Podcasts about avalere health

As AI becomes a more integrated part of our daily lives, it is vital that we consider all stakeholder perspectives to enable us to better foster collaboration for effective AI integration in scientific publishing. In this episode we will explore AI's transformative impact on the creation and dissemination of scientific content, addressing the real-world challenges and diverse perspectives needed to harness its full potential. By considering the opportunities and barriers  (real and perceived) to AI adoption, we can distinguish how these challenges vary among stakeholders from a pharma, publisher, and patient advocate perspective. . Joining us for this conversation is Stephen Griffiths, Publications Head at GSK; Stephanie Preuss, Director of Content Innovation at Springer Nature; and Stephen Rowley, Patient Advocate and Director at Artension.To join ISMPP, visit our website at https://www.ismpp.org/ This episode is generously sponsored by Avalere Health.

Avalere Health has united its 1,500-plus experts in a single mission to ensure every patient is identified, supported, treated and cared for equally. Every Patient Possible is about tackling the issues that are important for patients, no matter who they are or where they live, and creating solutions that drive change for every patient everywhere.During a recent MM+M podcast, Marc Iskowitz, editor-at-large of MM+M, sat down with Amar Urhekar, CEO, Avalere Health, and Ryan Mason, chief strategy officer, Avalere Health, to discuss what Every Patient Possible means and how the organization is uniquely positioned to make an impact. Check us out at: mmm-online.com Follow us: YouTube: @MMM-onlineTikTok: @MMMnewsInstagram: @MMMnewsonlineTwitter/X: @MMMnewsLinkedIn: MM+M To read more of the most timely, balanced and original reporting in medical marketing, subscribe here.

Scientific posters are evolving—are you keeping up? In this episode, host Rob Matheis sits down with Doreen Valentine, a medical communications professional most recently affiliated with Bristol Myers Squibb, to explore how innovation is reshaping the way research is presented. From interactive design to greater accessibility, they discuss what's changing, why it matters, and how we can balance progress with scientific integrity.To join ISMPP, visit our website at https://www.ismpp.org/ This episode is generously sponsored by Avalere Health.

Matt Sauter Linkedin Interview with Health Marketing Collective  

The Evolution of Creating Better Workplace Experiences Host: Mervyn Dinnen Guest: Nick Holmes, VP of Employee Experience at Avalere Health In this episode Mervyn Dinnen talks to Nick Holmes, VP of Employee Experience at Avalere Health, and recently named one of the 10 most influential thinkers in HR Technology by CIO Business World magazine.  During the conversation they cover: Creating meaningful and remarkable work experiencesThe importance of addressing wellbeing in the workplaceTaking a scientific approach to employee healthUsing data driven insights to revolutionise employee wellbeingGathering and acting on employee feedback to improve the 'moments that matter'Adopting long term initiatives to drive continuous improvement Thanks for listening! Remember to subscribe to all of the HR Happy Hour Media Network shows on your favorite podcast app!

Check us out at: mmm-online.com   Follow us:  YouTube: @MMM-online TikTok: @MMMnews Instagram: @MMMnewsonline Twitter/X: @MMMnews LinkedIn: MM+M   To read more of the most timely, balanced and original reporting in medical marketing, subscribe here.

For a full transcript of this episode, click here. This conversation I am having with Dan Mendelson, my guest today, all started with a post that he had written on LinkedIn considering how pharmacy benefits can or should be optimized within the broader context of value-based care. Total cost of care, value-based medical care, and pharmacy benefits—these worlds have to collide. There is just so much intertwined into all of this, which is why I pretty much immediately invited him to come back on the pod to discuss in greater detail. A few years ago, I heard a doctor say that practicing medicine without considering pharmacy is like getting to the 90 yard line, putting down the ball, and walking off the field. And, yeah … when a patient gets to a certain point in a whole lot of disease progressions, optimal medical therapy includes pharmacy. It's a thing. Adherence is a thing. In fact, I saw a stat the other day that patients not taking their meds costs an estimated $3874 PEPY (per employee per year). Also, half of all hospital admits are caused by nonadherence. Those two stats, by the way, are from a post on LinkedIn by Brian Bellware, who was recapping a video from Eric Bricker, MD. But also, as Barbara Wachsman (EP430) said on the show, half, I think she said, of all ER visits are due to patients not taking their meds right. Olivia Webb (EP337) was on the pod, if you want to go back and listen to that one, talking about how she spends hours every month trying to figure out how to navigate access issues to manage to get her Crohn's disease drug. So, yeah … one underlying reason why a lot of this stuff happens is that pharmacy benefits are purchased and siloed a lot of times. In fact, I have yet to see, really, any mainstream contract wherein a PBM (pharmacy benefit manager) is held accountable in any way for downstream medical costs, which may be incurred because of suboptimal pharmacy benefit design, right? And there are so many examples of bad downstream medical impacts. I really like how Mark Fendrick, MD, put it in episode 308. He said benefits, including pharmacy benefits, are like peanut butter and jelly relative to enabling high-quality care. You gotta have both working in concert, like CMS or a plan sponsor just paid a ton of money to get a patient an organ transplant, and then the patient can't afford their transplant meds, which aren't on formulary and are really expensive, and therefore there's organ rejection. This happens. Or a patient with uncontrolled diabetes with a huge co-pay for insulin. Doctor says, “Hey, you gotta take your insulin.” Patient says, “Can't afford it.” Right? This makes no sense, and it's shockingly common. I'm thinking right now of that young man who died in the Midwest because he could not get his asthma inhaler. It wasn't on formulary. So, here's the game plan. I talk with Dan about the five kind of vital considerations he had brought up in that aforementioned LinkedIn post when considering how pharmacy benefits can or should be optimized within the broader context of value-based care. Dan's advice for the pharma industry is woven in here as much as his advice for EBCs (employee benefit consultants) and employers. I am sure that most of our listeners are going to be very familiar with Dan Mendelson, my guest today, and his work; but the quick background here is that he runs Morgan Health. The mission over there at Morgan Health is to drive innovation in employer-sponsored healthcare, and they do that by investing and working with their portfolio companies in the context of the 300,000 or so employees over at JPMorgan Chase. At the same time, Morgan Health also engages in policy discussions because, as Dan says, no one employer is going to control public policy. As a footnote here, I just will say that I actively seek out opportunities to listen to Dan Mendelson's thoughts. He has spoken a lot and really eloquently and with great insight about setting up the economic models for healthcare, not sick care. Recently, actually, he was on a panel at the Milken conference along with Natalie Davis; Yele Aluko, MD, MBA; and Henry Ting, MD. There are definitely insights to be gleaned. Also mentioned in this episode are Brian Bellware, CIC, CHVP; Eric Bricker, MD; Barbara Wachsman; Olivia Webb; Mark Fendrick, MD; Natalie Davis; Yele Aluko, MD, MBA, FACC, FSCAI; Henry Ting, MD; Ashok Subramanian; Rik Renard; Nina Lathia, RPh, MSc, PhD; Don Berwick, MD; Kenny Cole, MD; Steve Pearson, MD, MSc; Sarah Emond; Alex Sommers, MD, ABEM, DipABLM; and Jodilyn Owen. You can learn more at the Morgan Health Web site and follow Dan on LinkedIn.   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.   04:50 How do we connect the dots between value-based care and pharmacy benefits? 07:43 Where do things need to go for employers in terms of drug spend integration? 08:42 How do we think about having a value-based component in the decision-making process? 09:44 How do we enable the necessary information to make proper decisions? 10:56 EP206 with Ashok Subramanian. 11:21 “Many payviders just haven't gotten to pharmacy yet; they need to.” 14:14 Why do pharmaceutical companies need to be prepared to contract on the basis of value? 16:46 EP426 with Nina Lathia, RPh, MSc, PhD. 17:36 EP431 with Kenny Cole, MD. 18:07 Why is it important to “let the market work”? 21:04 Why do we have cost sharing, and when does it not make sense to have that as a co-pay? 23:59 Why are evidence requirements good for everyone? 28:45 Why is pooling of risk important? 29:49 How do you pool risk without going to an insurance company? 32:03 What is Dan's advice to hospitals? 33:30 “In a value-based world, buy and bill does not make sense.” 33:36 What is Dan's advice to primary care doctors? 33:54 What is Dan's advice to entrepreneurs and innovators?   You can learn more at the Morgan Health Web site and follow Dan on LinkedIn.   @dnmendelson discusses #pharmacybenefits on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Benjamin Schwartz, Justin Leader, Dr Scott Conard (Encore! EP391), Jerry Durham (Encore! EP297), Kate Wolin, Dr Kenny Cole, Barbara Wachsman, Luke Slindee, Julie Selesnick, Rik Renard

The evolution of customer engagement across all verticals has led to significantly greater expectations of brands to understand, support, and relate to both HCPs and patients. Brands must continually understand the needs of their customers by sensing change and adapting dynamically in order to thrive. This podcast looks at how to leverage advancements in data, technology, AI and content development in order to become a Living Brand. Check us out at: mmm-online.com Follow us: YouTube: @MMM-onlineTikTok: @MMMnewsInstagram: @MMMnewsonlineTwitter/X: @MMMnewsLinkedIn: MM+M To read more of the most timely, balanced and original reporting in medical marketing, subscribe here.

Mike Cheek, CEO with SNP Alliance which is dedicated to improving policy and practice for frail, disabled, and chronically-ill beneficiaries. Cheek came to the SNP Alliance from his role as the Senior Vice President for Reimbursement and Market Strategy for the American Health Care Association/ National Center for Assisted Living (AHCA/NCAL). Prior to this role he was the director of Medicaid Long Term Care for the District of Columbia's Medicaid agency, the Department of Health Care Finance. In addition, Mike has worked for three state government associations: the state Medicaid directors where he focused on eligibility and long-term care, the state developmental disabilities directors, and the state aging directors. Mike also worked as a consultant for several years, first at The Lewin Group and later at Avalere Health, offering his expertise to states, health plans, pharmaceutical companies, and post-acute and long-term care provider organizations.https://snpalliance.org/

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)  

***Note: The views that the guest, Christina Badaracco, expresses are from her own perspective and not of the company's*** In today's episode, we welcome Christina Badaracco, a registered dietitian and a dedicated researcher and advocate aiming to transform healthcare through nutrition. She discusses her mission to elevate the role of nutrition services in healthcare through her healthcare consulting work and to promote better health through our food system more broadly. We'll discuss the importance of agriculture in promoting healthy diets, the need to better prevent and treat diet-related conditions through food is medicine and other nutrition interventions, and tactics for changing our healthcare system to better promote health for all Americans. Christina Badaracco is a healthcare consultant at Avalere Health, focusing on evidence generation, quality measurement, and elevating the role of nutrition in healthcare. She also regularly writes, teaches, and presents about nutrition, culinary medicine, and sustainable agriculture. “I think learning about, at least to a basic level, the latest nutrition science and evidence itself, looking for ways to bring in the nutrition experts to provide that most effective care, and then really understanding the most effective means of delivering the education and empowering patients to really prioritize nutrition.” On This Episode You Will Learn: The Tie Between Grassroots Experiences and Goal of Improving Health through Nutrition Farm Bill: Contributions to Healthy and Sustainable Food Core Gaps that Still Exist How can Healthcare Professionals Help Prioritize Nutrition? Ideal World: Healthy and Sustainable Food Connect with Yumlish! Website Instagram Twitter Facebook LinkedIn YouTube Connect with Christina Badaracco! Website Instagram  The Farm Bill: A Citizen's Guide SciProfiles Advocating For a Citizen's Farm Bill Why Current 'Food Is Medicine' Solutions Are Falling ShortSpeaking Engagements --- Send in a voice message: https://podcasters.spotify.com/pod/show/yumlish/message

On July 6, Medicare expanded coverage for new Alzheimer's Disease treatments under their Coverage with Evidence Development (CED) policy. Here, we will discuss how CMS, is operationalizing its policy through the recently launched Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease CED Study Registry. Opening Speaker Gary A. Puckrein, PhD President and Chief Executive Officer National Minority Quality Forum Dr. Puckrein is the Founder, President and Chief Executive Officer of the National Minority Quality Forum (NMQF) — formerly the National Minority Health Month Foundation—a not-for-profit organization that he founded in 1998. NMQF addresses the critical need for strengthening preventable illness in minority populations through prevention, early detection, and control of disease complications. In April 2001, the National Minority Health Month Foundation launched National Minority Health Month in response to Healthy People 2010, the national health promotion and disease-prevention initiative. NMQF has received support from a wide variety of organizations, including federal agencies, pharmaceutical companies, payers, and trade associations. With support from the U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation, NMQF undertook the Zip Code Analysis Project, developing a comprehensive database that links vital statistics and other elements—including demographic, environmental, claims, prescription, laboratory, hospital, and clinic data—in a centralized data warehouse, organized around zip codes. The Zip Code Analysis Project has enabled NMQF to develop the Health Assessment Tool, which measures and forecasts health status in small geographic areas, evaluates the impact of specific interventions, monitors changes in health outcomes, and undertakes risk assessments (health-care utilization and its financial implications). NMQF uses the Health Assessment Tool to stratify communities by geographic and health-status referents and to provide the health-disparities movement with a common set of indicators to measure and report on progress toward the elimination of disparities in health care and health status. Dr. Puckrein graduated Phi Beta Kappa from Brown University, where he received his master's degree (1974) and doctorate (1978). Between 1974 and 1992, he taught and lectured at Roger Williams College, Brown University, Connecticut College, and Rutgers University, where he was a tenured member of the faculty. Dr. Puckrein has received many awards and honors, including being named a visiting scholar and fellow at the Smithsonian's National Museum of American History and a visiting fellow at Princeton University. Speaker Amanda Bartelme, BS Executive Director, Policy Eisai, Inc. Amanda Bartelme is the Executive Director, Policy at Eisai, Inc. In her role, she serves as Eisai's lead on all engagement with the Centers for Medicare and Medicaid Services, with a particular focus on ensuring Medicare beneficiaries have appropriate access to treatments. She provides internal support on issues related to access, reimbursement, and drug pricing and represents Eisai on key PhRMA and BIO workgroups focused on drug pricing, access and reimbursement. She joined Eisai in May 2022. Prior to joining Eisai, Amanda held policy roles at GSK, supporting access to vaccines, oncology, respiratory, rheumatology, HIV, and Covid treatments; and at Baxalta where she focused on hemophilia, oncology, and plasma-based therapies. Amanda began her career in health policy and reimbursement at Avalere Health, where she spent over a decade working on access for drugs, devices, and services with a special focus on physician administered drugs, diabetes, biosimilar payment policy, and the 340B program, and the evolving drug pricing and payment landscape.

Richard Hughes, IV, JD, MPH, is a partner at Epstein Becker Green where he provides legal and strategic counsel to biopharmaceutical and other clients with a particular emphasis on vaccines, prevention, and early intervention.  He is also a professorial lecturer in law at The George Washington University Law School where he teaches vaccines and preventive services law.  Richard returned to EBG last year after serving Vice President of Public Policy at Moderna during the COVID-19 pandemic and as Managing Director at Avalere Health where he built and led the Vaccines Team. He previously held roles with Merck and the Association of State and Territorial Health Officials, and as a gubernatorial appointee to the Arkansas State Board of Health.  As a nationally recognized vaccine thought leader, he has led many efforts to expand access to vaccines and preventive services and improve public health outcomes. https://www.linkedin.com/in/richardhughesiv/ Learn more about Emily's work helping health tech and life sciences lawyers find their dream careers at her website, or on her LinkedIn profile. 

Lindsey Spindle serves as President of the Samueli Family Philanthropies and Chief Operating Officer of H&S Ventures which oversees all the Samueli Family's for-profit and not-for-profit activities. The philanthropic entities operating under the oversight of H&S Ventures include the Samueli Foundation, the Anaheim Ducks Foundation, the San Diego Gulls Foundation, the Irvine Ice Foundation, and The Rinks Foundation.Spindle was President of The Jeff Skoll Group, where she connected and advised Mr. Skoll's entrepreneurial portfolio of philanthropic and commercial organizations that include the impact entertainment company Participant, Capricorn Investment Group, and the Skoll Foundation. She was the first-ever Chief Communications and Brand Officer of Share Our Strength, a national nonprofit focused on ending childhood hunger in America through its groundbreaking No Kid Hungry campaign.Before focusing on domestic hunger eradication, Spindle spent nearly 20 years in health care communications, policy, and government relations working for some of the nation's most respected commercial and non-profit organizations. These include Georgetown University, Brookings, Avalere Health, and Porter Novelli. Lindsey currently serves on the Boards of Directors for the Skoll Foundation, World Central Kitchen, and advises the Shoah Foundation.Erin Samueli serves as the Director of Social Justice Philanthropy for the Samueli Foundation. She leads the Foundation's overall Social Justice portfolio with focus on its priorities to support grassroots organizing and organizations led by and for BIPOC and/or communities impacted directly at the intersections of gender/sexual justice, racial, economic and social justice, criminalization, reproductive rights and models for community justice. She also oversees the Foundation's collaboration with partners and programs that promote diversity, equity, inclusion and access by building empathy, cultural competency and reducing stereotypes. Erin was born and raised in Southern California. She earned a Bachelor of Science in Science Education from Boston University in 2017, then a Master of Arts in Education from Stanford University in 2019. She was a middle school science teacher in the San Francisco Bay Area for a number of years and in her teaching, she focused on equity, anti-racist practices, and hands-on learning experiences. Aside from teaching, Erin began her philanthropy journey by joining the Maverick Collective, where she worked closely with a team in Ethiopia with the goal of integrating adolescent reproductive health care into the school system.  Erin is passionate about reproductive justice, LGBTQ+ equality, racial justice, education, the environment, among more. She uses these social justice lenses as ways to view her work with the ultimate goal of leveling the playing field in America, and globally, so philanthropy is no longer a necessity. Adjust Accordingly: Placing Equity into Practice is a series of discussions about personal experiences of inequity and how industries, organizations, and people are working to move equity forward.Each conversation will highlight the challenges, opportunities, and strategies for confronting these issues in our communities while collectively progressing toward a more equitable future.Produced with Orange County Grantmakerswith support from Orange County Community Foundation.Guests: Lindsey Spindle and Erin SamueliHosts: Jon-Barrett IngelsProduced by: Past Forward

If you listened to the show with Dan O'Neill (EP359), you would know this already. But let me tell you: If you're a provider, even a provider very confident in your office's ability to confer better patient health, you will still have a super hard time getting off the fee-for-service (FFS) hamster wheel. Why? Because it's hard to find payer contracts out there which will reward you (the provider) for actually taking care of your patients and to be accountable for the value of healthcare that you deliver. This is a tangled web we weave because, despite some payers offering risk-based contracts, a lot of times there's some IPA (independent physician association) or other “holder of the actual payer contract” who does not pass along these contract terms. These IPAs or health systems even sometimes just keep paying docs or provider offices FFS even if they themselves have a risk-based or capitated or value-based-of-any-kind agreement. If I actually kept track of the issues raised in the emails I receive from docs, there's one thing that I would likely find amongst the most frequently cited points of consternation: Physicians or practices or CINs (clinically integrated networks) or ACOs (accountable care organizations) want contracts where they can do right by patients. These are the good docs. These are the ones burned out and suffering from moral injury because physicians, PAs (physician assistants), nurses, clinicians who actually follow up and coordinate care and spend time making accurate diagnoses instead of cramming in more procedures … these are the clinicians who want to do the right thing and are also the ones who are getting dinged on performance reports and paid less. Bottom line here, for a physician practice to transform itself from an FFS 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 volume, 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: 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). Invest in the data access needed to assess health outcomes. For a deep dive on this, listen to the show with Cora Opsahl (EP372). Align employees' health benefits with pop health outcomes. For a deep dive on this, listen to the show with Mark Fendrick, MD (Encore! EP308). 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). Make care navigation a central part of the benefits package and experience. I am looking for an expert to take a deep dive on care navigation who does not work for a care navigation company. Hit me up if you know someone (again, who does not work for a care navigation company). 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.   05:53 Why did Dan direct his article about health benefits at CEOs? 06:56 What does an accountable care model mean to a self-insured employer? 08:50 “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.” 12:21 “We're offering them a higher level of service.” 12:32 “Everything that we do is intended to be scalable and not just for us.” 13:01 “We have an obligation to do better for our employees.” 15:44 “Employers need to understand, the only way to get outstanding care is locally.” 18:21 Encore! EP206 with Ashok Subramanian and EP358 with Wayne Jenkins, MD. 19:10 Why is getting quantitative metric data important? 19:42 Encore! EP308 with Mark Fendrick, MD. 21:50 “This is a much broader vision of accountable care than … primary care.” 23:41 “Until everything is aligned, the employer is just not going to be providing an optimal product.” 24:32 “There are substantial issues with … health equity, and employers are paying for the care of 150 million Americans in this country.” 26:15 Is digital health access important for creating meaningful relationships between patients and providers? 30:43 What is the myth that employers need to tackle? 31:10 Why is care navigation important for employees? 32:37 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 Why did Dan direct his article about health benefits at CEOs? @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast What does an accountable care model mean to a self-insured employer? @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast “This alignment of value will never work if the 150 million Americans getting their health insurance through their employer are not aligned in the same way.” @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast “We're offering them a higher level of service.” @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast “Everything that we do is intended to be scalable and not just for us.” @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast “We have an obligation to do better for our employees.” @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast “Employers need to understand, the only way to get outstanding care is locally.” @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast Why is getting quantitative metric data important? @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast “This is a much broader vision of accountable care than … primary care.” @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast “Until everything is aligned, the employer is just not going to be providing an optimal product.” @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast “There are substantial issues with … health equity, and employers are paying for the care of 150 million Americans in this country.” @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast Is digital health access important for creating meaningful relationships between patients and providers? @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast What is the myth that employers need to tackle? @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast Why is care navigation important for employees? @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast Recent past interviews: Click a guest's name for their latest RHV episode! Wendell Potter, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein

In this episode of AUHSD Future Talks, Superintendent Matsuda interviews Samueli Family Philanthropies President, Lindsey Spindle.  During the talk, Ms. Spindle discusses her story and drivers, food insecurity, food deserts, her work in the "truth" campaign, food as medicine, the connection to AUHSD's Magnolia Agriscience Community Center/Biotechnology Pathway/iLab, and advice to students.With a career singularly motivated by achieving social impact, Ms. Spindle brings a depth and breadth of experience spanning philanthropy, business, not-for-profits, impact investing, entertainment, brand management, government relations, and communications.The common thread in Spindle's career is her dedication to shaping organizations and campaigns that improve people's lives, particularly women and children. She was the first-ever Chief Communications and Brand Officer of Share Our Strength, a national nonprofit focused on ending childhood hunger in America through its groundbreaking No Kid Hungry campaign. Under her leadership, The No Kid Hungry campaign won PR Week's prestigious Non-Profit Campaign of the Year in 2015, increased participation in federal meal programs by several million children year over year, and helped elevate childhood hunger to being a top 10 issue the public identified as “solvable.”Before focusing on domestic hunger eradication, Ms. Spindle spent nearly 20 years in health care communications, policy, and government relations working for some of the nation's most respected commercial and non-profit organizations. These include Georgetown University, Brookings, Avalere Health, and Porter Novelli. Throughout her career, Spindle has shaped major national campaigns such as the groundbreaking ‘truth' campaign that curbed youth smoking by 30% in one year; increased patient safety through reduced medical errors; and secured bipartisan Congressional funding for improving health care safety and quality.

In the 14th episode of BYOB: The Healthcare Podcast, the team sits down to speak with Morenike Ayo-Vaughan who represents The Commonwealth Fund. Morenike details the amazing origins of the organization as it was among the first private foundations started by a woman philanthropist, Anna M. Harkness, established in 1918 with the broad charge to enhance the common good. The mission of the fund today is to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, and people of color. Tune in to hear from the amazing work that Morenike does at TCF! Morenike Ayo-Vaughan – Program Officer at Commonwealth Fund Morenike Ayo-Vaughan, MHSA is currently the Program Officer for the Advancing Health Equity program at the Commonwealth Fund. She is responsible for supporting the Vice President of Health System Equity, who leads the Advancing Health Equity program, and coordinates the overall work and efficiency of the team. Most recently Ayo-Vaughan served as senior manager at Avalere Health, where she was responsible for serving myriad health care clients who sought the advancement of health equity and improvement in patient access to optimal care. She also was responsible for conducting literature reviews and key informant interviews and synthesizing findings and feedback from the advisory committee to inform the goals and strategies of Avalere's Health Equity Fund. Prior to Avalere, Ayo-Vaughan served as practice operations associate at Privia Health. She has an M.S. in health systems administration from Georgetown University and a B.S. in public health from Temple University. The crew asked Morenike the following questions: For our listeners who may not be aware, can you speak to the great work that The Commonwealth Fund does and who they are? You currently serve as a Program Officer, Advancing Health Equity at The Commonwealth Fund. What does your work entail? How has the dynamic of health equity changed throughout your career? What encouraged you to pursue healthcare administration? Can you speak about your education and career path? Your background has been in a myriad of avenues in healthcare, can you talk to us about what led to your decisions to follow the opportunities and organizations you have? Talking with Nakin – Expansion of Amazon Care Nationwide Amazon Care launched primarily as a pilot program in 2019 for employees, designed to provide free telehealth visits and low-cost in-home visits for employees. Amazon Care's in person offerings exist in 8 cities and plan to expand to 20 more by the end of the year. Even though Amazon Care is entering a crowded market, the news was somewhat bullish for Amazon with competitor Teladoc dropping 6% when the news was announced The crew debates the impact of Amazon expanding its healthcare presence and what the onslaught of primary care entrants means for patients across the country. Grab a drink and join us for another episode of BYOB: The Healthcare Podcast! Please give us some feedback via our Survey: https://forms.office.com/r/bZ8MHEDXNc --- Send in a voice message: https://anchor.fm/byob-health/message

As the nation and world continue to grapple with COVID-19, there is much to learn about how to improve our health preparedness in the midst of crisis. Nashville is one of the first communities in the nation to do a comprehensive review of lessons learned from Nashville's health, business and community response to the pandemic.   Today, we're going to share with you highlights of this review, with takeaways that all cities and communities nationwide should be considering as they assess, plan, and prepare for future.   I'm joined by Meharry Medical College President Dr. James Hildreth, a member of President Biden's COVID-19 Health Equity Task Force, and Dr. Leana Wen, an emergency physician, former Health Commissioner of Baltimore, and a senior adviser to Avalere Health.  Both have played important roles in Nashville's Covid-19 response review, and as physicians with significant public health leadership experience, they give their candid thoughts on what went right, and what went wrong.   Special thanks to NashvilleHealth, the Nashville Area Chamber of Commerce, the Nashville Health Care Council, Meharry Medical College, and Avalere Health, for making this review possible.   Read the summary and the full Nashville Covid-19 Response Review here: https://www.nashvillehealth.org/covid-response/

Dan Mendelson is CEO of Morgan Health at JPMorgan Chase & Co. He was previously Founder and CEO of Avalere Health, a healthcare advisory company based in Washington DC. Dan also served as Operating Partner at Welsh Carson, a private equity firm. Before founding Avalere, Dan served as associate director for Health at the Office of Management and Budget in the Clinton White House. Dan currently serves on the board of Champions Oncology (CSBR) and is 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. He holds a BA from Oberlin College, and an MPP from the Kennedy School of Government at Harvard University. The Caring Economy made it onto FeedSpots Top 30 CSR Podcasts Don't forget to check out my book that inspired this podcast series, The Caring Economy: How to Win With Corporate Social Responsibility (CSR). --- Support this podcast: https://anchor.fm/toby-usnik/support

Hillary Stires received her BS in behavioral neuroscience from Lehigh University and her PhD in endocrinology and animal biosciences from Rutgers University, and completed a postdoctoral fellowship in tumor biology at Georgetown University's Lombardi Comprehensive Cancer Center. Her research focused on tumor development and drug resistance in breast cancer. During her postdoctoral fellowship, Hillary became passionate about improving cancer research through establishing relationships between cancer researchers and patient advocates. Hillary actively engages with the patient advocate and research communities through twitter and has talked about her work in bringing these groups together in podcasts, blog posts, and a TEDx. After her postdoc, Hillary worked as a consultant at Avalere Health where she supported clients in regulatory strategy and navigating the FDA policy environment. Hillary is now a science policy analyst at Friends of Cancer Research, an advocacy think tank based in Washington DC. At Friends, Hillary supports the development and implementation of the organization's research and policy agenda to drive collaboration that improves cancer research and patient outcomes. She also works with Teresa's Research Foundation to support opportunities that build relationships between research scientists and patient advocates.

Social distancing, vigilant sanitizing, and mask wearing required by COVID-19 did more than combat the pandemic—it cut down on flu cases as well as improved respiratory health for some patients. Some studies indicate that the measures also reduced Clostridium difficile, or C difficile, in hospitals and facilities. A recent set of interviews on Medical World News®, the 24-hour online news program for health care professionals from MJH Life Sciences™, highlighted this development. The interviews, discussing the prospect of these mitigation efforts continuing post pandemic, were conducted by one of our sister sites, HCPLive®, which covered the Digestive Disease Week meeting this spring. This episode of Managed Care Cast features a few of those interviews: Christie Teigland, PhD, vice president of Advanced Analytics for Avalere Health; Alpesh N. Amin, MD, University of California Irvine School of Medicine; and Brian E. Lacy, MD, PhD, Mayo Clinic.

In this episode, Khaliah chats with Richard Hughes IV, JD, MPH, who is Vice President of Public Policy at Moderna. He is a nationally recognized vaccine thought leader and has led many efforts to expand access to vaccines and preventive services and improve public health outcomes. Previously, Richard was managing director at Avalere Health, where he founded and led the firm's vaccines group. Prior to joining Avalere, Hughes practiced healthcare law and served as a strategic advisor at Epstein, Becker and Green. He previously held roles with Merck and the Association of State and Territorial Health Officials, and as a gubernatorial appointee to the Arkansas State Board of Health. Hughes previously held an academic faculty appointment as a professorial lecturer in health policy and management at the George Washington University's Milken Institute School of Public Health. He earned his JD from the George Washington University Law School and MPH from the University of Arkansas for Medical Sciences. 

Dr. K sits down with Dr. Roy Beveridge, Sr. Strategic Advisor at Avalere Health and former CMO of Humana, to discuss the pressing need for standardization of care, and how to enact more efficient management of chronic illnesses. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play HealthcareNOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

Founder and former CEO of Avalere Health, Dan Mendelson, stops by to share his outlook on Bidencare and the future of health policy in the US. About Dan Mendelson:Dan Mendelson is Founder and former CEO of Avalere Health, a vibrant community of innovative thinkers dedicated to solving the challenges of the healthcare system.He is also Operating Partner at Welsh Carson, a private equity firm focused on healthcare and technology investments.  Prior to founding Avalere in 2000, Dan served as Associate Director for Health at the Office of Management and Budget in the Clinton White House where he was responsible for the full healthcare portfolio including Medicare, Medicaid, NIH, CDC, and FDA.  Dan presently serves on the boards of Champions Oncology (CSBR), Centrexion Corporation, and Audacious Inquiry.  He is Adjunct Professor at Georgetown University's McDonough School of Business, and a founding member of Guidon Partners, an investment management group.  Dan also serves on advisory boards for the Alliance for Health Policy, the Duke Margolis Center, and Faster Cures.  He previously served on the boards of Coventry Healthcare (CVTY, sold to Aetna in 2013), PharMerica (PMC, sold to KKR in 2017), and HMS holdings (HMSY).Dan is a leading national thought leader on healthcare business issues, is often quoted in the press, and enjoys speaking.  He has also published widely in peer-reviewed and professional journals on health information technology, the costs of disease, hospital costs and operations, physician payment, the economics of managed care, and medical malpractice. He holds a BA from Oberlin College, and an MPP from the Kennedy School at Harvard University.Watch this episode on YouTube: https://youtu.be/QWKdKhwAICw#danmendelson​ #medicare​​ #medicareadvantage​​ #healthinsurance​​ #healthcare​​ #healthcarebusiness​​ #healthcarepolicy

Alex Azar, who is the current Health and Human Services (HHS) secretary (until January 21 anyway), came out with a reboot of the proposal that effectively halts the practice of pharma manufacturers paying rebates to Part D plans. This reboot is supposed to go into effect on 1/1/2022. But this podcast is less about this may-or-may-not-actually-happen rule and is more about the actual impact of removing drug rebates within this unintuitively constructed health care system of ours. Should rebates go away, it’s actually a big deal that fundamentally could upend the heretofore-not-transparent messy middle of drug pricing. I’ll let Chris Sloan, associate principal over at Avalere Health, explain. Spoiler alert: The impact of killing pharma rebates to plans and PBMs (pharmacy benefit managers)? Bottom line, everybody’s insurance premiums go up in the current model when rebates go away. A few episodes from now, I’m talking with Ge Bai about why this is a suboptimal and not forgone conclusion. But this is what we’ve got going on right now. So, look for EP306 coming up for more on that. You can learn more at avalere.com.   Chris Sloan, associate principal at Avalere, advises a number of clients—including pharmaceutical manufacturers, health plans, providers, and patient groups—on key policy issues facing the health care industry. Chris’s economic analyses of key policy proposals and issues, including drug pricing and the repeal and replace efforts around the Affordable Care Act, have been featured in a wide range of publications, including the Wall Street Journal, the New York Times, the Washington Post, Politico, Axios, and Vox. 02:35 “Rebates are a really big part of Medicare Part D.” 02:49 What the “follow the dollar” looks like in this scenario. 04:14 How rebates between PBMs and manufacturers work, and how list prices play into this. 05:31 How this system can hurt the patient, and how this new proposal works to change that. 06:42 Pricing a product as a PBM. 08:06 The total dollar value of PBM rebates. 10:50 Do we know how much PBMs are making in incentives? 13:29 Are PBMs helping or hurting the process? 16:18 Why pharmaceutical manufacturers may be more compelled to raise their prices thanks to large PBMs. 17:13 Perverse incentives in the system. 17:57 “At the end of the day, PBMs are still going to be employed by health plans.” 18:56 How a new model is combating the perverse incentive that raises prices for patients. 22:11 The trade-off involving premium prices in this new proposal. 24:38 “We’re not talking astoundingly large amounts of money.” 25:12 Why PBMs and health plans are against this proposal. 26:02 Why Pharma is for this. 26:51 The perverse incentives for health plans. 28:39 The benefit of Part D. 29:25 The advantage of huge rebates. You can learn more at avalere.com.   @avalerechris discusses eliminated #drugrebates in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma “Rebates are a really big part of Medicare Part D.” @avalerechris discusses eliminated #drugrebates in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma What does following the dollar really look like? @avalerechris discusses eliminated #drugrebates in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma Do we know how much #PBMs are making in incentives? @avalerechris discusses eliminated #drugrebates in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma Are #PBMs helping or hurting the process? @avalerechris discusses eliminated #drugrebates in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma “At the end of the day, PBMs are still going to be employed by health plans.” @avalerechris discusses eliminated #drugrebates in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma “We’re not talking astoundingly large amounts of money.” @avalerechris discusses eliminated #drugrebates in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

Disclaimer before we get started here: This show is probably a 300-level class in pharmaceutical/PBM relations. If you are tuning in for the first time and you aren’t pretty familiar with the role of PBMs, I would go back and listen to, say, episode 241 with Vinay Patel or episode 166 with Tim Thomas from Crystal Clear Rx.  OK, now that that’s out of the way, if you’re still with me, this episode is like a ride on a roller coaster. In this health care podcast, I talk with Mike Schneider, who’s a principal over at Avalere Health. And we get into, you know, kinda deeply, the what and the why behind the "Big Three" traditional PBMs deciding that now might be a fantastic time to set up GPOs. PBMs are pharmacy benefit managers—there’s three huge ones. GPO stands for group purchasing organization. Traditionally, these GPOs have purchased drugs and supplies for hospitals and other providers at, according to their marketing materials, volume discounts. So, the unfolding story here, in a nutshell, is that ESI (Express Scripts) set up a GPO called Ascent in Switzerland. Optum has had an Ireland operation going in full swing for a while. And now we have CVS Caremark setting up a GPO called Zinc. These GPOs are not like normal GPOs working with hospitals, but instead, these GPOs are the entity which is now going to negotiate with pharma companies. In the past, it was the PBM that was negotiating with the pharma company to get rebates. Now it’s this GPO entity. “But wait,” you may say. “Wasn’t there an executive order the other day requiring PBMs to, for example, pass through all of the rebates that they’re collecting to patients?” Indeed, there was. And that rule doesn’t say anything about GPOs having to do the same, especially GPOs in, let’s just say, Switzerland. It’s a tangled web we weave. You can learn more at avalere.com. You can also connect with Mike on LinkedIn.  Mike Schneider is an experienced health care executive with over 20 years of experience in the pharmaceutical manufacturer, pharmacy benefit manager, and payer side of health care. He previously spent 9 years at CVS Caremark, where he was a director of industry relations with responsibility for trade strategy development, rebate negotiations, and contract execution for CVS Caremark’s own Medicare Part D plans and that of its clients. He held a similar position at Universal American (UA) before it was acquired by CVS Health, where he also negotiated UA’s commercial business. Mike has held various sales and market access roles with pharmaceutical manufacturers with increasing responsibility. Before entering health care, Mike began his career as a researcher at the Procter & Gamble Company in Cincinnati, where he worked on hair care product formulation development focusing on the key markets of China and Japan, and then moved on to work in drug development. Mike holds a BS degree from the University of Illinois and an MBA from the University of Akron. 02:30 What does a GPO add to a PBM? 05:05 Rebates vs driving more revenue. 10:20 PBMs vs safe harbors. 12:07 The net impact on the commercial side. 13:48 PBMs vs pharmaceutical manufacturers. 14:35 How the "Big Three" PBMs compete with each other, and how employers would choose between them. 15:37 What the net-net is here. 17:48 How PBMs are shifting their models. 20:23 How GPOs may be making things even less transparent. 21:11 “The PBM world as a whole is not very transparent.” 24:40 “One of the biggest beneficiaries of this whole rebate [system] is the government.” 25:25 “The question is, ‘Who’s paying those costs?’” 25:40 EP216 with Chris Sloan.26:40 A better way to move money from Pharma to employers and plan sponsors. 27:43 “Put your money where your mouth is.” You can learn more at avalere.com. You can also connect with Mike on LinkedIn.  Check out our newest #healthcarepodcast with Mike Schneider of @avalerehealth as he discusses #PBMs and #GPOs. #healthcare #podcast #digitalhealth #healthcarefinance #pharma What does a GPO add to a PBM? Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma Rebates vs driving more revenue. Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma PBMs vs safe harbors. Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma What is the net impact on the commercial side? Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma PBMs vs pharmaceutical manufacturers. Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma How do the "Big Three" PBMs compete with each other? Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma How do #employers choose between the "Big Three" PBMs? Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma What’s the net-net here? Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma How are PBMs shifting their revenue models? Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma How are GPOs making things even less transparent? Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma “The PBM world as a whole is not very transparent.” Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma “One of the biggest beneficiaries of this whole rebate [system] is the government.” Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma “The question is, ‘Who’s paying those costs?’” Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma A better way to move money from Pharma to employers and plan sponsors. Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma “Put your money where your mouth is.” Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma

The Patient-Driven Payment Model – and all the changes that came with it – arrived officially for skilled nursing providers in October 2019. The new Medicare reimbursement system for SNFs was top of mind throughout the year, but 2020 will bring a variety of new challenges, ranging from the entrenchment of accountable care organizations (ACOs) to the rise of managed care in the Medicaid program. Fred Bentley, managing director at the consulting firm Avalere Health, joined Rethink to talk about what SNFs should think about going into 2020 and how they can position themselves for viability and success. Listen to this episode to learn about: -The need to examine therapy and documentation as PDPM takes hold -Why some larger SNF chains are considering joining the ranks of ACOs -Why managed long-term supports and services in Medicaid is 'an existential challenge' for SNFs

Listen NowDespite gains made under the ACA, health insurance coverage in the US remains fraught with problems.  Over 28 million non-elderly remain uninsured.  Health care spending is extreme.  Health care coverage is the most expensive worldwide in absolute terms and relative to average incomes – despite the fact Americans consume no more or fewer health care resources than our comparative peers.  In 2018, an insurance premium for a family of four was $19,616 or almost one-third of median household income of $61,372.  Several factors explain this.   Among others, while Medicare spending per capita decreased by 1.2% between 2007 and 2014 however for private insurance spendingincreased per capita by 16.9%.  Rapidly rising drug prices, that account for 17% of all national health spending, are two times as much as comparative countries.  Americans also pay substantial health care administrative costs that equaled $259 billion in 2017, or nearly four times average of other developed countries.  (We spend more on health care administration the UK spends on all of health care.)  Relative to outcomes, US life expectancy at birth, that has declined for the past three years (for the first time in a century), is exceeded by 79 countries.  Per a recent Bloomberg health efficiency study, the US ranked 54th out of 56 countries.  Hong Kong, Singapore and Spain ranked 1 through 3, the US fell between Azerbaijan and Bulgaria.During this 29 minute conversation Mr. Eyles answers whether health care coverage is a right or a privilege, notes AHIP's position on Texas v. Azar, discusses the problem of consolidated insurance markets, i.e., lack of market competition and what can be done about it.  He responds to questions concerning the health care sectors efforts at measuring for value (outcomes achieved relative to spending), the Medicare Advantage (Part C) program, the future of the insurance industry, what it is doing to address or prepare for the health effects of climate change and we conclude with his brief comment regarding Medicare for All. Matthew (Matt) Eyles has served as President and CEO of America's Health Insurance Plans or AHIP (the national trade association representing commercial health insurance providers) for one year.  Mr. Eyles joined AHIP in 2015 to lead its Policy and Regulatory team and served as Chief Operating Officer just prior to his current position.  Just previously, he served in several senior positions at Coventry Health Care (now an Aetna company) and with Wyeth (now a subsidiary of Pfizer).  He also was employed by Avalere Health, a DC-based consulting firm, where his worked moreover concerned pharmaceutical industry issues.  Mr. Eyles began his career at the Congressional Budget Office where he examined an array of health care policy topics.  Mr. Eyles serves on the Board of Directors of the National Health Council and previously on the Board of the Network for Excellence in Health Innovation (NEHI).  He earned his undergraduate degrees in history and political science from The George Washington University and a graduate degree in public Policy from the University of Rochester. For information on AHIP go to: https://www.ahip.org/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Chris Sloan is an associate principal at Avalere Health, a Washington, DC–based nonpartisan consulting firm. He advises a number of clients—including pharmaceutical manufacturers, health plans, providers, and patient groups—on key policy issues facing the health care industry. His particular areas of expertise include drug pricing, the Affordable Care Act, generics, and biosimilars. Additionally, Chris is a recognized expert in the health care policy issues facing people living with HIV/AIDS and multiple sclerosis. Chris’s economic analyses of key policy proposals and issues, including drug pricing and the repeal and replace efforts around the Affordable Care Act, have been featured in a wide range of publications such as the Wall Street Journal, the New York Times, Politico, Vox, and others. He has a BBA degree in economics and marketing from the College of William and Mary. 01:12 The HHS proposal. 02:29 “Rebates are a really big part of Medicaid Part D.” 02:45 What the “follow the dollar” looks like in this scenario. 04:10 How rebates between PBMs and manufacturers work, and how list prices play into this. 05:26 How this system can hurt the patient, and how this new proposal works to change that. 06:37 Pricing a product as a PBM. 08:04 The total dollar value of PBM rebates. 11:24 Do we know how much PBMs are making in incentives? 14:08 Are PBMs helping or hurting the process? 17:13 Why pharmaceutical managers may be more compelled to raise their prices thanks to large PBMs. 18:10 Perverse incentives in the system. 18:55 “At the end of the day, PBMs are still going to be employed by health plans.” 20:29 How a new model is combating the perverse incentive that raises prices for patients. 23:45 The trade-off involving premium prices in this new proposal. 26:13 “We’re not talking astoundingly large amounts of money.” 26:46 Why PBMs and health plans are against this proposal. 27:37 Why Pharma is for this. 29:11 The perverse incentives for health plans. 31:00 The benefit of Part D. 31:46 The advantage of huge rebates.

From the federal government to Avalere Health to the advisory firm that bears her name, Anne Tumlinson has been a leading voice on the business of long-term health care in the United States. As CEO of Anne Tumlinson Innovations, she hears from providers around the country, who tell her about their struggles and successes with new payment models — including managed Medicare and accountable care organizations. In our conversation, Tumlinson said she’s no longer comfortable telling providers that all they need to survive in the new landscape is a solid set of data proving good outcomes. The reality is much more complicated than that, and success could require operators to band together to negotiate the best rates moving forward. Download this episode of Rethink to hear: - Why providers partnering with their competitors might be the path to success in some markets - Why consumers choose Medicare Advantage plans, and why seniors may not always understand what that decision might mean for nursing home coverage - How operators can navigate the dual — and dueling — worlds of fee-for-service Medicare and new payment models

Need a guide to Election Day — and all of the health care storylines? POLITICO's health team has you covered this week, with a roundtable episode that explains what we're watching around the nation. First, Victoria Colliver joins from California to discuss the record spending on the state's measure to cap dialysis clinic profits. (Starts at the 1:15 mark.) Then Adam Cancryn and Paul Demko sit down with POLITICO's Dan Diamond to review key races and share insights from reporting trips to states like Ohio, Idaho and Kansas (Starts at the 7:30 mark.) MENTIONED ON THE SHOW Victoria's story on the record $111 million in spending over California's ballot measure to rein in dialysis clinics' profits. (The story is behind POLITICO's Pro firewall.) Michael Hiltzik of the Los Angeles Times looks at the spending fight over the dialysis ballot measure. Paul's story on Idaho's ballot measure for Medicaid expansion. Alice Miranda Ollstein's story on the Medicaid expansion debate in Georgia and other states led by GOP governors. Avalere Health's projection that 2.7 million people could gain Medicaid coverage after this year's election. Paul shadowed GOP Rep. Cathy McMorris Rodgers on the campaign trail. Adam's story about the controversial opioid ballot measure in Ohio.

Interview with Alan G. Rosenbloom, President and CEO of Senior Care Pharmacy Coalition (SCPC) about the Avalere Health Study: Long Term Care (LTC) Pharmacy Sector Plays Key, Growing Role in U.S. Seniors' Care as New Payment, Delivery Models Gain Prevalence in the industry.  More Transparent Drug Pricing Can Help LTC Pharmacies Sustain High Quality SNF, ALF Patient Care Washington, DC - A new Avalere Health study of the nation's growing long term care (LTC) pharmacy sector - the most detailed analysis since Medicare Part D was implemented in 2006 - finds LTC pharmacies playing a greater role in seniors' clinical care as new health payment and delivery models such as Accountable Care Organizations (ACOs), bundled payments and value-based purchasing proliferate amid a rapidly changing healthcare marketplace. The study, entitled " Long-Term Care Pharmacy: The Evolving Marketplace and Emerging Policy Issues ," was conducted for the Senior Care Pharmacy

Interview with Alan G. Rosenbloom, President and CEO of Senior Care Pharmacy Coalition (SCPC) about the Avalere Health Study: Long Term Care (LTC) Pharmacy Sector Plays Key, Growing Role in U.S. Seniors' Care as New Payment, Delivery Models Gain Prevalence in the industry.  More Transparent Drug Pricing Can Help LTC Pharmacies Sustain High Quality SNF, ALF Patient Care Washington, DC - A new Avalere Health study of the nation's growing long term care (LTC) pharmacy sector - the most detailed analysis since Medicare Part D was implemented in 2006 - finds LTC pharmacies playing a greater role in seniors' clinical care as new health payment and delivery models such as Accountable Care Organizations (ACOs), bundled payments and value-based purchasing proliferate amid a rapidly changing healthcare marketplace. The study, entitled " Long-Term Care Pharmacy: The Evolving Marketplace and Emerging Policy Issues ," was conducted for the Senior Care Pharmacy Coalition (SCPC), and also suggests that a more transparent, streamlined drug pricing and distribution process can help sustain the beneficial LTC pharmacy clinical services that advance high quality care and Medicare cost-savings."As the launch of the SCPC was an important milestone for our sector in 2014, our release of this benchmark report in 2015 demonstrates independent LTC pharmacies, our patients and our business partners will continue to benefit from a robust, sector-specific advocacy and educational effort in which facts, data and metrics demonstrate the significant added value of medication therapy management and unique, clinical services we provide," stated Michael Bronfein, Chairman of the SCPC, and co-founder of the Baltimore, MD-based NeighborCare and Remedi SeniorCare. "With this report, and another to soon be released related to Maximum Allowable Cost (MAC) pricing, we will continue to focus not just upon the challenges facing independent LTC pharmacies and our patients, but also putting forward the bipartisan policy solutions to address them," Bronfein continued. "Moreover, we believe it is time to finally initiate an objective, constructive, data-informed policy discussion on how best to meet the interests and health needs of elderly consumers in a volatile, excessively opaque drug pricing marketplace.” Observes the Avalere Health report on more transparent drug pricing: "To preserve choice, and to ensure that elderly SNF and ALF patients continue to receive the LTC pharmacy clinical services that help advance high-quality patient care and cost-savings objectives, policymakers should consider how to address the unique needs and roles of LTC pharmacies as they seek to streamline, standardize and make more transparent the drug pricing and distribution process." In addition to noting LTC pharmacies are distinctly different than retail pharmacies -- with significantly greater clinical, operational, legal and regulatory requirements resulting in higher costs to dispense -- the 32-page study also details how LTCPs play an essential, unique role in patient care teams; that the typical skilled nursing facility (SNF) patient receives 8 to 10 different medications each day; and that LTCPs serve a crucial role in the care continuum by ensuring seniors' pharmaceutical needs are met, consultative services are performed and patient-specific clinical intervention is carried-out as needed. Other key sections of the study include an Overview of LTC Pharmacies and their national footprint; Understanding the Differences Between LTC and Retail Pharmacies; State of the LTC Pharmacy Sector and the most common conditions for which LTC Pharmacies dispense prescriptions; LTC Pharmacy Sector Consolidation and their relationship with prescription drug plans (PDPs) and pharmacy benefit managers (PBMs); LTC Pharmacy Policy Issues and Challenges including MAC pricing, dispensing fees and short-cycle dispensing, FDA repackaging guidance and the shift to value-based payment and other delivery models. The conclusion details the issues policymakers should consider to improve the viability and strength of the LTC pharmacy sector as it assumes a larger role in the broader spectrum of care. Alan G. Rosenbloom, President and CEO of SCPC, concluded: "Independent LTC pharmacists provide a unique set of capabilities to serve an increasingly vulnerable patient population. As baby boomers age, the population over 85 will grow by nearly 90 percent over the next 20 years, and these seniors' need for medications and related consultative services will grow. Independent LTC pharmacies can be increasingly integral to optimizing care outcomes and boosting spending efficiencies -- and this new study will help us to continue making this case on Capitol Hill and with the broader national healthcare community." Rosenbloom said SCPC would release subsequent news releases over the next several months corresponding to the wide variety of issues and topics addressed in this LTC pharmacy sector report. The SCPC represents companies that own and operate independent long-term care pharmacies (LTCPs) in more than 40 states, serving over 400,000 residents in skilled nursing facilities (SNFs) and assisted living facilities (ALFs) daily. To learn more, visit seniorcarepharmacies.org or follow us on Twitter . See omnystudio.com/listener for privacy information.

The U.S. Food and Drug Administration recently released long-awaited draft guidance regarding the naming of biologics, biosimilars, and interchangeable biologics. At the same time the agency released a proposed rule to apply the naming scheme to six current biological products with, or expected to soon have, biosimilar competitors. We spoke to Gillian Woollett, senior vice president with the healthcare business strategy and public policy advisory firm Avalere Health, about the FDA's actions, their implications, and some potential unintended consequences.

Listen NowHealth care insurance plans and policy makers are constantly working toward improving cost management.  Recently two techniques to do so have reemerged in this effort: narrow networks and reference pricing, techniques that have enjoyed success in the past.  Likely the largest (de facto) user of narrow networks is the integrated health plan Kaiser and CalPERS (the California Public Employees's Retirement System) has saved millions in its use of reference pricing.   What are these practices, to what extent are they successful in saving money (and improving health care quality) both for payers and patients and what are the real and/or potential downside risks associated with these practices.  During this 21-minute interview Dan Mendelson defines these two cost savings techniques, i.e., how do they work or why they are attractive to plans, do they improve health care quality both within and beyond the ACA insurance marketplaces and how or why these techniques might not be in the best interests of patients (and possibly providers as well).   Dan Mendelson is CEO of Avalere Health, a DC-based health care research and policy consulting firm.  Dan leads the organization's operations and engages in strategic advisory work for major clients in life sciences, managed care and in many provider segments.   Prior to founding Avalere in 2000, Dan served as Associate Director for Health at the White House Office of Management and Budget.  Dan also presently serves on the board of two public companies: HMS Holdings; and, Champions Oncology.  He previously served on the boards of Coventry Healthcare and Pharmerica.  Dan is also on the faculty at the Wharton School of Business at the U. of Penn.  He holds a BA in Economics and Viola Performance from Oberlin College and a MPP from the Harvard Kennedy School of Goverment.    This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com