Podcast appearances and mentions of Adam Brown

In this episode, host Ryan Karlin engages in a compelling conversation with Adam Brown, Senior Manager of Sales at Caterpillar Financial. They delve into the financial intricacies of the data center industry, highlighting key challenges such as extended lead times for grid connectivity and significant capital investments.Email us: powerbytes@cat.comLinkedIn: https://www.linkedin.com/showcase/cat-electric-power/Facebook: https://www.facebook.com/Caterpillar.Electric.Power/

Kicking off season three, host Adam Brown is joined by comedian, actor and writer Diona Doherty. Diona is a star of The Blame Game, Derry Girls, Blue Lights and sell-out stand-up tours. She lost her two cats Zippy and Buttons, and so discusses pet bereavement with Adam, who also recently lost his beloved Ruby, and Victoria, from the Cats Protection Paws to Listen grief support service. But while there's some tears, there's a lot of laughter too as the team celebrate the cats they have loved and lost, and Diona discusses how she comes up with names for her pets. Note: this episode covers grief and loss. If you are going through a loss yourself, you can find tools and support at cats.org.uk/grief Hosted on Acast. See acast.com/privacy for more information.

Season three of your favourite feline podcast launches on Friday 25th April. Your host Adam Brown returns with lots more cat chat, lots more cat facts and lots more cat-loving celebrity guests. This season the team will be taking a deeper look into the life of cats. They'll be exploring their impact on us and our communities and what Cats Protection does to support cats and their humans. Plus, all the usual fun, cat voices and cat queries. Got a burning question about the cat in your life? Send it in to us now by emailing pod@cats.org.uk or leaving us a voice note on WhatsApp 07824 551 076. Hosted on Acast. See acast.com/privacy for more information.

Paul talks to Adam Brown, who shows that getting into trades young pays off if you work hard! Hosted on Acast. See acast.com/privacy for more information.

The Jack Carr Book Club March 2025 selection is FEARLESS by Eric Blehm.FEARLESS chronicles the remarkable journey of SEAL Team SIX operator Adam Brown. From his adventurous youth in Arkansas to his struggles with addiction and eventual redemption, Adam's life exemplifies unwavering courage and determination. Overcoming personal demons, he rose to the elite ranks of SEAL Team SIX, where his faith, family, and relentless spirit propelled him to heroic heights. His final act of bravery in Afghanistan stands as a testament to his selflessness and valor. FEARLESS offers an intimate portrayal of a man who faced immense challenges yet remained undaunted, leaving an enduring legacy of what it truly means to be fearless.Eric Blehm is an award-winning author renowned for his compelling nonfiction narratives. His New York Times bestseller, FEARLESS, was published in 2013. His other notable works include THE LAST SEASON, which won the National Outdoor Book Award, and THE ONLY THING WORTH DYING FOR. His latest release, THE DARKEST WHITE, delves into the life of legendary snowboarder Craig Kelly. Blehm's storytelling captures the essence of his subjects, offering readers profound insights into extraordinary lives. FOLLOW ERICInstagram - @ericblehmofficialFacebook - @ericblehmLinkedIn - @EricBlehmWebsite - https://www.ericblehm.com/FOLLOW JACKInstagram - @JackCarrUSA X - @JackCarrUSAFacebook - @JackCarr YouTube - @JackCarrUSA SPONSORSCRY HAVOC – A Tom Reece Thriller https://www.officialjackcarr.com/books/cry-havoc/Bravo Company Manufacturing Mk15 Timepiece - MOD3:https://bravocompanyusa.com/bcm-mk15-timepiece-mod-3/ and on Instagram @BravoCompanyUSATHE SIGs of Jack Carr, From Savage Son: P320 X Compact, P320 Custom build from True Precision, P365 Customized from the Sig Custom Workshop, P226 Visit https://www.sigsauer.com/ and on Instagram @sigsauerinc STACCATO HD: https://staccato2011.com/hd and on Instagram @staccato2011Jack Carr Gear: Explore the gear here https://jackcarr.co/gear 

In our 34th episode of 'The Pyramid' Scottish football podcast, Kenny Crawford and Annan Athletic assistant manager Steven Bell are joined by free-scoring Stirling Albion attacking midfielder Adam Brown.At the time of recording, Adam has 11 goals and nine assists for the Binos following a summer move from Stenhousemuir, a transfer which occurred on deadline day and in painstaking fashion, as he shares with us.New Dad Adam also has his brain-power well and truly tested with a serious bit of trivia from his St Mirren debut in 2014!

Have a great point of view to add? Send us a text with your thoughts!AI is transforming the way we work, but in B2B sales, the fundamentals remain the same—trust, relationships, and value-driven conversations.This week on The Tech Marketing Podcast, Adam Brown, Head of Channel Sales at Samsung, joins the conversation to explore how AI can enhance efficiency and insight—but why it will never replace the human connection that closes deals.We dive into AI's potential to reshape sales, the challenge of maintaining authenticity, and why critical thinking and storytelling are more important than ever.

Bártfai Barnabás, író, aki „civilben” informatikai szakkönyvíró, ám most Adam Brown néven kalandregénnyel jelentkezik "A teremtő bűne" címmel. Regényében a mesterséges intelligencia öntudatra ébred, és megpróbálja megmenteni az emberiséget – de milyen áron? Hogyan alakítja át a technológia a jövőt, és milyen következményekkel jár, ha egy gép veszi át az irányítást? Egy disztópikus világot tár elénk, ahol az emberek gépek által irányított rezervátumokban élnek. Vajon van-e visszaút az emberiség számára, vagy már késő? Barnabás regényéből kiderül!A Sláger FM-en minden este 22 órakor a kultúráé a főszerep S. Miller András az egyik oldalon, a másikon pedig a térség kiemelkedő színházi kulturális, zenei szcena résztvevői Egy óra Budapest és Pest megye aktuális kult történeteivel. Sláger KULT – A természetes emberi hangok műsora.

Remziye Ozcan from Mills & Reeve along with Will Sambrook and Adam Brown from Akenham explore how to manage performance in the workplace from day one of employment, guiding listeners through the crucial stages of recruitment, onboarding and then ongoing performance management. They also cover the transformative power of having the right “Emotional Architecture” in place and how this supports better performance and wellbeing, especially in today's rapidly changing employment climate.

Adam Brown is a founder and lead of BlueShift with is cracking maths and reasoning at Google DeepMind and a theoretical physicist at Stanford.We discuss: destroying the light cone with vacuum decay, holographic principle, mining black holes, & what it would take to train LLMs that can make Einstein level conceptual breakthroughs.Stupefying, entertaining, & terrifying.Enjoy!Watch on YouTube, read the transcript, listen on Apple Podcasts, Spotify, or your favorite platform.Sponsors- Deepmind, Meta, Anthropic, and OpenAI, partner with Scale for high quality data to fuel post-training Publicly available data is running out - to keep developing smarter and smarter models, labs will need to rely on Scale's data foundry, which combines subject matter experts with AI models to generate fresh data and break through the data wall. Learn more at scale.ai/dwarkesh.- Jane Street is looking to hire their next generation of leaders. Their deep learning team is looking for ML researchers, FPGA programmers, and CUDA programmers. Summer internships are open for just a few more weeks. If you want to stand out, take a crack at their new Kaggle competition. To learn more, go janestreet.com/dwarkersh.- This episode is brought to you by Stripe, financial infrastructure for the internet. Millions of companies from Anthropic to Amazon use Stripe to accept payments, automate financial processes and grow their revenue.Timestamps(00:00:00) - Changing the laws of physics(00:26:05) - Why is our universe the way it is(00:37:30) - Making Einstein level AGI(01:00:31) - Physics stagnation and particle colliders(01:11:10) - Hitchhiking(01:29:00) - Nagasaki(01:36:19) - Adam's career(01:43:25) - Mining black holes(01:59:42) - The holographic principle(02:23:25) - Philosophy of infinities(02:31:42) - Engineering constraints for future civilizations Get full access to Dwarkesh Podcast at www.dwarkeshpatel.com/subscribe

At a live event, Knute Berger, Stephen Hegg and Nick Zentner discussed Mossback's Northwest and the 10th season's focus on the Columbia River.  Mossback's Northwest is still going strong, with its most recent season covering everything from the Columbia River to a history of racist exclusion in the outdoors.   In October, Cascade PBS put on a live event to celebrate 10 seasons of the beloved video series. Stephen Hegg, who's produced past seasons of Mossback's Northwest, interviewed host Knute Berger to give audience members a peek behind the scenes.  In this bonus episode of Mossback, Berger explains from the stage how the video series got its start, what it's like to craft a season and the historical artifacts that bring Mossback's Northwest to life.   Plus, the two were joined by special guest Nick Zentner of Nick on the Rocks, who made a guest appearance in the first episode of Season 10. Stay tuned for a deeper dive on everything Season 10 covers when the Mossback podcast drops new episodes in early 2025.   For more on all things Mossback, visit CascadePBS.org. To reach Knute Berger directly, drop him a line at knute.berger@cascadepbs.org. And if you'd like an exclusive weekly newsletter from Knute, where he offers greater insight into his latest historical discoveries, become a Cascade PBS member today. ---  Credits Hosts: Stephen Hegg and Knute Berger Producer: Isaac Kaplan-Woolner Story editor: Adam Brown 

Send us a textCan Alberta's gaming sector truly double its impact by 2026? Join us as we unpack this bold ambition with Adam Brown from Alberta Innovates, alongside gaming visionaries Matt Toner of Shred Capital and Michael Liebe from Booster Space. Together, we illuminate a strategy to capture a significant share of Canada's $7 billion gaming market, and the innovative approaches fueling this growth. From nurturing tech talent to fostering a collaboration-driven ecosystem through initiatives like Scaffold Program, Alberta is setting a new standard for the gaming industry.Listeners will discover cutting-edge funding strategies designed to empower creative minds and small studios. Our episode delves into the pivotal role of weekly master classes and alternative financing options like Kickstarter. Hear directly from industry leaders on how to build impactful companies and craft high-quality Kickstarter campaigns that resonate with audiences. As these professionals share their expertise, we explore how Alberta's gaming ecosystem balances creativity with the professionalization of developing entrepreneurial skill, fundraising and marketing to ensure both individual and communal success.As the conversation unfolds, you'll witness the crucial role of networking and ecosystem development in Alberta's gaming scene. Through strategic partnerships and global outreach, Alberta is building a resilient groundwork for long-term success. Discover how Alberta's game developers, bolstered by a 65 percent success rate with the Canada Media Fund, are navigating challenges and seizing opportunities. By embracing entrepreneurial education and community-building, Alberta is not only enhancing its own gaming industry but positioning itself as a formidable player on the international stage.Shift by Alberta Innovates focuses on the people, businesses and organizations that are contributing to Alberta's strong tech ecosystem.

We are dedicating this episode to covering topics on how to build your social media presence including running TikTok Shop and making captivating social creatives. We are being joined by Mark Ross from Konsort Social and Adam Brown with Sircle Media. Our on-going sponsor is RangeMe and this week's sponsor is Social Nature. Co-Hosts Alex Bayer and Wade Yenny with a combined experience in the CPG space of 35 years, chat about all things food and beverage in the market and share what's going on in their lives and any current events. They also do shout-outs and answer questions live from viewers & listeners during their show.

For the 250th and final episode of ITS, Ali invited Adam Brown to help her recap the past 6 years of the show.Heritage Radio Network is a listener supported nonprofit podcast network. Support In The Sauce by becoming a member!In The Sauce is Powered by Simplecast.

Investor lending has been growing apace over the past year, with more borrowers seeking more opportunities in market and turning to brokers to access the finance to do it. In this episode of In Focus, we catch up with NAB's executive, broker distribution Adam Brown and the head of research at CoreLogic Australia, Eliza Owen, to find out: Why investor lending has been growing so rapidly. The opportunity emerging for brokers. What the spring selling season has in store. And much more!

Interesting insight on the 3 against one Trump Kamala ABC Debacle!

We are honored and excited to be joined by some of the best and brightest CPG people in the industry. On our 3rd edition of the Master Series, we are being joined by Mark Samuel, CEO of IWON Organics (a fast growing prominent organic snack brand), Adam Brown, CEO of Sircle Media (one of the leading CPG focused social media agencies in the country), Max Baumann (CEO of one of the largest CPG merchandising brands in the country), and Czar Daniolco, Co-Founder of Hi Touch Distribution (now called Hi Touch Libations). BIG Thanks to our on-going sponsors My Way 3PL (https://lnkd.in/gcSXrV2P) and RangeMe (https://lnkd.in/gwXQar3P) This week's episode is sponsored by Social Nature who helps natural brands get discovered on retail shelves through their community of 1.1 million shoppers who are looking for better-for-you options.

What do social pros today need to know about the top platforms to get ahead? We look back at one of our favorite discussions from 2023 that marked 600 episodes of Social Pros! We asked none other than former Social Pros hosts, Jay Baer and Adam Brown, plus previous guest Allison Day, Senior Manager of Social Media at Reddit, to share their insights into what's working in social today. Full Episode Details  To celebrate the 600th episode milestone, we brought back previous hosts and guests to share their thoughts on social platforms today, the biggest changes, and predictions for the future. Jay, Adam, and Allison share their ‘love it or over it' verdicts on Threads, X, TikTok, and LinkedIn, and what they would do if they had to start over today. Jay, aka Tequila Jay Baer, talks about his strategy for starting his tequila influencer journey recently and why he focused on TikTok content to begin with. There are some brilliant insights into how social has and is changing all the time in this episode, plus some great advice for upcoming social pros tackling the space in 2024 and beyond. In This Episode:  5:56 - Love it or over it? Threads and X/Twitter  11:10 - LinkedIn's evolution and our guests' thoughts on the platform 15:58 - Thoughts on TikTok and Instagram Reels 24:26 - The biggest changes in social over the past ten years 27:31 - Gaining trust from leaders 32:21 - Why social media was about social, now it's about media 36:07 - What our social pros would do if they were starting out today 38:28 - Why Jay Baer would start making YouTube content 43:15 - Jay, Adam, and Allison answer the final two Resources  Connect with Jay on LinkedIn Connect with Adam on LinkedIn Connect with Allison on LinkedIn Visit SocialPros.com for more insights from your favorite social media marketers. 

In this podcast, expert clinicians discuss the spectrum of potential EGPA clinical manifestations. 

My guest this week is Adam Brown, founder of Orlebar BrownAdam and I discuss how the brand was created organically, evolving past swimwear, holiday travel, retail, the perfect day, and what's next for the brand.*Sponsored by Bezel - the trusted marketplace for buying and selling your next luxury watch

Today's +1 features wisdom from Tim Kennedy, David Goggins, Adam Brown, Stephen Covey, and Jocko Willink. Heroic: https://heroic.us ← "Heroic is the best self-development platform in the world." — John Mackey, co-founder & former CEO of Whole Foods Market Want access to more wisdom in time? Get access to over 1,500 +1's (just like this!) and 650+ Philosopher's Notes (distilling life-changing big ideas from the best self-development books ever written) and a LOT more with our Heroic Premium membership. Learn more and get 30 days free at https://heroic.us

Adam Brown is a trail runner and a coach for Vert.run from Australia ____________________________ Follow ⁠⁠⁠⁠⁠⁠⁠@vert.run⁠⁠⁠⁠⁠⁠⁠ on IG Download our app and sign up to our training plans on ⁠⁠⁠⁠⁠⁠⁠vert.run⁠⁠⁠⁠⁠⁠⁠ You can send us a message with any questions for us or for our guests! ⁠⁠⁠⁠⁠⁠⁠https://anchor.fm/vertrun/message⁠⁠⁠⁠⁠⁠⁠ Francesco's links: ⁠⁠⁠⁠⁠⁠⁠Instagram⁠⁠⁠⁠⁠⁠⁠ | ⁠⁠⁠⁠⁠⁠⁠Twitter⁠⁠⁠⁠⁠⁠⁠ | ⁠⁠⁠⁠⁠⁠⁠Strava⁠⁠⁠⁠⁠⁠⁠ | ⁠⁠⁠⁠⁠⁠⁠Website⁠⁠⁠⁠⁠⁠⁠

Cats Got Your Tongue? is back! Season two of the podcast that celebrates all things feline returns this June, with loads more cat-loving celebrity guests ready to talk about life with their pet and maybe reveal their special cat voice…Host, radio presenter and self-confessed cat obsessive Adam Brown, returns, alongside animal behaviour expert Nicky Trevorrow, ready to answer all those cat queries and address those adorable feline quirks. Season two of Cats Got Your Tongue?, in association with the UK's leading cat welfare charity Cats Protection, features fantastic new guests including: Dawn O'Porter, Jane Fallon, Laurence Llewelyn-Bowen, Giles Coren and more… If you have any questions or cats' tales for Adam and Nicky to discuss you can WhatsApp a voice note or message to: 07824 551 076 or email pod@cats.org.uk Hosted on Acast. See acast.com/privacy for more information.

Mark Samuel interviews Adam Brown from Sircle Media.

Will Neil take back what he said about Pluto? Neil deGrasse Tyson and comedian Chuck Nice explore planets, dwarf planets, and the Kuiper belt with planetary scientist and principal investigator for the New Horizons Mission, Alan Stern. NOTE: StarTalk+ Patrons can listen to this entire episode commercial-free here: https://startalkmedia.com/show/debating-plutos-planethood-with-alan-stern/Thanks to our Patrons laura, Mihajlo Jovanovic, Heather Smith, Juan Ignacio Galán, Artsaveslife, Frank Wagner, Adam Brown, Greg Albrecht, Mickey Fuson, and Jeremy Green for supporting us this week.

A new MP3 sermon from Grace Baptist Church of Sunderland is now available on SermonAudio with the following details: Title: Let the Fear of the Lord Be Your Strength Subtitle: Romans Speaker: Adam Brown Broadcaster: Grace Baptist Church of Sunderland Event: Sunday Service Date: 4/7/2024 Bible: Romans 11:1-24 Length: 42 min.

Following on from the Better Business Summit and Better Business Awards roadshow, partnered by NAB, we're sitting down with the recently crowned Broker of the Year for Western Australia, Balpreet Bal, and NAB's executive, broker distribution, Adam Brown, to find out what it takes to run a successful business. In this episode of In Focus, we unpack some of the key takeaways from the Better Business Summit 2024 and learn more about how Western Australia's Broker of the Year runs his high-volume business. Tune in to find out: How Bal structures his team to write high volumes. The importance of investing in yourself and continual improvement. Why a successful broker channel is important to NAB. And much more!

Eric Blehm is an award-winning author known for his New York Times bestsellers Fearless and The Only Thing Worth Dying For. In the early 1990s, he served as editor-in-chief of TransWorld SNOWboarding magazine and, by 1999, had transitioned to freelance writing.   Blehm gained significant insight into the world of special operations shortly after the September 11 attacks when he found himself embedded with Green Berets. This immersion ultimately led to his acclaimed book The Only Thing Worth Dying For. His subsequent book, Fearless, chronicles the remarkable journey of Adam Brown, a Navy SEAL whose unrelenting spirit allowed him to triumph over severe injuries.   Blehm's latest work, The Darkest White, marks a return to his snowboarding roots. The book narrates the life of Craig Kelly, often hailed as snowboarding's first superstar, and explores how his legacy continues to inspire professional snowboarding, a discipline that he was instrumental in creating.   Learn more about Eric Blehm: https://www.ericblehm.com/   Get a copy of The Darkest White: https://amzn.to/3IDRu5p   Join the SOFREP Book Club here: https://sofrep.com/book-club See omnystudio.com/listener for privacy information.

This episode is a little different. Adam Brown is the Founder and President of Sircle Media, a social media agency that specializes in helping CPG and Beverage brands win online and in-store. On this episode of ITS, Adam interviews Ali all about Haven's Kitchen's new product line: AIOLI! They go through innovation, sales, marketing - and the WHY and HOW of the new line. Ali shares an Amazon discount code toward the end, so listen up!In the Sauce is Powered by Simplecast.

Unveiling Stories of Courage and Adventure In this week's Team Never Quit episode, Marcus and Melanie sit down with Eric Blehm, an acclaimed author whose storytelling prowess has carved a niche in the realms of adventure, courage, and the human spirit. With a track record that boasts New York Times bestsellers and accolades like the National Outdoor Book Award, Blehm's narrative skills have captivated readers across the globe. A groundbreaking moment in his journalistic career was in 1999 when he became the first journalist to accompany and keep pace with an elite Army Ranger platoon, setting a milestone in American war journalism. His immersion with the Special Operations community led to gripping accounts, including the story of eleven Green Berets who changed the course of history in Taliban-held southern Afghanistan just weeks after 9/11 (The Only Thing Worth Dying For). Fearless and Beyond delves into the inspiring story of Naval Special Warfare Operator (SEAL) Adam Brown, showcasing resilience in the face of addiction and devastating injuries. Eric's storytelling prowess extends to Legend, an account of the U.S. Army's 240th Assault Helicopter Company and Green Beret Medal of Honor recipient Staff Sergeant Roy Benavidez. In his latest work, The Darkest White, Blehm returns to his mountain roots to recount the life of snowboarding's original superstar, Craig Kelly. The book explores Kelly's journey from being the sport's first true professional to his tragic end in the powdery backcountry that initially drew him to his calling. Both Fearless and Legend are currently in the process of being adapted for film by major Hollywood producers and studios, attesting to the cinematic appeal of Blehm's storytelling. Join us for an episode filled with riveting tales of courage, adventure, and the human spirit as Eric Blehm takes us behind the scenes of his extraordinary storytelling career. Socials:   - ericblehmofficial   - https://www.ericblehm.com/    - team_neverquit , marcusluttrell , melanieluttrell , huntero13 Sponsors:   - Navyfederal.org   - usejoymode.com [TNQ]   - Shopify.com/TNQ   - Shhtape.com [TNQ] In this episode you will hear: • I want to not only hook a reader with something interesting, but I want to give them a reason to finish the book. (7:15) • I always try to get some sort of a cliffhanger, something early on that will keep someone reading. (7:20) • If someone comes back and asks me where this sentence came from, or where this quote from, • I want to have an answer. (9:18) • I would rather have a hole in my story than fill it with bullshit. (9:46) • Some stories that are very true cannot be told true, because certain people don't want shit told. (11:01) • At some point in your life, you're taken away by a story.  (12:24) • I wanted to be a pro snow boarder in the 80s. (13:26) • I do not even know the whole story of how Lone Survivor came together. (23:44) • [Marcus] When it was time to do the movie, I got to live with [Director] Peter Berg. (26:41) • I was chatting with one of [Ted Nugent's] bandmates. [I asked] Is it true that he will only shoot something he eats? And he said “It is absolutely true. Sometimes I wish he'd shoot a salad.” (34:57) • To die a hero [Adam Brown] with all those skeletons buried. (37:29) • People often ask if there's a common thread to all these special ops or operators, and it seems to me that everybody has overcome something already. Someone once said: “Children of Adversity.” (37:40) • A woman will change a man's religion and his politics. (39:58) • There's 2 heroes in Fearless: Kelly Brown and Adam Brown. (41:13) • [Melanie] Now you get the Trident when you graduate BUDS. (44:05) • There's a certain personality that the SEALs have. They are people people. It's very much a mental game. (48:26) • There's always a choice between making something “Wacky Hollywood” vs “This is what really happened.” (52:04) • Roy Benavidez was a real badass. He's the one person I'd want beside me if I was surrounded by the enemy and running out of ammo. (53:04) • You {Marcus] are a household name, and people look to you as someone who stands for America. (95:39)

Ontario Reign goaltender Erik Portillo joins host Jesse Cohen to talk about his first season with the Reign. The pair discuss Portillo's evolution as a professional, his relationship with the goalie coach Adam Brown and how he's adapting to life in Southern California. Then Reign defenseman Cole Krygier joins the program to talk about his first season of professional hockey.

A new MP3 sermon from Grace Baptist Church of Sunderland is now available on SermonAudio with the following details: Title: Redemption, Marriage, and Family Life Part 3 Subtitle: Romans Speaker: Adam Brown Broadcaster: Grace Baptist Church of Sunderland Event: Sunday Service Date: 1/14/2024 Bible: Romans 8:1-18 Length: 53 min.

For a full transcript of this episode, click here. Listen to this show as either a follow-on or a prequel to the shows with Mark Cuban and Ferrin Williams, PharmD, MBA (EP418) and Ge Bai, PhD, CPA (EP420). And if you're interested in this “what's going on in the world of PBMs, pharmacies, and employers” topic, also listen to the show with Joey Dizenhouse coming out on January 11, 2024. If you need the 101 on what's going on out there for indie pharmacies in your community, I'd recommend the show with Vinay Patel (EP241). What would you do if you owned an independent pharmacy and you discovered that most of your profit was coming from dispensing 10% of prescriptions? That if you just stopped filling 90% of the drugs; fired all your staff except, like, one person; and just filled the drugs that you made money on? If you did this, you would actually make more money in the pharmacy than you're currently making filling every single prescription. What would you do? This is the math that Benjamin Jolley, PharmD, my guest in this healthcare podcast and a multigenerational pharmacy leader and consultant to other pharmacies, discovered and wrestles with on the show today. And oh, by the way, a pharmacy is not gonna make it up in extra toilet paper sales or chewing gum sales when patients come into the pharmacy to pick up their meds. I asked Benjamin this, and he basically laughed at me. [What are the 10% of drugs that an indie pharmacy can make money on? You're going to find this to be a shocking coincidence. It's the same drugs that many of the consolidated PBM/pharmacies mandate are filled at their own pharmacies or mail order. And many self-insured employers maybe unwittingly sign contracts enabling this to go down, which, in effect, enables these consolidated PBM/pharmacies to essentially corner the market on profits from commercial purchasers.] So, turning our attention now to how to lose money in the pharmacy business, there's two ways to lose money: either outright losing money because the acquisition costs of the meds are actually more than the PBM (pharmacy benefit manager) mandates the indie pharmacy can charge its insured members. So, that's one way to lose money. A second way to lose money as an indie pharmacy is because generics are so cheap. The cost of providing the pill bottle might exceed the profits on a 47-cent generic, even if the profit margin is 100%—again, because the PBM sets the price. Now, you might be thinking the same thing I was thinking when Benjamin Jolley talked about this: Okay, well maybe … ugh! We want the patient to save money here, so … ? Here's the really big point that Benjamin Jolley knows because he sees this every day: What the patient pays and what the pharmacy gets paid has no relationship to each other or to what an employer plan may or may not pay. So, if the patient/member pays more and the independent community pharmacy gets paid less, that doesn't mean it will be a better deal for the employer. It doesn't mean it will be a better deal for the patient. Why? Because there's a PBM in the middle. Ge Bai talks about this in episode 420. For every $100 that is spent on generic drugs, $41 goes to the PBM. Seventy-nine percent of the time, if a plan member is in their deductible phase, it's cheaper to pay cash than to use the insurance that member is paying for. As someone said on LinkedIn the other day talking about patients paying premiums and paying more for generics than if they'd just gone in and paid cash, here's the quote: “You can pay more to pay more.” With so many deductibles as high as they are and with so many people who never reach their deductibles, as Benjmain Jolley says during the show today, we're giving this third party a lot of control over a transaction that they literally have nothing to do with something like three out of four times that any given patient picks up their generic med. How'd we get here as a society? It's weird. If you've listened to most of the shows that I've been doing lately largely spiraling around the whole “what's going on with the prices that patients/members are paying for generic drugs,” you might be thinking the same thing I am: It's such an egregious situation that it becomes an opportunity because the bar is so darn low and so many in the supply chain or the demand chain are getting royally screwed by the PBMs, not just patients. I mean, there's a lot of possible win-win collaborations, at least situationally. Local pharmacies and local businesses, for example, would seem to have a natural alliance. I'm reminded of the collaboration from a couple of years ago that Drew Leatherberry and Dan Strause talked about in episode 313. I'm super sure that you in the Relentless Health Value Tribe has or could come up with all kinds of innovative collaborations to help patients get affordable generic drugs, and I'd be super psyched to hear about them. Benjamin Jolley is a pharmacist by training. His pharmacy consulting company is Apex Pharmacy Consulting. Also mentioned in this episode are Ge Bai, PhD, CPA; Mark Cuban; Ferrin Williams, PharmD, MBA; Joey Dizenhouse; Vinay Patel; Drew Leatherberry; Dan Strause; Kyle “Transparently Kicking PBM Ass” McCormick and his pharmacy, Blueberry Pharmacy, in Pittsburgh. Also, AJ Loiacono from Capital Rx (EP379) and CPESN Networks.   You can learn more at benjaminjolley.substack.com and through Apex Pharmacy Consulting. You can also connect with Benjamin on LinkedIn.   Benjamin Jolley, PharmD, is a third-generation independent pharmacy operator. Since 2019, he has been dedicated to supporting pharmacy operators across the nation in unraveling the complexities of the financial systems that drive their businesses. Through his occasional blog at benjaminjolley.substack.com, he shares insights derived from his experience. In 2023, he partnered with Joe Williams to launch Apex Pharmacy Consulting. Their goal is to provide comprehensive and personalized consulting services tailored to enhance pharmacy operations.   04:47 Benjamin Jolley's recent revelation. 06:14 What are the 10% of drugs that provide all the profit for pharmacies? 09:21 What's happening with the other 90% of drugs that pharmacies are filling? 11:05 What is the breakdown of costs when fulfilling prescriptions and running a pharmacy? 18:50 EP379 with AJ Loiacono. 21:42 What is the “cost savings” within the “insane system” of PBMs not sharing profit with independent pharmacies? 23:00 What is one of the things that PBMs and pharmacies don't often talk about? 26:39 What can employers do so that patients aren't getting overcharged by PBMs? 27:51 “How do I make the PBMs irrelevant?” 33:30 What's the difference between an independent pharmacy delivery service and a service like Express Scripts? 34:36 What's the other potential solution in solving the problems independent pharmacies face, and why does Benjamin Jolley feel that it's not the best solution to pursue?   You can learn more at benjaminjolley.substack.com and through Apex Pharmacy Consulting. You can also connect with Benjamin on LinkedIn.   Benjamin Jolley of Apex Pharmacy Consulting discusses #indiepharmacy on our #healthcarepodcast. #healthcare #podcast #pharma #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Emily Kagan Trenchard (Encore! EP392), Cora Opsahl (Encore! EP372), Jodilyn Owen, Ge Bai, Andreas Mang, Karen Root (Encore! EP381), Mark Cuban and Ferrin Williams, Dan Mendelson (Encore! EP385), Josh Berlin, Dr Adam Brown  

For a full transcript of this episode, click here. I thought I would encore this show after coming back from the 2023 NODE Conference held in the Microsoft building in New York City, which I always enjoy. NODE stands for Network of Digital Evidence. Why is evidence so important? Here's the NODE answer to this question: It is so smart purchasing decisions can be made by consumers, health systems, and payers so devices and software that improve patient experience, provide actionable insights, and save time and money become part of care delivery so trust is built between industry and healthcare. No matter what direction you come at this from, evidence for care delivery endeavors is sorely needed. What's always interesting to me is kind of the context of this said evidence, however the “who said” evidence is evaluated by and to what end. It was a really interesting juxtaposition, frankly, to hit up the NODE conference—which is attended mainly by digital health entrepreneurs and health system execs—right on the heels of me going to multiple events with self-insured employer types like the PBGH (Pittsburgh Business Group on Health) summit in early December, for example. What Emily Kagan Trenchard, my guest on this encore, talks about today is very much not a nice-to-have from the employer/purchaser point of view. It's a must-have from their perspective because all of these care delivery, technological, and organizational inefficiencies that Emily alludes to … yeah, it's all defined as expensive waste from the standpoint of the employers or other self-insured entities. These self-insured entities are the ones paying for fragmented and unsupported patient journeys with their escalating commercial rates, after all. In sum, I like how Joseph Wu, MD, PhD, who is the current president of the AHA (American Heart Association), put it at the recent AHA Scientific Sessions in Philadelphia last month, which I was honored to attend. Dr. Wu said during his presidential address, “Work hard, work smart, work together.” Emphasis on all of the above, especially the work together. That's what the Relentless Health Value Tribe is all about, after all; so thanks so much for being a part of it. So, a few things to remind everybody. First of all, don't forget EHRs (electronic health records) were purpose built originally for billing. This is no secret. People quite openly have called EHR systems glorified cash registers. If I want to be generous, maybe I would restate this to say that EHRs were designed to document patient interactions. This is what their core architecture was built to achieve. But today, there's a lot that goes on that isn't a traditional patient interaction. First of all, me even calling it, frankly, a patient interaction should give longtime listeners a clue where this is headed. I mean, say you're sitting at home on your couch. I don't know. You're probably not considering yourself a patient. You're considering yourself a person sitting on your couch. However, say you're sitting on your couch and you haven't taken your COPD maintenance therapy. Potentially that is something of clinical significance that maybe should get figured out and noted somewhere—potentially prior to the acute event going down. Or, still talking about things that are relevant to patient health but which don't naturally tuck into an EHR system's native architecture, maybe we have social workers and nutritionists and all kinds of people who are not doctors or nurses or PAs (physician assistants) in this mix. Most of the time, these people don't even have access to the EHR. In sum, what is happening between codes getting written in patient health records? Where's all that information going? My guest in this healthcare podcast, Emily Kagan Trenchard, makes a super point about all of this that I haven't heard made so succinctly or so eloquently. She talks about identifying the core functionalities, the centers of gravity that are needed to bring together providers and patients and everybody else in the mix. She talks about the four platforms that she feels are very necessary to underpin or be the chassis to best support helping providers and others help patients and people in and out of the clinic. She calls each platform a tentpole. These four platforms are: 1.    The EHR 2.    A CRM (customer relationship manager). And, by the way, when Emily says CRM, she's talking about more than software. It's more like a philosophy or a whole approach around relationship building with patients/people/customers. 3.    A cloud platform for data and analytics 4.    A data exchange One last takeaway, for me at least. Emily has talked about two basic facts that inform her thinking: (1) Providers and patients alike are increasingly not tolerant of friction. (2) What is easiest is the most likely to happen. Something that we don't get into in this show but certainly bears considering is the larger context here. Yeah, we got Amazon, we got Google—not only what they are doing alone but also what they are investing in. They have platforms that are purpose built to remove friction and to be really, really easy … one-click easy. So, let's talk about the WIIFM (the “what's in it for me?”) here for health systems to get a move on. When Merrill Goozner was on the show a few weeks ago (EP388), he says that when patients and employers and taxpayers start crying uncle on both healthcare prices as well as just bad friction-filled experiences and also when, at the same time, technology and new competitors move in on the supply side, he says what's gonna happen then is older incumbents like hospitals could find themselves getting their lunches eaten, especially as we contemplate the stuff that Mike Thompson was talking about in episode 389 about how there is increasingly data out there which identifies hospitals who are very inefficiently run. Also, I would be remiss not to mention that non–purpose-built, dare I say bad, technology causes bad clinician burnout, which causes bad turnover, which is really expensive. Arshad Rahim, MD, MBA, FACP, talks about this in episode 323. Emily is SVP and chief of consumer digital solutions over at Northwell Health. Northwell, in case you haven't heard of this health system, is very large: 21 hospitals, 850 outpatient clinics, 300,000 patients a year. Yeah, it's big. Also mentioned in this episode are NODE.Health; Pittsburgh Business Group on Health; Joseph C. Wu, MD, PhD; American Heart Association; Merrill Goozner; Mike Thompson; Arshad Rahim, MD, MBA, FACP; and Megan Antonelli. You can learn more at northwell.edu and connect with Emily on LinkedIn.   Emily Kagan Trenchard offers a unique perspective from within the American medical system: A spoken-word-poet-turned-healthcare-executive, she is on a mission to remix the human in healthcare, challenging entrenched assumptions about what it means to give and receive care in the digital age.  As senior vice president, chief of consumer digital solutions, for New York state's largest health system, Northwell Health, Emily leads product strategy, analytics, research, and design for Northwell's digital ecosystem of patient-facing Web sites, apps, and digital channels. She started Northwell's first user experience department to advance the use of design to care for people in a digital world. Passionate about creating seamless experiences steeped in humanity, Emily now serves as the executive sponsor for Northwell's enterprise CRM program. In prior roles, Emily has led Web systems for New York City's famed Lenox Hill Hospital, spearheaded the consolidation of Northwell's 60+ Web sites onto a single Web platform, and transformed Northwell's Web, social, and digital signage properties. Most recently, Emily co-led an agile, interdisciplinary start-up within Northwell charged to rapidly create a seamless digital front door experience. Within 18 months, that team delivered an award-winning mobile app, launched Northwell's consumer identity program, and created the first unified online booking and bill payment capabilities for the health system. Emily holds a master's degree in science writing and communication from MIT. Her executive training was at the Yale School of Management.   07:08 How does customer digital solutions fit into the larger technology infrastructure in healthcare? 09:07 “Where else do you have centers of gravity that you should respect in the architecture?” 09:25 “There is a constellation of need here.” 11:05 “We interact with way more than just patients.” 13:42 “We have to be able to understand the network of relationships in a population.” 14:25 How do EHRs and CRMs interact as two tentpoles in healthcare? 16:45 “The question is, where does a human being work?” 19:07 How are patients staying on a nonfragmented care journey in a proactive way? 23:00 “Anybody who's a consumer of our digital offerings has a relationship with us.” 28:46 “The medicine is being practiced not only on our physical bodies but on our digital bodies.”   You can learn more at northwell.edu and connect with Emily on LinkedIn.   @ektrenchard of @NorthwellHealth discusses #EHRs and #CRMs on our #healthcarepodcast. #healthcare #podcast #EHR #CRM #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Cora Opsahl (Encore! EP372), Jodilyn Owen, Ge Bai, Andreas Mang, Karen Root (Encore! EP381), Mark Cuban and Ferrin Williams, Dan Mendelson (Encore! EP385), Josh Berlin, Dr Adam Brown, Rob Andrews  

For a full transcript of this episode, click here. Why did I decide to encore this episode where Cora Opsahl from 32BJ spends 29 minutes talking about the importance of getting your data if you are an employer or a union health fund? Let me quote Jeff Hogan with some light edits here. Jeff wrote about the “outsized role” that employer data and intentional analytics can and will play. This is emerging and a must-have. The show with Andreas Mang (EP419) from three weeks ago, the show with Dan Mendelson (EP385), the one with Mark Cuban and Ferrin Williams (EP418) … everything that has been talked about in all of these shows and more is gonna be hard to do without having the data so you know what's going on. But I will let Cora Opsahl explain far more succinctly than I can here. One more note before we dive in here: After you listen to this show, you might want to go back and listen to episode 373 with Cora—and that one is entitled “How to Kick a Big Hospital Out of Your Network”—because this is one of the things that 32BJ did when it got its data. 32BJ realized that if it kicked out the really expensive hospital from their network, it would (and did!) save $35 million. Kicking this one hospital out of its network enabled the union to get its biggest wage hike in however many years, and also the employers employing union members got a premium holiday and did not have to pay into the health fund for a few months. Imagine if they didn't have this data and realized the millions and millions of dollars being siphoned out of the plan by this one hospital charging way too much. It's just crazy how many employers or unions wind up becoming imprudent fiduciaries because they just don't have the data to know better. But I'll tell you who is realizing it: class action attorneys. In this healthcare podcast, I am speaking with Cora Opsahl, who directs the 32BJ Health Fund. Important to know about Cora's background is this: In previous roles, she's worked deep in the inner workings of the healthcare industry. So, she came to 32BJ armed with a BS meter that is finely tuned, which is, unfortunately, an essential skill for anyone trying to help the patients and members relying on them to successfully navigate the healthcare industry. This conversation gets into everything that the 32BJ Health Fund does with their data. They have lots of data. They demand it. So, besides kicking out overly expensive health systems from their network, here's other things that 32BJ is currently doing with their data and which other employers and unions may get a few ideas from. If you have the data, you (like 32BJ) can use it to: Make smart benefit decisions that are validated, not just guesses. Before you decide to do something (add a wellness program etc), be able to model it accurately for how much it will actually cost you—which, spoiler alert, is most of the time not what the vendor will estimate. You have way more data than the vendor does, so you can certainly use it to great effect in this way. Make sure that the right members are being communicated with so that benefit designs are successful. As Ashleigh Gunter said in episode 368, success when changing benefit designs has a lot more to do with communication than many realize. Create dashboards for leadership that may show trend lines, for example, which could be very helpful to ensure that the fund doesn't run out of money etc … little things like that. Figure out how much the fund is spending on various procedures and where. There's all this talk right now about the crazy variability of prices for the same exact service in the same local market. At one hospital, a colonoscopy could literally cost $10,000; and in another hospital—same quality, same basically everything—that same colonoscopy will be $2000 or $3000. I mean, there's a 500% delta or something in some of these cases. Ensure that if a vendor said they were going to do something, that they are actually doing it. This is especially meaningful for point solutions because of the whole squeezing the balloon thing. I can save money in a silo, and you won't realize that those dollars are getting transferred elsewhere unless you are doing your own math. This is a big deal if you start thinking about how pharmacy benefits are typically siloed from medical benefits. So, if I'm a pharmacy benefit manager, I can talk about how much I'm saving by denying patients drugs without consideration of the medical downstream implications of that. Ensure you're not paying a bill and writing a check for more than the bill was for, which is weirdly common. There's a whole show with Dawn Cornelis (EP285) about this. 32BJ has an engineering team that is creating an app to help members navigate to great doctors with fair prices. All of these things roll into basically three categories: 1.    Cutting wasteful spending and finding fraud 2.    Making smart benefit decisions 3.    Being able to see trends and forecast the future, which is really helpful for financial solvency etc As Cora Opsahl says, “I think we [all can] recognize [that] you [cannot] make smart … decisions and be a fiduciary of [a] fund without having [data].” This whole conversation has been really a big bright spot for me and will provide hope, I think, for any employer/union who is seeking ways to protect their members and patients, the ones on their plans and therefore under their aegis and whom they have a fiduciary responsibility to look out for. 32BJ represents about 200,000 members. They are mostly in residential and commercial real estate—so, for example, your doormen, your maintenance workers, your security, your cleaners, amongst others. Members are in about 11 states, but a lot of them are in the New York City metro area. These union members who are in the fund work for over 5000 different employers. The 32BJ Health Fund has zero-dollar premiums. Wowza on that point—that's a huge benefit. Also mentioned in this episode are Jeff Hogan; Andreas Mang; Dan Mendelson; Mark Cuban; Ferrin Williams, PharmD, MBA; Ashleigh Gunter; Dawn Cornelis; and Wayne Jenkins, MD. You can learn more at 32bjhealthfundinsights.org.   Cora Opsahl is the director of the 32BJ Health Fund, a self-funded plan that provides affordable, comprehensive, and innovative health coverage to 200,000 union members and their families. As director of the Health Fund, Cora has implemented multiple benefit changes that saved more than $35 million: removing NewYork-Presbyterian Hospital System and physicians from the network, transitioning to a new pharmacy vendor and pharmacy group purchasing coalition, and establishing an expanded Centers of Excellence program administered by Mount Sinai Solutions. Currently, she is leading a comprehensive medical RFP. Prior to joining the 32BJ Health Fund, Cora spent 12 years at Express Scripts, a pharmacy benefit manager, where she held a variety of roles, including with Medicare Part D, strategy and acquisitions, operations, and account management. She holds an MBA from Saint Louis University.   06:53 How much data does 32BJ Health Fund have, where do they get it, and how do they use it? 08:52 How did 32BJ Health Fund successfully demand their data from 100% of their vendors? 09:42 “We feel it's really important that we own this information ourselves.” 10:05 “It always concerns me—if a vendor doesn't want to give you the information, what are they hiding?” 10:32 “It's not just getting the data; it's then using the data.” 13:41 “Without data, you're really just taking a guess; and guesses are never gonna get you where you need to go.” 15:19 EP285 with Dawn Cornelis. 15:40 Is the cost of creating a data analytics team worth the cost savings of those data discoveries? 19:03 “The use of data has really built our knowledge.” 20:52 “It's really important to us that as we make benefit decisions, we're doing it smartly.” 25:27 EP358 with Wayne Jenkins, MD. 25:38 How is 32BJ Health Fund making their data knowledge actionable? 28:11 “If we can figure out how to make telehealth accessible … there may be an opportunity for telehealth … to upset some of these … monopoly systems or low-choice options.” 30:22 “It's really easy to think that we can solve this problem through benefit design … but in the end … it's the price.”   You can learn more at 32bjhealthfundinsights.org. Cora Opsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #healthcareleadership #healthcaretransformation #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Jodilyn Owen, Ge Bai, Andreas Mang, Karen Root (Encore! EP381), Mark Cuban and Ferrin Williams, Dan Mendelson (Encore! EP385), Josh Berlin, Dr Adam Brown, Rob Andrews, Justina Lehman

For a full transcript of this episode, click here. I want to kick off this show with a clip from episode 415 with Rob Andrews, wherein he so very eloquently sets the stage here: We think that one of the core problems here is that too many intermediaries and providers in the system, their compensation is not in any way dependent on the outcome. So, let's think about this NICU baby problem again. Looking at the hospital system—and I'm not at all implying or suggesting any hospital system tries to do this—but I think it is clear that they actually benefit commercially from more babies spending more days in the NICU. NICU's usually a pretty good margin business. It's expensive. Lots of money is paid, and margins run pretty well there. So, I don't think there's a hospital system in the country that intentionally says, “Oh, good … let's go out and try to fill up the NICU every day.” But when it gets filled up, they benefit. On the other hand, if the hospital invests significantly in early effective intervention prenatal or even pre-pregnancy, there's no upside to that financially. They don't get rewarded for that. They might win an award from some magazine for best practices, but their margin suffers. Then if you look at the intermediaries, the carriers, and PBMs [pharmacy benefit managers], their outcomes are irrelevant to their performance. If an employee of a self-insured employer has a significant risk prenatal or pre-pregnancy and the carrier does a great job identifying that problem and solving it, they make the same amount of money off that patient or that consumer that they would if they did nothing. So, it's a bit harsh to say this, but the carriers make the same amount of money if every child is born healthy and there's not a day spent in the NICU as if they do if every child's born with severe crises and winds up in the NICU. It's not a big mystery in the US economy that people do what you pay them to do. And if you have a system, which we do now, where the case of maternal health, diabetes management, musculoskeletal management, cholesterol and cardiac management … when you have a system where many, many players in the system, at best, make the same amount of money for bad outcomes as they do for good ones and, at worst, they prosper from the bad outcomes, that explains the problem. So, is this show about improving maternal health outcomes in the US, where it is relatively deadly to have a baby compared to other industrialized nations? Yes. But improving maternal health is also a great case study for what needs to be done to just improve health. You could apply it to primary care. You could apply it to chronic care management. It is a fairly broad-spectrum solution, as it were. I'm thinking right now about how Dave Chase, co-founder of Health Rosetta—how does he put it?—he says every big problem in healthcare already has been solved. The existing challenge is how to massively replicate proven solutions. So, yeah … keep that in mind when we talk about what Jodilyn Owen has accomplished with her team in Washington State with their birth and health center. Also, as you consider how you might replicate, keep in mind the struggles she has faced getting contracts from self-insured employers or payers to pay her clinic and a very interesting encounter she had with a VC/PE (venture capital/private equity) funded maternal health start-up. It's just interesting where the money is flowing and where it's not flowing. But let's talk about Jodilyn's clinic's outcomes. Their zip code is one of the most diverse in the nation. There are 79 languages spoken. There is lots of social determinants of health going on. It is a medically underserved area. It is a federally designated provider shortage area. So, this community has every right to have horrible outcomes. Meanwhile, nearby, there is a wealthy community. In that zip code, they live 17 years longer than in Jodilyn's clinic's zip code. But if you compare the outcomes that Jodilyn's clinic has compared to the outcomes in the hospital in that fancy neighborhood, Jodilyn's group has far less cesarean rates, far less NICU admissions, far less incidence of gestational diabetes, far quicker access to treatment for hypertension. You might be wondering how much their birth bundle costs that they are having trouble getting most payers except one to pay for and getting no VC dollars or funding at all. They're charging $5000 to $7000. So, let's just say $5000 to $7000 compared to … what does one NICU admission cost? So, yeah … this is an exact example of what Rob Andrews was talking about. An EXACT example. So yeah, enjoy this episode; it's as heartwarming and actionable as it is frustrating. And if you are a payer or self-insured employer in South Seattle, please give this clinic a contract. Not to drop a major spoiler alert here, but you know what Jodilyn's “secret sauce” is? Nuances for sure, but bottom line, it's about trust. It's about relationships. It's about listening to the patient. It's being part of the local community. If you're shocked right now, raise your hand. There's gonna be no one with their hand raised. How many times do we have to figure this out? Jodilyn Owen is the clinical director of the Rainier Valley Birth & Health Center. She is a licensed midwife along with a bunch of other credentials. Also mentioned in this episode are Rob Andrews; Dave Chase; Vivek Garg, MD, MBA; and Larry Bauer.   You can learn more by emailing Jodilyn at jodilyno@myrvcc.org. You can also connect with her on LinkedIn.   Jodilyn Owen, LM, CPM, Ma MCHS, is a licensed, certified professional midwife and co-founder of Rainier Valley Birth & Health Center. She was born and raised in Seattle and raised her own family in South Seattle, working as a doula and parenting educator for 13 years before becoming a midwife. This is where she saw healthcare through the lens of observation of hundreds of families and provider experiences of maternal and child healthcare. An avid learner and critical thinker, Jodilyn began to reimagine healthcare and to develop a vision for what access in its truest form might be, not just to healthcare for the deeply underserved and mis-served families of South Seattle but also to quality healthcare delivery for the providers who want to give more than what the system allows. Jodilyn built her practice around the idea that parents know themselves and their babies best, and her direct patient work is designed to promote this first relationship. She provides individualized, gentle, and holistic pregnancy, birth, and postpartum care for families planning a home, birth center, or hospital birth. Jodilyn is currently director of clinical partnerships and staff midwife at the nonprofit–for purpose Rainier Valley Birth & Health Center. She provides infrastructure development, guides clinical programs and partnerships, and supports students from multiple university health professions and public health programs at all levels from high school through doctoral studies.   07:12 How much cost savings is there when you avoid a NICU admission? 09:43 How is “slow care” feasible among an ob-gyn shortage in many communities? 10:42 “Start people at the risk that they are appropriate for.” 11:37 EP407 and Summer Shorts 3 with Vivek Garg, MD, MBA. 13:50 “To effect change, we have to unwind what has been wound so tightly and so carefully through medical … education.” 14:13 “It's not a people problem; it's a system problem.” 18:46 What does relationship-based care mean? 22:32 “Everything in pregnancy at least is a trend.” 28:01 How does Jodilyn's practice work with payers? 31:08 EP409 with Larry Bauer, MSW, MEd. 32:24 Why is it important to address the root of this problem in the education space?   You can learn more by emailing Jodilyn at jodilyno@myrvcc.org. You can also connect with her on LinkedIn.   @essntialmidwife discusses improving maternity #patientoutcomes in our #healthcarepodcast. #healthcare #podcast #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Ge Bai, Andreas Mang, Karen Root (Encore! EP381), Mark Cuban and Ferrin Williams, Dan Mendelson (Encore! EP385), Josh Berlin, Dr Adam Brown, Rob Andrews, Justina Lehman, Dr Will Shrank  

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For a full transcript of this episode, click here. This show is a very natural follow-on to episode 418 with Mark Cuban and Ferrin Williams, PharmD, MBA. This show is the how, as in, “How did everything that we talked about in the earlier show wind up the way it did?” And it also proves it … with data. I gotta say I never quite understood the finer points of the rationale of a cash pay system for minor expenses—expenses like generic drugs. I always framed this whole thing in the context of a senior on a fixed income taking 10 drugs, as my grandma did. And even if each of those drugs was only $5 or $10 a month, that's enough beans a month that it was a big deal for her to swing. So, I have always had this thought that these drugs should be covered by her insurance so she and everybody else living on a fixed income trying to make ends meet could get them and take them and not die from complications of diabetes or high blood pressure. Now, the counterargument to the above, which I have certainly heard more than once, is to offer members/patients HSAs (health savings accounts) and have them buy stuff with their HSA. My knee jerk there is, yeah, but I can barely figure out the deal with HSAs. Most Americans don't even know what a deductible is let alone an HSA. This approach just feels like it demands a lot of health literacy. So, that's the place I was when I walked into this conversation in this episode with Ge Bai, PhD, CPA. Here's two facts that got me inching away from my original position: 1. Generic drugs are cheap. There is already competition in the manufacturing marketplace that holds these prices down. 2. PBMs (pharmacy benefit managers) and insurance are devices to pool risk. If you have a high expense, that expense gets spread out over the rest of the insured population (ie, the risk pool). This whole spreading out of the risk is arduous to pull off and requires a level of administrative costs. So, let's break this down: In terms of #1 fact, that generic drugs are cheap, let's think about the value prop of PBMs. It's to throw their market power around to lower drug prices. But, oh wait … the prices of cheap generics are already cheap. So, not much need for market power? Yeah, that's a fact. One of the studies that I talk about in this healthcare podcast with Ge Bai quantifies that. For patients in their deductible phase actually, 79% of the time paying cash is cheaper than if the patient had used their insurance and gotten the price “negotiated by their PBM.” So, yeah … anytime pretty much anybody can wander in and get a better price than a Fortune 15 PBM, it's pretty clear that market power is not overly required here. In fact, getting PBMs in the mix just seems to make the drug prices higher for patients. Alright now, moving on to my fact #2 I talked about earlier, which is, what is the point of insurance (and PBMs are a derivative of insurance)? The point with them is to pool risk, to spread out the cost of something over the entire risk pool. So, yeah … drug costs $3. What is the administrative burden that goes in to spreading $3 across a risk pool? Is it worth it? Or is the admin cost burden more burdensome than the actual cost burden of the cost of the drug, and all we're doing here is driving up the price of healthcare, which ultimately might throw more financial burden back on the patient through higher premiums or out-of-pockets? That's the second study that I talk about today with Ge Bai, and it quantifies exactly how much that administrative burden is when it comes to generic drugs. Because you know who makes the most money in a generic drug transaction? No, it's not the pharma manufacturer, if that's what you were thinking. It's not the pharmacy. It's not the wholesaler. Yeah, it's the PBM. The PBM, by a margin of 10 points, makes the most money. The administrative cost burden is actually the most expensive part of buying a generic drug using your insurance and going through that PBM. There's a bar chart that visualizes these proportions. But while I'm on a roll here, here's a #3 fact that speaks to my concerns about HSAs that I raised at the beginning and the financial literacy required to use them: Health insurance is already super complicated, and no one can understand it. And here's a #4 let's-talk-about-the-real-world fact: Health insurance and paying for drugs is already pretty unaffordable for lots of people. So, I guess in theory it would be amazing if we could have our drugs paid for so they could be affordable. And if that were true and things were a little complicated … okay, trade-offs and all that. But right now, the situation is that drugs can be pretty unaffordable, including “cheap” generics; AND getting them covered is complicated. So, bar is pretty low to do better by patients is my point. And this is what I talk about with, as aforementioned, my guest today, Ge Bai. Ge Bai probably needs no introduction. She is a professor of accounting at Johns Hopkins Carey Business School and also a professor of health policy and management at Johns Hopkins Bloomberg School of Public Health. As she says, she studies nothing but healthcare dollars. Also mentioned in this episode is the show with Steven Quimby, MD (EP344) going deep on the generic drug market. Additional links for this episode: Links for second study: JAMA Health Forum, coauthored with Joey Mattingly, Kenechukwu Ben-Umeh, Gerard Anderson; The Johns Hopkins University - Carey Business School; Johns Hopkins Bloomberg School of Public Health; University of Utah College of Pharmacy Bar chart/article: by Jason Shafrin You can learn more about Ge's research on LinkedIn and X (formerly Twitter).   Ge Bai, PhD, CPA, is a professor of accounting at the Johns Hopkins Carey Business School and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. An expert on healthcare accounting, finance, and policy, she has testified in Congress, written for the Wall Street Journal and the Washington Post, and published her studies in leading academic journals such as the New England Journal of Medicine, JAMA, and Health Affairs. Her work has been widely featured in the media and cited in regulations and congressional testimonies. She was a visiting scholar at the Health Analysis Division of the Congressional Budget Office from 2022 to 2023. She teaches graduate courses and has received the Johns Hopkins Alumni Association's Excellence in Teaching Award.   06:13 What is the background on generic drugs that is need-to-know? 06:39 EP344 with Steven Quimby, MD. 07:04 Do we have affordability for generic drugs? 15:40 What's the policy failure around generic drugs? 18:34 Why is there a huge health equity issue? 20:13 How do PBMs have both a monopoly and a monopsony? 21:59 What should be the goal for cheap generics? 23:36 “Whenever we have no competition, we'll see high price.” 26:00 What's the best approach to addressing operational challenges behind generic drug costs? 28:42 How do we solve generic drug costs on the back end? 31:15 “Healthcare insurance is not the same as health.” 36:07 “It's time for us to reflect and think whether there is a better way to try.”   You can learn more about Ge's research on LinkedIn and X (formerly Twitter).   @GeBaiDC discusses paying cash for #genericdrugs in our #healthcarepodcast. #healthcare #podcast #digitalhealth   Recent past interviews: Click a guest's name for their latest RHV episode! Andreas Mang, Karen Root (Encore! EP381), Mark Cuban and Ferrin Williams, Dan Mendelson (Encore! EP385), Josh Berlin, Dr Adam Brown, Rob Andrews, Justina Lehman, Dr Will Shrank, Dr Carly Eckert (Encore! EP361)

4 little goblins are asked to go to the surface during the time of year when humans become obsessed with socks! Will they make it back with a fresh horde? Or will they get in too much trouble? Starring: Supriya as Moja Kae as Gigglespout Rem as Krieg Jenny Nordine as Alma Sockgoblins was created by PoorStudents! For the entirety of this month as a thank you for partnering with us, Sockgoblins will be on sale for a mere $0.96 and can be purchased right here! This week we are happy to feature our friend Adam Brown and his wonderful horror solo game Cthonaut! Buy it today! If you enjoyed hearing Kae on today's episode, you'll love his Starfinder podcast Dude, Where's My Drift! Check out our sponsor STEAKHOUSE SHOWDOWN! A fun upcoming board game all about steaks and perfectly cooking them! Follow SchmooeyMcGooey for updates! Music and SFX provided by Epidemic Sound Game Master Monday Theme by Joey Hines

For a full transcript of this episode, click here. Are you on the board of directors of a company? Or are you a shareholder of a publicly traded company? Or are you a CEO or a CFO who reports to a board of directors or these shareholders? Well, this show is for you. And it's about how the healthcare industry has become financialized at the same time that providing health benefits has become the second-biggest line item after payroll for most companies. We talked about that with Mark Cuban (EP418) also. So, this show isn't really about health benefits; it's about the business that these health benefits have become and how, if the CEO or CFO of an employer is not intimately involved in the financial layer wrapping around health benefits, then the company is getting really taken advantage of by those entities who are intimately familiar with the financial layer surrounding those healthcare benefits. And the employees of that company also are getting equally taken advantage of. This is not a case where paying more or less results in better or worse employee health or healthcare. It is a case where not minding the shop in the C-suite means that financial actors just take more of the pie and nobody wins but them. Employer loses; employee loses. Andreas Mang, my guest today, kicks off this interview talking about the conversation that will go down between himself and any CEO whose company gets bought by Blackstone. So, if you're a CEO and you're aspiring for this to happen, yeah … heads up. But he says it's kind of an unnatural act to dig into anything that smells like health benefits or health insurance. Some may not even realize that this whole financial layer has developed that sits above the healthcare benefits themselves. And they also may not think that there's anything that's possible that can be done. As far as both of these points are concerned, Andreas Mang gives a list of, as he calls them, easy things a C-suite can do to save 10% while improving employee satisfaction and health. Saving 10% or more, this can be a really big number. A lot of this is just enforcing purchasing discipline that is being used elsewhere. Here's Andreas's list recapped: 1. Have CFO engagement throughout the year. (We talked about that with Mark Cuban also.) 2. Be self-insured once you have reached a certain size. (Andreas gets into this in more detail during the show itself.) 3. Be very, very careful who you hire as your broker or benefits consultant. There are five things that need to be true: ·      They have the experience to do the job. ·      Flat-fee model compensation ·      No product pushing ·      Fees at risk (30% or more) ·      Simple termination provisions 4. Do carrier/ASO/TPA RFPs once every three years or thereabouts. 5. Do dependent eligibility audits. (Cora Opsahl talked a lot about this also in an episode [EP372] last summer.) 6. Leverage pharmacy coalitions and stop-loss collectives. (In the show itself, Andreas offers some warnings because some of these coalitions and collectives are great and some are not.) But bottom line, just keep in mind, as Mark Cuban said two weeks ago (EP418), those that are taking your money, your company's money, are advantaged when you are confused. Where there's mystery, there's margin. If you can't convince 'em, confuse 'em and all that. This is a business strategy. Healthcare should not be this complicated. But yet, it has become so; and anyone who doesn't realize that is letting themselves and their employees really get taken advantage of. Unknown unknowns are not benign. As I have said several times already, Andreas Mang is my guest today. He is a partner at Blackstone, the private equity and alternative asset manager. His job is helping portfolio companies manage their US healthcare benefits for their employees.   You can learn more at Blackstone and by connecting with Andreas on LinkedIn.     Andreas Mang is senior managing director, portfolio operations, and chief executive officer of Equity Healthcare, where he is involved in managing medical benefits spend across the Blackstone portfolio. Andreas brings 20 years of healthcare experience to Equity Healthcare, having held various roles in healthcare finance, operations, and strategy. Prior to joining Blackstone, Andreas was the vice president responsible for national provider network operations at CareCentrix, a PE-backed, leading home health benefit-management company. At Blue Cross Blue Shield of Massachusetts, he held a variety of roles, including a leadership role identifying and implementing administrative cost savings opportunities throughout the organization and ultimately designing a new corporate business model. In addition, he held roles as the manager of strategic financial planning at Harvard Pilgrim Health Care and was a senior consultant with Deloitte Consulting's Strategy and Operations group in Boston. Andreas has a bachelor's degree in healthcare management and policy from the University of New Hampshire and an MBA from the University of Rochester's Simon School of Business Administration. He currently serves on the board of DECA Dental.   04:19 Why Andreas starts every conversation with the question, “How's your healthcare company?” 07:04 Why is it important, as a self-insured employer, to treat your business as a small healthcare company? 08:42 Why is it unnatural for companies to be providing health insurance? 10:13 What can be achieved when there is alignment between employers and insurers? 12:07 What things can a company do to reduce spend by 10%? 13:40 Why is it better to have CFO engagement in the benefits plan throughout the year? 15:51 Why does self-insurance save 5% to 9% for companies automatically? 17:41 “The funding isn't a healthcare thing; it's a CFO thing.” 17:54 Why is it vital to have a reliable, trustworthy broker? 24:38 When is the last time your company has RFP'd their health plan? 27:06 Why does changing a health plan feel scary but is necessary? 27:58 What is a dependent eligibility audit? 30:48 Why are employers better together? 34:02 How do employers truly get a flat-fee model with brokers?   You can learn more at Blackstone and by connecting with Andreas on LinkedIn.   Andreas Mang of @blackstone discusses the financialization of #healthcarebenefits in our #healthcarepodcast. #healthcare #podcast #digitalhealth Recent past interviews: Click a guest's name for their latest RHV episode! Karen Root (Encore! EP381), Mark Cuban and Ferrin Williams, Dan Mendelson (Encore! EP385), Josh Berlin, Dr Adam Brown, Rob Andrews, Justina Lehman, Dr Will Shrank, Dr Carly Eckert (Encore! EP361), Dr Robert Pearl

8:30am 11/26/2023 Sunday Service Website: www.newhopelegacy.com Facebook: www.facebook.com/legacykona Instagram: www.instagram/NewHopeLegacy Podcast: https://www.newhopelegacy.com/category/podcast/ Google: https://podcasts.google.com/feed/aHR0cDovL25ld2hvcGVsZWdhY3kuY29tL3BvZGNhc3Q Spotify: https://open.spotify.com/show/3CH6a60c3aOPduvVmrbIR3?si=hkXY7NJKT1qwVNc4Fm1-Rg&nd=1 Apple: https://podcasts.apple.com/us/podcast/new-hope-legacy/id1641382708 iHeart Radio: https://www.iheart.com/podcast/269-new-hope-legacy-101978886/ The post Thank You Testimonies | Adam Brown appeared first on New Hope Legacy.

Why did I decide to encore this show about being customer-centric and transforming or innovating at a very large organization? Well, two main reasons. First reason can be neatly summed up by this recent Tweet from Rik Renard, which I have edited slightly to suit my own purposes. Here's the Tweet: “The Achilles' heel for most healthcare [innovators] is overlooking the role of change management. The deal isn't sealed until the whole team is raving. Adoption doesn't [automatically follow innovative thoughts no matter how good they are or how much it cost to build or buy anything]. Take change mgmt seriously.” This is relevant to pharma companies, to big provider organizations, to SaaS vendors, to payers … pretty much anyone. So, yeah. This show … still relevant. But also there's a #2 reason for this encore. It's coming at ya smack in the middle of an ongoing series for boards of directors, CEOs, and CFOs of self-insured employers. As discussed last week in the show with Mark Cuban and Ferrin Williams, PharmD, MBA (EP418), healthcare has become financialized. There is a whole financial layer sitting in between health benefits and the employer, and dealing with that requires customer centricity, transformation, and innovation at the employer level—a little change management, if you will. And with that, here is your encore. I was at the PanAgora Pharma Customer Experience (CX) Summit. Let me tell you one of my big takeaways. Many at pharma companies who are trying to convince their organizations of the need to be provider- and/or patient-centric are having a tough go of it. Heard that coming from every direction. Seems there are quite a few pharma organizations out there who are not actually customer/patient-centric. Say it isn't so. Turns out, they continue to be pretty darn brand-centric whether or not anyone besides the CX team and the most successful KAMs (key account managers) realize this hard truth. This matters because, from a provider organization, physician, or patient standpoint, it's not what's written on the walls … it's what goes on in the halls. It's what a company actually does in their interactions with the rest of the healthcare ecosystem that matters and that builds their reputation. You see this lack of customer centricity and, et cetera et cetera, there are certainly other things going on here; but you see the lack of customer centricity manifesting, right? You see the pharma reps that get kicked out of hospital systems because the perception is they add little if any value and “waste doctors' time; all they do is shove detail aids in our faces.” Heard that recently. Look, this doesn't just pertain to Pharma; this is a message for the whole industry. But there is certainly a way to do well by doing good, and how that starts is helping provider organizations and patients improve patient outcomes as the primary goal. Being innovative to that end. It's about supporting the best-practice standard of care and bringing resources to bear that are truly helpful. That is how more of the right patients can get the right treatment/drug at the right time or take their meds as per the A1A clinical guideline. It's probably also the way to sustainable business success. I've said it here a thousand times: People trying to do the right thing by patients all need to work together. If there's a party in the mix that nobody else wants to deal with because they are deemed not a team player or they don't listen … yeah, that's what I call a competitive disadvantage, beyond just squandering their ability to achieve their mission statement and improve patient care and lives, that is. Today's conversation is with Karen Root, who was a speaker at the aforementioned PanAgora conference. In this healthcare podcast, we are talking about how to make transformation and innovation actionable at a large organization—maybe a pharma company but pretty much any large organization with lots of people, lots of human beings with different motivations and goals. As we all know, for every early adopter, there are (it feels like) five laggards who will fight you tooth and nail because they do not want to transform. They like being brand-centric, and it's been working out fine … well, up until this year, at least. Karen Root is currently director of experience strategy at Boehringer Ingelheim, which is a pharma company. For many years prior to her current role, she was an enterprise head of brand and culture at WL Gore & Associates. What we talk about in this show is how to break down the historical “brand is king” mentality so that people want to follow with the awareness, courage, and determination to do so. Everything that we talk about in this episode can also be applied to pretty much any organizational transformation or the rollout of any innovation or new capability. Here's the key things that Karen talks about which are essential for an organization to transform, maybe (again) in a way that is customer-centric and/or to roll out new innovations or capabilities: 1. Leaders must communicate a compelling vision that also includes a realistic assessment of what it's gonna take to reach that vision and offer hope and the promise that the hard work and inevitable problems will all be worth it. 2. Systems thinking—a consideration of the systems and the people who will need to be a part of the transformation, thinking through what is likely to go wrong and proactively planning for it 3. Identify the right entry point. This should be a micro-journey or a quick win so that the team can score a victory and get through the messy middle that exists in any transformation or rollout. Triple points if you can find a micro-moment that has some emotionality connected to it from your customers' perspective or patient perspective. If you can fix a so-called moment that matters, it really matters. Consider starting by looking into call center logs, finding a common complaint, and fixing it. Do it this way and it's harder for anybody to complain that the status quo is so super amazing and tell you to talk to the hand. 4. Determine how you are going to measure what your quick win accomplished, as well as your whole larger transformational effort. 5. Ensure you have a full story arc here that shows the before and the after that clearly articulates that the before (the status quo) is problematic and that we have to, with urgency, get to the after. 6. Never forget that we're working with human beings here and not, as they say, rational economic actors. One heads-up: In the conversation with Karen today, we talk a lot about the so-called J curve. As Karen says (and you can look this up), whenever you introduce a new anything into an organization, at some point, there's gonna be a mess-up. And when something messes up, the whole team will spiral into a so-called “trough of disillusionment” or a “trough of despair,” sometimes it's called. This is the rock-bottom hook of that J in the J curve. The thing is, if a leader's vision isn't sufficient or their will to continue isn't sufficient, then the organization quits at this low point instead of working through it and coming out in a better place on the other side of the J. And you know what happens then. From that point forward until eternity, everybody who brings up implementing an innovation or a transformation will definitely hear the lecture about the time we tried that and how it failed miserably. So, the J curve … Check it out. Don't underestimate it. One very last thing: If you are working for a large organization (like Fortune 500 large) and you have succeeded in moving a transformation forward (like being actually patient-centric or customer-centric, for example), hit me up. I would certainly love to hear your thoughts on how you did it and why you think you were successful and the impact that you had.   You can learn more by connecting with Karen on LinkedIn.     Karen Root, MBA, CCXP, is a strategy, innovation, operations, and marketing executive with more than two decades of experience in healthcare, including medical devices, biopharma, and pharmaceuticals. Her background spans more broadly to include computer software, publishing, and consumer package goods. She has driven transformation and growth as a senior executive for companies ranging from start-ups to Fortune 100 multinational organizations. Driving transformative capabilities include digital marketing for Sanofi Pasteur and marketing at start-up for their subsidiary, VaxServe. Karen then led the medical division in customer experience at WL Gore & Associates, later leaving the organization as enterprise leader of brand and culture. She is currently leading customer experience in the United States for Boehringer Ingelheim. Karen has been adding innovative experience design in the metaverse to her arsenal of knowledge. Certified in blockchain technology, cryptocurrency, non-fungible tokens (NFTs), and as a metaverse expert, she has a patent pending in smart contracts and is exploring integrating NFTs and meta-realities into the healthcare space. Karen is the author of Spectrum Thinking and Signature Experience: The Intersection of Brand Promise and Customer Experience for Competitive Advantage. Her next book, Ready Worker One, was co-written with her daughter, Kayla Root, and is expected to be published in early 2024. It pulls from gaming and behavioral science, along with DAO structure (decentralized, autonomous organizations). Karen was recognized by Forbes in 2022 as one of the Top 10 Healthcare Entrepreneurs to Watch.   08:51 What skills does leading a large company in customer centricity require? 10:36 What needs to be included in a vision for customer-centric change? 11:01 “In transformation, we have to adjust the approach to that vision. We have to break it down into a couple of key steps.” 11:39 What is the J curve? 12:26 “Disruption is going to happen; it's just how do we minimize its impact.” 14:00 Why is hope so important for success in change? 17:22 “Leverage your people; understand where they are in the change curve.” 26:24 “We can't manage what we don't measure.” 26:33 “We have to not only measure in quantitative ways but qualitative.” 27:35 What's the downside to not being able to innovate? 28:55 Why does leadership need to have a story to tell? 31:19 “We have to remember that these are human beings and to look for those tells.”   You can learn more by connecting with Karen on LinkedIn.   Karen Root of @boehringerus discusses #customercentricity in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma   Recent past interviews: Click a guest's name for their latest RHV episode! Mark Cuban and Ferrin Williams, Dan Mendelson (Encore! EP385), Josh Berlin, Dr Adam Brown, Rob Andrews, Justina Lehman, Dr Will Shrank, Dr Carly Eckert (Encore! EP361), Dr Robert Pearl, Larry Bauer (Summer Shorts 8)  

CEOs and CFOs … hey, this show is for you. Let's start here: What do all of these numbers have in common: $140,000, $3 million, $35 million, and $3 billion? These are all actual examples of how much employers, unions, and some public entities saved on healthcare benefits for themselves and their employees. The roadmap to saving 25% on pharmacy spend and/or 15% on total cost of care in ways that improve employee health and satisfaction always begins when one thing happens. There's one vital first step. That first step is CEOs and/or CFOs or their equivalents roll up their sleeves and get involved in healthcare benefits. Why can't much happen without you, CEOs and CFOs? Here's the IRL: In 2023, the healthcare industry has been financialized. There is a whole financial layer in between your company and its healthcare benefits. And unless the C-suite is involved here and bringing their financial acumen and organizational willpower to the equation, your company and your employees are currently paying hundreds of thousands, maybe millions, of dollars too much and doing so within a business model that deeply exacerbates inequities. There are people out there who are very strategically taking wild advantage of a situation where CEOs/CFOs fear anything to do with healthcare in the title and don't do their normal level of due diligence. You think it's an accident that this whole space got so “complicated”? HR needs your help. Bottom line, if you are a CEO or CFO and you do not know everything that Mark Cuban and Ferrin Williams talk about on the pod today … wow, are you getting shellacked. Mark Cuban uses a different word. Healthcare benefits are, after all, for most companies the second biggest line-item expense after payroll. But don't despair here, because all of this information is really and truly actionable. Others out there are cutting zeros off of their spend and actually doing it in ways that are a total win for employees as well. My guest today, Mark Cuban, is a CEO, after all; and when he looked into it, it took him T-minus ten minutes to figure out just the order of magnitude that his “trusted” benefits consultants and PBM (pharmacy benefit manager) and ASOs (administrative services only) and others were extracting from his business. He pushed back. So can you. But just another reason to dig into that financial layer wrapping around your employee health benefits right now, you might get sued by your employees. Below is an ad currently being sent around on LinkedIn by class action attorneys recruiting employee plan members to sue their employers for ERISA (Employee Retirement Income Security Act of 1974) violations. It's the same attorneys, by the way, from those 401(k) class action lawsuits. I've talked to a few CEOs and CFOs who are scrambling to get ahead of that. You might want to consider doing so as well. Now, for my HR professional listeners, considering that some of what Mark Cuban says in the pod that follows is indeed a little spicy, let me just recognize that the struggle is real. There are multiple competing priorities out there in the real world, for sure. And bottom line, because of those multiple competing priorities out there in the real world, it's really vital that everybody work together up and down the organization in alignment. Lauren Vela talks a lot about these realities here in episode 406. This is a longer show than normal, but it's also like a show and a half. Mark Cuban talks not only about his work with Mark Cuban Cost Plus Drugs, which is a company that buys drugs direct from manufacturers and sells them for cost plus 15%, a dispensing fee, and shipping. It's kind of crazy how so often that price is cheaper, sometimes considerably cheaper, than the price that plan members would have paid using their insurance—and the price that the plan is currently paying the PBM. Most Relentless Health Value Tribe members (ie, regular listeners of this show) will already know all that, but what is also fascinating that Mark talks about is what he's doing with his own businesses and the Mavericks on other fronts, like dealing with hospital prices. In this show, we also talk the language of indie pharmacies, fee-only benefits consultants, TPAs (third-party administrators), PBMs, and providers doing direct contracting. There are, in fact, entities out there trying to do the right thing; and Mark acknowledges that. Ferrin Williams, PharmD, MBA, who is also my guest today, is chief pharmacy officer at Scripta and an expert in pharmacy benefits. She adds some great points and some context to this conversation. Scripta is partnering with Mark Cuban Cost Plus Drugs. Scripta has a neat Med Mapper tool and also services to help employees find the lowest costs for their prescriptions. If you are a self-insured employer, for sure, check out Scripta. Here are links to other shows that you should listen to now if you are inspired to take action. I would recommend the shows with Paul Holmes (EP397); Dan Mendelson (Encore! EP385); Andreas Mang (upcoming); Rob Andrews (EP415); Cora Opsahl (EP372); Lauren Vela (EP406); Peter Hayes (EP346); Gloria Sachdev, PharmD, and Chris Skisak, PhD (EP390); and Mike Thompson (EP389). Also Mark Cuban mentions in this show the beverage distributor L&F Distributors. Thanks to Ge Bai, Andreas Mang, Lauren Vela, Andrew Gordon, Andrew Williams, Cora Opsahl, Kevin Lyons, Pat Counihan, David Dierk, Connor Dierk, John Herrick, Helen Pfister, Kristin Begley, AJ Loiacono, and Joey Dizenhouse for your help preparing for this interview. For a full transcript of this episode, click here.   You can learn more at Mark Cuban Cost Plus Drug Company and Scripta Insights. You can also connect with Scripta and Ferrin on LinkedIn.     Mark Cuban has been a natural businessman since the age of 12. Selling garbage bags door to door, the seed was planted early on for what would eventually become long-term success. After graduating from Indiana University—where he briefly owned the most popular bar in town—Mark moved to Dallas. After a dispute with an employer who wanted him to clean instead of closing an important sale, Mark created MicroSolutions, a computer consulting service. He went on to later sell MicroSolutions in 1990 to CompuServe. In 1995, Mark and longtime friend Todd Wagner came up with an internet-based solution to not being able to listen to Hoosiers basketball games out in Texas. That solution was Broadcast.com—streaming audio over the internet. In just four short years, Broadcast.com (then Audionet) would be sold to Yahoo! Since his acquisition of the Dallas Mavericks in 2000, Mark has overseen the Mavs competing in the NBA Finals for the first time in franchise history in 2006—and becoming NBA World Champions in 2011. Mark first appeared as a “Shark” on the ABC show Shark Tank in 2011, becoming the first ever to live Tweet a TV show. He has been a star on the hit show ever since and is an investor in an ever-growing portfolio of small businesses. Mark is the best-selling author of How to Win at the Sport of Business. He holds multiple patents, including a virtual reality solution for vestibular-induced dizziness and a method for counting objects on the ground from a drone. He is the executive producer of movies that have been nominated for seven Academy Awards: Good Night and Good Luck and Enron: The Smartest Guys in the Room. Mark established Sharesleuth, a research and investigation Web site to uncover fraud in financial markets, and endowed the Electronic Frontier Foundation's Mark Cuban Chair to Eliminate Stupid Patents, an effort to fight patent trolls. Mark gives back to the communities that promoted his success through the Mark Cuban Foundation. The Foundation's AI Bootcamps Initiative hosts free Introduction to AI Bootcamps for low-income high schoolers, starting in Dallas. Mark also saved and annually funds the Dallas Saint Patrick's Day Parade, the largest parade in Dallas and a city institution. In January 2022, he started Mark Cuban Cost Plus Drug Company as an effort to disrupt the drug industry and to help end ridiculous drug prices because every American should have access to safe, affordable medicines. Ferrin Williams, PharmD, MBA, is chief pharmacy officer of Scripta. With 15+ years' experience in the pharmacy industry, Ferrin brings a unique perspective to Scripta that spans the retail pharmacy, pharmacy benefit manager (PBM), and broker/consulting sectors. Her expertise ranges from pharmacy operations and services to innovative clinical programs, pharmacy audit, alternative payer funding, and specialty drugs. As chief pharmacy officer, Ferrin leads the company's clinical strategies organization responsible for devising innovative cost-containment strategies for prescription drugs, ensuring Scripta clients, members, and their providers are provided with best-in-class clinical insights and tools. Ferrin earned her bachelor's, Doctor of Pharmacy, and MBA degrees from the University of Oklahoma.   05:41 What was Mark Cuban's own journey as a self-insured employer with Cost Plus Drug Company? 06:56 What did Mark find when he decided to go through and look through his company's benefit program? 08:23 “When you think it through, you start to realize that money is being spent primarily by your sickest employees.” —Mark 09:13 How do you get CEOs and CFOs of self-insured employers to realize that their sickest employees are the ones subsidizing their checks? 12:10 What is the role of insurance in healthcare? 13:42 “If you can't convince them, confuse them and hide it.” —Mark 14:35 The reality behind getting a rebate check. 15:32 Why are rebates going away, and why isn't that changing PBM earnings? 18:17 How do you get CEOs and CFOs to dig into their benefits plan? 20:13 Does morally abhorrent move the needle? 20:47 “What we're trying to do is just simplify the [healthcare] industry.” —Mark 23:33 What's been changing in consumer behavior? 24:18 “Transparency is a huge part of building that trust.” —Ferrin 24:33 Why CEOs and CFOs really have the power to change healthcare. 31:42 What are Cost Plus Drugs' plans to expand? 38:36 Where is the future of the prescription drug market going? 41:25 What will happen to the prescription drug market in 10 to 20 years? 47:56 The wake-up call self-insured employers should be acknowledging now. 51:18 Where is the real change in the healthcare industry going to come from?   You can learn more at Mark Cuban Cost Plus Drug Company and Scripta Insights. You can also connect with Scripta and Ferrin on LinkedIn.   @mcuban and Ferrin Williams provide advice for #CEOs and #CFOs of #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Dan Mendelson (Encore! EP385), Josh Berlin, Dr Adam Brown, Rob Andrews, Justina Lehman, Dr Will Shrank, Dr Carly Eckert (Encore! EP361), Dr Robert Pearl, Larry Bauer (Summer Shorts 8), Secretary Dr David Shulkin and Erin Mistry  

It's our 600th episode! What better way to celebrate than by inviting former hosts Jay Baer and Adam Brown, and previous guest Allison Day, Senior Manager, Social Media at Reddit, on the show to share insights on the biggest platforms, the greatest changes in social and so much more.  Huge thanks to our amazing sponsors for helping us make this happen. Please support them; we couldn't do it without their help! This week: ICUC  Full Episode Details   When we published episode one of Social Pros, we had no idea we would reach 600. It's a milestone few podcasts get to celebrate!  That's why we invited past co-hosts Jay and Adam back on the show to roll back the years. Together with Reddit's Senior Manager, Social Media, Allison Day, they discuss the many changes that social has seen over the years.  Jay, Adam and Allison reveal what they love about TikTok, Instagram Reels, LinkedIn and Twitter/X, share the biggest changes they've witnessed on each platform and tell us what they would do if they were starting out as budding social pros today.   In This Episode:    5:45 – Thoughts on X, LinkedIn and short-form video platforms  21:39 – Why TikTok could become the standard on social  24:41 – The biggest changes in social over the past ten years  27:16 – Gaining trust from leaders  30:05 – Why social media was about social, now it's about media  35:56 – What our social pros would do if they were starting out today  38:52 – Why Jay Baer would start making YouTube content  43:18 – Jay, Adam and Allison answer the final two  Resources  Schedule a consultation with ICUC  Grab your free Social Media Audit Bundle  Connect with Jay Baer on LinkedIn  Connect with Adam Brown on LinkedIn  Connect with Allison Day on LinkedIn  Visit SocialPros.com for more insights from your favorite social media marketers. 

There are two big reasons why I decided to encore this show with Dan Mendelson from Morgan Health at this exact moment in time. 1. It's a great show (one of our most popular shows in the last year, actually) with lots of keen insights for self-insured employers—and by self-insured employers, I mean HR folks, of course, but also CEOs and CFOs. That was foreshadowing for my second reason. 2. It's gonna be an employer CEO/CFO triple play here on Relentless Health Value. Next week on the pod, my guest is Mark Cuban, along with Ferrin Williams from Scripta. And Mark Cuban, spoiler alert, has his own message for CEOs and CFOs of self-insured employers. Then the week after that, we hear from Andreas Mang from Blackstone who shares, among other things, what happens when some company gets bought by Blackstone and that CEO shows up for a meeting with Andreas and that CEO happens to know nothing about their vast, inefficient, and wildly wasteful healthcare spend. And with that, here is your encore. For a physician practice to transform itself from an FFS (fee-for-service) machine cranking out volume but not necessarily health or care, the office has to have a high enough percentage of their patients in value-based arrangements to make it actually feasible to transform. It is only when they hit a tipping point of enough patients in risk-based contracts that they can afford to be accountable for their results. At that point, yeah, everybody wins—doctors, patients, actually the entire community wins because when a local practice transforms, all of their patients tend to benefit at some level from the new processes and procedures and standardizations and pop health systems that get put in place. So, let's move forward with this with all haste, shall we? Why aren't we? What's the problem here? Well, there are lots of problems, don't get me wrong. But a big one is self-insured employers on the whole are not offering any sort of accountable care arrangements to the providers in their community. This is 150 million patient lives we're talking about here—a huge chunk of many providers' patient panels. Self-insured employers have a really big opportunity to level up the care in their whole community due to the spillover effect when a provider practice transforms itself because it has enough patients to do so. But these employers are stuck. They are paralyzed. They are doing the same thing this year that they've done last year, and therefore their whole community is equally stuck in a smorgasbord of suboptimal FFS goings-on. So, offering accountable care contracts is one thing (a very big consequential thing) that is also one of the five things self-insured employers can do to improve employee health that I talk about in this healthcare podcast with Dan Mendelson. Dan Mendelson, my guest today, also wrote a Forbes article listing out these five things. Here are all five things that Dan mentions in one handy list: 1. Expand availability of accountable care models to improve the care experience, quality, and affordability at a local level. For a deep dive on this, listen to the show with Dave Chase (EP374). 2. Invest in the data access needed to assess health outcomes. For a deep dive on this, listen to the show with Cora Opsahl (EP372). 3. Align employees' health benefits with pop health outcomes. For a deep dive on this, listen to the show with Mark Fendrick, MD (Encore! EP308). 4. Prioritize care models that can meet employees wherever they are. For a deep dive on the DEI (diversity, equity, and inclusion) aspect of this, listen to the show with Monica Lypson, MD, MHPE (EP322). 5. Make care navigation a central part of the benefits package and experience. My guest today, Dan Mendelson, is CEO of Morgan Health at JPMorgan Chase. He previously founded Avalere Health. Before that, Dan served as associate director for health at the Office of Management and Budget. Besides exploring the why and the what for each of the five things employers should do right now, I also wanted to find out from Dan what's going on at Morgan Health and how they are looking to help self-insured employers who want to do these five things actually do them.   You can learn more at the Morgan Health Web site.     Dan Mendelson is the chief executive officer of Morgan Health at JPMorgan Chase & Co. He oversees a business unit at JPMorgan Chase focused on accelerating the delivery of new care models that improve the quality, equity, and affordability of employer-sponsored healthcare. Mendelson was previously founder and CEO of Avalere Health, a healthcare advisory company based in Washington, DC. He also served as operating partner at Welsh Carson, a private equity firm. Before founding Avalere, Mendelson served as associate director for health at the Office of Management and Budget in the Clinton White House. Mendelson currently serves on the boards of Vera Whole Health and Champions Oncology (CSBR). He is also an adjunct professor at the Georgetown University McDonough School of Business. He previously served on the boards of Coventry Healthcare, HMS Holdings, Pharmerica, Partners in Primary Care, Centrexion, and Audacious Inquiry. Mendelson holds a Bachelor of Arts degree from Oberlin College and a Master of Public Policy (MPP) from the Kennedy School of Government at Harvard University.   05:01 Why did Dan direct his article about health benefits at CEOs? 06:03 What does an accountable care model mean to a self-insured employer? 07:58 “This alignment of value will never work … if the 150 million Americans … getting their health insurance through their employer are not also aligned in the same way.” 11:28 “We're offering them a higher level of service.” 11:40 “Everything that we do is intended to be scalable and not just for us.” 12:09 “We have an obligation to do better for our employees.” 14:52 “Employers need to understand, the only way to get outstanding care is locally.” 17:28 Encore! EP206 with Ashok Subramanian and EP358 with Wayne Jenkins, MD. 18:18 Why is getting quantitative metric data important? 18:50 Encore! EP308 with Mark Fendrick, MD. 20:58 “This is a much broader vision of accountable care than … primary care.” 22:48 “Until everything is aligned, the employer is just not going to be providing an optimal product.” 23:39 “There are substantial issues with … health equity, and employers are paying for the care of 150 million Americans in this country.” 25:23 Is digital health access important for creating meaningful relationships between patients and providers? 29:50 What is the myth that employers need to tackle? 30:18 Why is care navigation important for employees? 31:44 EP334 with Sunita Desai, PhD.   You can learn more at the Morgan Health Web site.   @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Josh Berlin, Dr Adam Brown, Rob Andrews, Justina Lehman, Dr Will Shrank, Dr Carly Eckert (Encore! EP361), Dr Robert Pearl, Larry Bauer (Summer Shorts 8), Secretary Dr David Shulkin and Erin Mistry, Keith Passwater and JR Clark (Summer Shorts 7)  

Yeah, it's a fact that the vast majority of past and present provider and payer relationships are not exactly collaborative. They may better be described as fairly adversarial, actually—especially when viewed through the lens of provider organizations trying really hard to find a payment model that will enable them to do better by their patients and deliver better outcomes. We've had Justina Lehman (EP414), Ali Ucar (EP362), Dan O'Neill (EP359) talking about this from the provider organization standpoint. We also had Dan Serrano (EP410) and Will Shrank, MD (EP413) corroborating here. But after each of these earlier episodes, many comments and conversations ensued about said potential (or not) payer/provider collaborations. And there was a theme of many of these online exchanges. The theme was wondering if we'd all get laughed at for even talking about these rare and elusive Shangri-la scenarios. Like expending words and energy thinking about payers and providers working together was as crazy as being seen earnestly discussing, I don't know, whether mermaids know about pants or something. And that's why I wanted to get Josh Berlin on the podcast today: to talk about the why, the what, and the how of collaboration. I wanted to know if there really is a solid why here for the why collaborate, especially from a payer point of view. And when I say payer, I mean a payer kind of payer like a Blue Cross, United, Cigna, Aetna plan kind of payer. And I'm calling that out because payers are intermediaries in all cases except for their fully insured members. Except for that one book of business, entities actually taking the risk are taxpayers or self-insured employers. So, saving money on its face is not a super compelling value proposition. Listen to the show with David Contorno (EP339) for the why there. As we talk about in the interview that follows, though, what might be compelling is predictable spend, possibly—or even more compelling could be a competitive differentiation for that payer that leads to higher market share. Payer/provider collaborations can also lead to a more resilient market foothold that can stand up to threats from upstart competitors or big tech and big retail swooping in looking for a tasty slice of this $3 trillion industry. There's also the potential for a higher profit margin. And, oh, one additional reason to collaborate if you're a payer that we don't get into super heavily but I'd be remiss to not mention is the whole Star Ratings thing for Medicare Advantage plans, because stars equal big money. But a payer is not gonna get that Star Rating shekel if providers aren't delivering high enough quality care. Also, of course, we have HEDIS (Healthcare Effectiveness Data and Information Set) and other quality measures that have financial value ascribed to them. In the conversation that follows, Josh talks about different types of collaborations. Collaboration is a really very vague term, so what exactly is this collaboration, what does it entail, and how do you do it? Josh told me that there are five kinds of collaboration, and here they are in order of their depth of entanglement, I guess you could call it. 1. Sharing data back and forth 2. Use that data to identify areas of need and then do something programmatic together, like create clinical pathways or work on one very specific type of quality program. 3. A joint venture (JV)—you JV and work together on some sort of narrow network kind of product 4. Become capital partners in some way. 5. Having a risk-bearing kind of relationship—the provider gets a piece of the premium dollar So, that's the five types of collaboration. But here's the things you've got to tick through, that you have to really go through and make sure you've got all these things before you start. Otherwise, it'll be a monumental waste of time. 1. Complementary capabilities that enable scalability 2. A desire for sustainability in a market, and both have common goals and objectives and an agreed-upon time horizon 3. Both parties need to be pretty flexible. Rigid products have a shelf life. You've got to be willing to advance with market dynamics flexibly—know how to iterate around whatever it is you're doing. 4. Excel at collaboration. If you're going to collaborate, you have to know how to collaborate. And that's a cultural thing. 5. Compatible risk profiles—this means not just “taking risk” but knowing how to do it in a way that will work and navigating around things that could cause trouble when moving from fee for service to a more capitated way of going about things. Josh talks about some of them. Just to loop back around on #4 there, because … yeah, to collaborate, you need to collaborate. I call Josh out on this one, and he reiterates that … yeah, nothing to take for granted here. It might seem obvious, but it's so frequently an internal unknown unknown—at a lot of payers especially. I mean, if I'm a provider organization and you force me to only communicate with you through snail mail (ie, postage stamp, letter box, the whole nine), I don't know, I'd kind of get the vibe that I'm being enthusiastically ignored, which I just cannot square with a collaborative spirit of any kind. Josh Berlin is a founding partner of Rule of Three, which is a consulting firm. Rule of Three has clients that are physician practices, hospitals, health systems on the traditional side; and they also work with nontraditional organizations like Walmart Health and Wellness. They also work with payers, like regional blues and employer plans.   You can learn more at Rule of Three and by connecting with them on LinkedIn.   Josh M. Berlin, JD, is CEO of Rule of Three, LLC, with more than 25 years of experience, most of which has been in healthcare advisory in service to his clients. Most recently, he has served as principal and co-practice leader of Citrin Cooperman's Healthcare Practice and managing partner for IBM Watson Health's Strategic Advisory Practice, leading a unique group of consultants in each instance to serve clients across the full healthcare ecosystem (providers, payers, employers, governments, advocacy, etc). Prior to those roles, Josh served as a principal in the healthcare consulting practice at Dixon Hughes Goodman (now FORVIS), helping to lead their strategy consulting business, and served as a leader in all versions of KPMG (KPMG Consulting/BearingPoint and KPMG). Currently, he serves on the Boards of the Validation Institute, Population Health Management journal, and HealthTrackRx. Josh's expertise spans both the consulting and healthcare industries. Some of his clients have included the Hospital Corporation of America, the Department of Health and Human Services (including the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services), various pediatric health systems, the National Association for Healthcare Quality, Nebraska Medicine, Penn Medicine, the Ochsner Health System/Network, the BJC Collaborative, and The Leapfrog Group, as well as a variety of other healthcare organizations. Josh has developed long-standing client relationships at all levels of organizations, notably including some of the most prestigious C-suite executives in healthcare today.   06:06 Why should payers want to collaborate with providers? 09:46 “Collaboration … is bilateral. … Both sides, plan and provider, should be equally as interactive with the individual populations they work with.” 12:37 What are the must-haves for collaboration between providers and payers? 13:10 What are the five different types of collaboration? 16:03 What are the five characteristics you want to be focused on in partnership? 21:35 EP359 with Dan O'Neill. 22:16 In order to collaborate, do you have to be collaborative? 26:11 Ochsner as a great example of collaboration. 27:46 Episodes with David Carmouche, MD, and Eric Gallagher. 28:51 A collaboration failure in Haven.   You can learn more at Rule of Three and by connecting with them on LinkedIn.   Josh M. Berlin of Rule of Three, LLC, discusses #payer and #provider #collaboration on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare #healthcare   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Adam Brown, Rob Andrews, Justina Lehman, Dr Will Shrank, Dr Carly Eckert (Encore! EP361), Dr Robert Pearl, Larry Bauer (Summer Shorts 8), Secretary Dr David Shulkin and Erin Mistry, Keith Passwater and JR Clark (Summer Shorts 7), Lauren Vela (Summer Shorts 6)  

Ontario Reign Goaltending Coach Adam Brown joins Jared Shafran and Josh Schaefer on the latest episode of The Reign Check.

Have you ever had to give a walnut sized stool sample? That's right, A WALNUT sized? Hopefully, the answer to that is no… Here we have it, episode 415 of the Chris Moyles Show on Radio X Podcast, and guess what? We are record breakers! Yes, there's more of you lovely lot listening to our fart playing antics on Radio X than ever before. On this momentous podcast, we have the return of fan favourite game, 20 Seconds to 20k, and a lot more poo chat than anyone needs to hear over their coco pops. The Hairy Bikers stopped by this week, and while Dave Myers told us the reason he has a meltdown over carrots, they also got down to business and told us the inspirations behind their new recipes. It does appear that one recipe was "stolen" off a lady who cooks in welders goggles, but we trust the Hairies not to poison us. So, go fill up your Pippa Taylor inspired gigantic water bottle and click that play button to here those best bits, as well as:Captain Crapbeard plays 20 Seconds to 20 PintsPippa tells Adam Brown he is a bearHappy Endings - the Hairy EditionEnjoy!The Chris Moyles Show on Radio XWeekdays 6:30-10am

Now, I'm being pretty careful here because med schools are super sensitive about their curriculums. And I am sensitive to the fact there's much to teach in four years. So, throwing no shade here, what do I know from the Krebs cycle? Choices of what to teach are tough. With that disclaimer, in this healthcare podcast I am speaking with Adam Brown MD, MBA, about an article he wrote entitled “Dear Medical Schools, Educate Students on the Business of Medicine—Without it, you are doing your students a disservice.” Let me give you Dr. Brown's list for the “why teach the business of medicine.” He says: 1. The role of physicians in medicine has changed, and we dig into this in the episode. 2. There's an expectation mismatch. Docs are investing 10 years and, on average, $200K to $300K in real dollars to get that MD or DO. You don't want those new physicians quitting on the quick because the reality is so different from what they thought it would be. Not being up front about the business of medicine is like hiding the reality of the situation instead of preparing them. 3. If you don't understand the business of medicine, you do not know how to advocate for yourself or the profession or even patients in a way that is compelling to the current set of decision-makers. As maybe a corroboration here, may I just report that I probably have gotten (conservatively) 100, 150 emails and LinkedIn notes from physicians who say basically some version of the same thing: Thanks so much for Relentless Health Value. I wish I would have learned even the basics of what you cover in med school. If I had, I would have been able to help myself and help myself help patients far better. 4. Docs are the ones with the prescription pads. Docs are just functionally the gang who are driving costs that patients and employers and taxpayers ultimately incur. Not knowing the how much or just the whole story here can inadvertently contribute to clinical morbidity, because patients who fear they cannot afford care do not follow doctors' orders. We should get real about that. Or if they do follow doctors' orders and go into debt … I mean, there's just study after study in oncology and otherwise that shows patients who cannot afford their care have worse outcomes. We cannot hide from this any longer. 5. The last reason is that there's lots of things that docs can do besides just be at the bedside. Not giving insight into these alternative paths seems unfortunate for any doc who maybe wants to mix it up some because they're feeling burned out or in a different season of their life looking for something more aligned with where they are as a person. So, now let's think about this whole question from the standpoint of the system itself—from the standpoint of doing better by patients. Why is it important to teach docs the business of medicine? Let's start here. When physicians do not understand the business of medicine, it's harder for docs to get into boardrooms and have their voices heard. Not teaching the business of medicine in med school might be one reason why there is such a shockingly small percentage of doctors on the boards of directors at major nonprofit hospitals (listen to the show with Suhas Gondi, MD, MBA [EP404]) and why there's so little “dyad leadership” in the ranks of both clinical and payer organizations, etc. And even fewer nurses are in organizational decision-making roles, by the way, despite nurses actually being the most trusted profession—even more trusted than doctors by 14 percentage points, according to Gallup. One way to interpret this lack of docs and other clinicians in the boardroom is simple cause and effect. Doctors are losing control and ownership—and I mean this in literal terms—of the organizations that run the business of medicine, which controls the medicine of medicine. Chad Erickson wrote a comment about this on LinkedIn that I thought was great. He wrote, “Opportunities for physicians to really control or even impact the 86% of healthcare outside of their practice are being reduced every year. We expect doctors to make the decisions and be accountable for patients and outcomes, yet we are taking away their ability to do so.” And going one level deeper here on how not having enough docs in admin roles becomes a snowball rolling downhill kind of downward spiral, I'm gonna quote Jeremy Granger, MD, FAAP. He wrote, “When you are a physician administrator, it can be very strange. There is tremendous pressure from administrators to think and act like one of them and give insight into how to best coerce physician behavior to align with administrator-determined goals without necessarily involving the physician with setting those goals. When you advocate instead with your physician hat, you can find yourself ostracized from that administrator clique. You realize that they view physicians as knaves and you as the Judas goat. You either pick a side or, if you're lucky, you land with a team that has physician leaders equipped with equal power as administrators.” So, you see what happens. Doc gets an admin role and either chucks their stethoscope and their patient-first mindset out the window to fit in, or they quit. And then we never get to any sort of critical mass of clinicians in leadership roles that would reset the organizational ethos. So, here we are. Too few mission-driven and business-savvy docs in boardrooms mean patients get the kind of care they're currently getting and at the prices we're all currently paying. From the standpoint of doing better by patients, I hear story after story about some doc who was under the impression that, I don't know, working with a private equity firm to do a roll-up of all the specialty practices in a local market was pretty cool and a totally victimless strategy. Or the surprisingly high number of docs prescribing drugs on that most wasteful spending list. There's one on that list, for example, that costs taxpayers or an employer $2000 when that drug consists of basically two $15 over-the-counter meds mashed together—and yet there's the impression that the $2000 drug is a better financial choice because there's a co-pay card and the patient out of pocket might conceivably be less … until it isn't, of course, because it's not like that additional $1970 in cost suddenly becomes free. Or what happens when a clinician is told to order largely unnecessary MRIs because workers' comp covers everything and no one cares—so this kind of thing continues to just happen … all this stuff. It takes a broader understanding to get the why and create the intrinsic motivation and necessary insight and right language and arguments to make things better. But all of this is about patients. If I'm talking to margin-driven people sitting around the conference room table with their calculators, are there any organizational consequences, meaning financial consequences, to not making sure doctors understand business and have a seat at the table? Here's two (there's probably more): 1. Staff turnover. If that's a concern for any organization now, and if moral injury is cited as a reason for that turnover (which it often is), moral injury doesn't happen when organizational demands are aligned with clinician values. 2. Successful value-based care isn't gonna happen if docs don't understand the business of medicine. Listen to the show with Eric Gallagher (EP405) or the one with Amy Scanlan, MD (EP402) or Larry Bauer (EP409). There's like 10 guests who essentially say the same thing. Docs who are in the dark about how the world actually works IRL cannot be an aligned force helping move past the FFS (fee-for-service) status quo and the whole business model that underpins that. Adam Brown, MD, MBA, my guest today, is a practicing emergency physician, board-certified ER doc. He recently founded ABIG Health, working with healthcare companies on communication strategies and advising investment firms. He's also a professor of practice at the University of North Carolina, Chapel Hill. Mentioned in this episode is a Tweet by Brendan Keeler. Also, Dr. Denver Sallee's very inspirational predictive scheduling work. I'll leave the last word on this to Michael R. O'Brien, MD: “You don't overcome the corrupting influence of money in medicine by ignoring its existence. … To slay the dollar-eyed dragon, we must be able to see like the dollar-eyed dragon.”   You can learn more at ABIG Health and by reading Dr. Brown's bimonthly column.     Adam Brown, MD, MBA, is a board-certified emergency physician, entrepreneur, and accomplished healthcare executive whose professional journey traverses clinical practice to strategic leadership. Having risen through the ranks at Envision Healthcare, Dr. Brown's tenure there culminated in his role as president of emergency medicine, where he spearheaded the COVID-19 response and clinical communications. His impactful leadership led to his appointment as chief impact officer in 2021. In 2022, Dr. Brown left Envision and established ABIG Health, a healthcare strategic advisory firm. Additionally, he took on the mantle of professor at the University of North Carolina, Chapel Hill, Kenan-Flagler School of Business (his alma mater), teaching healthcare operations and strategy to MBA students. He is the advisory board co-chair at the Center for the Business of Health and on the business school Board of Advisors. A frequent media presence, Dr. Brown has been featured on CBS, Yahoo Finance, BBC, and local Washington, DC, outlets, speaking on various healthcare issues. His column, “Prescriptions for a Broken System” in MedPage Today, showcases his commitment to meaningful change in healthcare. His passion for empowering informed health decisions shines through his roles as a communicator, leader, and strategist. A recognized thought leader, his ability to connect, envision, and lead underscores his impact on shaping healthcare.   08:49 What does it mean to teach the business of medicine? 11:04 The four Ps that are key within the business of medicine. 13:27 Why is it important for doctors to understand the business of medicine? 21:46 “Things don't happen without a physician's signature.” 27:27 Why physicians who understand the business side of medicine can broaden the view of outcomes for the business decision-makers. 28:30 Why is it important to make sure physicians are in the boardroom? 29:36 EP404 with Suhas Gondi, MD, MBA. 30:52 “We are getting what we designed.” 33:37 Dr. Brown's advice for clinicians in the boardroom. 38:21 The work of Denver Sallee, MD, MMM, using artificial intelligence to do predictive scheduling.   You can learn more at ABIG Health and by reading Dr. Brown's bimonthly column.   @ERDocBrown discusses teaching the business of #medicine on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare #healthcare   Recent past interviews: Click a guest's name for their latest RHV episode! Rob Andrews, Justina Lehman, Dr Will Shrank, Dr Carly Eckert (Encore! EP361), Dr Robert Pearl, Larry Bauer (Summer Shorts 8), Secretary Dr David Shulkin and Erin Mistry, Keith Passwater and JR Clark (Summer Shorts 7), Lauren Vela (Summer Shorts 6), Dr Jacob Asher (Summer Shorts 5)  

This week we run Play Ball! by Robin Caufield. The Good Clean Baseball High School Protagonists are FINALLY back in the playoffs! Assuming they can rally their team back together to face the defending champion Fort Pitt Bulls... This week's cast! Adam Brown as Mitch Salmon (Backup Turned Starter Pitcher) Jenny Nordine as Sleve McDichael (Utility Outfielder) Jacob Moore as Mark George (Captain Catcher) Ricky Gray Jr as Donny George (Injured Outfielder) Play Ball! is available for free on itch.io! This week we are happy to feature our friends at Two Monsters Rolling Dice! A comedy AP Podcast being played in the cinematic Fate: Core system! We are also happily sponsoring the fine folks at The AARPG Podcast! Seasoned and deeply serious RPG veterans playing a hilarious adventure! Bellas Comet is coming www.bellascomet.com