Tuning Healthcare, Powered by Lumeris

This episode of Tuning Healthcare features Dr. Matthew Harris, Clinical Senior Lecturer in Public Health, in the department of Primary Care and Public Health at Imperial College London. Dr. Harris is an honorary consultant in public health medicine for the Imperial College Healthcare NHS Trust. His research spans global health, innovation, diffusion, primary care and health services. Dr. Harris has worked for several years as a primary care physician in Brazil, a WHO polio consultant in Ethiopia, an HIV technical consultant in Mozambique and the global health advisor to the UK Department of Health. Dr. Harris discusses The benefits, biases and challenges for adopting frugal innovations and community health solutions in leading healthcare markets

This episode of Tuning Healthcare features Anthony Del Rio, the President of Rush Health, the Clinically Integrated Network of Rush University System for Health (RUSH). As Senior Associate General Counsel and Managing Director at RUSH, Anthony also oversaw the Business Development and Transactions team, where he managed multiple hospital affiliations and joint ventures with large healthcare entities. Prior to joining RUSH, Anthony represented healthcare clients at an international law firm with a focus on mergers and acquisitions. He also worked as a management consultant for large healthcare systems, helping develop and manage hospitals in multiple states. Anthony discusses RUSH's pivot to value and how the health system clinically integrated network controls costs, supports the mission of managing populations and delivers better outcomes for the patient.

This episode of Tuning Healthcare features Dr. Amy Abernethy, an internationally recognized oncologist, health data expert and digital health leader. Dr. Abernethy was recently the Principal Deputy Commissioner and Acting Chief Information Officer for the United States Food and Drug Administration. She also held positions of Chief Medical Officer and Chief Scientific Officer at Flatiron, as well as, Professor of Medicine at Duke University School of Medicine. Dr. Abernethy has written over 500 publications, spanning many topics, including real-world data and evidence, clinical trials, health policy, and patient-centered care. In this episode, Dr. Amy Abernethy and Lumeris Senior Vice President Nigel Ohrenstein discuss: • Overcoming the challenges of leading an immense bureaucratic agency like the FDA • The importance of public-private partnerships in driving healthcare innovation • How she maintained focus and successfully drove data modernization amid the distractions surrounding the Trump administration • The role real-world data and real-world evidence will have in shaping the future of healthcare • The need to accelerate the transition from fee for service to a system of aligned incentives

This episode of Tuning Healthcare features Renee DeSilva, the CEO of the Health Management Academy. She previously served as executive vice-president and chief talent officer at EAB and senior vice president of sales and marketing at The Advisory Board. Renee also serves on the board of Inova Health System and leads the Mosaic Network, a joint venture project to expand the number of board-level roles in health care companies for people of color. Renee DeSilva discusses The Academy’s role as a major industry convener and shares insights from their alliances with health systems driving transformation. In this episode, Renee DeSilva and Lumeris Senior Vice President Nigel Ohrenstein discuss: • Using data to improve health equality and the efforts to increase diversity within boardrooms across the healthcare industry • The unprecedented opportunity for health systems to lead the transformation of healthcare • How the Academy has maintained a leadership role during the pandemic and key issues they are addressing with health systems CEOs • Reasons why fee for value is the best opportunity to drive a transformational healthcare system • The current industry trends poised to become part of the healthcare landscape and those likely to wane

This episode of Tuning Healthcare features Dr. Jennifer Schneider, former Chief Medical Officer and President of Livongo. Dr. Schneider was also the Chief Medical Officer of Castlight Health and trained as an internal physician at Johns Hopkins and Stanford, where she was the Chief Resident. She recently joined the Board of Directors of Cityblock and is an executive in residence at Endurance Partners, a private equity firm in New York City. Dr. Schneider shares her notable startup experience and provides a unique perspective on being a parent, athlete, clinician, and consumer of chronic disease healthcare.

This episode of Tuning Healthcare features Dr. Ashwini Zenooz, Chief Medical Officer and SVP for Healthcare and Life Sciences at Salesforce. Dr. Zenooz was most recently the Chief Medical Officer at the Department of Veterans Affairs (VA) overseeing the national EHR modernization program. She is board certified in radiology and continues to practice medicine today. Dr. Zenooz provides a unique perspective from her clinical and healthcare policy experience and shares insight into digital health innovation.

This episode of Tuning Healthcare features Dana Safran, Senior Vice President, Value Based Care & Population Health at WELL Health. She formerly held leadership roles at Haven and Blue Cross Blue Shield of Massachusetts and served in advisory roles to numerous local, national and international organizations and government agencies. Dana shares key insights from his payer and healthcare retail experience, and where he expects the industry to move in the future.

This episode of Tuning Healthcare features Bradley Fluegel, Principal at BMF Advisors and an executive healthcare advisor to numerous healthcare organizations. He formerly served senior leadership roles at Walgreens, Anthem, Aetna and has led various consulting roles for healthcare organizations. Brad shares key insights from his payer and healthcare retail experience, and where he expects the industry to move in the future.

This episode of Tuning Healthcare features Brian Lobley, Executive Vice President, Health Markets at Independence Health Group, the parent company of Independence Blue Cross in Philadelphia. He is also a founding member and the board chair of Quill, a newly formed joint venture between Independence Health Group and Comcast. Brian shares his perspective on the opportunity for payers and providers to collaborate in improving health outcomes and the consumer experience. Particularly in the age of COVID-19, the acceleration of healthcare innovation and the move away from fee-for-service will continue to spur industry transformation. “I think what is emerging is a recognition across all stakeholders that the fee-for-service marketplace needs massive, massive transformation. Customers are demanding it. Providers are looking forward to it on how they earn incentives and help drive adherence, and quality and costs down, and payers as the intermediary need it. We need to be able to get to equations where we're able to do partial or full risk deals.” – Brian Lobley, Executive Vice President, Health Markets, Independence Health Group In this episode, Brian and Lumeris Senior Vice President Nigel Ohrenstein discuss: • How a large commercial payer is helping its members through COVID-19 • The market dynamics encouraging industry transformation that have emerged during the pandemic • What successful payer-provider collaboration looks like in the future • The complexities of the healthcare journey for patients and caregivers • Rethinking the consumer experience in healthcare • How payers and providers can help drive value-based care outcomes together • The need for innovative partnerships in healthcare across all verticals To tune in, subscribe below: Soundcloud: https://soundcloud.com/lumerishealthcare iTunes: https://podcasts.apple.com/us/podcast/tuning-healthcare-powered-by-lumeris/id1468061183 Tune IN: https://tunein.com/podcasts/Podcasts/Tuning-Healthcare-p1270312/ Spotify: https://open.spotify.com/show/5lSXJs7CbiHhgN93rW35fI Stitcher: https://www.stitcher.com/podcast/lumeris/tuning-healthcare-powered-by-lumeris The opinions of the podcast guests are not necessarily reflective of those of Lumeris. Cited works: • Text Message Alert 1 Sound. Available at http://soundbible.com/2154-Text-Message-Alert-1.html. • ECG Sound. Available at http://soundbible.com/1730-ECG.html. • AM Radio Tuning Sound. Available at http://soundbible.com/2099-AM-Radio-Tuning.html. • Intro music. Gordon Household. August 2019. WAV File.

This episode of Tuning Healthcare features John Gorman, industry expert and Founder and Chairman of Nightingale Partners. He was formerly the Founder and Chairman of Gorman Health Group as well as Assistant to the Director of Health Care Financing Administration’s (HCFA, now the Centers for Medicare and Medicaid Services, CMS). In the episode, John discusses the importance of social determinants of health interventions to support the most vulnerable patient populations. He also discusses the role that the government and private sectors play in driving industry transformation and the need to move toward value-based care. In light of the COVID-19 pandemic, where should health systems be focusing for a sustainable future? [On the future for health systems] “I think the strategy that's been illuminated especially during this pandemic, … has got to be, you got to get on a path of value-based care. You've got to be accepting risks and you've got to be capitated. Because to continue to try to operate in a fee-for-service environment when elective procedures are all shut down and you're just living on the whims of infection rates right now, getting paid fee-for-service is what kills you in a pandemic. And this isn't going to be the last one of these that we have. … So I think against that backdrop and where payers are certainly marching in formation too is toward value-based care, toward a more accountable care, toward really delivering on very specific performance metrics that are moving from process measures much more oriented toward outcomes. And I think as we've seen in every survey shown of health systems in this last two years…they all agree that one of the absolute top strategic priorities has to be mastering social determinants of health.” – John Gorman, Founder and Chairman of Nightingale Partners. In this episode, John and Lumeris Senior Vice President Nigel Ohrenstein discuss: • The impact of the growing elderly population on the healthcare system • The crisis facing caregivers, low income families, and the uninsured that has been further exposed during the COVID-19 pandemic • The role of the federal and state governments in managing healthcare access and coverage • The importance of moving away from volume-based fee-for-service reimbursement toward value-based payment models • The power of non-clinical interventions to improve population health • Why addressing social determinants of health is critical for truly managing health and improving outcomes. Cited works: • Text Message Alert 1 Sound. Available at http://soundbible.com/2154-Text-Message-Alert-1.html. • ECG Sound. Available at http://soundbible.com/1730-ECG.html. • AM Radio Tuning Sound. Available at http://soundbible.com/2099-AM-Radio-Tuning.html. • Intro music. Gordon Household. August 2019. WAV File.

In this episode of Tuning Healthcare, David Zaas, MD, MBA, the CEO of Medical University of South Carolina (MUSC) Health – Charleston Division and Chief Clinical Officer for MUSC Health, discusses why healthcare leaders must step up, with academic medical centers (AMCs) leading the way. Preserving the current fee-for-service business model is not sustainable. Instead, health systems need to manage more of the healthcare premium dollar, shift to a patient/customer-centric system, and partner with organizations to drive innovations that drive real change and address the needs of their communities. “I think AMCs have the opportunity to have unique partners, not just with other hospitals and providers whether it's technology companies and payers, and to go back to the foundation of our mission. We should be the most mission-driven organizations of any industry in the country around improving the health of the communities we serve, educating all of our future leaders, driving the innovation and research to change what we do. For us to really achieve that at a greater scale and to accomplish things more quickly, we're going to need to understand different partnerships. … How do we become nimble to identify those partners, to figure out how we work together to be willing to leverage our talent and brand to drive not just revenue and not just the existing business models, but to drive true transformation?” – David Zaas, MD, MBA, CEO of MUSC Health – Charleston Division, and Chief Clinical Officer for MUSC Health In this episode, Dr. Zaas and Lumeris Senior Vice President Nigel Ohrenstein discuss: • How academic medical centers should lead the transformation of healthcare • A blueprint for health systems to be successful in the post-COVID-19 world • The role of leadership, mentorship, and collaboration in solving problems and improving health outcomes • Finding synergies with outside partners to take risks and drive true innovation that meets the needs of communities • The importance of not mistaking incremental progress for real transformation and change • Shifting to a mindset that treats patients as customers, while also addressing the disparities of care delivery and social determinants of health • Managing more of the premium dollar to create sustainable growth and support population health needs. Cited works: • Text Message Alert 1 Sound. Available at http://soundbible.com/2154-Text-Message-Alert-1.html. • ECG Sound. Available at http://soundbible.com/1730-ECG.html. • AM Radio Tuning Sound. Available at http://soundbible.com/2099-AM-Radio-Tuning.html. • Intro music. Gordon Household. August 2019. WAV File.

In this episode of Tuning Healthcare, Mike Englehart, Senior Vice President for Medical Groups and Ambulatory Strategy at Trinity Health System shares his insights on the current healthcare crisis and what health systems must do to create a sustainable long-term strategy. He recently served as the interim CEO of the Mount Carmel Health System in Columbus, Ohio. Prior to that role, Mike was the President and CEO of Presence Health in Chicago. He was also formerly an Advocate Health Care leader where he was the President of Advocate Physician Partners. “But if your heart is, 'Yeah, we really do believe that population health is the right thing to do," then your capital dollars will start to be spent more on ambulatory, technology, medical group physicians, ASCs, because those become cost effective ways in a diversification of your portfolio. And the conversations you're having with the payers and the employers are critical because that's where you get rewarded for doing the right thing. And if you don't ask and you don't sit down at the table and try and find those new opportunities to share risk, give a little bit of protection as you go into risk, but ultimately take the training wheels off and go all in, you'll stay in a fee-for-service world as long as you need to, until you're forced out of it.” – Mike Englehart, Senior Vice President for Medical Groups and Ambulatory Strategy, Trinity Health In this episode, Mike and Lumeris Senior Vice President Nigel Ohrenstein discuss: • How a national health system like Trinity Health is thinking about revenue recovery in light of COVID-19 • Why revenue diversification is critical for a health system’s sustainable future • Risk-based models and how payers, employers and providers can align to create a better health experience for consumers • The expansion of telehealth and virtual care • The balanced strategy of delivering healthcare locally across a national system • How Medicare Advantage plays into Trinity Health’s strategy both now and into the future. Cited works: Text Message Alert 1 Sound. Available at http://soundbible.com/2154-Text-Message-Alert-1.html. ECG Sound. Available at http://soundbible.com/1730-ECG.html. AM Radio Tuning Sound. Available at http://soundbible.com/2099-AM-Radio-Tuning.html. Intro music. Gordon Household. August 2019. WAV File.

In this latest episode of Tuning Healthcare, Joe Ruth, the Executive Vice President and Chief Operating Officer of Sparrow Health System in Michigan discusses the impact of COVID-19 and recovery approaches in a post-pandemic world. He also talks about the importance of advancing value-based care strategies, moving from fee-for-service toward managing the entire premium dollar, and investing in the right care that drives happier physicians, happier patients, and better outcomes. “I think fee-for-service has been a challenge for a long time. When you get paid for what you do, and again, most of that payment is on the back end of very high, very expensive procedures and towards the end of life. If we can reposition the spend towards more preventative medicine, being more connected, providing greater access to our patients, the care will be better at a lower cost. There'll be a happier physician involved, there'll be a happier patient involved. … I think as healthcare providers we have an opportunity to really reset what we think is important in how best to care for patients.” – Joe Ruth, the Executive Vice President and Chief Operating Officer of Sparrow Health System In this episode, Joe and Lumeris SVP Nigel Ohrenstein discuss: • The impact of COVID-19 in Lansing, Michigan (Note: this episode was recorded on Tuesday, April 14, 2020) • How the course of the pandemic across the country illustrates how healthcare is local • A patient-centered, phased recovery approach for coming out of COVID-19 • How owning and operating a provider-sponsored Medicare Advantage plan can drive broader population health efforts • The importance of managing the entire premium dollar that allows investment in the right care, allowing for higher provider and patient satisfaction Recorded April 14, 2020 To tune in, subscribe below: Soundcloud: https://soundcloud.com/lumerishealthcare iTunes: https://podcasts.apple.com/us/podcast/tuning-healthcare-powered-by-lumeris/id1468061183 Tune IN: https://tunein.com/podcasts/Podcasts/Tuning-Healthcare-p1270312/ Spotify: https://open.spotify.com/show/5lSXJs7CbiHhgN93rW35fI Stitcher: https://www.stitcher.com/podcast/lumeris/tuning-healthcare-powered-by-lumeris

In this episode of Tuning Healthcare, Aneesh Chopra discusses how the lack of data transparency and interoperability has crippled the ability for the U.S. to respond to the COVID-19 public health crisis. Aneesh is the President and Cofounder of CareJourney, a data and analytics company focused on the move to value-based care, and was also the former first Chief Technology Officer of the United States, serving under President Obama from 2009 to 2012. He also discusses how the move to value-based care may accelerate as a result of this crisis, and how revitalizing our nation’s healthcare IT infrastructure could speed up improvements for providers, payers and consumers. “We may emerge with a different cost structure in the healthcare delivery system, that's more asset light. That may be disruptive to organizations that generate the big institutional revenue, but we're going to work our way through that change. That would have come anyway through value-based care, but this will just accelerate. And then you'd ask the question, "If I can treat this group of patients at home, in a much lower cost setting, with this remote monitoring, with physicians checking in at this time period and we get similar or better outcomes, remind me again why we're not doing that today?" – Aneesh Chopra, President of CareJourney and former Chief Technology Officer of the United States In this episode, Aneesh and Lumeris Senior Vice President Nigel Ohrenstein discuss: • The lack of data transparency and interoperability in healthcare and its impact during the COVID-19 crisis • How the move to value-based care may accelerate in the post-pandemic era • What the new normal of healthcare could look like from a care delivery and infrastructure standpoint • What a fully informed provider and patient experience could look like • How data transparency and consumer apps can help speed up interoperability Cited works: • Text Message Alert 1 Sound. Available at http://soundbible.com/2154-Text-Message-Alert-1.html. • ECG Sound. Available at http://soundbible.com/1730-ECG.html. • AM Radio Tuning Sound. Available at http://soundbible.com/2099-AM-Radio-Tuning.html. • Intro music. Gordon Household. August 2019. WAV File.

In this episode of Tuning Healthcare, step into a doctor’s office and listen to Dr. Tom Hastings, a high-performing accountable primary care physician at Esse Health, discuss his practice with Lumeris Senior Vice President Nigel Ohrenstein and discuss: • A day in the life of an accountable primary care physician • Team-based care and workflows that enable patient and care team satisfaction • The importance of finding what is of value for patients • Advice for physicians new to value-based models • How a Collaborative Payer can be a value-driven companion for physicians • How ongoing learning, transparency and continuous improvement help drive better care • What to change in today’s healthcare system Cited works: • Text Message Alert 1 Sound. Available at http://soundbible.com/2154-Text-Message-Alert-1.html. • ECG Sound. Available at http://soundbible.com/1730-ECG.html. • AM Radio Tuning Sound. Available at http://soundbible.com/2099-AM-Radio-Tuning.html. • Intro music. Gordon Household. August 2019. WAV File.

In this episode, Jordanna and Lumeris’ Senior Vice President Nigel Ohrenstein discuss: • Insights from working in Capitol Hill and on the Affordable Care Act (ACA) • Benefits and unintended consequences of the passage of the ACA • Why transparency plays a critical role in transforming healthcare • Why consumerism in healthcare is a huge challenge • The newly proposed Direct Contracting model from CMMI • How provider appetite for risk-bearing models is changing • How to create virtually integrated delivery networks Subscribe, listen, share—and leave reviews as we continue to release new episodes Cited works: • Text Message Alert 1 Sound. Available at http://soundbible.com/2154-Text-Message-Alert-1.html. • ECG Sound. Available at http://soundbible.com/1730-ECG.html. • AM Radio Tuning Sound. Available at http://soundbible.com/2099-AM-Radio-Tuning.html. • Intro music. Gordon Household. August 2019. WAV File.

As a widely renowned industry expert, Paul Keckley has a first-hand view of the changing forces in healthcare today. In addition to being Managing Editor of The Keckley Report, Paul is a distinguished writer and researcher, who also worked extensively with industry trade groups on the development of the Affordable Care Act. In this episode of Tuning Healthcare, Paul shares insights around key factors that are impacting payers, providers and consumers during the industry’s constant state of change. “There are winners and losers in every sector, and the winners in those sectors have the technology, have the scale, have access to capital. They've got leaders that see a future where they're paid for a result instead of volume. They are looking at individuals, they're not looking at patients, and they're looking at ways of treating that go beyond a pill or a test.”– Paul Keckley In this episode, Paul talks to Lumeris Senior Vice President Nigel Ohrenstein and discusses: • The pace of industry change from volume to value, • Insights from working on healthcare reform and the Affordable Care Act, • The evolution of primary care and where health systems need to prioritize, • Changing dynamics between payers and providers—and who will win and lose in the future, • Private equity interest in primary care models and holistic care, • The importance of leadership, technology, scale and access to capital in enabling the move to risk. Cited works: • Text Message Alert 1 Sound. Available at http://soundbible.com/2154-Text-Message-Alert-1.html. • ECG Sound. Available at http://soundbible.com/1730-ECG.html. • AM Radio Tuning Sound. Available at http://soundbible.com/2099-AM-Radio-Tuning.html. • Intro music. Gordon Household. August 2019. WAV File.

As a population health expert tasked with helping New York’s Mount Sinai Health System transition to value-based arrangements, Executive Vice President and Chief Population Health Officer Niyum Gandhi is well-versed in the many cultural and organizational challenges that occur when a system shifts its focus from filling beds to managing the health of patient populations. In this episode of Tuning Healthcare, Niyum, who is also an Assistant Professor of Health System Design at the Icahn School of Medicine, shares insights around organizational transformation and effective execution of population health initiatives. [On overcoming the resistance to moving to value]: “It all starts at the top. [It] can't possibly be overstated how important that is. The vision for what we want to do came directly from the board and the CEO. Without that, there's no chance of the type of transformative change that we want to have. ...Without that commitment from the top, I think it's pretty much impossible.” – Niyum Gandhi In this episode, Niyum talks to Lumeris Senior Vice President Nigel Ohrenstein and discusses: • Why transformative change starts at the top from the board and CEO, • How to find the right risk-based contracts to start a value-based journey, • Why organizations will likely find it quicker to scale if they partner with a collaborative payer instead of trying to start their own Medicare Advantage plan, • What health systems need to do to engage physicians, and • Why health systems must focus on building a highly effective primary care model that is purposely built for scale to transition to risk models. Cited works: • Text Message Alert 1 Sound. Available at http://soundbible.com/2154-Text-Message-Alert-1.html. • ECG Sound. Available at http://soundbible.com/1730-ECG.html. • AM Radio Tuning Sound. Available at http://soundbible.com/2099-AM-Radio-Tuning.html. • Intro music. Gordon Household. August 2019. WAV File.

Few individuals know more about the intersection of health care and technology in government than Ryan Panchadsaram, the former U.S. Deputy Chief Technology Officer. Ryan, who served in the Obama administration, now works as an advisor at the renowned venture capital firm Kleiner Perkins, where he helps the firm invest in disruptive companies that solve big problems and transform industries. “[Regarding] this shift to value-based care: the exciting part is that the system wins if it's done well. … Anyone who's putting the patient first with the efficiency mindset of getting them to be the healthiest they can and not pointing them to excess waste, those are the winners.” – Ryan Panchadsaram In this episode, Ryan talks to Lumeris Senior Vice President Nigel Ohrenstein and shares: ● What he learned from the technology debacle that followed the government’s $40 billion investment in Healthcare.gov ● Why data transparency is the key to achieving value-based health care outcomes ● How public-private partnerships can drive digital innovation and transform health care ● What the health care industry can learn from the Ubers and Airbnbs of the world, as well as the two things today’s most successful health care companies have in common ● His four key pieces of advice for budding entrepreneurs trying to disrupt their industries ● Who will win and lose in the new healthcare system Cited works: • Text Message Alert 1 Sound. Available at http://soundbible.com/2154-Text-Message-Alert-1.html. • ECG Sound. Available at http://soundbible.com/1730-ECG.html. • AM Radio Tuning Sound. Available at http://soundbible.com/2099-AM-Radio-Tuning.html. • Intro music. Marcus Gordon Household. August 2019. WAV File.