential for upcoding exaggerated by detractors of Medicare Advantage? 20:30 Eliminated risk adjustment in Medicare Advantage is an example of throwing out the baby with the bathwater. 21:00 How Star Ratings work in Medicare Advantage to unlock bonuses and rebates when improving care quality.

We have Dr. Omolara Thomas Uwemedimo as a guest on this week's Race to Value! She is a healthcare social entrepreneur, board-certified pediatrician, community health equity consultant, career transition and business coach, public health researcher, and health justice advocate. She is currently the CEO and Co-Founder of Strong Children Wellness, a multi-award winning healthcare practice in New York City, providing integrated, physical, mental, and social health services for low-income communities of color. Back in 2019, Omolara lost her ability to walk. She was diagnosed with Multiple Sclerosis, a chronic autoimmune condition. During her recovery, she became a staunch wellness advocate for women of color who in healthcare often experience disproportionally higher rates of chronic disease due to weathering – the deterioration of one's health due to medical racism and toxic environmental stress in the workplace and in society.  In response, she founded “Melanin and Medicine”, a community health equity consulting and social entrepreneurship company that helps women of color thrive by building purposeful careers within healthcare enterprises.  She also has a weekly podcast called “Funding Your Healthcare Vision” that helps visionary leaders of health centers & practices to secure grants, contracts and other funding to strengthen, scale & sustain their vision, mission & impact to support under-resourced communities of color. With her leadership insights, you too can break the barriers to health justice by building a healthcare social enterprise built on CBO partnerships and social impact innovation! Episode Bookmarks: 01:30 Introduction to Dr. Omolara Thomas Uwemedimo (CEO and Co-Founder of Strong Children Wellness, founder of Melanin and Medicine, and host of Funding Your Healthcare Vision). 04:00 The intersection of Social Entrepreneurialism and Value-Based Care, where private profit creates public good. 06:30 The difference between “health equity” and “health justice”. 07:00 Creating health justice for a psychosocially complex Medicaid patient population dealing with social and mental health challenges. 07:30 Working with grant partners and Community Benefit Organizations (CBOs). 08:30 Closing the loop between physical health and social determinants of health (SDOH). 09:00 Overcoming a flawed business model by moving physical health care delivery into the CBO setting. 09:30 Aligning the public health interest in patient outcomes with economic incentives. 09:45 How healthcare capitation (PMPM reimbursement) merges with philanthropy dollars to drive holistic care delivery. 10:00 “The collective impact of capitation and philanthropy is the precipice of an integration model that makes an impact with payers and patients.” 11:00 The majority of healthcare organizations are not conducting place-based interventions to improve health equity and create health justice. 12:30 The fatigue of healthcare providers dealing with under-resourced communities. 13:30 Starting with the patient first by addressing the referral process in addressing social health needs. 14:00 Developing a social navigation workforce as a baseline to deliver primary care to Medicaid populations. 15:00 Funding a healthcare social enterprise through embedded CBO partnerships (“reverse integration”). 16:00 “We thought we were dealing with psychosocially complex patients until we integrated our care model with CBOs.  This in where the impact can be made in VBC.” 16:30 Identifying the right community organizations (e.g. homeless shelters) in creating a holistic care model. 17:30 Securing over $2 million in grant funding within a community health network and working with other BIPOC, women-led healthcare practices to create sustainable health justice. 19:45 “Human social organizations are an essential leader in health.  We must think beyond the delivery of care when building a mission-driven healthcare social enterprise.”

The only way for the health care sector to sustainably contain costs and fulfill its mission is by putting the patient -- and the delivery of outcomes that matter to patients -- at the center of the industry's efforts. We must align incentives around the continuous improvement of health outcomes in a cost-effective matter. This is what value-based health care is all about – better health outcomes to patients for the money spent. Contrary to traditional approaches to health system reform that emphasize cost containment, value-based health care shifts the focus to continuous improvement in the outcomes delivered to patients. On the Race to Value this week, we are joined by two of the four authors from the new healthcare book, “The Patient Priority”. With this book, they wrote a practical step-by-step guide for clinicians, payers, policymakers, and other industry stakeholders to lead patient-centered, value-based health care innovation. It presents case studies from leading innovators and provides a roadmap for the comprehensive value-based transformation of national health systems. On the show this week is Stefan Larsson, MD, PhD -- an independent advisor in health care and life sciences, and a senior advisor to Boston Consulting Group (BCG).  Joining him is Robert Howard, a former senior editor at Harvard Business Review and MIT Technology Review who collaborates with BCG on the topics of value-based care and health system transformation.   Episode Bookmarks: 01:30 Putting patients first is the only way for the health care sector to sustainably contain costs and fulfill its mission. 02:00 Introduction to Stefan Larsson, MD, PhD and Robert Howard and their new book, “The Patient Priority.” 03:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:30 The Triple Crisis:  There is a Crisis of Value, a Crisis of Evidence, and a Crisis of Purpose in American Healthcare! 05:30 How the vicious cycle of how a continued explosion of medical research knowledge drives higher costs due to anxiety and lack of guidance. 07:00 The crisis of outcomes (e.g. obesity, declining life expectancy) have persisted over a long period of time. 07:30 “The health care crisis will only get worse unless there is a fundamental shift in how we lead, define success, and agree on what good looks like.” 08:00 The criticality of shifting to an outcomes measurement model that values what matters to patients. 08:30 “Outcomes that matter to patients is the essence of the future of health care.” 09:00 Why the value-based care movement should focus more on the system than the individual provider organizations. 09:30 “The only way individual organizations can sustain value-based change is if we transform health systems as a whole – on a regional, national, and even international level.” 10:00 Health care is a complex adaptive system, and you don't change it through rules-based policy. 11:00 “Measuring outcomes in accordance to what matters to patients should be the key metric to drive change in health care.” 12:30 This importance of clinical registries that collect comprehensive data on health outcomes in a population of patients with the same condition. 13:00 How a fragmented specialty-dominated healthcare system limits our ability to develop consensus standards for measuring outcomes that matter to patients. 15:00 “By measuring the outcomes that matter to patients, we take a holistic view of health care.  We can then integrate all the different professional capabilities in the most ultimate way.” 15:45 The important work of the International Consortium for Health Outcomes Measurement (ICHOM). 16:00 How Sweden is a driving force for the international adoption of patient-centered outcomes measures and clinical registries. 17:30 Why a health care comparison of Sweden to the United States is relevant. (Patient needs are the same!) 18:00 Stefan discusses how his partnership with Michael P...

In the universe of value-based care transformation, there has been one disease that represents a metaphorical black hole, where the gravitational pull of fee-for-service is so strong that nothing can escape. These patients experience the fullest depths of pain and despair, and this chasm is so deep and wide that there is only darkness. You may have guessed it, but we are talking about chronic kidney disease, a condition that impacts 37 million people in the U.S. The suffering of those inflicted with CKD is so immense, yet the Medicare reimbursement system is designed to fail this patient population. In fee-for-service medicine, we wait until patients succumb to end-stage kidney disease, where they crash and burn and need costly dialysis to stay alive for a little while longer. Because of this flawed reimbursement model, Medicare pays over $125 billion for people with all stages of renal disease, which is around 20% of all Medicare spending!  Unless we go upstream and start engaging patients prior to kidney failure, success in value-based kidney care will be limited.  We must “give life” to this patient population in the Race to Value! The giving of life and that is what DaVita Kidney Care is doing.  In fact, the name DaVita is an adaptation of the Italian phrase for giving life. In value-based care, DaVita works with healthcare payers and providers to develop and implement care delivery models that focus on improving outcomes and reducing costs for CKD patients. And I am excited to share with our listeners, that our guest this week is Dr. Adam Weinstein, the Chief Medical Information Officer for DaVita. Dr. Weinstein works across numerous lanes helping bridge the intersection of IT, clinical nephrology, and healthcare policy. He is focused on delivering IT tools that take advantage of DaVita's clinical data and help nephrologist and DaVita teammates deliver the best care possible.  A kidney doctor from Maryland, Dr. Weinstein is passionate about slowing the progression of chronic kidney disease in patients. This was such an outstanding conversation with one of the true innovators in technology and clinical care! Episode Bookmarks: 01:30 The importance of crossing the chasm of chronic kidney disease, a condition that impacts 37 million people in the U.S. 02:30 Introduction to Dr. Adam Weinstein, the Chief Medical Information Officer for DaVita Kidney Care. 03:30 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:30 Dr. Weinstein shares how his lived experiences and positive mindset have shaped his work as a nephrologist, healthcare executive, and technology innovator. 06:45 Treating kidney disease costs Medicare $130B – although CKD patients are 1% of the population, they account for over 7% of all Medicare spending! 08:30 An overview of the DaVita Integrated Kidney Care (IKC) program and how it produces solid results through data enablement and relationship building. 10:30 Integrated Kidney Care accomplished through people working in collaboration, predictive modeling, and population health management. 11:30 Facility versus At-Home Dialysis and the empowerment of patients through education and health literacy. 12:30 An overview of DaVita's participation in value-based care payment models focused on CKD and ESKD. 14:30 Dr. Weinstein on how to bring scale to value-based payment innovation in kidney care. 16:00 The need for specialist and care team coordination that goes well beyond the office visit. 17:00 Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) Models and how they provide financial and philosophical alignment for integrated care. 18:00 The challenges of including broader specialties and building an advanced data infrastructure in value-based kidney care. 19:00 The “clinical nebulous” that requires a longer runway for value-based payment model innovation to deliver improved patient outcomes.

Data enablement has the power to transform American Healthcare. It can foster trust between patients and clinicians and make healthcare more accessible, affordable and equitable. This future of an open and connected health ecosystem may seem elusive, but it's not out of reach. Technology will not hold us back — instead our biggest challenge will be creating a value-based model of care where new innovations can thrive.   This week we our joined by Dr. David Feinberg, the Chairman of Oracle Health. Dr. Feinberg is committed to advancing thought leadership and strategy related to unleashing the healing power of data through an open and connected healthcare ecosystem.  Previously Dr. Feinberg served as president and CEO of Cerner, now Oracle Health, where he led teams delivering tools and technology to improve the patient and caregiver experience. He has also served as the VP of Google Health, and he served as the President and CEO of Geisinger where he led a complex turnaround and guided Geisinger's transition to value-based care.  Episode Bookmarks: 01:30 Introduction to Dr. David Feinberg, Chairman of Oracle Health. 02:45 The massive generation of data by humankind in the modern day (projected to be 175 Zettabytes by 2025). 03:45 Approximately 80% of healthcare data today is unstructured. 04:30 People are dying unnecessarily and suffering poor outcomes despite the amount of data generated by the healthcare system. 05:30 "Healthcare fundamentally is people caring for people. Data is secondary; the primary aspect of healthcare is trust.” 06:30 Making Electronic Health Records usable is of paramount importance (PCPs Need 27 Hours a Day to Do Their Best Work!) 07:00 Digitizing the medical record has made clinical workflows humanly impossible and compromises trust. 07:30 The vision for an open and connected health data ecosystem. 08:45 The Meaningful Use program did nothing for EHR usability (an example of the Gartner Hype Cycle). 10:00 Dr. Feinberg's clinical and executive leadership background provided a great lesson in technology adoption. 11:00 Can there be a high level of technology adoption in healthcare like Google dominates the non-healthcare marketplace? 12:30 We have solved for interoperability, but healthcare lacks a level of usability to allow a true longitudinal health record. 14:00 Motivating doctors for high performance ultimately comes down to the data scorecard. 15:00 Knowing the game (volume vs. value) and the promise of data enablement in value-based care. 16:00 The 21st Century Cures Act and the path forward in interoperability. 17:00 Can scalable FHIR-based interoperability and Open APIs eventually reach critical mass in the U.S. to improve population health? 19:45 Dr. Feinberg describes the two points of failure by technology companies trying to disrupt the healthcare ecosystem. 20:30 How Oracle Cerner is designing an intelligent, cloud-enabled platform to change healthcare for the better. 22:00 An example of disruption with Internet Banking and how application of those principles could change the healthcare system. 23:45 Digitization of medical records was a requisite first step. 24:00 Integration and normalization of disparate data sets provides an opportunity to create data intelligence. 25:00 How Larry Ellison's impatience for healthcare disruption clashes with the realities of the industry. 26:30 Recognizing the "life and death" aspects of healthcare transformation. 27:00 Making incremental progress with a digitized medical record…and then COVID happens to accelerate value-based care! 29:00 Workforce burnout and EHR usability - “Simplicity is the ultimate art of sophistication.” 30:00 “Value-based care is ultimately the best way to address the root cause of burnout in the workforce.” 30:45 The need for UX in the design of EHR applications to optimize physician workflow. 31:30 Results in usability redesign — ex: 19% reduction in nursing time at the terminal,

Dr. Stephen Klasko is a transformative leader and advocate for a revolution in our systems of health care and higher education. He has been a university president, a dean, a CEO, and an obstetrician, and now pursues his vision for the creative reconstruction of American healthcare by bridging traditional academic centers with entrepreneurs and innovators. His passion is using technology to eliminate health disparities and offers everyone the promise of health assurance. Dr. Klasko is also a lifelong DJ who believes that the message in the music can give us the courage to tackle a broken, fragmented, unfriendly, expensive, and inequitable healthcare system. In this episode, Dr. Klasko merges with his alter ego “Stevie K the DJ” to discuss his new book, “Feeling Alright: How the Message in the Music can Save Healthcare” published by ACHE.  Feelin' Alright leverages the emotional power of song lyrics to inspire healthcare executives to envision and build a more accessible, high-quality, and equitable healthcare system. Using music as a metaphor,  Dr. Klasko encourages us to examine what is problematic in the existing healthcare model and to take tangible steps toward a more consumer-centered healthcare experience. Infused with the passion inherent in music, this interview motivate healthcare leaders to take the lead in building a better healthcare system! Episode Bookmarks: 01:20     DJ Eric “The Dream” Weaver introduces Dr. Stephen Klasko (aka Stevie K the DJ)! 03:30 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:30 Using the power of music to inspire a more optimistic world. 05:30 Dr. Klasko discusses his prior career as a DJ and how getting fired started him on the path to medicine. 06:30 Using music at Jefferson to inspire his others to find hope in overcoming the pandemic, financial tsunami, and systemic racism. 07:00 “Choice of Colors” by Curtis Mayfield and the Impressions (healing during the George Floyd protests) https://www.youtube.com/watch?v=Zr0SLv9WFr4 07:45 “Courage to Change” by Sia become a theme song for frontline workers and their heroic response to the COVID-19 pandemic. https://www.youtube.com/watch?v=mWQACEqf4QY 10:00 Health care delivery during the pandemic was a war and how music helped to see a brighter day. 10:45 “We have to stop saying we are the best healthcare system in the world.” 11:00 “Medicine's Dilemmas: Infinite Needs Versus Finite Resources” and the “Iron Triangle” of Healthcare 11:30 The performance of stocks as evidence for flawed thinking around healthcare disruption. 12:30 Kaiser Permanente and Geisinger come together to launch Risant Health and expand access to value-based care. 13:00     Payer-Provider Alignment in Medicare Advantage 13:45 Cityblock Health leveraging capital investment to build a Community Health Worker model for population health. 14:30     Taking population health, social determinants, predictive analytics, and health equity to the mainstream of healthcare. 14:45 “Keep the Customer Satisfied” by Simon & Garfunkel as inspiration for health assurance to rebuild trust and equity in a broken system. https://www.youtube.com/watch?v=qx6_0Do0qGQ 17:00 In healthcare, do we really view the people as the customer? 18:00 The healthcare system is setup to enrich the people in control. 18:30 “The concept behind health assurance is that costly sick care will give away to affordable, personalized, and preemptive care, partly through genomic sensors and AI-based digital therapies.” 19:00 The future of Jefferson as a health system without a location. 20:00 Livongo and Jefferson Health -- a strong, sustainable partnership between technology and providers to remake medicine. 21:00 Poor consumer segmentation in American healthcare (viewing patients monolithically). 22:45 Radical change needed! (collaboration,

In rural communities, the transformation towards value-based care is an ongoing journey rather than a fixed destination. Rural healthcare faces unique challenges such as geographic barriers, limited resources, and reduced access to specialized care. The value journey in these communities involves adapting care models to meet the specific needs of rural populations. It requires innovative solutions to overcome barriers which can bridge the distance between patients and healthcare providers.  It represents a fundamental shift in healthcare delivery, focusing on improving patient outcomes, enhancing the patient experience, and controlling costs. Ultimately, this journey involves continuous adaptation, collaboration, and innovation that is fostered by a mission-driven culture to improve community health and wellbeing. One of this nation's leading examples of value-based rural health transformation is the Bassett Healthcare Network, and we are joined this week Leonard Lindenmuth, their Vice President of Strategy and Population Health.  Since 2014, he has been leading value-based care transformation throughout Central New York. In this episode you will learn about what it takes to lead a successful value journey through a cultural evolution that increasingly seeks innovation to improve rural health outcomes.  We discuss such topics as risk progression, the use of commercial ACOs as a learning laboratory in value-based care, population health playbook success that focuses on pharmacy optimization and interdisciplinary team-based care, deploying remote patient monitoring to rural populations, how workforce burnout is related to fee-for-service payment, and the importance of SDOH innovation to better serve vulnerable patients in underserved communities.   Episode Bookmarks 01:30 Introduction to Leonard Lindenmuth, DHA - Vice President, Strategy & Population Health, Bassett Healthcare Network 02:00 Bassett Accountable Care Partners, LLC – BHN's Accountable Care Organization founded in 2014 03:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:30 How a data-enabled value-based care journey changed the culture of the health system. 05:45 “The value journey helped us understand much more about ourselves so we can better care for our rural communities. It has evolved our culture.” 06:00 A calculated progression to downside risk as a rural healthcare provider. 09:00 An increase in Medicare Advantage penetration in the marketplace and how that is impacting value-based care strategy. 10:00 Developing a co-branded regional MA product and the intention to take aggregated risk with a national MA plan. 12:00 Leveraging brand equity of the health system to develop a MA plan in the future. 12:30 Approaching MA risk-readiness of providers through coding education. 13:00 “MA Risk is clearly on the horizon.” 14:45 Leonard describes BHN's commercial value-based playbook strategy that includes focus on pharmacy spend. 15:30 The Ambulatory Intensive Pharmacotherapeutics (AIP) program to reduce pharmacy costs through lower medication-related adverse events, avoidable hospital admissions and ED visits. 16:00 How the AIP program reduced BHN's commercial spend on pharmacy through comprehensive medication management. 16:30 1% of the population drives 55% of specialty drug costs. 17:00 Risk progression in a two-sided risk arrangement with Excellus Health Plan (a local Blue Cross affiliate). 18:00 What being in a Commercial ACO has taught BHN about value-based care transformation. 18:30 How a rural health system balances the “two canoes” – volume vs. value. 19:00 “We have to get to a point where value drives the equation, but it is not an overnight transformation.” 19:30 How a healthcare organization performs better – both financially and clinically – under a fully-capitated environment. 21:30 An alarming divergence of health outcomes and life expectancy between urban and...

This week is National Nurses Week, and it is a time to honor the contributions and sacrifices of nurses who perform some of the most difficult and heartbreaking tasks in the medical world.  As workers who perform the most essential healthcare tasks, nurses serve as the first point of contact for most patients…and they save lives and restore health in the process.  Yet, nursing is often a thankless profession that is underappreciated and experiences high levels of burnout and moral injury.  There are a multitude of factors related to societal attitudes towards the nursing profession, and many of them result in a lack of recognition and support, inadequate compensation, limited opportunities for career advancement, and ultimately a lack of respect and appreciation for the work they do.  We must begin to think about how to better position the profession to take a leading role in healthcare innovation.  Nurses must become more empowered as we transition to a future of value-based care. This week on the podcast, we are honored to be interviewing Rebecca Love.  She is an experienced nurse executive, the first nurse featured on Ted.com, and part of the first nurse panel at South by Southwest. Rebecca is a regular contributor on the Forbes Business Council, and has been featured in BBC, Fortune, Becker's, Forbes, Chief Healthcare Executive Magazine and ABC news. Rebecca, was the first Director of Nurse Innovation & Entrepreneurship in the United States at Northeastern School of Nursing – the founding initiative in the Country designed to empower nurses as innovators and entrepreneurs, where she founded the Nurse Hackathon, the movement has led to transformational change in the Nursing Profession. In early 2019, Rebecca, along with a group of leading nurses in the world, founded and is President Emeritus of SONSIEL: The Society of Nurse Scientists, Innovators, Entrepreneurs & Leaders, a non-profit that quickly attained recognition by the United Nations as an Affiliate Member to the UN. Rebecca is a world renowned Nurse Entrepreneur and currently serves as the Chief Clinical Officer of IntelyCare. Click here to learn more Episode Bookmarks: 01:30 National Nurses Week – a time to honor the contributions and sacrifices of nurses who perform some of the most difficult and heartbreaking tasks in the medical world. 02:00 We must better position the nursing profession to take a leading role in healthcare innovation.  Nurses must become more empowered as we transition to a future of value-based care. 02:30 Introduction to Rebecca Love – a nationally-recognized nurse executive and entrepreneur, the first nurse featured on TED.com, and part of the first nurse panel at SXSW. 03:00 Rebecca founded and is President Emeritus of SONSIEL: The Society of Nurse Scientists, Innovators, Entrepreneurs & Leaders and currently serves as the Chief Clinical Officer of IntelyCare. 04:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:30 How do we better position the nursing profession in the value-based care movement? 06:30 “There is going to be no healthcare in the future without nurses leading value-based care.” 07:00 How tracking VBC outcomes by Provider NPI # is a challenge since nurses do not have assigned NPI #'s. 07:45 Nursing costs were rolled into room rates in the 1930's with the establishment of modern-day insurance models. This occurred due to a male physician-dominated environment. 08:30 Nurses are the only clinical professional in the healthcare environment without a NPI for billing or tracking outcomes! 08:45 “Value-based care cannot fully be amplified or adopted until we address the lack of a NPI number with nurses.” 09:30 The infuriating pay inequity between executives and nurses. (Nonprofit hospital CEOs make on average 10X the rate of nurses!) 10:00 Should we align compensation to both executives and clinicians tied to patie...

Medication adherence remains an important yet vexing issue in American health care. According to the World Health Organization, medication adherence can have a more direct impact on patient outcomes than a specific treatment itself. Still, it is estimated that a staggering 50% of Americans don't take their chronic long-term therapy medications as prescribed. Statistics show that each year, poor adherence contributes to more than $500 billion in avoidable health care costs, around 125,000 potentially preventable deaths, and up to 25% of hospitalizations in the United States.  This issue of medication adherence is so important, yet so vexing to solve for because it is so multi-faceted and entrenched into the business economics of healthcare.  In this Race to Value, we must find a better way to ensure affordability and promote adherence to medication therapies.  This is a life or death situation – both from an economic and a clinical perspective.  If we don't find solutions to improve medication adherence as part of value-based care, patients will die.  And eventually, the weight of the entire healthcare system will collapse upon itself due to the unsustainable costs that are incurred due to avoidable healthcare utilization that medication adherence would have prevented! Our guest this week is Jason Rose, a leading expert on the trillion dollar impact of the medication adherence issues in our country and what can be done to address them. Since 2018, Jason Rose has been spearheading value-based care as CEO of AdhereHealth. The innovative technology company is focused on transforming healthcare by leveraging intelligent data analytics, promoting medication adherence and working with patients to resolve social determinants of health. Customers are managed care companies and employers looking to improve quality of care and reduce costs for their patients and employees, respectively. After one year in his role, AdhereHealth experienced its fastest-ever year of growth and has grown from about 100 employees to nearly 1,000 employees over the past three years.  This is a leader in the value-based care movement that you should be listening to, as medication adherence is one of the most critical challenges to overcome in the transformation of our industry.   Episode Bookmarks: 01:30 According to the World Health Organization, medication adherence can have a more direct impact on patient outcomes than a specific treatment itself. 01:45 50% of Americans don't take their chronic long-term therapy medications as prescribed. 02:00 Poor adherence contributes to more than $500 billion in avoidable health care costs, causes 125,000 potentially preventable deaths, and up to 25% of hospitalizations. 03:00 Introduction to Jason Rose, a leading expert on medication adherence and CEO ofAdhereHealth. 04:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 06:30 If unabated, medication non-adherence will soon be a trillion-dollar problem with no end in sight. 07:00 Jason discusses the financial impact of non-adherence and the criticality of addressing this issue in healthcare. 08:00 “Medication non-adherence should be one of the top issues in all of healthcare, given the size of the actual problem.” 08:30 How value-based care programs can improve adherence outcomes in both senior and commercial populations. 10:00 A series of factors, rather than a single one, determine patients' ability to follow treatment recommendations correctly. 11:00 Jason discusses the impact of social determinants of health (SDOH) on medication adherence. 12:00 How SDOH symbolize the “Maslow Hierarchy of Needs for Health Care” (e.g. safe drinking water, transportation, health literacy). 13:00 A critical decision point – paying for the food of a beloved pet instead of purchasing lifesaving medication! 14:00 Referencing Jason's recent AJMC article: “Medication Adherence is a Force Multiplier for Medicare...

In value-based care, we have both an economic and a moral imperative.  What's at stake is so much more than saving our healthcare system. It is about ensuring the continued prosperity of our nation to ensure that we leave it better for future generations. The best indicator of whether our country is on the right path is the assurance that healthy mothers can give birth to healthy children. And those children, in turn, must be assured of good care and a sound education that will enable them to face the challenges of a changing world. If we could have but one generation of properly born, educated, and healthy children, many of the insurmountable problems in our country would vanish in our lifetimes. This week on the Race to Value, you are going to hear from a value-based care leader who is boldly moving beyond with a call to action to serve our nation's youth. Karen Wilding, the Chief Value Officer at Nemours, is on a passionate pursuit of the Quadruple Aim, and her health system is redefining children's health in our country. Nemours Children's Health is truly “leaning in” to the promise of population health by transforming the very definition of what it means for children to be healthy. And their value journey reflects a bold vision to create the healthiest generations of children that will take us beyond medicine by ultimately impacting the world. If you are looking for an example of inspirational leadership in value-based care, look no further than Karen Wilding and the Nemours Children's Health System!   Episode Bookmarks: 01:30 “If we could have but one generation of properly born, educated, and healthy children, many of the insurmountable problems in our country would vanish in our lifetimes.” 02:30 Introduction to Karen Wilding, the Chief Value Officer at Nemours Children's Health 03:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:45 Karen describes the whole-person care orientation at Nemours and how the mission of “Well Beyond Medicine” guides their value-based care journey. 06:45 Social Determinants of Health (SDOH) screening in underserved populations to expand care network and create community partnerships. 07:45 Driving “macro-system impact” as an anchor institution (e.g. best practice clinical research, cross-sector partnerships, health equity investments) 08:30 Health Equity opportunities in pediatric whole-person care (e.g. teen birth rates, preventative care access, infant mortality rates…and even household income). 09:00 “Well Beyond Medicine is a commitment to not just care for the medical aspects of children – we also care for the larger health ecosystem to create whole-child health and healthier generations.” 11:45 “Payment transformation is foundational to being able to create sustainability in value-based care.” 12:30 Karen explains how the fee-for-service infrastructure does not align incentives for healthy outcomes (e.g. asthma exacerbations with children in Delaware). 13:30 “Investing in children's health is the single most important thing we can do as a society.” (balancing present-day economics vs. future economics). 14:45 Partnering with payers to pursue health equity transformation and the importance of community-based investments. 16:45 Nemours has been utilizing Community Health Workers to conduct SDOH screenings and individualized interventions through a culturally competent care model. 17:45 Karen explains how the interdisciplinary care team at Nemours works together to capture, assess, and address SDOH barriers. 18:45 The importance of enterprise-level buy-in when launching a SDOH population health strategy. 20:30 Overcoming fears and concerns of families in sharing personal information about their social barriers. 21:00 The creation of a national toolkit on whole-child population health and how Nemours is collaborating with policy stakeholders at the federal level.

Patients who are high utilizers, also known as multi-visit patients (MVPs) or frequent flyers, whether found in the ED, inpatient units or other departments, drive up readmission rates and tie up resources. Often, clinicians and administrators hold out little hope that they can end the multi-visit cycles of these patients. Yet, by looking at a patient's multiple visits as a symptom of a deeper problem, and then identifying and rectifying that underlying problem, clinicians can end a patient's cycle of care utilization. On this podcast, a leading expert in high-utilizer care discusses her MVP Method which has been used by rural hospitals, community hospitals, safety net hospitals, and academic medical centers across the country. Dr. Amy Boutwell, President of Collaborative Healthcare Strategies, is a nationally recognized thought leader in the field of reducing readmissions and improving care for highest risk and multi-visit patients. She is the developer of the STAAR, ASPIRE, ASPIRE+ and MVP methods to reduce avoidable acute-care utilization and deliver whole-person care across settings and over time. The general principles and actions of the MVP Method can revolutionize care, break the cycle of utilization and change the life of your patients.  The Institute for Advancing Health Value has released an Intelligence Brief and Case Study to accompany this special podcast episode. Download the Open Access Intelligence Brief: “Building An Effective Care Pathway for Multi-Visit Patients: The MVP Method” (Available to Everyone!) https://www.advancinghealthvalue.org/building-an-effective-care-pathway-for-multi-visit-patients-the-mvp-method/ Download the Members-Only Case Study Brief: “Transforming Care MVPs at a Safety-Net Health System” (Available to Institute Members – Join the Institute for free if you work for a Provider Organization!) Episode Bookmarks: 01:30 High utilizers, also known as multi-visit patients (MVPs) or frequent flyers, whether found in the ED, inpatient units or other departments, drive up readmission rates and tie up resources. 02:00 Can high utilization by MVPs be impacted by addressing symptoms of a deeper problem? 02:30 Introduction to Dr. Amy Boutwell and the MVP Method to improve care for High Utilizers. 03:15 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:45 Referencing the Dr. Atul Gawande article called “The Hot Spotters” which showed how a health system experienced a 40% reduction in super-utilizer reduction. 07:00 The risk of conflating the terms of “high risk,” “high utilizer,” “high cost,” and “complex”. 07:45 Busting the myth that multi-visit patients are un-impactable. 08:30 “We must walk away from the dogma that it is not worth serving high utilizers. The industry must reengineer its thinking around that to advance health equity.” 09:00 Dr. Boutwell references the work of the Camden Coalition and how “Hot Spotters” did not confirm the myth of un-impactability. 10:30 The Hospital Readmissions Reduction Program (HRRP) aims to minimize the number of avoidable hospital readmissions by incentivizing hospitals to improve post-discharge planning. 11:30 Dr. Boutwell discusses the challenges of HRPP as a health policy and why hospitals have still yet to evolve in care delivery transformation. 12:30 Readmissions programs often are treated as a pilot instead of as a strategy for transformation. 13:30 Dr. Boutwell's work in partnering with health systems to develop a population health playbook to lower hospital readmissions. 14:30 The challenge of focusing on just one chronic condition in a readmission reduction strategy (e.g. heart failure). 15:45 “Multi-visit patients account for over half of all readmissions at every single hospital in the United States.” 16:45 “We have to go beyond payer-specific or disease-specific paradigms to find higher leverage population segments to impact.”

Three perfect storms in recent years – the health storm produced by the COVID-19 pandemic; the economic storm that resulted from its disruptions; and the social storm that followed the murder of George Floyd which sparked fresh outrage at longstanding inequities – have sharpened and added important nuances of what health care really means. The goal of health care has always been to reduce suffering, but we must now prioritize transformation in leadership now more than ever. Building trust, eliminating inequities, and ensuring high reliability are of the highest magnitude of importance as we blaze a new path forward. This week, on the Race to Value, we are joined by Thomas H. Lee, M.D., the author of the new book “Healthcare's Path Forward” to discuss how the healthcare industry is being transformed by deeper knowledge of what suffering means for patients, their families, and healthcare providers themselves. Since healthcare is not working for anyone, Dr. Lee provides wisdom and insights of optimism for where true change can happen in creating new standards for excellence. In addition to being a bestselling author and expert on healthcare transformation, Dr. Lee is the Chief Medical Officer of Press Ganey.  He brings more than three decades of experience in healthcare performance improvement as a practicing physician, leader in provider organizations, researcher, and health policy expert. He's responsible for developing clinical and operational strategies to help providers across the nation measure and improve the patient experience, with an overarching goal of reducing the suffering of patients as they undergo care and improve the value of their care. Episode Bookmarks: 01:30 Introduction to Thomas H. Lee. M.D. and his new book “Healthcare's Path Forward” 03:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:00 The six elements of organizational culture that lead to transformation – Excellence, Trust, Respect, Inclusion, Resilience, Reliability 05:00 John Nash (“A Beautiful Mind”) and Non-Cooperative Game Theory 06:00 Optimism for healthcare because how bad things really are! 07:00 Nash Equilibrium states are commonplace in healthcare – it creates inertia and stifles change. 08:30 “Equilibrium states break down when the pain of the status quo exceeds the fear of the unknown for multiple parties.” 09:00 “Healthcare is not working for anyone.  That is where real change can happen and what makes me optimistic.” 09:45 The destabilizing trends of supply chain disruption, social unrest, political divisiveness, consumerism, demographic shifts, workforce drain, and environmental disasters. 11:30 Responding to social justice, climate change, and the need to redesign healthcare – is it too much for us to tackle all at once? 12:00 “Changing the way healthcare is paid for – in absence of other reforms – is grossly inefficient.  There are many other things that have to happen.” 12:30 Michael Porter's Value Chain and the importance of clarity and differentiation in the creation of value. 13:30 “Payment reform is just one activity of healthcare reform.  We also need trust in the workforce and with patients, an understanding of what safety means, and a response to consumerism.” 15:00 In times of turmoil, healthcare organizations need more than a performance culture; they need a learning culture. 16:30 The most important part of transformational leadership is division of responsibilities and areas of key focus to enact organizational change. 17:30 No one can do everything!  If leaders focus on only three things, they will be successful in strategy execution. 18:30 3 Functions of Governing Boards and Executives: Articulate the Core Values, Develop Strategy, Understand the Value Chain 18:45 “An organization is the lengthened shadow of its leaders.” – Ralph Waldo Emerson 20:30 3 Functions of Managers: Create Social Capital,

It is Black Maternal Health Week, and this week's episode provides context and value-based solutioning on how to address the alarming rise of maternal mortality in the U.S. We have horrifically poor maternal health outcomes in the African American population of our country, and it is directly attributable to a flawed design of our healthcare system juxtaposed with the presence of longstanding and systemic institutional racism. If there ever was an opportunity for improving health equity through value-based care, it is with this moral imperative to ensure the fundamental human right to have a safe and evidence-based childbirth that optimizes the chance of survival. On this week's podcast, you are going to hear from one of the leading voices in health equity, reproductive justice, and value-based maternal health. Our guest is Dr. Neel Shah, the Chief Medical Officer of Maven Clinic, the world's largest virtual clinic for family health care. He is also a visiting scientist at Harvard Medical School where he previously served as a professor of obstetrics, gynecology and reproductive biology. Dr. Shah has been recognized with the Franklin Delano Roosevelt Humanitarian of the Year Award from the March of Dimes for his impact on maternal health in the United States. He is featured in the films Aftershock, which won the Special Jury Prize for Impact at the 2022 Sundance Film Festival, and The Color of Care from the Smithsonian Channel and Executive Producer Oprah Winfrey. As a physician-scientist, Dr. Shah has written landmark academic papers on maternal health and health care policy, and contributed to four books, including as senior author of Understanding Value-Based Healthcare. He is listed among the "40 smartest people in health care" by the Becker's Hospital Review, and he currently serves on the advisory board of the National Institutes of Health, Office of Women's Health Research. In this podcast, we discuss a special documentary that Dr. Shah contributed to called “Aftershock”. This inspiring film on black maternal health equity turns pain into power and should be watched by all who strive to make a positive change in American healthcare.  Join us on April 12th, for a screening of the Aftershock documentary and a discussion with other attendees.   This podcast is dedicated to Shamony Gibson, Amber Rose Isaac, Kira Johnson, Maria Corona, Sha-Asia Semple, Cordielle Street, and the thousands of women who have lost their lives in the United States maternal health system. Bookmarks: 01:30 Black Maternal Health Week and the fundamental human right to have a safe and evidence-based childbirth that optimizes the chance of survival. 02:15 Introduction to Dr. Neel Shah, one of the leading voices in health equity, reproductive justice, and value-based maternal health. 03:30 AFTERSHOCK, is an original documentary on black maternal health equity.  (Watch Trailer and attend special free virtual screening on April 12th). 04:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:15 This podcast is dedicated to Shamony Gibson, Amber Rose Isaac, Kira Johnson, Maria Corona, Sha-Asia Semple, Cordielle Street, and the thousands of women who have lost their lives in the United States maternal health system. 05:30 Since 1970, we have seen a 500% increase in C-Section procedures over vaginal deliveries, with the rate of C-sections among black birthing persons being much higher than the general population. 06:00 C-sections bring in an average of $10k per procedure, compared to an average reimbursement of $4,500 for a vaginal delivery. 07:30 “Childbirth is the most utilized healthcare service in the United States of America and accounts for 25% of all hospitalizations.” 08:30 The opportunity to extract more “value” in the maternal health system. 08:45 “In childbirth, we predominantly have a “too much too soon” problem. One in three receive a major surgery to give birth,