Podcast appearances and mentions of aaron mitchell

Host Dr. Davide Soldato and Dr. Aaron Mitchell discuss the JCO article "Quality of Treatment Selection for Medicare Beneficiaries With Cancer" TRANSCRIPT Dr. Davide Soldato: Hello and welcome to JCO After Hours, the podcast where we sit down with authors from some of the latest articles published in the Journal of Clinical Oncology. I am your host, Dr. Davide Soldato, medical oncologist at Hospital San Martino in Genoa, Italy. Today, we are joined by JCO author Dr. Aaron Mitchell. Dr. Mitchell is a medical oncologist working at Memorial Sloan Kettering Cancer Center where he is also part of the Department of Epidemiology and Biostatistics. Dr. Mitchell specializes in treating genitourinary malignancy and has a research focus on improving how the healthcare system helps people with these and other cancers. So today, Dr. Mitchell will be discussing the article titled, “Quality of Treatment Selection for Medicare Beneficiaries with Cancer.” Thank you for speaking with us, Dr. Mitchell. Dr. Aaron Mitchell: Well, thank you for inviting me. I'm very glad to be here. Dr. Davide Soldato: So I just wanted to introduce the topic by asking a couple of questions, very general, about the background of the article. So basically you reported the data using the SEER-Medicare to assist to assess the determinants of optimal systemic therapies delivery and selection. So, in particular, you focused on individuals that were diagnosed with cancer who were Medicare beneficiaries and in particular were part of the low income subsidy, which is also known as LIS. So I just wanted to ask you if you could briefly explain to our listeners how this program works, and what was the rationale of the study, and if there is any element of novelty in your study compared to what was done before the study was published. Dr. Aaron Mitchell: Yeah. So that's a lot to cover, but yeah, a lot of opportunity to introduce the low income subsidy program which is a very important part of the Medicare program for prescription drugs, but often one that flies under the radar a little bit in the policy discussion. So this subsidy was created synchronously back with the Medicare Part D Program, which was created in 2006. There was some anticipation that for some high cost drugs, not all patients would be able to afford them even with the Part D program insurance as it was being created. And so they created a pathway to give an additional subsidy to some patients who had low income, who were anticipated to being at need and needing that assistance to afford high cost drugs. As the number of high cost drugs has really risen since 2006, this program has played an important role in helping patients afford drugs, especially those who need very expensive cancer drugs.  And what this program does is, once you meet the eligibility requirements, which require patients to have both quite a low income. So if you're single, that is at 135% of the federal poverty limit or below, and it also places some restrictions on assets. You also have to have low assets, so low income and low assets in order to qualify for the subsidy. But then once you do, the subsidy is really quite large. Patients who qualify for the LIS at the full subsidy level will pay about $10 per month per drug, even for specialty cancer drugs. So if you think about drugs such as those that we use to treat prostate cancer, my specialty, drugs like enzalutamide or XTANDI that run $15,000 to $20,000 per month, the out of pocket cost for a low income subsidy beneficiary is $10. So that is a huge discount. $10 isn't nothing, but even for someone with a low income, if they've got one or two cancer drugs that are at this rate, it's something that they can often afford.  This program applies to Part D cancer drugs that are prescription drugs basically. By and large, these are oral pills that patients are taking on a daily basis at home. These are the drugs that the low income subsidy program applies to. So if a patient needs a drug like that to treat their cancer, then they are able to receive it at very low cost. And what you'll see is a patient- in the studies that have been done, when a patient has low income, low enough for them to be able to qualify for this program, they then have better access to these drugs. You see increased adherence rates, you see increased prescription fill rates. And then when someone, when their income is just high enough to no longer qualify for this program, and they go back to regular Medicare Part D coverage, that's when the problems arise. So it's like as your income moves up the scale, you actually get more problems affording your cancer drugs. So that's the state of the literature so far.  And what we realize though, is that all these studies that have looked at the low income subsidy have really focused on just the Part D drugs themselves, the oral drugs. And that's certainly not all of cancer care. There is a growing number of oral drugs, but for many cancers, especially when you're talking about immunotherapy drugs or new systemic radioligand therapies, these are not Part D drugs, these are Part B drugs. And so even if you are low income and you're qualifying for this subsidy, it's not going to help you if you need a Part B drug. Yes, there are certainly a whole host of other programs and different avenues that we can get patients assistance, but some percentage of them, even though they're low income and high need, would not have assistance with a Part B drug.  So now, in coming back, the long answer to your question, our rationale was, let's look at these Part D low income subsidy patients and let's see what their access looks like, not just to the oral drugs, but to cancer care writ large. And can we study where they're fitting into the system, not only when they need oral drugs, but when they need any kind of cancer care across the board? Dr. Davide Soldato: So basically, just to summarize, it was an extension of previous literature, but specifically evaluating whether novel regimens that use, for example intravenous drugs, they were covered at the same level and whether there were any inequities in access to cancer treatment under this specific program, which is the LIS. Dr. Aaron Mitchell: Yes, I'd say that's a fair summary. Dr. Davide Soldato: Okay. So more or less, you included 9,000 patients inside of the study and 25% of them were beneficiaries of the LIS program. And you specifically looked at factors that could be associated with not receiving therapies at all, and also whether the quality of care that these patients were receiving were any different compared to those who were not part of the LIS program. So I just wanted to see if you could guide us a little bit in the results, whether you see any kind of differences when we look at access to any type of systemic therapies and whether being a part of the LIS program modified access to the drugs. Dr. Aaron Mitchell: Let me take this opportunity also to highlight a feature of our study that differentiates us a little bit from previous work that's been done. And this is around the specific definition of quality that we use. I know quality is in the title of the manuscript, but I think it's important to emphasize exactly what we mean in this study when we say quality, and it's something very specific. So our measure of quality references back to the NCCN guidelines, which I don't think our audience needs much of an introduction to that. It's the most worldwide recognized standard of care guidelines for oncology practice. And we specifically looked not only at the NCCN guidelines, but at their evidence block scoring system. So what we did was we looked not only at one set of guidelines, but we looked at guidelines across time. We looked at guidelines across our full study period, which was, give or take, 2015-2018, depending on the cancer. And we looked at each point in time to see what was the treatment regimen that was recommended by the NCCN guidelines as being preferred. Some of them make that designation, some of them don't. If there was not a designation of preferred, then we turned to the evidence blocks. And the evidence blocks, we then apply several different measures to kind of rank treatments from those that get high scores for efficacy and safety to those that get low scores for efficacy, safety and the quality of evidence. So we basically come up with a kind of a rank list of the recommended treatments at each point in time. And then we look at the ones that are the highest, we say which are the most highly recommended treatments at any given point in time. That then becomes our definition of quality treatment. And I'm saying this with air quotes, we use the term “optimal treatment” in the study. Did they get that treatment? If there were ties, you could have gotten either of the two treatments that got the equally good score, did you get that treatment versus did you get anything else?  So then getting back to our analysis, what we really did was kind of a two-stage study. First, we put all of our patients into our pool, into one big analytic model. And we looked to see what are the factors that predict or are associated with a patient either getting no systemic therapy or any systemic therapy. And then as a second question, we look at the patients who got some form of systemic therapy, and then we ask, again, what percentage of those got the optimal treatment or high quality treatment as opposed to one of the more lowly recommended treatment regimens? So that's how we asked it. We found that patients who were low income subsidy recipients, the low income ones, they were both less likely to receive any systemic therapy. And then even the ones that receive systemic therapy, the ones who made it in the door to see their doctor or their part of the system, they still were less likely to get the optimal treatment that was recommended for their cancer type at the time that they were diagnosed. Dr. Davide Soldato: So basically, even when you are a part of this subsidiary program, you still have a lower access to any type of treatment. And even if you get treatment, you kind of get the ones that were not the preferred according to the NCCN guidelines, or at least they were not scoring as well as those specific regimens. But I think that what our audience might be wondering about is that frequently there are also some other types of characteristics, for example, age or number of comorbidities, which can be associated with having a low socioeconomic status. So I was wondering whether in the analysis you kind of looked specifically also at patient factors, for example, income rather than age or comorbidities, and whether you found any significant association with those and whether it was something that you planned to do in your study. Dr. Aaron Mitchell: Yes. So we looked at many patient factors and those included age and they included the degree of comorbidity. And what we saw with respect to those characteristics was not too surprising. We saw that patients who were older were less likely to receive systemic therapy. We saw that patients who had more comorbidities were also less likely to get systemic therapy. And then across our different designations of treatments, we saw that those patients were also less likely to get the optimal treatment for their cancer. This result though, we would say it certainly needs more study in the future, but it's not immediately concerning. And that is because for patients who have more age, more comorbidity, those often correlate with frailty. And so it could be that these patients aren't getting optimally treated or it could be that their oncologists are just making clinically appropriate decisions about patient selection.  We saw as we were doing this work that the treatment regimens that are often getting the highest recommendations from the NCCN, hence, it would become our definition of high quality optimal treatment, are often ones that are aggressive. They're often ones that are multi-drug combinations. They're often ones that it's not just your old antineoplastics, it's the antineoplastics plus an additional immunotherapy or plus a targeted drug. So it's the ones that are more aggressive by and large, and that might be in some cases more than a patient who is older, more frail, could be able to tolerate. And so the oncologist might be making inappropriate judgment to say I'm going to do something a little bit less aggressive here and make an appropriate trade off between anti cancer efficacy and safety.  I think we've got kind of a bookmark there and we can look at those trends in the future. So we saw that kind of as expected, and then we turned and looked towards the low income subsidy. And our premise there is, well, your income shouldn't predict what you're getting clinically. In an ideal world, you'd be able to get the appropriate treatment for a patient, and not depend on whether their income is above or below 135% of the poverty limit. So that one seems more like on its face an immediate concern. Dr. Davide Soldato: Thank you very much for the explanation. I was just wondering, did you make some kind of selection when you were analyzing specific diseases or settings where you included just metastatic patients or you also included patients with early stage neoadjuvant treatments? Because I think that it is also very interesting from the perspective of the objectives that we have as oncologists when we are administering systemic treatments. Dr. Aaron Mitchell: Yeah, thank you for bringing that up. That was also one of the goals of our study was to be broad. And we wanted to look for factors, whether it be low income subsidy, whether it be age, socioeconomic background, etc., things that would be broad predictors of outcomes, and by which I mean care delivery outcomes across the board. So not just for, let's say, metastatic breast cancer, but also across any cancer that a patient might walk in the door with, what are the systemic predictors. And so when you mentioned before that our overall cohort is approximately 9,000 patients, that's 9,000 patients split over a variety of what we call clinical scenarios or clinical indications. And that includes multiple solid tumor as well as liquid tumor malignancies. It includes both patients who are initiating systemic therapy with palliative intent for metastatic disease. It also includes several groups of patients who are getting adjuvant therapy. So we want it to be as broad as possible. Our selection of those scenarios was really done with the goal of being as broad as possible and really bringing in everything that we could within the constraints of our data source. And that was really the only limitation that we applied in concept was tumor types that are common enough to have a meaningful sample of patients to analyze. So, one, are there enough patients? And then two, are you able to identify this specific group of patients within SEER-Medicare data? Because when the NCCN divides groups of patients by biomarkers that are not available in SEER-Medicare, we can't really say, “Oh, we're going to study this group of patients.” That would then be one that we have to leave on the side and not include. But everything else where one of those things didn't apply, we tried to include it as best we could. Dr. Davide Soldato: Thank you very much for the explanation. And among the scenarios that you included in the study, were there any striking differences in terms of access to treatment and access to quality treatment the way you define the study? Dr. Aaron Mitchell: Yes, there were differences between these different cancer types, these different cancer indications, but they're not differences that I want to over interpret or read too much into. Certainly, every cancer indication is going to be different, but when we start getting into the individual cancer types, the sample size does get smaller. And we've not done formal tests of comparison or heterogeneity among cancer types. So I don't want to say that the differences which we certainly do see, like numerically, there are differences in the proportion of patients who are getting optimal treatment versus no treatment. I don't want to say that it's because the low income subsidy status or patient age has a bigger impact, let's say for lung cancer than breast cancer. I want to say that is heterogeneity for potential future study when we are able to do a similar follow up analysis with say a larger sample size. I don't want to over interpret those differences at the moment. Dr. Davide Soldato: I was just wondering in case there was anything in particular that you wanted to highlight. But in the end, I think that we also have to acknowledge that the data are based on claims data, observational data. So maybe you're right when you say we should not over interpret this type of difference.  And this is just to speculate a little bit, do you think that if you would look at this same specific question in a more contemporary diagnosis frame, like for example, you refer to the fact that most of the diagnoses were between 2016 and 2018. Now that we have more and more of these drugs that would qualify as Part B in the adjuvant or new adjuvant setting, do you think that you would see more differences compared to what you observed in the current study or do you think that it would be more or less the same? Of course this was not part of the analysis that you did, but it's just to have your opinion on the topic in general. Dr. Aaron Mitchell: My expectation would be that since not much has changed with respect to the low income subsidy program from the time period of our study until now, my baseline expectation would be that those results would hold. On the other hand, it is the case that there have been improvements to the standard Medicare Part D benefit since the time of our study. So the low income subsidy patients would be paying the same low out of pocket costs that I mentioned before, about $10 a month give or take, for a specialty cancer drug. But what has started to happen is that for everyone else, their coverage has improved. Because in the US we're in the process of closing, or I think now we finally finished, but you know, a few years lag in claims data, we've closed what used to be called the donut hole, where there was this big coverage gap where patients had to pay a large amount out of pocket for drugs. So there might therefore be a narrowing of the difference, let's say between our low income subsidy participants, the lowest income patients, and then everyone else. But not so much because the low income subsidy status improved or changed, but just because the baseline level of coverage for everyone else may have improved, narrowing that gap. So I'd say that would be very possible.  And if your question is more geared towards not so much policy changes, but treatment landscape changes, I would say the big thing that I would maybe guess, and again, this is very much speculation, but you introduce the speculation in TBD on follow up. I think the big change in the landscape has been the broadening indication and uptake of immunotherapy drugs, our PD-1, PD-L1 inhibitors, for a variety of cancer types. And I think the way that that would manifest in our data, were we to repeat it in a more contemporary data set, would be, I think that the access for, let's say, that any systemic therapy among older patients might change. And that is because rather than just having your cytotoxics in hand, the clinical oncologists now know that for many cases there's if not first line therapy, then second line therapy for patients who don't qualify, you can go straight to it, to someone who's not a chemo candidate, you've got a much more tolerable treatment in your back pocket. And so I think that for patients who are more old or more comorbid, we might start to see that a greater proportion of them receive some systemic therapy, it just might not be the cytotoxic agent that is still most highly recommended. It might be, say a single agent, PD-L1 inhibitor, because their oncologist wants to be able to give them something. So I wouldn't be surprised if that gap starts to narrow as well if you're measuring no systemic therapy versus any systemic therapy. Dr. Davide Soldato: And going back to the policy part of the study that you did, do you think that the results of the study that you published in the JCO can better inform policy makers on how to make these treatments more available and be sure that the largest possible proportion of patients gets a systemic treatment and gets the optimal systemic treatment? Dr. Aaron Mitchell: Yes, I do think that this study has some direct and indirect policy implications. I think that our finding is one to highlight the low income subsidy program and maybe help it not to fly under the radar so much anymore. I think all the work that has been done on how much it has helped patients who need oral cancer medications is great, and it shows how beneficial this program can be. We're now shining the light kind of everywhere else and saying, “Okay. That's great. Here's how well it can work when it covers an oral drug, but we've got this group of low income patients who are still at need and they're still very clearly not able to access everything else. When it's not axitinib that they need, it's a pembrolizumab, they're still very much behind the curve and they need some help.” So I think that's one thing just to call attention to this as an ongoing problem. Low income patients, it's not a solved problem yet. It's something that needs further attention.  And then for direct policy implications that are on the table, I think we're about to see the Medicare program be able to start negotiating not just Part D drugs, but also in future years, Part B covered drugs and try to lower the price for everyone, both for insurance, both for Medicare itself. And then to the extent that that boils over to the patient's out of pocket responsibility, it'll start to reduce the patient out of pocket costs as well. So I think we can look forward to hopefully an aggressive negotiation program by Medicare to start to directly lower the prices of Part B cancer drugs that these patients are unable to afford. Dr. Davide Soldato: Thank you very much. You did the research you published in the JCO, but you really seem very passionate about the topic of care delivery and quality of care and policy. So I just wanted to ask on a personal note, how did you come to this area of research which is frequently not one that is very cared for by oncologists? It's more frequently something that biostatisticians or public health scientists put their attention to. I just had this curiosity and I wanted to ask you if you could explain a little bit how you came to this area of research. Dr. Aaron Mitchell: Thank you for asking. That's a great question. I'll tell my favorite story about my journey there. I entered medical school planning to be a clinical investigator or maybe even a basic science researcher, and I had some background in that. I went to medical school at NYU where the teaching hospital is Bellevue, which is a large, well known public hospital within New York City. And my eyes started to open regarding the inequities in the system. You always hear about it, you read about the problems in the US healthcare system, but then when you see it on a day to day basis and you can walk four blocks from a private, very well resourced hospital to see a patient with a similar condition four blocks down the road at a under resourced public hospital getting very different treatments and receiving very different outcomes, the injustice in the system really hits you on a visceral level. And it was really, I would say, as soon as I started my clinical rotations in medical school that I realized maybe that's where I can make the most impact with my career and just really fell into it. By the time I was done with medical school, I then knew that I wanted to do something that was in the health policy space. And then by the time I was done with residency, I was like, “Oh, someone had mentioned the words health services research” and the light went on. It's like, “Oh, that's me. That's what I want to do.” Dr. Davide Soldato: Thank you very much. That was a nice story. And I really think that we should all work towards trying to make sure that the inequities inside of the system are eliminated as much as possible.  So I think that this concludes our interview for today. So thank you again, Dr. Mitchell, for joining us. Dr. Aaron Mitchell: You're very welcome and thank you so much for your interest. Dr. Davide Soldato: We appreciate you sharing more on your JCO article titled, “Quality of Treatment Selection for Medicare Beneficiaries with Cancer.”  If you enjoy our show, please leave us a rating and review and be sure to come back for another episode. You can find all ASCO shows at asco.org/podcasts.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.  Guests on this podcast express their own opinion, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.

In this episode of the Bring The Juice, Aaron Mitchell, Steven Comstock, and Stratton Brown join host Frank Dalena to tackle the evolving landscape of college football. They dive into the controversial trend of mid-season redshirting, highlight the biggest surprise teams at the halfway point, and discuss strategies for bouncing back after tough losses in CFB. The group also shares their predictions for the upcoming 12-team playoff, sips on Red Wave Light Lagers, and debates the Heisman front runners, spotlighting Travis and Jeanty.

Today on our show, we're talking about what it takes to build loyalty by creating long-lasting relationships between brand and consumer. To do this, we're joined by Christopher Baird, frog's head of loyalty based in the UK, in conversation with Aaron Mitchell, Global VP of Membership and Personalization at The LEGO Group. Throughout their chat, the two talk about the intersection of play, people and purpose, and what that means for long-term business strategies that simultaneously create a new level of customer value.Brought to you by frog, a global creative consultancy. frog is part of Capgemini Invent. (https://www.frog.co) Download the new frog report 'Chief Challenges 07: Your Consumer Responsibility' (https://fro.gd/3JSdvOK) Host/Writer: Elizabeth Wood, Editorial Director, frog Research & Story Support: Camilla Brown, Editorial Manager, frog Audio Production: Richard Canham, Lizard Media (https://www.lizardmedia.co.uk)

This episode is available in audio format on our Let's Talk Loyalty podcast and in video format on www.Loyalty.TV.The LEGO Group is the company behind the world's beloved LEGO® bricks, the world famous toy brand that has been sparking imaginations and inspiring the builders of tomorrow since 1932.The company remains proudly family-owned and is headquartered in Denmark with regional hubs as well as multiple manufacturing facilities around the world, creating play-based experiences that are sold in over 130 countries.Joining us today to share the story of Lego's loyalty strategy is Aaron Mitchell, Lego's Global Vice President of Membership & Personalisation, who explains how Lego is increasing its focus on membership and community in order to connect with customers (new and old) and inspire them.Watch for free with our partner Capillary Technologies via Loyalty.TV or subscribe to watch this episode ad-free.Show notes:1) Aaron Mitchell2) LEGO Group3) LEGO Insiders4) Watch the full video interview for free at www.Loyalty.TV

The LEGO Group is the company behind the world's beloved LEGO® bricks, the world famous toy brand that has been sparking imaginations and inspiring the builders of tomorrow since 1932.The company remains proudly family-owned and is headquartered in Denmark with regional hubs as well as multiple manufacturing facilities around the world, creating play-based experiences that are sold in over 130 countries.Joining Loyalty TV today to share the story of Lego's loyalty strategy is Aaron Mitchell, Lego's Global Vice President of Membership & Personalisation, who explains how Lego is increasing its focus on membership and community in order to connect with customers (new and old) and inspire them.https://www.theguardian.com/lifeandstyle/2017/jun/04/how-lego-clicked-the-super-brand-that-reinvented-itself

Send us a textThere's no doubt that physicians who take money from pharmaceutical companies prescribe more expensive drugs.But is that really best for patients? And what are the real dangers of these financial incentives? In this episode of CareTalk, David Williams and John Driscoll talk with Dr. Aaron Mitchell, a genitourinary medical oncologist at Memorial Sloan Kettering Cancer Center, about the precarious role of financial incentives on physician behavior.This episode is brought to you by BetterHelp. Give online therapy a try at https://betterhelp.com/caretalk and get on your way to being your best self.As a BetterHelp affiliate, we may receive compensation from BetterHelp if you purchase products or services through the links provided.TOPICS(0:22) Sponsorship: BetterHelp(1:44) Why Should We Care About Incentives in Healthcare?(2:40) The Nature of Relationships Between Doctors and Pharma(4:48) The Average Size of Incentives(6:53) The Impact of Incentives on Prescribing Patterns(7:45) How Pharma Justifies Financial Incentives(12:05) When Financial Incentives Lead to Prescribing Worse Drugs(14:44) A Doctor's Perspective on the Ethics of Incentives (17:31) Branded Drugs Versus Unbranded Drugs(20:26) How Doctors Have Reacted to Findings on Financial Incentives (23:26) Should Patients be Afraid of Getting the Wrong Drug?(27:15) What's Next for Dr. Aaron Mitchell?

Send us a Text Message.In this episode of Causes or Cures, Dr. Eeks chats with Dr. Aaron Mitchell about his recent research on pharmaceutical industry payments to medical doctors for promoting specific drugs on X (formerly known as Twitter). Dr. Mitchell describes the financial relationships between pharmaceutical companies and doctors, the prevalence of this issue, and what is known about its impact on prescribing practices and patient outcomes. He also shares his thoughts on direct-to-consumer drug advertisements and offers solutions to mitigate the massive influence of pharmaceutical companies on our health system.Dr. Mitchell is an oncologist and health services researcher at Memorial Sloan Kettering Cancer Center in NYC, with a research focus on the interaction between financial incentives and physician behavior. You can learn more about him and his work here. You can contact Dr. Eeks at bloomingwellness.com.Follow Eeks on Instagram here.Or Facebook here.Or X.On Youtube.Or TikTok.SUBSCRIBE to her monthly newsletter here.Support the Show.

A hoops journey finds itself in Vegas this week so it's a brief Q&A with Mitch and Mitch only! We cover the game between the US and Canada on Wednesday, some thoughts on local hoops, how to improve within the club AND high school system and more! A fun episode tap in!!! Aaron Mitchell - Host Instagram: https://www.instagram.com/a_a_mitch/ Instagram: https://www.instagram.com/ahoopsjourney/ Website: https://www.ahoopsjourney.com/

A new MP3 sermon from Jacks Mountain Community Church is now available on SermonAudio with the following details: Title: Stand Up, Believer! Subtitle: An Exposition of 1 John Speaker: Aaron Mitchell Broadcaster: Jacks Mountain Community Church Event: Sunday Service Date: 6/30/2024 Bible: 1 John 1:1-4 Length: 28 min.

We're back with another guest, and he's a real life detailer! Aaron Mitchell joins us to talk about his experiences and quickly learns to disrespect the host of this lovely podcast - he's a true fan! Also don't forget to email any questions, suggestions or feedback to speckyandpaultalkdetailing@gmail.com and consider supporting the podcast at Patreon.com/speckyandpaultalkdetailingLove you! x --- Send in a voice message: https://podcasters.spotify.com/pod/show/speckyandpaul/message

A new MP3 sermon from Jacks Mountain Community Church is now available on SermonAudio with the following details: Title: Confidence in Who? Speaker: Aaron Mitchell Broadcaster: Jacks Mountain Community Church Event: Sunday Service Date: 4/28/2024 Bible: Mark 14:66-72 Length: 39 min.

A new MP3 sermon from Jacks Mountain Community Church is now available on SermonAudio with the following details: Title: Confidence in Who? Speaker: Aaron Mitchell Broadcaster: Jacks Mountain Community Church Event: Sunday Service Date: 4/28/2024 Bible: Mark 14:66-72 Length: 39 min.

LISTEN: When Aaron Mitchell was 15, he went on a family vacation to Mexico. While browsing around a marketplace, he happened to spot an old, cheap guitar and told his father how much he wanted it. His dad let him get the guitar, and he immediately started teaching himself how to play it so that he could write his own songs.When he was young, he mostly listened to alternative and punk, and country music was always in the background for him. After he moved to Chicago, though, he started listening to folk artists such as Hank Williams, Woody Guthrie, and Townes Van Zant, becoming obsessed with classic country. He also cites Bob Dylan as an influence, getting into classic songwriters and later finding John Prine as an inspiration. Thank you for listening to The Mountain-Ear podcast featuring the news and culture from peak to peak.SUBSCRIBE ONLINE and use the COUPON CODE PODCAST FOR A 10% Discount for ALL NEW SUBSCRIBERS https://www.themtnear.com/subscribe/ You can find us online by visiting https://www.themtnear.com/Find us on Facebook @mtnearYou can contact our editor at info@themountainear.com.Thank you for listening.

For a full transcript of this episode, click here. Here's something Randy Vogenberg, PhD, wrote the other day; and I made some light edits: Research has documented the unintended impacts of poor pharmacy benefit strategy. Examples include increasing costs of care, bankruptcies, and member satisfaction declines. And, yeah … agreed. Also, probably health problems if we're talking about a member unable to access a drug they really need. I heard the other day about how so many patients who have had organ transplants have a hard time getting their transplant rejection meds. What?! I just can't even with that one. On the other hand, you could have a plan that pays for all manner of drugs, cost-effective or not, appropriate or not. And now we have premiums that no one can afford, and everybody loses for the exact opposite reason. These are the downsides that happen when pharmacy purchasing gets itself into a suboptimal place. And this can happen for many reasons, but one of them is when there is not a concerted effort to buy pharmaceuticals in a value-based way. Now, here's some reasons why employers may have a rough time paying for value (ie, paying a fair price for drugs that work). Here's one reason: Most employers do not have the power to influence the price of a medication. So, any given employer could decide, based on some cost-effectiveness analysis, that the price of a drug is too high. But it's not like they can march into Pharma HQ and haggle. It's more of a take-it-or-leave-it kind of thing. Here's a number two reason why value-based pharmacy purchasing can be tough: Pharmacy spend is siloed a lot of times from medical spend. So, the pharmacy vendor is only concerned about cost and denies access to even drugs that are proven to reduce medical spend. Why wouldn't they do that? The PBM (pharmacy benefit manager) was hired to reduce pharmacy spend. The end. Who cares how many ER visits or disease exacerbations transpired? That's the medical director's problem, not theirs. Here's the number three reason why value-based purchasing is rough: The time horizon an employee is with an employer, which is not one day—and it's not a lifetime. Why did I say one day? I have heard more than once that the actuarial time horizon that some pharmacy plans use to determine if a drug is cost-effective is one day. If the drug doesn't accrue any benefits in one day, well then, it's a cost. It's not effective. On the other hand (and also problematic in the real world), sometimes cost-effectiveness analyses are done with a timeframe of the patient's lifetime. And, yeah … there aren't many employers who have employees for a lifetime—like, they're 85 years old and still on the employer's dime—so the time horizon can't be too short. But if it's a really expensive med that will, at most, prevent something that's not gonna happen anytime soon (heart failure, kidney failure, a stroke), these are things that an employer may pay for but likely is never gonna see the cost benefit of because that benefit will happen 30 years from now when the patient is on Medicare. And here's a fourth reason why value-based purchasing is tough: The FDA is approving drugs based on evidence from one study (ie, not a ton of evidence). And these drugs are also really expensive. So, some of the above issues are solvable; some are less solvable. With this in mind, let's tick through some advice that my guest today, Nina Lathia, suggests if you want to offer members a value-based formulary. 1. Have a stated goal. And maybe that stated goal is to meaningfully improve health of plan members while maintaining access, satisfaction, and affordability for said plan members and the plan. 2. Think holistically about healthcare spend, not just pharmacy spend. 3. Know what the value-based price of a drug has been calculated to be. I talked about this at length in the show with Anna Kaltenboeck (EP303). Also, Bryce Platt, PharmD, has written about this a lot. 4. Look into risk-based deals with Pharma and/or installment payments and/or some of these other interesting payment models that are emerging. Luke Prettol linked to one of them the other day. 5. Set good decision-making precedents that include shared decision-making with members/patients. This means communicating with employees and plan members about what you are doing to make good drug purchasing decisions and evaluate the clinical pros and cons of expensive drugs for any given patient. There are genetic tests now that can be done to determine if a drug is ever going to work for a patient, were these tests even done. I mean, from a patient standpoint, some of these drugs have horrible side effects; and they might be being prescribed by a doc who's not an expert in that condition. If I'm a patient and there's a genetic test I could take before I pay a ton of my own money and subject myself to what might be some pretty nasty side effects (you know, all the things that you hear about at the ends of those pharma ads on TV, right?), this could be, in the right hands, a patient benefit. This feels very different from prior auths administered by a vendor doing all kinds of stuff, where it's hard to make any connections to clinical value or patient upside, even if you squint at it sideways and use your imagination. And, yeah … this is easy to say and really hard to do. One definition I want to chuck in here for you: If we're talking about a cost-effectiveness analysis, cost-effectiveness analyses calculate how effective is the drug, minus side effects at diminishing the so-called burden of illness—burden of illness meaning the financial and health costs of the disease itself or its exacerbations. Nina Lathia, my guest today, is a pharmacist by training who has worked in hospital pharmacies. She earned a PhD in health economics. Currently she's doing consulting work, helping purchasers make value-based decisions about pharmacy spend and managing formularies. Specialty Pharmacy Playlist: https://lnns.co/uNZ3moCaQMb Hit the subscribe button to add it to your podcast player. Also mentioned in this episode are Randy Vogenberg, PhD; Anna Kaltenboeck; Bryce Platt, PharmD; Luke Prettol; Olivia Webb; Pramod John, PhD; Scott Haas; Aaron Mitchell, MD, MPH; Keith Hartman, RPh; Erik Davis; Autumn Yongchu; and Berkley Accident and Health.   You can learn more by emailing Nina at nina.lathia@healthcaredecisionmaking.com. You can also connect with her on LinkedIn.   Nina Lathia, RPh, MSc, PhD, has spent over 15 years helping healthcare payers achieve value on their drug spend. As the chief executive officer of Healthcare Decision Making, Nina works with public and private healthcare payers, helping them to make evidence-based decisions about their pharmaceutical benefits that lead to improved health outcomes and long-term financial sustainability of their health plans. Her focus is on providing independent, actionable advice for healthcare payers on reimbursement decisions related to expensive new drug therapies. Nina is a frequent public speaker and commentator on employer-sponsored pharmacy benefits design, value-based healthcare decision-making, and evidence-based medicine. Nina honed her skills in value-based assessment of drug therapies when she was a senior technical advisor at the National Institute for Health and Care Excellence (NICE) in the United Kingdom from 2014 to 2017. She has also worked as a clinical lecturer at the University of Toronto. Her work has been published in a number of high-impact peer-reviewed journals. Nina holds a master's degree and doctorate in health economics from the University of Toronto.   06:34 What does cost containment mean? 07:43 Why is it important to consider health outcomes? 10:00 What does value-based purchasing mean in Pharma? 11:09 What are the principles of cost-effectiveness analysis? 12:50 Pharmacy plan time horizons versus employer time horizons. 14:42 Why is it increasingly important for payers to take a more global look at health and cost outcomes? 16:14 Why is the first step establishing a value-based price for drugs? 16:43 Why is the second step thinking about risk-sharing agreements with manufacturers? 18:57 LinkedIn article by Bryce Platt, PharmD. 19:20 What should an employer do if there's only one drug option and the price is too high? 21:20 What's a specialty carve-out solution? 21:26 EP352 and EP353 with Pramod John, PhD, of VIVIO. 22:10 Why should employers get more comfortable with saying “no” to certain drugs? 25:36 Why is patient engagement key? 28:23 What does “good” look like for employers implementing drug-spend changes? 29:51 EP337 with Olivia Webb.   You can learn more by emailing Nina at nina.lathia@healthcaredecisionmaking.com. You can also connect with her on LinkedIn.   Nina Lathia discusses #costcontainment and #valuebasedpurchasing in #pharma on our #healthcarepodcast. #healthcare #podcast #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Marshall Allen, Stacey Richter (INBW39), Peter Hayes, Joey Dizenhouse, Benjamin Jolley, Emily Kagan Trenchard (Encore! EP392), Cora Opsahl (Encore! EP372), Jodilyn Owen, Ge Bai, Andreas Mang  

When Dr. Aaron Mitchell felt a nudge from the Holy Spirit to leave behind his comfortable life and a busy medical practice for the unpredictable streets of Cairo with his teenage son Caleb, his faith was put to the ultimate test. The timing of the trip coincided with the war breaking out in the neighboring Israel. In this episode of the Limitless Spirit Podcast, host, Helen Todd, sits down with Aaron to explore the emotional and spiritual implications of answering God's call. His story, a narrative of courage and trust, reminds us that the path of true discipleship often leads us through the wilderness of our fears and into the promised land of divine purpose. Aaron's candid recount of their adventures offers a vivid illustration of the challenges and joys found in connecting with people across language barriers and the rich spiritual rewards that follow. Aaaron challenges us to answer the question: "If we are comfortable, are we doing enough for God?"Visit World Missions Alliance website: rfwma.org to doscover opportunities to serve in short-term missions across the globe.Support the showThanks for listening! Visit our website rfwma.org and follow us on Facebook and Instagram!Help us make more inspiring episodes: https://rfwma.org/give-support-the-podcast/

We sat down with former Bulldogs Offensive lineman Aaron Mitchell before the season started to his insight on the current state of NIL. --- Send in a voice message: https://podcasters.spotify.com/pod/show/beware-of-bulldogspodcast/message

HUGE NEWS EPISODE 100!!!!! One of the Godfathers of Juice - Aaron Mitchell finally comes on the pod for a high energy, gritty episode. We discuss the origins of juice, the different types of leadership, NFL dreams turning into Professional Rugby , the insides of NIL, college football recruiting landscapes and oh , more juice.

In today's episode, I chat with Aaron Mitchell, the visionary game-changer who sparked a wave of financial equity and inclusion when he drove an initiative to move $100m of Netflix's cash into Black-owned banks in 2020. The groundbreaking effort provided a platform for marginalized communities to thrive and drew nationwide attention, leading to features in The New York Times, CNBC, and Wired.I originally met Aaron in 2020. I was in the throes of planning the global HR summit, to this day - still the world's largest enterprise conference presented in virtual reality, and I wanted to have Aaron be a part of it. Unfortunately, schedules didnt line up, though we've remained in touch ever since, keeping tabs on each other's progress, until one day we'd get a chance to speak again. Today's that day and our discussion surpassed even my wildest expectations. Together we delved deep into Aaron's journey and motivations, his experiences at Netflix, and the genesis of his pivotal Black Banks initiative. We'll also explore our shared passion for Brazil, Aaron's tactics for "hacking" the system for racial equity, and his vision for the coming 12 months.It was a long time coming, worth every bit of the wait, and I hope you enjoy our conversation, as much as I did recording it.Aaron MitchellAaron Craig Mitchell is an LA based Entrepreneur, Advisor, Coach, and Change maker with nearly 20 years experience across various industries. He is currently the Co-founder and CEO of Pega Visão Salvador Club (PVSC), a Web3 entertainment company as well as CEO of Aaron Craig Mitchell Enterprises, LLC (ACME, LLC), a coaching and advisory business. He was recently the Director of HR for Netflix Animation, one of the largest and fastest growing animation studios in history and prior to that spent his career as a leader in Talent Acquisition across various industries, companies and geographies. An experienced business leader with a demonstrated history of executing change, Aaron has become globally recognized for his historic work pioneering Netflix's 2% Cash Holdings Pledge of $100 Million into Black Owned Banks. LinkedInWebsiteThinking Inside the BoxConstraints drive innovation. We tackle the most complex issues related to work & culture. And if you enjoy the work we're doing here, consider giving us a 5-star rating, leaving a comment & subscribing. It ensures you get updated whenever we release new content & really helps amplify our message.LinkedInInstagramTwitterWebsiteApple PodcastsGoogle PodcastsSpotifyStitcherPocket CastMatt BurnsMatt Burns is an award-winning executive, social entrepreneur and speaker. He believes in the power of community, simplicity & technology.LinkedInTwitter

Putting a spotlight on new Black owned Web3 company, Pega Visão Salvador Club (PVSC). Co-founders Javonté Anyabwelé and Aaron Mitchell break down what Web 3 is, how they came up with PVSC, why Salvador, Brazil is Black travel goals, and how the community can get involved with this ground breaking movement.    Learn more and stay in the know about the initial NFT launch by signing up for their newsletter at pvsclub.com Instagram: @_pvsclub

Rachel Kraus is the Managing Director/Partner at DoAble, a brand strategy and marketing collective and Executive-in-Residence at LionTree. In this episode of Listen on Purpose, UNICEF Board Member and former HR leader for Netflix Animation Studio Aaron Mitchell shows us how he's used what he learned from his upbringing and his background in music to find the harmony of dissonance.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In the second episode of this Hematopoiesis Bench to Bedside series, Dr. Manuel Espinoza-Gutarra has conversations with Dr. Aaron Mitchell, Dr. Yousuf Zafar (@yzafar), Dr. Aju Mathew, and Dr. Nandita Khera (@khera_nandita), experts in the field of financial toxicity in cancer patients, who offer different perspectives regarding the impact of the financial costs of modern anticancer treatment puts on patients, how should we adequately measure it and how to tackle it.Music: “Somebody New” RYYZN (www.toneden.io/ryyzn/post/somebody-new-copyright-free). Licensed under Creative Commons: By Attribution 3.0 creativecommons.org/licenses/by/3.0/.

I saw a Tweet from Farzad Mostashari, MD, the other day; and I'm gonna rewrite it in the context of today's show: This is why we can't have nice things! As soon as someone comes up with something that might accomplish some good things when done in moderation and with good intent, it gets exploited for revenue maximization. I have to admit, this conversation with Aaron Mitchell, MD, MPH, and actually the one with Mark Miller, PhD (EP380), from two episodes ago were both kind of painful for me—and let me tell you why. It's the same reason I find conversations painful about hospitals or leading cancer centers or even some self-insured employers and EBCs (employee benefit consultants): It hurts my heart when some percentage of healthcare industry peeps who have the opportunity to produce so much good in the world instead choose to do stuff that is financially or otherwise toxic. But let me get to the point of today's show. Dr. Aaron Mitchell and I are talking about conflicts of interest (COI), and we're talking about COI in the payments that are made from Pharma to physicians. COI might mean when physicians are paid in a way that skews their clinical decision-making. Nobody wants to be the patient of a physician with skewed decision-making, after all. That's the “why” of this whole discourse. Now, let's get into two important points re: skewed decision-making. Any payment that skews decision-making is, in fact, considered no bueno by the current writing of the AKS, the anti-kickback statute. Second, almost any payment, direct or indirect, turns out, skews physician decision-making. It's not just getting paid the big bucks to make a speech or consult or whatever. Getting a modest free lunch can also have the same effect. Prescribing is affected. That's what the data show and what the recent paper that Dr. Aaron Mitchell and his colleagues published in the Journal of Health Politics, Policy and Law articulates. Their paper is titled “Industry Payments to Physicians Are Kickbacks: How Should Stakeholders Respond?” So, hmmm. Much to cogitate upon in what I just said, which is what the conversation with Dr. Aaron Mitchell that follows is all about. But let me offer up a few spoilers and maybe some additional thoughts. First of all, some “Are payments COI and kickbacks?” contemplations are pretty black and white. We start out the conversation in this healthcare podcast talking about the recent Biogen incident, I guess I'll call it, which is sadly not an outlier. Biogen never admitted any wrongdoing here. But if what they are accused of doing is true, this could be considered not a gray area. This is black-and-white COI—unquestionably should not happen. But where things get a little bit more open to interpretation and require some consideration and thoughtfulness is if we're trying to weigh the gray in the middle between black and white. Here, what needs to be thought through is the aggregate good versus the aggregate bad of Pharma paying physicians to do stuff or buying things for them. If Pharma needs help during its clinical trials to figure out a breakthrough therapy and they want to talk to leading experts in a specialty, that's maybe a good thing so that they can get a drug that actually works well for patients. So is—and this is me talking, not Dr. Mitchell—but I could see that Pharma helping to figure out ways to educate clinicians about the best ways to help patients suffering with real diseases that nobody else is making any effort to do anything about at a national scale … it could help humans live better lives if Pharma takes the advice of the right thought leaders and helps to disseminate their teachings. Maybe physician societies could fill this role, but a lot of times, who needs educated are not the actual doctors in the society in question. It's other doctors the patient is seeing who don't realize the root cause is a GI problem or CKD (chronic kidney disease) until the patient needs a liver transplant or “crashes” into dialysis in the ER. But irrespective of the validity of my musings here, the point is to quantify the in-aggregate “good” that might happen as a result of Pharma paying appropriate clinical experts appropriate amounts. Contrast that aggregate good against some not so good. Study findings that Pharma can drive up not only Rx's (prescriptions) for its own drugs but also drugs in general when they buy stuff for doctors or pay doctors. Patient populations get overmedicated when compared to a baseline as a result. Too many patients get diagnosed and treated for some condition that they may not actually have. Too many expensive me-too drugs get prescribed at big unnecessary costs to patients, taxpayers, and employers. When I say costs to patients, by the way, I also might be implying a clinical overtone here as much as a financial one, because there's almost no drug that comes without side effects. So, what are some solutions that Dr. Aaron Mitchell mentions in this episode, or I that bring up, if we are trying to steer physician payments into the aggregate good zone and out of the bad COI zone? Here we go, and these are not necessarily in the order in which they are discussed: Keep an eye on practice patterns and overall costs. This might make physicians aware when their clinical decision-making is getting swayed, so to speak. Get payers involved. Listen to this whole episode for the “how” and “why” here, but if anyone has a visceral reaction to this, here's one possible positive from a physician standpoint: It could be a way to get rid of a lot of PAs (prior auths). If a doc's practice pattern is average, on trend, and/or they do not take industry dollars, then they get what amounts to a PA gold card. With that carrot, a doc may have less inclination to let their prescribing decisions sway and/or take pharma dollars. The federal government can get involved in a few ways that Dr. Mitchell talks about. One of them is a direct ban on all payments. Or maybe they could just clarify what is okay and what is not okay, since what is listed as COI in the current AKS is also currently considered an industry norm. Asking providers themselves to pay attention and self-regulate and to, for example, not accept speaking gigs where they are paid to talk to an empty room or “consult” on topics that really they should know they're not thought leaders in. You can learn more at Dr. Mitchell's personal profile on the Memorial Sloan Kettering Cancer Center Web site. You can also connect with Dr. Mitchell on Twitter at @TheWonkologist. Aaron Mitchell, MD, MPH, is a practicing medical oncologist and health services researcher. He is an assistant attending at Memorial Sloan Kettering Cancer Center in the department of epidemiology and biostatistics. His research focuses on understanding how the financial incentives in the healthcare system affect physician practice patterns and care delivery to cancer patients. He cares for patients with prostate and bladder cancer. 07:32 How does the recent whistleblower case serve as a good example of what shouldn't be permissible in Pharma? 11:23 “There's a little bit of a disconnect between what the law currently says and maybe the ideal world that we would want.” 11:56 Dr. Aaron Mitchell's paper in the Journal of Health Politics, Policy and Law, titled “Industry Payments to Physicians Are Kickbacks: How Should Stakeholders Respond?” 14:37 How should stakeholders react to this new legislation? 17:56 What is the aggregate benefit versus risk of these payments to doctors? 19:53 BMJ paper by Tyler Greenway and Joseph Ross. 23:51 What should providers and the federal government be doing in light of this new legislation? 29:07 “It's just always so much harder to get to the outcomes because there's so much more that happens in between the clinical decision and then what the patient's outcome is down the road.” 30:42 Will innovation be stifled with this new crackdown on kickbacks? You can learn more at Dr. Mitchell's personal profile on the Memorial Sloan Kettering Cancer Center Web site. You can also connect with Dr. Mitchell on Twitter at @TheWonkologist. @TheWonkologist discusses #pharma conflicts and kickbacks on our #healthcarepodcast. #healthcare #podcast #digitalhealth How does the recent whistleblower case serve as a good example of what shouldn't be permissible in Pharma? @TheWonkologist discusses #pharma conflicts and kickbacks on our #healthcarepodcast. #healthcare #podcast #digitalhealth “There's a little bit of a disconnect between what the law currently says and maybe the ideal world that we would want.” @TheWonkologist discusses #pharma conflicts and kickbacks on our #healthcarepodcast. #healthcare #podcast #digitalhealth Dr. Aaron Mitchell's paper in the Journal of Health Politics, Policy and Law, titled “Industry Payments to Physicians Are Kickbacks: How Should Stakeholders Respond?” @TheWonkologist discusses #pharma conflicts and kickbacks on our #healthcarepodcast. #healthcare #podcast #digitalhealth How should stakeholders react to this new legislation? @TheWonkologist discusses #pharma conflicts and kickbacks on our #healthcarepodcast. #healthcare #podcast #digitalhealth What is the aggregate benefit versus risk of these payments to doctors? @TheWonkologist discusses #pharma conflicts and kickbacks on our #healthcarepodcast. #healthcare #podcast #digitalhealth What should providers and the federal government be doing in light of this new legislation? @TheWonkologist discusses #pharma conflicts and kickbacks on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It's just always so much harder to get to the outcomes because there's so much more that happens in between the clinical decision and then what the patient's outcome is down the road.” @TheWonkologist discusses #pharma conflicts and kickbacks on our #healthcarepodcast. #healthcare #podcast #digitalhealth Will innovation be stifled with this new crackdown on kickbacks? @TheWonkologist discusses #pharma conflicts and kickbacks on our #healthcarepodcast. #healthcare #podcast #digitalhealth Recent past interviews: Click a guest's name for their latest RHV episode! Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360)

So, this is a 400-level episode in specialty pharmacy options for plan sponsors, meaning here are your prerequisites: You gotta know what buy and bill is, and you gotta know what pharmacy bagging is, meaning white bagging, for example. If you do not, I would listen to Encore! EP282 with Aaron Mitchell, MD, MPH, where we go deep on buy and bill. And then listen to EP369 for the skinny on pharmacy bagging. If you already know what buy and bill is and you already know what white bagging is, then not only do you know more than 98% of the people in the healthcare industry, but also, you're going to get as much out of this conversation with Erik Davis and Autumn Yongchu as I did.   Last week's show was also with Erik Davis and Autumn Yongchu. Last week, we talked about how some hospitals and cancer centers are managing to ring up up to six times the cost of an expensive-already injected or infused drug through buy and bill. This is why pharmacy bagging became a thing, if we want to talk about this in historical perspective. It's a direct market response to buy and bill. Hospital systems start making egregious amounts of money marking up drugs that already cost hundreds of thousands of dollars, and their markups are hundreds of thousands of dollars on top of that. Hospital starts making a fortune off of drug markups. Plan sponsors need an alternative, and … enter pharmacy bagging (ie, carving out specialty pharmacy drugs to a PBM [pharmacy benefit manager]). In this show, we compare the potential benefits and problematic loopholes and/or patient concerns for plan sponsors who are trying to figure out whether to carve out specialty pharmacy benefits to a PBM or grin and bear it with the buy and bill. Or, as another option, whether to steer patients to specific infusion centers or specific provider organizations that might have more favorable contract terms for the plan sponsor. Or, hooking up with a home infusion company, again, who is willing to negotiate terms that might be far better for said plan sponsor than just letting some hospital have their way with employees and the health plan. As another alternative, of course, plan sponsors could consider medical travel, which some certainly are. My biggest takeaway from this whole conversation and from the episodes that we have had in this, dare I call it, series about pharmacy benefits, starting with the show with Scott Haas (EP365) where we talked about PBM contracts, moving to the show with Dr. Aaron Mitchell (Encore! EP282) where we talked about buy and bill, then going to the show with Keith Hartman (EP369) where we talked about pharmacy bagging, then last week's show how hospitals manage to buy and bill at 6x the price of these expensive pharmaceuticals … my takeaway from this whole specialty drug extravaganza is that specialty drug procurement is very different than retail drug procurement. Retail drugs, you worry about them en masse at scale almost at the population level. Specialty drugs? You can have one patient on a specialty drug, and that one patient costs as much as the entire rest of the member population combined. So, managing specialty drugs and their administration becomes almost a case-by-case operation. What drug is it? Where is the patient? What options are available? It's possible to save hundreds of thousands of dollars on that one patient, for that one patient's care, and get better patient outcomes by getting the right patient on the right drug that is administered in the right setting.   You can learn more by connecting with Erik and Autumn on LinkedIn or by emailing them at erik.davis@usi.com and autumn.yongchu@usi.com.   Erik Davis, AAI, CIC, CRM, is senior vice president and principal consultant, managed care and analytics, at USI Insurance Services. He has over 30 years of experience in the insurance and risk management industry. Erik works to create an environment that supports the healthcare risk management goals of an organization while maintaining focus on compliance and financial accountability. He is instrumental in vendor negotiations, data benchmarking, population health strategies, claims analysis, recommendations in plan design, and communication strategies. In this capacity, Erik has been involved with development of rates, payment structures, and recommendations of changes in processes, policies, and procedures. He has a broad understanding of contract analysis, evaluating risk, auditing for correct payment, and structuring of excess loss and pharmacy programs. Erik's experience extends from overall employee benefits consulting to workers' compensation, as well as managed care organizations in Medicaid, Medicare, and commercial contractual risk arrangements. Erik earned his bachelor's degree in economics from Oregon State University. He holds Accredited Advisor in Insurance (AAI), Certified Insurance Counselor (CIC), and Certified Risk Manager (CRM) designations. Autumn Yongchu is a healthcare operational risk consultant at USI Insurance Services. Autumn works with multiple database platforms to examine data for trends and abnormalities. Using investigative querying, medical coding analysis, and report development, she provides resources that help identify cost control opportunities and assists organizations in strategic business decisions regarding the management of healthcare risks. Autumn analyzes and interprets healthcare utilization data, allowing the development of initiatives regarding claim and risk management. This includes identifying fiscal and clinical strategies and providing necessary information to develop, design, and implement management initiatives. Autumn also analyzes trends, assists with insurance underwriting, and adjudicates stop-loss claims. Autumn has an in-depth knowledge of Medicaid and Medicare billing guidelines and payment methodologies. Prior to joining USI, Autumn was a claims auditor and trainer for a managed care organization which serviced over 100,000 commercial, Medicaid, and Medicare lives. Her responsibilities included contract analysis, claims adjudication, ensuring accurate payment, and identifying and recouping errors. 04:45 Can you actually save money by carving out specialty infused drugs and making them a pharmacy benefit? 06:28 How can plan sponsors use white bagging as leverage to reduce costs from markups? 06:47 Does white bagging save money compared to buy and bill? 07:42 “You also need to understand that with some of these drugs, you're dealing with very vulnerable people.”—Erik 08:41 EP369 with Keith Hartman, RPh. 11:10 “When your insurance carrier is married to your PBM, it doesn't matter where the money goes.”—Autumn 11:33 EP365 with Scott Haas. 12:00 “You need to have a collective understanding of every variable … when you're making those … decisions.”—Erik 14:53 How can comparison shopping save plan sponsors money when it comes to specialty infusion costs? 16:51 How can comparison shopping be a vicious circle in the wrong setting for plan sponsors? 18:43 “That's part of the problem: It's not just the plan sponsor not being educated enough; it's also the consultant … that they believe is supposed to be that isn't.”—Erik 19:03 How has transparency been used by healthcare systems to keep buyers' eyes off the ball? 26:55 “It is very case by case, but it comes down to your risk appetite.”—Autumn 28:19 “It's something that you have to, as a plan sponsor, really continue to monitor throughout the plan year.”—Autumn 28:38 “The more you know, the better equipped you're gonna be.”—Autumn 29:27 What can employers who are feeling aggressive do? 31:19 “The dollars circle, whether people realize it or not.”—Autumn You can learn more by connecting with Erik and Autumn on LinkedIn or by emailing them at erik.davis@usi.com and autumn.yongchu@usi.com.   Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma Can you actually save money by carving out specialty infused drugs and making them a pharmacy benefit? Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma How can plan sponsors use white bagging as leverage to reduce costs from markups? Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma Does white bagging save money compared to buy and bill? Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma “You also need to understand that with some of these drugs, you're dealing with very vulnerable people.” Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma “When your insurance carrier is married to your PBM, it doesn't matter where the money goes.” Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma “You need to have a collective understanding of every variable … when you're making those … decisions.” Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma How can comparison shopping save plan sponsors money when it comes to specialty infusion costs? Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma How can comparison shopping be a vicious circle in the wrong setting for plan sponsors? Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma “That's part of the problem: It's not just the plan sponsor not being educated enough; it's also the consultant … that they believe is supposed to be that isn't.” Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma How has transparency been used by healthcare systems to keep buyers' eyes off the ball? Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma “It is very case by case, but it comes down to your risk appetite.” Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma “It's something that you have to, as a plan sponsor, really continue to monitor throughout the plan year.” Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma “The more you know, the better equipped you're gonna be.” Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma What can employers who are feeling aggressive do? Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma “The dollars circle, whether people realize it or not.” Erik Davis and Autumn Yongchu discuss #buyandbill and #pharmabagging on our #healthcarepodcast. #healthcare #podcast #pharmacy #pharma   Recent past interviews: Click a guest's name for their latest RHV episode! Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O'Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger  

Last week's show was an encore episode with Dr. Aaron Mitchell (Encore! EP282), and we talked about buy and bill. To continue our exploration of specialty pharmacy intrigue, let's talk about so-called “bagging.” I wanted to get an overview of all of the different kinds of specialty pharmacy bagging. Bagging is a big deal. If you have anything to do with trying to control pharmacy costs or the clinical outcomes of specialty pharmacy patients, you too are going to want to understand what's going on here with bagging. I was thrilled to have a chance to chat with Keith Hartman, who is my guest in this healthcare podcast. He is the CEO of ContinuumRx. He's a pharmacist by education and has been in the pharmacy space for over 25 years now, touching just about every aspect of pharmacy from retail operations to long-term care and now, most recently, home infusion. This makes him an ideal person to chat with about this topic. And FYI, it was not easy to find someone to do so to clearly see the actions and reactions going on here because that's what this is all about: actions and reactions—how any self-respecting market distortion is going to cause a cascade of equal and opposite market distortions. So, let's cruise through the whole infused/injected specialty pharmacy historical play-by-play, shall we? It's like a “Who's on First?” routine—except very, very not funny. So, here we go. This is, of course, the semi-reductive abridged version; but let's do this thing. Once upon a time, the bagging story starts in ye olden days, meaning more than ten years ago, before specialty pharmacy drugs really became the massive profit centers for any party who can manage to get their fingers in the specialty pharmacy cookie jar. In these ancient and halcyon times, brown bagging was kind of a modus operandi. Don't forget, we're talking about infused or injectable drugs here, especially ones that need to be infused or injected in the provider's office. So, brown bagging means and meant when a specialty pharmacy drug is shipped directly to a patient, or a patient goes and picks up the specialty pharmacy drug at the pharmacy. Doc takes out prescription pad (this is in ye olden days, remember) and writes out the Rx. Patient picks up the drug from the pharmacy, which may be handed to them in a brown bag. Get it? But then they take that “brown bag,” as it were, to their doctor's office. The doctor takes the drug out of the brown bag and infuses or injects it. I say doctor's office because many times, in the olden days, that's where this went down. And this brown bagging had some issues, for sure; but specialty pharmacy drugs really weren't all that big of a thing either dollar-wise or frequency-wise. At some point in our story here, pharma manufacturers start seeing just exactly how much money the market will bear for specialty pharmacy drugs, and the prices of these specialty drugs go through the roof. At the same time, for a bunch of reasons I actually discussed with Dr. Bruce Rector (EP300), a whole bunch of these specialty pharmacy drugs start hitting the market all at once. So, these drugs have skyrocketing prices—and there's lots of them.   At that point, some (certainly not all, but enough) CFOs at provider organizations were like—wowza, epiphany, light bulb moment—there's a lot of money that can be made here because buy and bill. In buy and bill, which I talked about last week with Dr. Aaron Mitchell, provider organizations get reimbursed the cost of the drug plus some percentage when they administer it—meaning the more expensive the drug, the more money a provider can make because a percentage of a bigger number is, of course, a bigger number. Add to that a party-sized container of other provider shenanigans to maximize revenue on specialty pharmacy patients—and that revenue got bigger every single year. A recent report just came out that, on average, for oncology drugs, some providers are making six times the cost of the drug. Six times the cost of a drug that can cost lots of zeros! Just wow—6x! That's real money. This is winning the lottery every single time a patient needing a specialty drug shows up on your doorstep.   Continuing the tale here, this buy and bill health system extreme greed hits employers in their pocketbooks. And, of course, plan sponsors start desperately seeking relief. Who rides up on a white horse? PBMs (pharmacy benefit managers), of course. PBMs say that they will negotiate with drug companies and buy the drugs on behalf of the plan sponsors for much cheaper. Then they will ship the drugs purchased to the provider organizations. Thus, the plan sponsor only needs to pay providers to administer the drug, not that and some crazy markup on the drug itself. Ladies and gentlemen, white bagging has entered the building. White bagging is when the drug is not shipped directly to the patient à la brown bagging. It is when the drug is shipped to the provider. But wait … there's more to the story than a grand PBM gesture of goodwill. They see how much money the employers are used to paying providers for these drugs and realize that the PBM only needs to come in with a price that's less than that, at least at the beginning. So, over the years, weird stuff starts happening with rebates on the specialty drugs. Listen to the show with Scott Haas (EP365) for more on that. But bottom line, white bagging becomes not exactly a mecca of cost savings. PBMs are, as we all know, not known for their ability to moderate their profitability, after all. At this point in our story, let's just pause to say that provider organizations are very, very, very not happy with this whole white bagging intervention. Not only did a piece of the provider's specialty pharmacy cash cow get snatched by the PBMs, but there are also clinical issues with white bagging that we talk about on the show today. And some of these issues are not BS. Do not get me wrong. They are very real, and I do not want to minimize them. And so, provider organizations start to stand up their own hospital specialty pharmacies because then at least they can get some of the white bagging cha-ching. See what I mean? Plan sponsor, health plan mandates that the drug be filled in a pharmacy, hospital owns the pharmacy or part of the pharmacy … and now they have so-called clear bagging. Clear bagging is when one organization owns the pharmacy and the provider who will administer the drug. Clear bagging solves some of the clinical issues with white bagging, and the hospital also gets to take a cut. I'd be remiss not to mention here that some hospitals have worked very hard on their clear-bagging programs and definitely have tried to improve the quality of service here. You're going to have to listen to the show to hear about gold bagging and also the latest developments in this whole war employers and patients and taxpayers are fighting with PBMs and hospitals who are fighting with each other over who gets the money. Also, the continuing trend of brown bagging, especially as “in the patient's home” gets tagged on the end of lots of care delivery like “in bed” gets tagged on the end of lots of fortune cookies. Next week's show will dig into how exactly some providers are managing to get the up to 6x the cost of specialty pharmacy drugs when Medicare Part B at least says that they're only supposed to get ASP [average sales price] + 6% (ish). I just could not figure out how they were managing to get 6x just given that Medicare Part B rule, but yeah, they are—and we'll learn about that next week. You can learn more at continuumrx.com.   Keith P. Hartman, RPh, is chief executive officer of ContinuumRx and an experienced operating entrepreneur and pharmacy business owner spanning two decades. Keith founded and grew a chain of retail pharmacies, a compounding pharmacy, and two specialty pharmacies along with a long-term care pharmacy. All were built and grown under the guise of operational excellence and produced great results. Some were sold, while others he still owns and provides limited strategic guidance as a member of the board of directors. Keith graduated from the University of the Sciences with a degree in pharmacy. Today he is still involved mentoring future pharmacists and pharmacy owners. 08:09 What kinds of patients and/or drugs is the concept of bagging relevant to? 08:53 What is brown bagging, and what are the issues with it? 10:28 What is white bagging, and how is it different from brown bagging? 11:30 Who are the key players in pharma bagging? 12:25 Why does a PBM want a specialty drug to go through them? 12:49 From the physician's perspective, why is buy and bill ideal? 16:46 How does white bagging impact patient clinical care? 22:12 Encore! EP216 with Chris Sloan. 23:05 What are the two main reasons patients might not continue their therapy? 23:29 “We've got to leave some authority with our prescribers to be able to make a clinical decision of what's best for that … patient.” 24:41 What is clear bagging? 26:51 How does a hospital specialty pharmacy get in network with a PBM? 28:57 What is gold bagging? 30:11 “Outlook really needs to be what's best for the patient.” 32:10 EP337 with Olivia Webb.   You can learn more at continuumrx.com.   Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma What kinds of patients and/or drugs is the concept of bagging relevant to? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma What is brown bagging, and what are the issues with it? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma What is white bagging, and how is it different from brown bagging? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma Who are the key players in pharma bagging? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma Why does a PBM want a specialty drug to go through them? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma From the physician's perspective, why is buy and bill ideal? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma How does white bagging impact patient clinical care? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma What are the two main reasons patients might not continue their therapy? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma “We've got to leave some authority with our prescribers to be able to make a clinical decision of what's best for that … patient.” Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma What is clear bagging? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma How does a hospital specialty pharmacy get in network with a PBM? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma What is gold bagging? Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma “Outlook really needs to be what's best for the patient.” Keith Hartman of @continuumrx1 discusses #specialtypharmabagging on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O'Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider  

After that recent episode with Scott Haas (EP365), where we talked about the real deal with PBM contracting, I kicked into high gear trying to untangle this whole apocalyptic honky-tonk we call benefits for prescription drugs. Notice I did not say prescription drug benefits because that would imply that pharmaceuticals are only charged for under the umbrella of pharmacy benefits. Ha ha, that would be just too easy. No, some pharma drugs are charged as part of patients' medical benefits. An amazing primer for what that looks like in the real world follows.   Just pointing out that any self-respecting healthcare market distortion deserves another, and if anything qualifies as a market distortion, it's buy and bill—what I talk about with Dr. Mitchell in this healthcare podcast. In the following weeks, we'll chat about how the market has responded to this buy and bill market distortion that we talk about in this episode. So, next week, we're gonna get into all the different kinds of bagging: the so-called brown bagging, the white bagging, the clear bagging … and what is this newfangled gold bagging? Spoiler alert there. Tune in next week. And here's another spoiler alert: While in this show today we chat about how provider organizations tend to make somewhere between 4.5% and 20% additional over drug costs, there was a recent study claiming that 4.5% to 20% is chump change. Some provider organizations are, in fact, making four times to six times the cost of the drug—a very expensive drug, mind you (lots of zeros here)—in profit. In the show in two weeks, I'm speaking with April Yongchu and Erik Davis from USI about exactly and specifically how provider organizations can manage to perform this “let's make hundreds of thousands of dollars today” magic trick. So, with that, here's your encore. In the April [2020] issue of Value-Based Cancer Care (that's a journal), there's an article talking about a keynote presentation and a study highlighting a big problem for patients with cancer: toxicity. It's a fact that some chemo agents are pretty toxic, but in this healthcare podcast I am talking about financial toxicity. The financial burden of cancer care has a seriously negative influence on patients' quality of life. This keynote speaker quoted in the Value-Based Cancer Care article implored his fellow oncologists: “Think twice before ordering costly interventions that may have little impact on the clinical course,” he said. This might be difficult for a number of reasons, and one of them is that oncology centers make money, a whole lot of money, sometimes the most money, from infusing cancer medications. It's this little payment paradigm called “buy and bill.” The cancer center buys the meds and then gets paid an additional fee to infuse the drug. This fee is a percentage of the drug cost. You've probably heard a lot lately about the skyrocketing costs of some of these cancer agents. Realize that if you're an oncology center, the higher the drug costs, the higher your revenue. Now consider the patient suffering under the weight of increased cost sharing and employers and taxpayers who are funding this strange payment model. In this healthcare podcast, I dig into this so-called “buy and bill” payment model with Aaron Mitchell, MD, MPH. Dr. Mitchell is an oncologist and health services researcher over at Memorial Sloan Kettering. You can learn more at drugpricinglab.org. You can also connect with Dr. Mitchell on Twitter at @TheWonkologist.   Aaron Mitchell, MD, MPH, is a practicing medical oncologist and health services researcher. He is an assistant attending at Memorial Sloan Kettering Cancer Center in the department of epidemiology and biostatistics. His research focuses on understanding how the financial incentives in the healthcare system affect physician practice patterns and care delivery to cancer patients. He cares for patients with prostate and bladder cancer.   04:34 Following the drug and following the dollar. 04:56 The “buy and bill” system. 05:43 The perverse and problematic incentives of the system. 08:38 “It creates the incentive for us to gravitate toward the more expensive drug.” 08:42 The hesitancy to address the financial toxicity of drugs for patients. 09:53 Why the only person losing in this situation is the patient. 10:51 The financial impact from the patient perspective. 13:57 Are patients realizing this impact? 14:42 Solving the problem of oncology drug choice. 16:45 Reimbursement reform. 18:24 Capitated systems and incrementalist impacts to reimbursement reform, and what these look like. 23:30 Are we at a tipping point? 23:51 “The current system … works too well for too many people.” 25:01 Who isn't well served by the current system. 25:32 Who has to lead the charge for change. 28:28 Large oncology providers vs small oncology providers in the buy and bill system.   You can learn more at drugpricinglab.org. You can also connect with Dr. Mitchell on Twitter at @TheWonkologist.   Check out our #healthcarepodcast with @TheWonkologist of @sloan_kettering as he discusses #oncology #drugpricing and #reimbursement. #healthcare #podcast #digitalhealth Following the drug and following the dollar. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth The “buy and bill” system. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth The perverse and problematic incentives of the system. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth “It creates the incentive for us to gravitate toward the more expensive drug.” @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Why is there hesitancy to address the financial toxicity of drug pricing for patients? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Why the patient is the only one that loses. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth What's the financial impact from the patient perspective? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Are patients realizing this financial impact? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Solving the problem of oncology drug choice. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth What should reimbursement reform look like? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth “The current system … works too well for too many people.” @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Who has to lead the charge for change? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Large oncology providers vs small oncology providers in the buy and bill system. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth   Recent past interviews: Click a guest's name for their latest RHV episode! Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O'Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes  

Crafted in the burning deserts of Arizona during the inevitable demise of previous bands, An Awful Mess is an amalgamation of all things 2000s. From the days of MTV and Taste Of Chaos, drawing influence from bands like Senses Fail, Taking Back Sunday, and My Chemical Romance, the band seamlessly strings together the raw ferocity of live performance with touches of electronic production to cover all sonic ground. The band is comprised of vocalists and guitarists Andrew James and Aaron Mitchell, bassist Troy Sanchez, lead guitarist Michael Andriano, and are rounded out by drummer Kenneth Mustafa. Elements of pop punk, post-hardcore, and emo are blended together to create... An Awful Mess. www.theloudspot.net patreon.com/theloudspot Learn more about your ad choices. Visit megaphone.fm/adchoices

"Let's Talk Loyalty" is today looking back on our conversation with IKEA's global vice president of loyalty, Aaron Mitchell. As one of the world's most iconic retail brands, IKEA boasts 156 million members of its Family Club worldwide, a programme that brings the very best of the IKEA brand to its customers. The IKEA Family Club focuses on community and creating emotional loyalty with customers, with the intention to create value, deepen relationships and personalize interactions with customers. Listen to learn what we learnt from Aaron Mitchell and IKEA. Show Notes: 1) Episode #70: Ikea Family Club with Aaron Mitchell - Global VP Loyalty 2) Aaron Mitchell on LinkedIn

Plenty of topics covered in Thursday's show. We hear from Illinois Farm Bureau president Rich Guebert. We get an update from Illinois Farm Bureau young leader chair Aaron Mitchell. Darin Copeland stops by to talk Prairie Farms Dairy followed by an energy market conversation with GROWMARK's Scott Wilson. The show finishes with I-L Corn's Don Guinnip discussing the organization signing onto a petition challenging EPA rulemaking on final greenhouse gas standards for passenger cars and light trucks.

Aaron joins in to talk about nonsense on this 3 part journey! --- Support this podcast: https://podcasters.spotify.com/pod/show/skumcast/support

Aaron joins in to talk about nonsense on this 3 part journey! --- Support this podcast: https://podcasters.spotify.com/pod/show/skumcast/support

Aaron joins in to talk about nonsense on this 3 part journey! --- Support this podcast: https://podcasters.spotify.com/pod/show/skumcast/support

In Part 2 of our two-part series, How to Work With Netflix, I'm continuing my conversation with Aaron Mitchell, Director of HR at Netflix Animation Studio and a fellow alum from Harvard Business School. Aaron has had an amazing career and I'm honoured that he took the time to speak with me and share his journey. In this episode Aaron shares: 1. His background and early days growing up in Connecticut 2. The biggest roadblocks Aaron faced throughout his career journey and how he overcame these blocks 3. The key decision that Aaron took that led him to his Soul Career And more... I hope his story inspires you as much as it inspired me. Also, be sure to check out my free masterclass - '3 Steps to Leaving a Job That Makes You Miserable Even When No One is Hiring' https://www.soulcareer.com/masterclass/

We're back from a break that we took from the podcast at the end of 2021. And we're starting 2022 with a bang! We're joined by Aaron Mitchell, the Director of HR for Netflix Animation Studios, which is the division of Netflix that produces and develops animated programs and feature films. Aaron has had an impressive career journey taking him from Boston, to New York and even to Singapore and now to Los Angeles with Netflix. Aaron is certain he has found his Soul Career. In this episode, he shares his journey, offers career advice and gives tips for anyone who is interested in working with Netflix. We hope you enjoy this episode. Be sure to share your comments below And don't miss next week's episode where Aaron shares the key decision that he took that led him to his Soul Career. Also, don't miss my free masterclass - '3 Steps to Leaving a Job That Makes You Miserable Even When No One is Hiring' https://www.soulcareer.com/masterclass/

As one of our guests, Dr. Tony DiGioia (EP332), has said, healthcare has been pushed to its limits this past year; but that doesn't mean that nothing good has come of it. Celebrating our bright spots and using our experiences to inform future innovations is really the key to more accessible, equitable, and higher quality of care. While the timing of the celebration could, in general, be better given the latest pandemic news, as they say, there's no time like the present. So, let's do this thing. Also, it's just definitely good from a mental health perspective to find bright spots and to be grateful for them. So, let me kick this off with all of the gratitude I can hold in my two hands for anybody listening who is on the so-called front line of healthcare. My appreciation cannot be expressed more fiercely. I wish, in fact, that there was more that I/we could do to address the systemic issues that plague our healthcare industry and really impact you directly. Speaking of doctors as one of these frontline healthcare groups, in the Doximity Physician Compensation Report that was released for this past year, here's four stats to know:   Twenty-two percent of physicians are considering early retirement because of overwork. Sixteen percent of physicians are looking for another employer because of overwork. Twelve percent of physicians are looking for another career because of overwork. Twenty-seven percent of physicians said they're not overworked, so I guess there's that—that's a bright spot. So, all you docs, nurses, PAs, social workers, therapists of all kinds, any other healthcare workers: Thank you for all that you do even in the face of these adversities and a bunch of seemingly shortsighted policy and/or administrative decisions. Take care of yourself first and foremost. We need you; we appreciate you. Thank you. I'd also like to thank everybody who listened to Relentless Health Value this past year. Thank you for being part of an inspired and inspirational community of individuals who are trying hard to do the right thing and learn and connect with others on a similar journey—even in the face of all the perverse incentives and calcified status quo processes, the whole host of factors that add up to formidable barriers to positive change. All of us—and I'm thinking that includes you—we continue to press forward. This is important because the more of us there are, the more of us who link hands and do some combination of educate, cajole, scold, guilt into, demand, lead, vote, wear down … the more of us who consider ourselves part of the change, the more effective we can be. So, recruit your fellow thinkers and let's continue to make inroads. I want to give a special thank you to the many of you who have reached out to me over this past year. You have encouraged, coached, and debated with me. You have added details and case studies. You've provided context. You have offered up topics to explore and introduced me and our team over here to some great guests. You have changed my mind. You have made me realize that there's some maybe underlying reason for something that is, in fact, valid or a consequence that maybe hasn't been thought through well enough by me and/or others. I couldn't be more thankful or appreciative to every single one of you. For more information, go to aventriahealth.com.   Each week on Relentless Health Value, Stacey uses her voice and thought leadership to provide insights for healthcare industry decision makers trying to do the right thing. Each show features expert guests who break down the twists and tricks in the medical field to help improve outcomes and lower costs across the care continuum. Relentless Health Value is a top 100 podcast on iTunes in the medicine category and reaches tens of thousands of engaged listeners across the healthcare industry. In addition to hosting Relentless Health Value, Stacey is co-president of QC-Health, a benefit corporation finding cost-effective ways to improve the health of Americans. She is also co-president of Aventria Health Group, a consultancy working with clients who endeavor to form collaborations with payers, providers, Pharma, employer organizations, or patient advocacy groups. 03:36 Thank you to our listeners and the feedback you've given the show over the years. 05:10 “Good and bad is a matter of extremes.” 06:20 Thank you to Dr. Steve Schutzer, Dr. George Mathews, Dr. Ge Bai, Troy Larsgard, Dr. Hugh Sims, Vinay Eaton, Dr. Brian Decker, Jeff Hogan, Peter Hayes, Dr. Aaron Mitchell, Parker Edman, Andre Wenker, Doug Aldeen, Cristy Gupton, LynAnn Henderson, Chad Jackson, and Darrell Moon. 07:27 Thank you to our iTunes reviewers. 07:47 If you haven't given us a review yet, please do here. 08:01 Thank you to Malfoxley, Jopo1234, and Teresa O'Keefe for your 2021 reviews. 08:19 Thank you to Dr. Nadia Chaudhri, who sadly died this past year of ovarian cancer but who did so much to advance the awareness of ovarian cancer and pursue better outcomes and better patient care. Look through her Twitter feed. 08:39 Thank you to Brian Klepper, who is a great writer but also runs what might be the largest Listserv for those on the innovative self-insured employer side of healthcare. What I most admire about Brian is his ability and dedication to fact-based and productive debate. Brian is featured on several RHV episodes this past year. You can check them out here: EP335 and AEE16. 09:09 I'd also like to thank Dr. Eric Bricker for his series called AHealthcareZ. Dr. Bricker is a guest on an episode coming up that I'm so looking forward to publishing. 09:45 Thanks to these writers for taking the time and effort to put out such worthwhile content: Brendan Keeler, Kevin O'Leary, Nikhil Krishnan, Olivia Webb, Joe Connolly, Christian Milaster (Telehealth Tuesday), Gist Healthcare daily/weekly newsletter and podcast, John Marchica's newsletter and podcast, and Merrill Goozner.10:10 If you don't already, I'd also recommend following these individuals on LinkedIn: Darren Fogarty, Leon Wisniewski, and Christin Deacon (listen to Christin's episode about the CAA this past fall). 10:26 David Contorno and Emma Fox, thanks so much for all of your work motivating collaboration and inspiring self-insured employers to wield the power they possess in meaningful ways. There's a symposium coming up that anyone interested should check out. 10:42 I appreciate and periodically check out Julie Yoo from Andreessen Horowitz's collection of resources on a Google doc. 10:55 Thanks to Rohan Siddhanti and Ezequiel Halac for organizing events in NYC. 11:03 People often ask me for podcast recommendations, so here's a few I listen to regularly: John Lynn's podcasts, Creating a New Healthcare with Dr. Zeev Neuwirth, Race to Value with Eric Weaver, Radio Advisory, Gist Healthcare Daily, The #HCBiz Show! with Don Lee, and Primary Care Cures with Ron Barshop (I was on the show released Thanksgiving week). There's also the Pharmacy Podcast Network.11:42 Also thanks to the following publications who have given us press credentials and passes to conferences: STAT News, NODE.Health, HealthIMPACT, and JAMA. 12:03 Lastly, we have a tip jar on our Web site which we don't really publicize. I say this to emphasize that those who choose to donate are just simply kind and gracious individuals: Alex Dou, Linda Garcia, James Farley, Arthur Berens, Lois Drapin, James Cheairs, Robert Matthews, Lois Niland, Teresa O'Keefe, Richard Klasco, Hugh Sims, Matt Warhaftig, Meredith Fried, Chad Jackson, Vidar Jorgensen, and Brandon Weber. 12:38 Thank you ALL for your continued leadership in improving healthcare. 12:42 Christin Deacon has said, “What we need more of in the healthcare industry are leaders who are willing to take on legacy institutions and their lobbyists, in both public and private discourse. We need leaders that are willing to take on an industry that makes up about 20% of our GDP and is willing to go on record stating that the goal is not just to curb growth but, rather, stop it and rebuild this whole thing better for patients.” For more information, go to aventriahealth.com. From all of us at Relentless Health Value, THANK YOU for your listenership and support. Our host, Stacey, shares highlights and resources from this past year on our latest #healthcarepodcast. #healthcare #podcast #digitalhealth Did you know you can review our #podcast? https://relentlesshealthvalue.com/4-steps-rate-review-podcast-itunes/ Our host, Stacey, shares highlights and resources from this past year on our latest #healthcarepodcast. #healthcare #digitalhealth In memory of @DrNadiaChaudhri, check out her Twitter feed for info on better #patientoutcomes and care. Our host, Stacey, shares highlights and resources from this past year on our latest #healthcarepodcast. #healthcare #digitalhealth Check out @DrEricB's AHealthcareZ for in-depth industry information. Our host, Stacey, shares highlights and resources from this past year on our latest #healthcarepodcast. #healthcare #digitalhealth Thanks to @healthbjk, @olearykm, @nikillinit, @OliviaWebbC, @JConnol, @GistHealthcare, @DarwinHealth, @_GoozNews, and @HealthChrism for putting out great content. Our host, Stacey, shares highlights and resources from this past year on our latest #healthcarepodcast. #healthcare #digitalhealth We appreciate and recommend following @julesyoo for more #healthcareinsights. Our host, Stacey, shares highlights and resources from this past year on our latest #healthcarepodcast. #healthcare #digitalhealth Thanks to @RSiddhanti and @halac_ezequiel for their event organizing in NYC. Our host, Stacey, shares highlights and resources from this past year on our latest #healthcarepodcast. #healthcare #digitalhealth We love #podcasts! Check out some of Stacey's recs in our show notes, including @techguy, @ZeevNeuwirth, @Eric_S_Weaver, @raemwoods, @Alexolgin, @The_HCBiz, @RonBarshop, and @PharmacyPodcast. #healthcare #healthcarepodcast Thanks to the following #healthcarepublications as well: @statnews, @HITHealthIMPACT, @JAMA_current, and @nodehealthorg. Recent past interviews: Click a guest's name for their latest RHV episode! Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen  

This episode discusses Aaron's days as a part of Starcross, An Awful Mess, and everything in between. Important Links: HTTP://www.anawfulmess.com --- Send in a voice message: https://anchor.fm/musichustlers/message Support this podcast: https://anchor.fm/musichustlers/support

Coverage from the Illinois Farm Bureau Annual Meeting. DeLoss Jahnke met with Mark Gebhards, Executive Director of IFB Governmental Affairs and Commodities Division, who recaps the Delegate Session. Jim Taylor visits with Aaron Mitchell, newly elected IFB Young Leader Chair.

Aaron Mitchell – is an incredible Warrior. He is a husband, father, entrepreneur, networker, author, and life coach. Aaron is the founder of Chaplapreneur Resources and the author of several books including Righteous Fury. During his Warrior journey he married his high school sweetheart, Heidi, and they live in Rockwall, TX, where they are raising their daughter Anna. In college Aaron was a Division I wrestler at Clarion University in PA, where he earned a Bachelor of Science in Communications and then went on graduate from Bethel Seminary in St. Paul, MN. His various life experiences in ministry, athletics, and business give him a fresh take on how to live out the Christian life in our day.Find Aaron on BeeKonnected https://bkvisionwarrior.com/WarriorAaron's Websitehttp://chaplapreneur.com/

Fashion. Not just an excellent Gaga song.The boys have virtually welcomed up-and-coming style superstar Aaron Mitchell to the studio this week to deep dive into the glamorous (or maybe not so glamorous?) rag trade. Inspired by fashion's biggest night, The Met Gala, Age & Mitch decided that their comments as two couch experts on how to put together a designer lewk might need some professional backing.Aaron fills us in on how an elite acrobatic gymnastics coach, choreographer and judge, who just really loves clothing, came to turn it into his full-time gig. Tune in for some hot tips on breaking into the industry, why it might be a good idea to don the sketchers on shoot day and where to store a $65k necklace in the middle of Melbourne CBD, in a pinch. For those looking for some free fashion advice on how to start building a successful wardrobe, we've got you covered. And for those who want to hear about when Aaron and Age tried to date and Age royally fucked it (shocker) that's in there too.Of course, it'd be remiss not to take a quick look back at some highs and lows of the recent Met Gala, before looking to the future and some trends to keep an eye on if you're keen to stay ahead of the curve, darling. For our two hosts, it was a joy to chat to someone who is so passionate about making other people feel beautiful, and all we can say is head over and give @aaronmitchellstyling a follow now. Because the revenge heel is bursting onto the scene. And so is he.Make sure you're the first one to press play on every message we leave on your machine by following/subscribing on your favourite podcast platform and leaving us a GLOWING review. Then be sure to head to our insta @messageonthemachine to keep up with all our antics on those long days in between. #afterthebeep See acast.com/privacy for privacy and opt-out information.

Host Sean Lennon welcomed IL Native Welterweight Brandon Jenkins on The Fightlete Report, He will be making his PFL debut against Jacob Kilburn at PFL Playoffs Week 3 on August 27th ESPN + and ESPN 2. He Trains out of Syndicate MMA in Las Vegas, NV. He is the Caged Aggression Catchweight Champion defeating Aaron Michell by Unanimous Decision and has competed at LFA for the LFA Lightweight Championship as well.He talked about his fight with Aaron Mitchell and being confident did he was going to get the call to fight in a big promotion next, joining Syndicate MMA, John Wood has been one of the best coaches in MMA recently talked about having him in his corner for this fight, training with some of the best in Syndicate MMA, signing with PFL the season format and how beneficial it is for him and more!To shop for the Official Fightlete Report Tee- https://www.prowrestlingtees.com/fightletepweFor MMA articles, interviews, and UFC/BellatorMMA coverage or Like The Fightlete Report Facebook Page -https://m.facebook.com/FightleteReportAnd follow The Youtube Channel for exclusive content including all the fighter interviews now!Subscribe to The Fightlete Report now on Apple Podcast#BrandonJenkins #PFLMMA #PFLPlayoffsWeek3 #SyndicateMMA #JohnWood #CagedAggression29 #MMA #BJJ #JiuJitsu #LasVegasMMA #Boxing #Kickboxing #MuayThai #Striking #Grappling #ESPNMMA #ESPN2 #ESPN #ProfessionalFightersLeague #PFLLightweights

It's not official, but chances are that Aaron Mitchell holds the Longwood men's basketball record for the longest professional basketball career in the Division I era.  Nine and counting.  The 32-year-old guard from Matoaca Virginia just completed a year in Iraq and is looking forward to returning to the Middle East, perhaps in Kuwait for number 10.  Listen to Longwood's veteran basketball globetrotter describe how he has worked hard to reinvent and sharpen his game.  

Welcome back to How To Build An App!This is part two of our two part episode with Aaron Mitchell, founder of FreePlay.In part one, Aaron shared some of his back story and what led him to create FreePlay, as well as some of the hard lessons he learned along the way.  Just to recap a little, FreePlay is an app that allows any group fitness instructor to connect with and coach their fitness communities live, but it has a lot of other awesome features we talked about in part one.In part two, Aaron talks about how he was able to build an awesome founding team that has persevered and pivoted through major challenges like the COVID-19 pandemic.  Stick around to the end for three awesome pieces of advice for new founders and some great insight into how to pick the right team and why it's so vital. ---Learn more about FreePlay here: https://www.freeplayapp.com/ Follow Aaron on Linkedin here: https://www.linkedin.com/in/aaron-mitchell-b7172525/ Read the medium.com article Aaron mentioned in this episode:https://blog.usejournal.com/3-big-mistakes-ive-made-as-an-early-stage-entrepreneur-8647e1c4ab1a ---This show is produced by Strides Development, a full-service app development agency. We specialize in taking your ideas and turning them into a finished app in only a few months. If you have an app you're building, we would love to talk to you. You can schedule your free strategy call by clicking here.Make sure you're following Strides:Instagram:https://www.instagram.com/strides.dev/Linkedin:https://www.linkedin.com/in/betzeraustin/ 

Welcome back to How to Build an App. This week we're talking with Aaron Mitchell, founder of FreePlay.FreePlay is an app that allows any group fitness instructor to connect with and coach their fitness communities live.It didn't start out that way, but we'll let Aaron tell you how it did and how it became what it is today.Aaron started out in project management at a tech software company called Landesk and then took those skills over to Domo where he ran multiple product teams.Now he's working full-time on FreePlay while consulting huge companies like Twitter, Sony, and ADT on the side.  In this episode, Aaron will give us some of his back story and what led him to create FreePlay.He'll share some of the hard lessons he learned along the way and what he'd do differently if he could go back.---Learn more about FreePlay here: https://www.freeplayapp.com/ Follow Aaron on Linkedin here: https://www.linkedin.com/in/aaron-mitchell-b7172525/ ---This show is produced by Strides Development, a full-service app development agency. We specialize in taking your ideas and turning them into a finished app in only a few months. If you have an app you're building, we would love to talk to you. You can schedule your free strategy call by clicking here.Make sure you're following Strides:Instagram:https://www.instagram.com/strides.dev/Linkedin:https://www.linkedin.com/in/betzeraustin/ 

Jockey Aaron Mitchell joins Andrew Bensley to chat about his rides over the jumps today at Hamilton.

Hey PAL. On today's episode, the gang chats about the new Sony Animation film "The Mitchells vs. the Machines". Join them as they discuss the plot, characters, animation, jokes, dinosaurs, "Infinity Train", robot overlords, "Jurassic World Camp Cretaceous", space crocodiles in Meg's Star Trek RPG, why Aaron Mitchell is the best, and more. What did we think about the film? Would we want to see an Aaron movie? Are robots the ideal children? Turn in to find out!   Special Thanks to this week's sponsor Wild Bill's Soda! Enjoy crisp unique olde fashioned soda flavors anytime with Wild Bill's. Head over to drinkwildbills.com and use code FANDOM10 to get 10% off your purchase!    Thanks to One Outta Ten for supplying the music for this episode.  Check them out on: Instagram @one_outta_ten Spotify at One Outta Ten   Do you have suggestions for the show? Do have specific voice actor or creator that you would like us to interview? We would love to hear from you! Feel free to shoot us an email HERE. Be sure to head over to our website AnimationStationPodcast.com to check out both What's Up, Fandom & Animation Station Podcast episodes.  If you enjoy the show, please rate and review!   Follow the show on: Instagram @WhatsUpFandom Twitter @WhatsUpFandomPC YouTube What's Up, Fandom Podcast   Follow Josh @JoshLCain Follow Meg @thirdchildart Follow Connor @talllankyguy96   Tags: podcast, podcasts, movies, tv, comics, popculture, fandom, netflix, themitchells, themitchellsvsthemachines, dinosaurs, lqbtq, roadtrip, dinosaur, jurassicpark, startrek, rpg, infinitytrain, sony, sonyanimation

Jockey Aaron Mitchell joins Andrew Bensley following a breakthrough win for him as a Jumps Jockey, riding his very first winner over the jumps at just his first ride.

Trainer Patrick Payne joins Andrew Bensley to chat about the win of his jumper Michelin yesterday, which also brought about the first win as a jumps Jockey for Aaron Mitchell at just his first ride. Patrick speaks about his pride in Aaron's performance yesterday, and also gives us an update on his star steeplechaser Zed Em who tackles the Grand Annual Steeplechase today.

The CD-ROM game of tyrants everywhere! It's RollerCoaster Tycoon! Join us for a conversation on killing machine rollercoasters, simulation computer games, and a real life theme park with free soda?SUBSCRIBE to our Podcast Feed, and leave us a REVIEW!TWITTER - https://twitter.com/mostxtremepodINSTAGRAM - https://www.instagram.com/mostxtremepod/EMAIL - mostxtremepodcast@gmail.comWEBSITE - https://mostxtremepodcast.simplecast.com/ 

Wes is back!  And he shares his surgery experience with Marty and together they have a chat with former WA jockey Aaron Mitchell.See omnystudio.com/listener for privacy information.

Join me this week as Aaron and I talk about all the things theology, and why it is important!

Firemen Roundtable!  Aaron and Kyle are members of Class 37 of the Hawaii County Fire Department.  We dive in to the circumstances surrounding why they decided to join the department, they swap some fun and memorable stories, and give insight and advice to those interested in joining up.  They also discuss the physical, mental, and emotional rigors the job entails and how the bond they've formed with their fellow firefighter keeps them grounded and sharp.  A lot of heart, laughs, and good times in this one. 

A Hoops Journey celebrates the big 50 by bringing in former guest Novell Thomas to interview our host, Aaron Mitchell. We flip the script and put Mitch on the hot seat. One of the very few to win a provincial title as a player, a national college title, and a provincial title as a coach, Aaron has had a long storied basketball career, starting off with his time at Terry Fox and ending in Brandon University. Plus, the back story of Corbs and Aaron, deep reflections, hilarious anecdotes, tough challenges - we have all that in this special episode! We want to thank YOU, our audience for supporting us in so many ways. There is zero chance we make it to Episode 20, let alone 50 of these without your continued support. Lastly, this episode is dedicated to the life of Rich Goulet.

Aaron Mitchell is a fellow RTW traveller who set off in April 2016 to ride his trusty DRZ400s 31,000 miles around the world in a trip that lasted over 500 days!An ex-army bomb disposal expert who’d served tours in Iraq and Afghanistan to name only a few, Aaron reached a stage in life where he needed to live his dream - the rest is history.Now returned, he’s active in the TA, guides motorcycle expeditions to Nepal and beyond, is a successful business owner and had a zest for life you’ll find infectious.Aaron's Socials:Instagram - @_rocknroadFacebook - @RocknRoadUKWebsite - Rock-n-Road.co.ukSupport the show (https://www.patreon.com/TeapotOne)

As one of the world's most iconic retail brands, Ikea boasts 156 million members of its Family Club worldwide - a programme that brings the very best of the Ikea brand to its customers. Today's episode features an interview with Aaron Mitchell, Ikea's Global Vice President of Loyalty who shares the loyalty proposition that's already driving the extraordinary success of the club as well as some of the latest insights and innovations being launched in test markets around the world. Aaron talks through the importance of key principles such as trust, community and the importance of ensuring your loyalty programme is designed to show the brand's loyalty TO your customers, rather than first expecting it from them! Listen to this first episode of 2021 to enjoy a masterclass in the marketing and management mindset that is needed to drive success at such scale. Show Notes: 1) Aaron Mitchell - Global VP Customer Engagement & Loyalty 2) Ikea.com 3) RGA - Marketing Agency

What says The Shitty Movie Podcast in January like another...Christmas...movie? And for those confused about the ending, this was meant to be posted before Hillbilly Elegy. But Cassi ruined everything.  Our lost holiday episode is here and it's even got a special guest attached! Join us as we watch Madeline berate and manipulate her blind, widowed, best friend Nora into going places she doesn't want to go, doing things she doesn't want to do and feeling things she doesn't want to feel. Grief? Pfft! Who has the time? It's Nora's Christmas Gift and it's ready for you now! Rate and review! Like and subscribe!  It really does help us reach new people. We want to cackle in their ears. Follow us on Instagram and Twitter @tsmpod Shoot us a message. Send a request. WE. WILL. DO. IT. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/tsmpod/support

Episode 52 - Games of Spies and Guns of Paper *Caution* Citizen Employee Geistman and Clone David 7 still at large. Intelligence gathered by an undisclosed line manager known only as Plartro Hiltz working with the kind assistance of Fernsworth, Head of Sabotage and Espionage. None shall escape The Board... or would want to... Hail The Board! Content Warning for: Emotional abuseExistential crisisBullying/tauntingComedic violenceJump-scareFire (inc SFX)Mentions of: death, injury, alcohol/smoking, guns.TRANSCRIPT: https://cutt.ly/YhYA7pPSpecial thanks to Fleuranna for this episode's Brief Submission and this week's Patrons: theflyingpiano, Ana, Christian Nabli, thisistrashking, Catherine N., Shane Crowley, Robert Johnson, catsandbolts, Sarah Kitchen, schneefink, Spookyghostboy, Lyssie, Indigo Lee, Kait Sanchez, TheCookieOfDoom, Dana Milligan, David Michalek, XBFNoodles, .vouivre, Caisey Robertson, Kris Tsvirkun, Amelia Ford, Mistodon, Mia Cong, Alice Erebus, Nine, Alice Kneipp, HoloXam, Aaron Mitchell, Christina Connolly, Emily Brooks-Martin, Caroline Schmitt, Rebecca Bonomi, Falcolmreynolds, Kirsty Proctor, Parker, salem helgadóttir, Rebecca Burrows, A.C., Amber, Eternitarian, Buffmothman, Stuart Platt, Michael Goulish, Lauren Fisher, A Grue, Daine, ilikecetaceans, scp2521.If you'd like to join them, be sure to visit www.patreon.com/rustyquill.Created by Tim Meredith and Ben Meredith Produced by Katie Seaton Executive Producer Alexander J Newall Performances: I.M.O.G.E.N: Imogen Harris David 7: Ben Meredith Trexel Geistman: Tim Meredith Hartro Piltz: Jenny Haufek Editing: Maddy SearleMusic: Samuel DF Jones Artwork: Anika Khan Mastering: Jeffrey Nils Gardner Featured SFX: bevibeldesign, DNABeast, Jarred Gibb, florianreichelt, FractalStudios, zabuhailo, profcalla, pugaeme, tonywhitmore, edwar64896 & previously credited artists via freesound.org. Additional Voice by Maddy Searle.Additional music: Hard Boiled by Kevin MacLeodLink: https://incompetech.filmmusic.io/song/3857-hard-boiledLicense: http://creativecommons.org/licenses/by/4.0/ Subscribe using your podcast software of choice or by visiting www.rustyquill.com/subscribe and be sure to rate and review us online; it really helps us spread across the galaxy. Check out our merchandise, available at https://www.redbubble.com/people/RustyQuill/shop and https://www.teepublic.com/stores/rusty-quill. For more information on this weeks sponsor, visit http://bit.ly/RhythmofWarJoin our community: WEBSITE: www.rustyquill.com FACEBOOK: www.facebook.com/therustyquill/ TWITTER: @therustyquill REDDIT: www.reddit.com/r/RustyQuill/ DISCORD: https://discord.gg/KckTv8y EMAIL: mail@rustyquill.com Stellar Firma is a podcast distributed by Rusty Quill... See acast.com/privacy for privacy and opt-out information.

Some young Illinois farmers share what they’re trying to do to help replenish the resources of Illinois food banks and pantries. Knox County farmer Drew DeSutter and Winnebago County farmer Aaron Mitchell join the Executive Director of Feeding Illinois, Steve Ericson in discussing efforts to help keep all Illinoisans well-nourished in the weeks and months ahead.

Some young Illinois farmers share what they’re trying to do to help replenish the resources of Illinois food banks and pantries. Knox County farmer Drew DeSutter and Winnebago County farmer Aaron Mitchell join the Executive Director of Feeding Illinois, Steve Ericson in discussing efforts to help keep all Illinoisans well-nourished in the weeks and months ahead.

Welcome to the Varsity Letters podcast for Wednesday, Oct. 28. Our guest this week might be the only person to have led a B.C. senior boys basketball team to a provincial title as a head coach, while also having played in a B.C. senior boys hoops varsity final, a CCAA national final, and a U Sports Final 8 national final. All that said, St. Thomas More Knights head coach Aaron Mitchell, a proud Terry Fox, Capilano, Langara and Brandon alum, is also a fine broadcaster in his own right, launching A Hoops Journey this past May, a podcast which gets inside the basketball lives of so many who have left an imprint on the game in B.C. Mitchell joins host Howard Tsumura to chat about all things basketball, education and life. Varsity Letters, Canada’s only podcast dedicated solely to provincial high school and university sports, is back on the air. You can find us at Spotify, Apple Music or wherever you listen to podcasts.

Case ########-22Notes on healing.Recorded by the Archivist in Situ.Content warnings:HospitalsSurgery (inc SFX)Extreme medical malpracticeInvoluntary commitment & treatmentBody horrorTortureCharacter deathSuicide (inc assisted) / Suicidal ideationMentions of: Mental deterioration, chronic pain, needles, stillbirth imagery, strokes, rotSFX: screaming, high-pitched sounds, blades, drillingThanks to this week's Patrons: theflyingpiano, Ana, Christian Nabli, thisistrashking, Catherine N., Shane Crowley, Robert Johnson, catsandbolts, Sarah Kitchen, schneefink, Spookyghostboy, Lyssie, Indigo Lee, Kait Sanchez, TheCookieOfDoom, Dana Milligan, David Michalek, XBFNoodles, .vouivre, Caisey Robertson, Kris Tsvirkun, Amelia Ford, Mistodon, Mia Cong, Alice Erebus, Nine, Alice Kneipp, HoloXam, Aaron Mitchell, Christina Connolly, Emily Brooks-Martin, Caroline Schmitt, Rebecca Bonomi, Falcolmreynolds, Kirsty Proctor, Parker, salem helgadóttir, Rebecca Burrows, A.C., Amber, Eternitarian, Buffmothman, Stuart Platt, Michael Goulish, Lauren Fisher, A Grue, Daine, ilikecetaceans, scp2521 If you'd like to join them visit www.patreon.com/rustyquillEdited this week by Annie Fitch, Elizabeth Moffatt, Brock Winstead & Alexander J NewallWritten by Jonathan Sims and directed by Alexander J NewallProduced by Lowri Ann DaviesPerformances:- "Martin Blackwood" - Alexander J. Newall- "The Archivist" - Jonathan Sims - "Dr Jane Doe" - Ms Mabel Syrup- "Breekon" - Martin CorcoranSound effects this week by patchytherat, tedlundwall, SpliceSound, Anthousai, tim.kahn, conleec, sethlind, smithw027, hyderpotter, zolopher, giddster, ivolipa, afterguard, kyles, OroborosNZ, kylepyke, alec_mackay, alienistcog, Svanne78, Cell31_Sound_Productions, dheming, Archeos, Volonda, bulbastre, klankbeeld, megmcduffee, pimstoltz, RavenWolfProds, ProductionNow, 1histori, sethlind, taure, Soundmark_Melbourne, samfk360, bcginn, ReiyaManor, The_Funktasm, daboy291, sturmankin, neohylanmay, Brotherprovisional, LittleRobotSoundFactory, 7h3_lark, dav0r, bbrocer, MTJohnson, DanielVega, leonelmail, ultradust, spanrucker, misjoc, Perel, ProductionNow, cabled_mess, morgothFLOW, altfuture, duckduckpony, Hitrison, EricsSoundschmiede, JanKoehl, Zigzag20705, Eelke, LamaMakesMusic, Snapper4298, jpkweli, chimerical, mikerie, smithw027, nofeedbak, tmkappelt, david_sounds, daboy291, bewagne, sturmankin, Iceofdoom, dheming, ThunderQuads, Ama_Dis, RutgerMuller, courter, LPA134, BeeProductive, Vidrik, BenjaminNelan, Daniela-Santos, univ_lyon3 & previously credited artists via freesound.orgThanks to this episode's sponsor: Maeltopia.Find Maeltopia: A New World of Horror Fiction on your favourite podcast platform or visit maeltopia.com for more information.Check out our merchandise at https://www.redbubble.com/people/rustyquill/collections/708982-the-magnus-archives-s1You can subscribe to this podcast using your podcast software of choice, or by visiting www.rustyquill.com/subscribePlease rate and review on your software of choice, it really helps us to... See acast.com/privacy for privacy and opt-out information.

Missing one year old --- Support this podcast: https://anchor.fm/missingpersoncases/support

You may or may not know (I don’t know why you would, honestly), but I speak Swedish. I mention this because there’s this famous and really culturally emblematic Swedish word which is this: lagom. It means “the exact right amount.” In Swedish culture, the exact right amount deserves its own word. For example, “Did you have enough watermelon?” “Why, yes, I had half a slice. It was lagom.” Lagom has no direct translation in US English because, in the United States, we don’t need a word for “the exact right amount.” Why? Because the exact right amount already has a word: the most. More. More is always better. I think this shows up in health care in this country, and it definitely showed up in my conversation with Dr. Bishal Gyawali in this health care podcast. There’s this cultural bias in this country that more is better. The point I’m making is that there’s a sort of fundamental belief that aggressive therapy—the most aggressive therapy—is the best therapy and conservative therapy, or following the treatment pathway that works for the majority of patients, is kind of like a surrender. It’s not about being pro or anti anything. It’s about being data driven. It’s about finding the “lagom” amount of care that the data suggest is the best amount of care and not immediately assuming that if something isn’t done that it’s been a subpar outing. In this health care podcast, I’m talking with Bishal Gyawali, MD, PhD. Dr. Gyawali is a practicing oncologist; assistant professor at Queen’s University in Kingston, Canada; and he has studied and worked in Nepal, Japan, and the US, and now in Canada. He’s a thought leader in studying the data impartially and finding ways to help patients and oncologists systematically make the best decisions toward high-value oncology care that is not financially toxic. You can listen to Dr. Gyawali sum this up in his own words or read his paper on the topic, but here’s his top-line suggestions: Follow NCCN and ASCO guidelines. Payers: Negotiate drug prices based on clinical benefit—and this means you, too, Medicare. Hospitals: more price transparency up front but also for the doctors. Financial toxicity is a thing. It’s been shown that patients who are suffering from financial toxicity die earlier. So, this is definitely data that a doctor needs to know as much as some kind of clinical decision-making factor. Hospitals: Have a financial advisory desk. Correct the misincentives at the physician/patient level (ie, all that’s going on with “buy and bill”). You can read Dr. Gyawali's published paper in JAMA and connect with him on Twitter at @oncology_bg.  Bishal Gyawali, MD, PhD, is a medical oncologist with work experience in various low- and high-income countries. He graduated medical school in Nepal with seven gold medals and received his PhD from Nagoya University, Japan, as a MEXT scholar. He then practiced as a medical oncologist at Civil Service Hospital, Kathmandu, Nepal. He currently works as a medical oncologist and scientist in the Division of Cancer Care and Epidemiology at the Queen’s University Cancer Research Institute in Kingston, Ontario, Canada, where he is also an assistant professor of public health sciences. He was a research fellow at PORTAL (Program On Regulation, Therapeutics And Law) from 2018-2019. He also serves as a medical consultant for the not-for-profit Anticancer Fund, Belgium, and as editorial board member for the Journal of Global Oncology and ecancer. His clinical and research interests include cancer policy, global oncology, evidence-based oncology, financial toxicities of cancer treatment, clinical trial methods, and supportive care. Dr. Gyawali is an advocate of the “cancer groundshot,” a term he coined to imply that research investment should be made on known high-value interventions in cancer care that are affordable and easy to implement globally. Dr. Gyawali is active in the oncology and clinical research communities on Twitter. 03:18 Oncology decisions on the individual level and oncology policy decision making. 05:10 Reverting to the mean. 06:29 “We’re assuming … more care is good care, which is not necessarily true.” 06:49 “What we need to focus on is above-average level of health outcomes.” 07:55 “Sometimes we forget the goal, and we get so entangled in the path itself that we forget the destination.”11:19 Cutting out low-value care during the pandemic. 12:09 Reevaluating cancer screens and looking at the evidence for appropriate use cases. 13:24 Distinguishing the term “survival” from “mortality.” 16:34 “If a person dies, it does not matter what the person died of.” 17:26 “A lot of the things that we do routinely in medical practice need to be reevaluated.” 18:53 The FDA approval of oncology agents and things that make a difference. 20:37 “What exactly are we gaining from these drugs?” 20:53 EP282 with Aaron Mitchell, MD, MPH.23:15 Dr. Gyawali’s advice to policy decision makers. 23:42 Policy decision-making interventions that are possible. 24:50 “The problem with these guidelines … is that a lot of these people who are on these guidelines, they have huge conflicts of interest to the industry.” 26:58 How to pay less for low-value care. 27:42 A better path forward to pay for value. 31:02 Ways to help on the individual level. 32:07 “At the end of the day, the ultimate use of an intervention happens in the clinic.” 34:24 “We should never be pro or anti anything; we should just be pro-data.” You can read Dr. Gyawali's published paper in JAMA and connect with him on Twitter at @oncology_bg.  Check out our newest #healthcarepodcast with @oncology_bg as he discusses #oncologyscreening and #oncologycare. #healthcare #podcast #oncology #digitalhealth #healthcarepolicy #oncologypolicy “We’re assuming … more care is good care, which is not necessarily true.” @oncology_bg discusses #oncologyscreening and #oncologycare. #healthcarepodcast #healthcare #podcast #oncology #digitalhealth #healthcarepolicy #oncologypolicy “What we need to focus on is above-average level of health outcomes.” @oncology_bg discusses #oncologyscreening and #oncologycare. #healthcarepodcast #healthcare #podcast #oncology #digitalhealth #healthcarepolicy #oncologypolicy What’s the difference between “survival” and “mortality”? @oncology_bg discusses #oncologyscreening and #oncologycare. #healthcarepodcast #healthcare #podcast #oncology #digitalhealth #healthcarepolicy #oncologypolicy “If a person dies, it does not matter what the person died of.” @oncology_bg discusses #oncologyscreening and #oncologycare. #healthcarepodcast #healthcare #podcast #oncology #digitalhealth #healthcarepolicy #oncologypolicy “A lot of the things that we do routinely in medical practice need to be reevaluated.” @oncology_bg discusses #oncologyscreening and #oncologycare. #healthcarepodcast #healthcare #podcast #oncology #digitalhealth #healthcarepolicy #oncologypolicy “At the end of the day, the ultimate use of an intervention happens in the clinic.” @oncology_bg discusses #oncologyscreening and #oncologycare. #healthcarepodcast #healthcare #podcast #oncology #digitalhealth #healthcarepolicy #oncologypolicy “We should never be pro or anti anything; we should just be pro-data.” @oncology_bg discusses #oncologyscreening and #oncologycare. #healthcarepodcast #healthcare #podcast #oncology #digitalhealth #healthcarepolicy #oncologypolicy  

In this health care podcast, I’m speaking with Dan O’Neill, MA, MS. Dan says that, in many ways, this is a fantastic time to be an entrepreneurial physician leader. We are in a place to reinvent the practice model, meaning finding ways to increase value while losing bloated business practices in labor and capital. It’s more possible than ever to make a medical practice more efficient and effective with less overhead and, at the same time, meet the needs of patients in ways that are, you know, were impossible in the business model of five years ago and earlier. It’s just a new world, and I don’t just mean because of COVID. I mean in all the ways that everybody—including me—has been squawking about for years: consumerism, the rise of technology and its attendant expectations, Medicare running out of money, and employers who have cried uncle on rising health care costs and/or gone out of business. The silver lining in everyone getting used to telehealth and aggregated FFS (fee-for-service) revenue tanking for a couple of months is that suddenly some of the cushy cha-ching reasons to keep the old model don’t feel quite as much of a sure thing for the risk averse any longer. On the flip side, it’s also a fine time for you insurers to step up. Consider what some of the plans are doing right now to help PCPs (primary care providers), for example, transition to value and help independent docs stay in practice at the same time. I could say the same for some of the self-funded employers. It’s gonna suck for you all if the PCPs not connected to consolidated health systems go belly-up. Now is the time that you really can help them help you, and everybody wins from a quality and cost standpoint now and down the line. My guest on this health care podcast is Dan O’Neill, MA, MS. Dan’s a consultant who spent most of 2019 working in the Senate on the professional staff of the health committee focused on issues related to health care cost mainly. Now he’s doing consulting with entrepreneurial physician leaders and also start-ups. You can learn more at dponeill.com. Daniel O’Neill, MA, MS, is an executive in the digital health and health care technology industry. He has a track record of building teams, executing successful go-to-market strategies for new and established solutions, and structuring effective partnerships to scale venture stage businesses, particularly in health care/digital health. Dan works as consultant with venture-backed firms to define, develop, commercialize, and scale new health care services and software solutions. His areas of focus include bundled payments in the commercial population; virtual networks for specialist consults; tools for Medicare Advantage, Managed Medicaid, and other quality-rated and risk-adjusted plans; interoperability and clinical data exchange infrastructure; and new approaches to streamline the revenue cycle. Prior to becoming a consultant, Dan spent a year in Washington, DC, as a Robert Wood Johnson Foundation Fellow at the National Academy of Medicine, working on health policy in the US Senate. Dan has assembled and managed teams in product, sales, professional services, and account management. He also led the launch and growth of several products to facilitate care coordination and population health initiatives for primary care practitioners, accountable care organizations, hospitals, health plans, and other clinicians. In addition, he has worked on the development and commercialization of decision support tools to implement clinical pathways and avoid medical errors, and on predictive analytics using early versions of artificial intelligence. Dan completed his undergraduate study at Claremont McKenna College. He earned a Master of Arts from Johns Hopkins University and a Master of Science from the Stanford School of Engineering, where he focused on health care operations management and clinical informatics. 02:37 Why switching revenues to a different model isn’t simple. 03:45 The segmentation approach we need to focus on. 04:15 The straightforward answer for PCPs. 04:27 The path forward for specialists. 05:21 Moving away from “buy and bill” economics. 05:31 EP282 with Aaron Mitchell, MD, MPH. 07:36 Are health systems buying more practices, or are more practices becoming independent? 09:22 “It starts from why are they making the investment and what is the thesis?” 11:01 Separating the venture-/growth-oriented approach from the financial engineering approach. 12:47 Opportunities for physicians with an entrepreneurial mind-set. 15:55 “What services am I currently delivering?” 21:37 The opportunity to do well by doing good. 24:00 Health insurers as a barrier to change. 24:54 “This is a good opportunity to affect real change.” 25:40 “If you’re just waiting around for change, it’s probably not gonna walk in the door.” 27:43 The attempt to reinvent care delivery. You can learn more at dponeill.com. Check out this week’s #healthcarepodcast with @dp_oneill as he discusses #entrepreneurial #physicianleadership. #healthcare #podcast #digitalhealth #healthtech Why switching revenues to a different model isn’t simple. @dp_oneill discusses #entrepreneurial #physicianleadership. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech The segmentation approach we need to focus on. @dp_oneill discusses #entrepreneurial #physicianleadership. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech The straightforward answer for PCPs. @dp_oneill discusses #entrepreneurial #physicianleadership. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech The path forward for specialists. @dp_oneill discusses #entrepreneurial #physicianleadership. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech Moving away from “buy and bill” economics. @dp_oneill discusses #entrepreneurial #physicianleadership. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech Are health systems buying more practices, or are more practices becoming independent? @dp_oneill discusses #entrepreneurial #physicianleadership. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech “It starts from why are they making the investment and what is the thesis?” @dp_oneill discusses #entrepreneurial #physicianleadership. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech Separating the venture-/growth-oriented approach from the financial engineering approach. @dp_oneill discusses #entrepreneurial #physicianleadership. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech Opportunities for physicians with an entrepreneurial mind-set. @dp_oneill discusses #entrepreneurial #physicianleadership. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech “What services am I currently delivering?” @dp_oneill discusses #entrepreneurial #physicianleadership. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech “This is a good opportunity to affect real change.” @dp_oneill discusses #entrepreneurial #physicianleadership. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech “If you’re just waiting around for change, it’s probably not gonna walk in the door.” @dp_oneill discusses #entrepreneurial #physicianleadership. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech The attempt to reinvent care delivery. @dp_oneill discusses #entrepreneurial #physicianleadership. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech

Episode 15 of A Hoops Journey brings legendary basketball and rugby coach, Ian Hyde-Lay. A long-time teacher and coach at St. Michael's University School in Victoria, Coach Hyde-Lay talks with us about the 1975 Provincial Final against a Rich Goulet-led STM Team, falling in love with both rugby and basketball as a teen, playing for legendary Canadian coach Ken Shields on some historic UVic team, coaching Steve Nash, coaching against a young Aaron Mitchell in '95; and so much more. You can also find Coach Hyde-lay on his blog: A Life In Sport. Plus, a controversial take on the ketchup on macaroni debate.   This podcast is dedicated to the memory of Simon Ibell. You can read about his story HERE. ----more----   Sponsored by: Goodlad Clothing Sponsored by: Parkside Brewery Follow @ahoopsjourney on Instagram! Send any mailbag questions to ahoopsjourney@gmail.com Sounds by: Zapsplat, AudioJungle and Finn Leahy   ----more----  

Current Brandon University Men's Basketball head coach Gil Cheung joins A Hoops Journey today! A former badminton National Champion, Gil talks to former teammate and rommate Aaron Mitchell about playing for legendary BC coach Bill Disbrow, being recruited out of high school, his time playing for Langara and Brandon, transitioning into coaching; plus, some funny stories being Aaron's roommate.   Sponsored by: Goodlad Clothing Sponsored by: Parkside Brewery Follow @ahoopsjourney on Instagram! Send any mailbag questions to ahoopsjourney@gmail.com Sounds by: Zapsplat, AudioJungle and Finn Leahy

A very special Canada Day episode features former Richmond Colt, Northern Arizona University Hall of Fame player and National Team Member Andrew Mavis. With a decorated basketball career, we sit down with the former Olympian and discuss growing up in Richmond, playing for legendary BC Coach Bill Disbrow, the 1994 Provincial Final playing against our very own Aaron Mitchell, playing for Ben Howland and being in the NCAA Tournament, playing with Steve Nash at the 2000 Olympics and much, much more.   Sponsored by: Goodlad Clothing Sponsored by: Beat Parky by Michael Cheung Follow @ahoopsjourney on Instagram! Send any mailbag questions to ahoopsjourney@gmail.com Sounds by: Zapsplat, AudioJungle and Finn Leahy

Join Alex, Helen, Bryn, Lydia and Ben as they actually get some R & R and explore the city!This week Zolf goes shopping for Wilde, Hamid heads to the bank, Azu finally gets to enjoy space her size, & Cel has eyes on a new project!Thanks to this week's Patrons:theflyingpiano, Ana, Christian Nabli, thisistrashking, Catherine N., Shane Crowley, Robert Johnson, catsandbolts, Sarah Kitchen, schneefink, Spookyghostboy, Lyssie, Indigo Lee, Kait Sanchez, TheCookieOfDoom, Dana Milligan, David Michalek, XBFNoodles, .vouivre, Caisey Robertson, Kris Tsvirkun, Amelia Ford, Mistodon, Mia Cong, Alice Erebus, Nine, Alice Kneipp, HoloXam, Aaron Mitchell, Christina Connolly, Emily Brooks-Martin, Caroline Schmitt, Rebecca Bonomi, Falcolmreynolds, Kirsty Proctor, Parker, salem helgadóttir, Rebecca Burrows, A.C., Amber, Eternitarian, Buffmothman, Stuart Platt, Michael Goulish, Lauren Fisher, A Grue, Daine, ilikecetaceans, scp2521 If you'd like to join them visit www.patreon.com/rustyquillEditing this week by Lowri Ann Davies, Tessa Vroom & Alexander J Newall SFX this week by Martineerok, RTB45, jeo, tmc_zach, GuntherDorksen, SpliceSound, maisonsonique, Tetrisrocker, UncleSigmund, pwausc1, kyles, waweee, MrVasLuk, Suburbanwizard, "old barn empty wind" by klankbeeld (http://freesound.org/people/klankbeeld/), PhilSavlem, DWOBoyle, gastonsaenz, rui_aires, FreqMan, deleted_user_7146007, Iamgiorgio, davidferoli, Bowesy and previously credited artists via Freesound.org Music“harp heaven” by X3nus (https://freesound.org/people/X3nus/sounds/476782/)As always, today’s game system is available for free at d20pfsrd.comCheck out our merchandise available at https://www.redbubble.com/people/RustyQuill/shopJoin our community:WEBSITE: rustyquill.comFACEBOOK: facebook.com/therustyquillTWITTER: @therustyquillREDDIT: reddit.com/r/RustyQuillDISCORD: https://discord.gg/KckTv8yEMAIL: mail@rustyquill.comRusty Quill Gaming is a podcast distributed by Rusty Quill Ltd. and licensed under a Creative Commons Attribution Non-Commercial Share alike 4.0 International Licence. For information regarding your data privacy, visit acast.com/privacy See acast.com/privacy for privacy and opt-out information.

In the April issue of Value-Based Cancer Care (that’s a journal), there’s an article talking about a keynote presentation and a study highlighting a big problem for patients with cancer: toxicity. It’s a fact that some chemo agents are pretty toxic, but in this health care podcast I am talking about financial toxicity. The financial burden of cancer care has a seriously negative influence on patients’ quality of life. This keynote speaker quoted in the Value-Based Cancer Care article implored his fellow oncologists: “Think twice before ordering costly interventions that may have little impact on the clinical course,” he said. This might be difficult for a number of reasons, and one of them is that oncology centers make money, a whole lot of money, sometimes the most money, from infusing cancer medications. It’s this little payment paradigm called “buy and bill.” The cancer center buys the meds and then gets paid an additional fee to infuse the drug. This fee is a percentage of the drug cost. It ranges from 4.5% to about 20% of the cost of the drug. You’ve probably heard a lot lately about the skyrocketing costs of some of these cancer agents. Add 4.5% to 20% onto those costs and realize that if you’re an oncology center, the higher the drug costs, the higher your revenue. Now consider the patient suffering under the weight of increased cost sharing and employers and taxpayers who are funding this strange payment model. In this health care podcast, I dig into this so-called “buy and bill” payment model with Aaron Mitchell, MD, MPH. Dr. Mitchell is an oncologist and health services researcher over at Memorial Sloan Kettering. He seeks to understand how changes to current reimbursement models for oncology services may be used to achieve better patient outcomes and reduce low-value care. You can learn more at drugpricinglab.org. You can also connect with Dr. Mitchell on Twitter at @TheWonkologist.  Aaron Mitchell, MD, MPH, is a practicing medical oncologist and health services researcher. He is an assistant attending at Memorial Sloan Kettering Cancer Center in the department of epidemiology and biostatistics. His research focuses on understanding how the financial incentives in the health care system affect physician practice patterns and care delivery to cancer patients. He cares for patients with prostate and bladder cancer.   03:00 Following the drug and following the dollar. 03:28 The “buy and bill” system. 04:15 The perverse and problematic incentives of the system. 07:24 “It creates the incentive for us to gravitate toward the more expensive drug.” 07:28 The hesitancy to address the financial toxicity of drugs for patients. 08:40 Why the only person losing in this situation is the patient. 09:40 The financial impact from the patient perspective. 13:07 Are patients realizing this impact? 13:53 Solving the problem of oncology drug choice. 16:06 Reimbursement reform. 17:49 Capitated systems and incrementalist impacts to reimbursement reform, and what these look like. 23:04 Are we at a tipping point? 23:27 “The current system … works too well for too many people.” 24:47 Who isn’t well served by the current system. 26:27 Who has to lead the charge for change. 29:54 Large oncology providers vs small oncology providers in the buy and bill system. You can learn more at drugpricinglab.org. You can also connect with Dr. Mitchell on Twitter at @TheWonkologist.  Check out our #healthcarepodcast with @TheWonkologist of @sloan_kettering as he discusses #oncology #drugpricing and #reimbursement. #healthcare #podcast #digitalhealth Following the drug and following the dollar. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth The “buy and bill” system. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth The perverse and problematic incentives of the system. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth “It creates the incentive for us to gravitate toward the more expensive drug.” @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Why is there hesitancy to address the financial toxicity of drug pricing for patients? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Why the patient is the only one that loses. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth What’s the financial impact from the patient perspective? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Are patients realizing this financial impact? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Solving the problem of oncology drug choice. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth What should reimbursement reform look like? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth “The current system … works too well for too many people.” @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Who has to lead the charge for change? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Large oncology providers vs small oncology providers in the buy and bill system. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth

So, you have a great idea for a product and want to form a startup?   It’s visionary, you say? It’ll change the world?   Well, I hate to break it to you, but, these days, everyone has a great product. It’s what you do with it that matters.    So say my guests today, Aaron Mitchell, CEO of Freeplay App, and Jeff Whitlock, CEO of Unbird.    Drawing upon their product creation experience at Mokriya, Aaron and Jeff came on to explain: How to avoid some of the biggest pitfalls early-stage entrepreneurs can fall into  Why everything should center on the customer How great products actually get created    This post is based on a TechTables podcast with Aaron Mitchell and Jeff Whitlock. To hear this episode, and many more like it, you can subscribe to TechTables here.  If you don’t use iTunes, you can find every episode of TechTables here.

A group of Illinois young farmers and agriculture professionals stepped up and raised funds to help replenish Illinois food banks and pantries. Listen in on Aaron Mitchell, a 28-year old farmer who serves on Illinois Farm Bureau’s (IFB) Young Leader Committee, Steve Ericson, executive director of Feeding Illinois, and Raghela Scavuzzo, IFB’s director of food systems development, as they share thoughts on food availability, efforts to replenish pantry shelves, and the short and long-term future of the food and farming sector as we battle COVID-19.

A group of Illinois young farmers and agriculture professionals stepped up and raised funds to help replenish Illinois food banks and pantries. Listen in on Aaron Mitchell, a 28-year old farmer who serves on Illinois Farm Bureau’s (IFB) Young Leader Committee, Steve Ericson, executive director of Feeding Illinois, and Raghela Scavuzzo, IFB’s director of food systems development, as they share thoughts on food availability, efforts to replenish pantry shelves, and the short and long-term future of the food and farming sector as we battle COVID-19.

Aaron Mitchell is a high school teacher at St Thomas More and calls into the podcast to share how COVID-19 has affected his day to day life. Aaron shares his thoughts on kids being able to finish the year at school, moving to online classrooms, staying active while at home, the negativity of news and the importance of adaptability in these situations.   Podcast Videos can be found on the Zero to Here YouTube channel Email us at zerotoherepodcast@gmail.com Aaron Mitchell Facebook: https://www.facebook.com/aaron.c.mitchell.9 Denny Dumas Instagram: https://www.instagram.com/denny.dumas Facebook: https://www.facebook.com/denny.dumas.5 Website: https://www.dennydumas.com    

Today, I am joined by Aaron Mitchell! This was an awesome conversation and I hope you get something out of it. We talk about growing up, changing, and the impact we have on others. If you like philosophy, books, or film... this is for you! Remember, after the show, to take time out of your day to listen to someone else. Just 5 minutes. It’ll change your life. Follow us on  mechoradio.com (https://mechoradio.com/) Thanks again for listening! As always, you can contact us  Patreon (https://www.patreon.com/mywaxmuseum) . And thanks to  Tanner (https://www.instagram.com/jspr_productions127/) for the music. Follow me on  Twitter (https://www.twitter.com/alexwilliamns) to know what else is happening. Listen to "My Wax Museum" on your favourite app! - Pocket Casts:  https://pca.st/7VF5 (https://pca.st/7VF5) - Spotify:  spoti.fi/2zNZcWO (http://spoti.fi/2zNZcWO) - Apple Podcasts:  apple.co/2OCYbWY (http://apple.co/2OCYbWY) - Google Play:  bit.ly/2DA9KgT (http://bit.ly/2DA9KgT) - Stitcher:  bit.ly/2T1ucvm (http://bit.ly/2T1ucvm) - Swoot:  https://bit.ly/2KCjE45 (https://bit.ly/2KCjE45) - TuneIn:  http://bit.ly/2IjuNoc (http://bit.ly/2IjuNoc) Archive:  https://www.mechoradio.com/mywaxmuseum/archive (https://www.mechoradio.com/mywaxmuseum/archive) Support this podcast

The Laughter for All Podcast is for people who appreciate funny clean comedy. It’s for those who want some Good Medicine, encouragement and inspiration.   You will Laugh, be Entertained and Encouraged   Each Monday, Join Comedian Nazareth as he welcomes Comedians, Artists, Musicians, Pastors, Leaders and other interesting people to entertain and encourage you. https://www.nazarethusa.com/

Super Bowl LIV is happening this weekend! It's the 49ers vs. the Chiefs; who are you going for? We talk about the Super Bowl and so much more in this episode. If you are interested in being a guest on UNEDITED or you have an idea for the show, send us an email : theuneditedpodcast@gmail.com. This podcast is supported by Lux Royale Productions, and produced by Aaron Mitchell & Austin Whitley © 2020.

In this episode, we talk about the impact that teenagers have on the world, with the co-founder of the Defiant Ones Teen Magazine, Christian "Kindafye" Robinson. If you are interested in being a guest on UNEDITED or you have an idea for the show, send us an email : theuneditedpodcast@gmail.com. This podcast is supported by Lux Royale Productions, and produced by Aaron Mitchell & Austin Whitley © 2020. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

The 2010s are now over, and in this episode we talk all about what has happened in this decade. We also talk about what the new year (2020) holds. Have a question, a suggestion for an episode, or are you interested in being a guest on the show? Please email us - theuneditedpodcast@gmail.com UNEDITED is supported by Lux Royale Productions. Aaron Mitchell & Austin Whitley © 2019-2020 --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Aaron Mitchell is an educator and a coach and has been at St. Thomas More Collegiate for the past 16 years. The two talk about the current state of high school basketball in BC, the value of getting a college degree, technology in the classrooms, getting the most out of kids, and Aaron shares his personal experiences with adopting a baby. Aaron Mitchell - Facebook: aaron.c.mitchell.9 // Denny Dumas - dennydumas.com, Instagram: denny.dumas // Podcast Videos can be found on YouTube

We're back with the official wrap-show of Caged Aggression XXV: The Return, hosted-by Andy Hayes, who talked to Brandon Sagraves, Michael Shipp, Dominic Martin, Shawn West, and Jordin Hinman. The Pearled Up Podcast Presents and Jason Vargas wants to shout-out everyone who made this past weekend possible (or as many as it will let us tag… here it goes…) Bailey Biscontine, Jordan Clark, Jesse Hannam, Kurtis Ellis, Kaedin Harmon, Austin Houp, Chad Williamson, Zack Riley, Scott Buffington, Brayden White, Tommy Hand, Tyler Dehaven, Claire Schneckloth, Jordan Mott, Logan White, Brandon Sagraves, Michael Shipp, Aaron Mitchell, Bobby Downs, Wesley Powers, Gabe Taylor, Wesley Schultz, Phillip Ahrens, Nick Klein, Brock Swinburn, Garret Carlson, Elijah Sabo, Levi Kilroy, Brynn Heathcock, Kyle Colvin, Caleb Gall, Joshua Richardson, Austin Smith, Sam Agushi, Parnell Davis, Ryan Delf, Jordin Hinman, Mike Demakes, Mike Goodwin, Bruce Allen, Eric Carr, and Ben Wilson. Don't forget to show us some love wherever you download and listen to our show. Leave us a rating and review or drop some comments in the comment section and help us grow this thing for 2019. All 4 Star and up reviews get read live and promoted to an honorary general the Pearled Up Platoon! As always, many thanks to Stephen Burroughs and Say Uncle Photography for the images used to promote The Pearled Up Podcast Presents.Spreaker: https://bit.ly/2TMkbGjStitcher: https://bit.ly/2f0OJB3iTunes: https://apple.co/2wVEapfNow on Spotify, Google Podcasts, and iHeart Radio! (search for and follow 'The Pearled Up Podcast Presents')

Chris Hambling is joined by Mark Ross, Albert Kerly and Aaron Mitchell for the last game review of the season, whilst Nathan Symonds drops in to summarise the events of the Cardiff game. We hear Ben Nagle and Chris interview young winger Bayan Fenwick - twice - and we also hear from Geoff Warren on the Destination Dubai charity drive. Loads more too in what was the longest regular show of the season! See acast.com/privacy for privacy and opt-out information.

Aaron Mitchell and Mark Ross do a wonderful job supporting the overworked Chris "Hambo" Hambling this week in a show designed to be a lot shorter than it was. The team give their considered views on the current attitudes of fans, long term planning, frustration and the youngsters. Nathan calls in with some well researched positivity and Serial Thriller discusses the off pitch entertainment. Also the first attempt at an intro ended with Mark and Chris having a row! Hope you enjoy all that! See acast.com/privacy for privacy and opt-out information.

This week we witness "Return of the Packs" as Matthew Packham rejoins the team, with Aaron Mitchell also on hand to support a sober Chris. We have a chat about Balotelli, Stewarding, CPFC cocktails, Feral children, Cher Lloyd, our prospects against the league leaders and we analyse the Birmingham game with significant help from the listeners. Chris also becomes confused by religion. Enjoy. See acast.com/privacy for privacy and opt-out information.

Chris is joined by Mark Ross and Aaron Mitchell to discuss the win against Forest and the defeat to Barnsley See acast.com/privacy for privacy and opt-out information.

Joining Chris today is Mark Ross, Aaron Mitchell and Matt Packham discuss disapointing Portsmouth and Cardiff results See acast.com/privacy for privacy and opt-out information.