Podcast appearances and mentions of brandon weber

Play Episode Listen Later Mar 17, 2022 34:42

Last week's show was with Wayne Jenkins, MD, from Centivo; and we talked about how insurance design, when not done well, can lead, in a nutshell, to mental and physical health problems for employees. This is a great lead-in to the conversation in this healthcare podcast with Dan O'Neill. And before I get into why it's a great lead-in, let me just start here—and don't roll your eyes. What is value-based care? Consider this delineation: There's value-based payments, and then there's the type of care that these payments incentivize. You would hope that a value-based payment would result in care that was of value (ie, great patient outcomes and patient satisfaction at a fair total cost of care). But those are two distinct things—the payment and the care. If we change the payment model but the provider behavior doesn't change in a way that actually improves patient outcomes and care, then what are we doing here? Or the converse: If we do not change the payment model, then how does anyone expect the care paid for is going to change? Employers or carriers who just meander along with the broad PPO network happily paying as much for low-value care as for high-value care and happily paying centers of excellence as much as non–centers of excellence … how is a provider who wants to spend time and money building out a practice to deliver better patient outcomes, how can they do that without overcoming some pretty fundamental business model challenges? This whole concept is one that my guest today, Dan O'Neill, has talked about and will talk about in this episode. Dan says the first step is for insurers, IPAs, managed care organizations to take an absolute chainsaw to their network management bureaucracy. There must be a clear door to a value-based payment model. It must be that if you're a provider or you're a physician practice (primary care practice, in particular), and you want to go down a value-based care path, there has to be a clear door and a pathway for you. I think I have a non-perfect litmus test for anybody with a value-based payment program who wants a heuristic to check if their value-based payment program is actually meaningfully impacting models of care in the marketplace: If most of the provider organizations who are part of that value-based program still incentivize and pay their doctors using FFS incentives like RVUs (relative value units), I'd step back and think about that for a piece. Contemplate that doctors, who are responsible for care decisions, still have every incentive to do everything that they would have done had the provider organization just been paid FFS. What's the point of value-based payments that extract exactly zero behavior change? And that is not a rhetorical question. So, back to the conversation from last week with Dr. Wayne Jenkins citing all of the things that can go horribly wrong when an employer's benefit designs are misaligned with the financial realities of their workforce. You get what you pay for, and I don't just mean that in terms of the dollars outlaid, since we all know in healthcare prices and quality have nothing to do with each other—I mean, in terms of what you choose to pay for and how you choose to pay for it. That's the macro of this whole thing, but indulge me as I get into the micro for just one sec. Let me just remind everybody about Goodhart's Law: “When a measure becomes a target, it ceases to be a good measure.” More on the why of this in the interview with Rishi Wadhera, MD, MPP, on the hospital readmission reduction program (EP326) and also what happens when we don't adhere to Goodhart's Law as we evaluate PCPs, which Rebecca Etz, PhD, talks about in EP295. In this episode with Dan O'Neill, we go through where we're at on the continuum of value-based payments and how those payments are impacting the care, value-based or otherwise, that is incentivized by those payments. We tick through four gradations of value-based payments: A pure volume contract (otherwise known as FFS [fee for service]) A clinician bonus for achieving quality measures A piece of the savings (ie, MSSP [Medicare Shared Savings Program]) Global risk My guest, Dan O'Neill, is chief commercial officer over at Pine Park Health. Besides over a decade in healthcare tech and services, he was a policy fellow at the National Academy of Medicine and worked in the Senate on the Senate Health Committee. You can learn more at dponeill.com or connect with Dan on LinkedIn. Daniel O'Neill, MA, MS, currently serves as chief commercial officer for Pine Park Health, a value-based primary care group that delivers on-site care in senior living communities. Prior to that, Dan was a health policy fellow at the National Academy of Medicine, working primarily in the US Senate on legislation focused on surprise billing, anti-competitive contracting practices in the commercial market, and price transparency. Dan has also worked as a senior vice president with Change Healthcare and as an advisor to venture-stage healthcare services and technology firms. At Pine Park, Dan is responsible for risk-based contracting with IPAs and insurers and for the group's participation in CMS value-based care models, including direct contracting. Dan's research is available in NEJM Catalyst and on the Health Affairs blog, and he holds graduate degrees from Johns Hopkins University and Stanford University. 05:06 What is the spectrum of value-based contracts? 07:24 Why don't value-based contracts at the organizational level always trickle down to the provider level? 11:25 What are the two things that need to happen to drive outcomes in value-based healthcare? 15:24 How do insurers play into improving value-based contracts? 19:46 “There's a strong case to actually clamp down on prices.” 23:47 “Right now, we're still in a place where if you want to do something other than fee for service … you have to fight like hell.” 24:03 What's the first step to making value-based contracts more accessible? 24:27 What's the second step to making value-based contracts accessible? 25:23 Why are the incentives to change American healthcare pretty weak? 27:10 “Organizational change is just exceedingly difficult.” 28:45 What should you do if you want to start pushing organizations toward value-based contracts? 32:42 EP351 with Eric Bricker, MD. You can learn more at dponeill.com or connect with Dan on LinkedIn. @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth What is the spectrum of value-based contracts? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth Why don't value-based contracts at the organizational level always trickle down to the provider level? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth What are the two things that need to happen to drive outcomes in value-based healthcare? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth How do insurers play into improving value-based contracts? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth “There's a strong case to actually clamp down on prices.” @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth “Right now, we're still in a place where if you want to do something other than fee for service … you have to fight like hell.” @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth What's the first step to making value-based contracts more accessible? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth What's the second step to making value-based contracts accessible? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth Why are the incentives to change American healthcare pretty weak? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth “Organizational change is just exceedingly difficult.” @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth What should you do if you want to start pushing organizations toward value-based contracts? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth Recent past interviews: Click a guest's name for their latest RHV episode! Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber

american law phd ms medicine healthcare md senate stanford university payments employers johns hopkins university us senate organizational national academy cms dano ipas valuebased contemplate mpp ffs value based care ppo change healthcare goodhart health affairs pcps vbc peter hayes mike schneider rvus senate health committee wayne jenkins katy talento brandon weber nejm catalyst nikki king

EP358: How Health Insurance Plan Design Can Lead to Patients Sacrificing Needed Care, Their Mental Health, and (Sometimes) Buying Groceries, With Wayne Jenkins, MD

Play Episode Listen Later Mar 10, 2022 33:51

First of all, anybody who thinks that your average citizen in the United States today is unaware of the financial double jeopardy of going to a doctor, going to an emergency room, getting a procedure is sorely mistaken. Americans today are well aware of the financial risk that they are taking by seeking healthcare in this country. To illustrate this point, let me read the first couple of sentences from a New York Times best-selling book review: “The illness narrative, ending in financial ruin and decreased quality of life, has become one of the classic 21st-century American stories. In her debut essay collection, Emily Maloney documents the … intersections of money, illness and medicine. For Maloney, the primary experience of receiving health care is not merely a bodily or spiritual event but always … a financial one. She understands … the relationship of money to being ill, … to managing an unfathomable amount of debt.” This is a New York Times best-selling book in the beginning of 2022. Add to this something I saw Pete Scruggs write on LinkedIn a while back, which I found actionable. He said: “Patients selling personal items or taking on credit card debt after medical procedures is a failure of creativity in providing healthcare. It is possible to build creative health plans that reduce costs for patients with expensive procedures by giving wise guidance at the time patients need it the most. “It is not enough for insurance to provide access to a wide range of health providers but effectively leave the patient in debt … after the procedures are done. It is possible to buy healthcare so well in the local community that employers can reduce cost dramatically at the time most needed by those using health services.” And lastly, let me quote from a recent article in JAMA by David Scheinker, PhD; Arnold Milstein, MD; and Kevin Schulman, MD, which says, “The financial consequences of an underperforming health insurance market (one that is not holding down … cost … ) diminishes the quality of life affordable to US employees and their families and the financial viability of employers not in the health care industry.” So, in this healthcare podcast, I am speaking with Wayne Jenkins, MD, who is chief medical officer over at Centivo. Before his move into value-based healthcare about 10 years ago, Dr. Jenkins started his career as a radiation oncologist. He has also served as the chief clinician at a bunch of large health systems. I wanted to have Dr. Jenkins on the show to discuss a recent report which was published by Centivo that methodically dissects how financial toxicity is affecting patients. This includes how it affects choices that employees/patients/members are making both in terms of the care they decide they are willing to pay for or, more likely, the financial risks they're willing to take. In short, the three key findings of the report are as follows: Workers face mounting healthcare affordability issues, and health plan cost sharing features such as high deductibles are an underlying cause. Just a quick spoiler here: Do you know the percentage of employees who are forgoing buying groceries in order to afford medical expenses left on their shoulders by their high-deductible health plan or by their health plan with excessive premiums? Going hungry isn't just for minimum wage workers. Medical expenses are a significant cause of mental health and well-being issues for both individuals and also families. The conventional wisdom that health plan members will never “trade off” certain offerings for greater savings is simply false. The big takeaway here, though, is that the situation that we have in this country today is not a secret among your average regular American civilian. They do fully understand that by entering a healthcare setting, they are very well trading off, in their attempt to be healthy and going to the doctor in pursuit of that aim, they are trading off their financial well-being. And that financial toxicity actually has health implications. If you can't afford groceries, for example, or your mental health suffers, we get ourselves rather rapidly into a downward spiral, as you may be able to see. Other episodes dedicated to the impact of financial toxicity and possible solutions are in the show notes. I'm just gonna mention here quickly, we talked to Marty Makary, MD, about his book called The Price We Pay (EP242). There's an interview with Marshall Allen (EP328) and then also a very interesting conversation with Mark Fendrick, MD (EP308). You can learn more at centivo.com. Wayne Jenkins, MD, is the chief medical officer at Centivo. He is an accomplished physician and executive with a proven track record of patient-centered, revenue-driven results. Over the course of his career, he has consistently transformed large, complex healthcare systems into market leaders that deliver quality and value in a dynamically changing environment. Prior to Centivo, he was the chief clinical officer for population health at Vanderbilt University Medical Center, where he provided clinical oversight of value-based care delivery and completed the formation of Medicare accountable care organizations (ACOs). Before his time at Vanderbilt University Medical Center, he served as the senior vice president and chief strategy officer of Orlando Health, as well as president of Orlando Health Physician Partners. Previously, Wayne was the chief of radiation oncology and then subsequently the medical director for the Florida affiliate of M.D. Anderson Cancer Center, a subsidiary of Orlando Health, Inc. Wayne holds a bachelor's degree from the University of Tennessee, an MD from Vanderbilt University School of Medicine, and a master's of health policy and administration from Johns Hopkins University. He is board certified in radiation oncology and was recognized in Best Doctors in America annually from 1994 to 2015. He has published 18 scientific articles and is often sought out to speak at state and national conferences. 05:23 How is financial toxicity in healthcare affecting patients? 07:02 How do we define a “normal” deductible in today's healthcare? 08:14 What's the point of having a deductible? What does a plan gain from a high deductible? 10:43 How does the cost of a patient's deductible correlate with their use of their health insurance? 12:51 EP308 with Mark Fendrick, MD.15:18 How is health insurance actually sometimes reducing patients' health? 16:24 What is the defining characteristic of those who are more adversely affected by high deductibles? 17:04 Why should CFOs consider plans with lower deductibles for their employees? 18:26 “Are there other ways to approach this in a marketplace, to get more value for what you're paying for so this problem can be addressed?” 21:56 How should employers contemplate health plans moving forward? 22:24 “Having the health plan choice gives more financial viability in addition to that open access.” 22:58 “In some sense, [that] can be a zero-sum game. Do you get it in the premium, or is it paid in the higher deductible?” 23:45 “I think there are value choices in the market that may help negate some of the problems that we were just discussing.” 25:33 “I think conventional wisdom may be left over from the '90s.” 26:49 Why does building these narrow networks have to be a science? 28:38 Does a narrow network adversely affect mental health? 32:20 “Narrow and excellent is not a bad choice for people.” You can learn more at centivo.com. Wayne Jenkins, MD, of @Centivo_Health discusses health insurance plan design on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts How is financial toxicity in healthcare affecting patients? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts How do we define a “normal” deductible in today's healthcare? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts What's the point of having a deductible? What does a plan gain from a high deductible? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts How does the cost of a patient's deductible correlate with their use of their health insurance? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts How is health insurance actually sometimes reducing patients' health? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts What is the defining characteristic of those who are more adversely affected by high deductibles? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts Why should CFOs consider plans with lower deductibles for their employees? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts “Are there other ways to approach this in a marketplace, to get more value for what you're paying for so this problem can be addressed?” Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts How should employers contemplate health plans moving forward? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts “Having the health plan choice gives more financial viability in addition to that open access.” Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts “In some sense, [that] can be a zero-sum game. Do you get it in the premium, or is it paid in the higher deductible?” Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts “I think there are value choices in the market that may help negate some of the problems that we were just discussing.” Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts “I think conventional wisdom may be left over from the '90s.” Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts Why does building these narrow networks have to be a science? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts Does a narrow network adversely affect mental health? Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts “Narrow and excellent is not a bad choice for people.” Wayne Jenkins, MD, of @Centivo_Health discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcarecosts Recent past interviews: Click a guest's name for their latest RHV episode! Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30)

EP357: Standing Up Telehealth That Actually Advances Providers' Core Business, With Liliana Petrova

Play Episode Listen Later Mar 3, 2022 34:36

Here's the biggest problem with a lot of telehealth endeavors: Someone decides that they need to be doing telehealth, for whatever reason. Maybe there's a pandemic, for example. And the basic plan is this: Install some technology, give everyone a username and password and a link for patients, check that box, and move on to the next thing. My guest in this healthcare podcast, Liliana Petrova, has seen and talked about how, far too many times, the whole concept of telehealth is narrowed down to the exact moment where a patient and a doctor have a visit together. That's it … that transaction. There's little effort, if any effort, made to integrate telehealth into the existing clinical workflow, into the existing patient/customer experience, into the core business, into anything longitudinal. Telehealth becomes a weird island of a service only used by intrepid clinicians willing to put in the time and effort required to deal with its vagaries and inconveniences. Only used also by patients who manage to find the telehealth link buried on some Web site somewhere and then figure out how to schedule their telehealth appointments within a scheduling system mostly unable to accommodate virtual visits without a party-sized amount of technical expertise and, probably, chutzpah. There are consequences to this narrow and pretty slapdash thinking. One of them is that you have very few clinicians and patients willing to brave the organization's telehealth experience or lack thereof, so they don't use it. And then at some point the organization does a survey of how much telehealth is going on—and wow! Surprising news: Incredibly few are using telehealth. So, the conclusion is drawn that patients and/or clinicians don't want telehealth. What happens then? Further funding is withdrawn and/or the whole telehealth thing goes down on the chopping block. It reminds me of a cartoon I saw the other day. It was a picture of a bar chart showing some survey results. One of the bars in the bar chart was huge, and then the other one was, like, zero. It was a poll. There were two questions in the poll. Here are the two questions: Do you respond to polls, or don't you respond to polls? And as per the poll results in the bar chart in the cartoon, turns out, 100% of people respond to polls. Funny but, at the same time, true. Many organizations don't really think through the provenance of the “data” they're using to make really important decisions, and when it comes to telehealth, there's a lot of dirty data flying around. This dirty data, though, might be one explanation for the delta between the conclusions of all those studies showing that three out of four patients, always a comfortable majority of patients, intend to use telehealth versus the many health systems and/or provider organizations or even some doctors themselves sniffing and turning up their noses and saying that none of their patients are interested in using telehealth because no one is using telehealth in their office. Right. The only thing that's being anecdotally determined by these anecdotal conclusions is that patients don't like and/or even know about that office's telehealth solution. It says nothing of the larger trend. When organizations make decisions to not do telehealth well or at all because they didn't do it well and no one could figure out how to use it, then the value that telehealth could bring to both patients and clinicians is forfeit. Sad. Also, considering the X on the backs of some specialists and health systems in general these days, this could have longer-term consequences. Some good clinicians could find themselves way behind the curve after making what amounts to a very poor strategic decision. In this episode, I am speaking with Liliana Petrova, CEO of The Petrova Experience. Liliana is an expert on customer and patient experience. She hails originally from the aviation industry, where she was director of customer experience at JetBlue, where she built and maintained customer centricity across organizations. Today we're talking about telehealth. Last time Liliana was on the show (EP236), we talked about customer centricity—so go back and listen to that one if you're interested. In that show, we talked about, as one aspect, lobby design—the impact of having front desk people and clinicians literally barricaded behind cement and glass like they work in some bodega in a bad part of town that gets held up every other day. I never really thought about that and the message that it sends before. Liliana served this past year on the NODE patient committee and did a whole lot of work exploring telehealth and its potential and challenges. NODE stands for the Network of Digital Evidence. In this show, we go through the essentials to pull off a telehealth program that is actually going to deliver returns. In short, here's the ingredients: A telehealth “board” comprised of all the cross-disciplinary folks needed to pull this off: clinicians, IT, and also administrative peeps for a few very critical reasons that we talk about. Having executives on this board with enough power in the organization to define long-term goals that supersede all the short-term ones that usually define and plague organizations, especially public ones, is also very essential here. Redefining IT and the role of IT. This is an interesting one. Liliana talks about how the legacy role of IT is changing. IT leaders can no longer just be the help desk or maintainer of computers or manager of outsource contracts for the place far away that you call when you can't get on the portal. Today's IT teams need to think like they're a vital part of supporting the needs of patients and clinicians. After all, you can't have technology-augmented care when the IT group is shacked up in the basement doing their own thing. Identifying a physician ambassador for the telehealth internally (the telehealth program). Getting patient feedback. I was shocked, literally shocked, to discover that some of the most vocally “patient-centric” health systems do not collect patient feedback systemically. WTH, really? Liliana gets granular here. What might be the silver bullet? Patient navigation. We talk about this at some length. Map the end-to-end patient visit. Continuous improvement—you're never done. Also, March 8, 2022, is International Women's Day, by the way. This episode honors women in healthcare doing great things. You can learn more at thepetrovaexperience.com or join the patient NODE group by emailing Liliana at liliana@thepetrovaexperience.com. Liliana Petrova, CCXP, is a visionary and a proven leader in the field of customer experience and innovation. She pioneered a new customer-centric culture, energizing the more than 15,000 JetBlue employees with her vision. She has been recognized for her JFK Lobby redesign and facial recognition program with awards from Future Travel Experience and Popular Science. Liliana is committed to creating seamless, successful experiences for customers and delivering greater value for brands. In 2019, she founded an international customer experience consulting firm that helps brands improve their customer experience. The Petrova Experience focuses on three pillars of customer experience: organizational culture that inspires employees to be brand ambassadors, design and implementation of customer centric journeys, and technology implementations with customer experience value in mind. 06:59 Who should be on the telehealth board to incorporate telehealth successfully? 08:44 What is the population that you're serving, and how does telehealth serve that population? 09:45 “When they think of this as a project versus a program or a strategic imperative, then there is no business case.” 11:49 “How do you integrate telehealth in your core business?” 12:32 What does a CIO need to do to be best equipped to serve their organization? 14:05 Why are CIOs and CFOs naturally in conflict these days? 15:30 Why is it important to have a physician be an ambassador for telehealth implementation? 17:05 Why is it important to utilize patient feedback properly? 18:37 Why must the patient own their own health? 20:29 “The key is, if you start at the strategic level with cross-functional leaders, then the working team will also be cross-functional.” 21:49 “You won't have a successful telehealth experience if you don't think through the end-to-end experience.” 21:55 EP332 with Tony DiGioia, MD.23:40 Who is the digital navigator in implementing telehealth? 24:55 What is a digital navigator, and how does it show up in the telehealth journey? 30:55 Why is it important to have continuous growth in telehealth? You can learn more at thepetrovaexperience.com or join the patient NODE group by emailing Liliana at liliana@thepetrovaexperience.com. @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth Who should be on the telehealth board to incorporate telehealth successfully? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth What is the population that you're serving, and how does telehealth serve that population? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth “When they think of this as a project versus a program or a strategic imperative, then there is no business case.” @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth “How do you integrate telehealth in your core business?” @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth What does a CIO need to do to be best equipped to serve their organization? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth Why is it important to have a physician be an ambassador for telehealth implementation? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth Why is it important to utilize patient feedback properly? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth Why must the patient own their own health? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth “The key is, if you start at the strategic level with cross-functional leaders, then the working team will also be cross-functional.” @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth “You won't have a successful telehealth experience if you don't think through the end-to-end experience.” @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth Who is the digital navigator in implementing telehealth? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth What is a digital navigator, and how does it show up in the telehealth journey? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth Why is it important to have continuous growth in telehealth? @LilianaPetrova discusses #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth Recent past interviews: Click a guest's name for their latest RHV episode! Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16)

EP356: PBMs React to GoodRx, Mark Cuban, and Amazon Pharmacy, With Ge Bai, PhD, CPA

Play Episode Listen Later Feb 24, 2022 36:17

So … let's start here. Mostly this whole episode is about the so-called “Big Three” PBMs that provide between the three of them pharmacy benefit services for 95% of insured Americans. PBM stands for pharmacy benefit manager, and the Big Three PBMs being ESI, otherwise known as Express Scripts; OptumRx, which is a part (a big profitable part) of United Health Group; and then also CVS. Yes, CVS is not just for your retail pharmacy needs; they are also a huge pharmacy benefit manager. Now, we get to the GoodRx part of our story. If you don't know how GoodRx works, I would strongly encourage you to go back and listen to “An Expert Explains” with Dr. Ge Bai from last year (AEE13). That said, here's the super short semi-reductive version to keep us all level set here. If you already know how GoodRx works, you can skip forward about four minutes. So, first of all, let's all understand that GoodRx's business model only exists because the pharmacy supply chain dominated by these three big PBMs that we just talked about is such a cluster. GoodRx profits from that dysfunction. So, as I said, here's the short version of how they do that. It all hinges on so-called spread pricing, and this is what I mean by that. Patient goes into pharmacy with a prescription for generic drug X. The patient has insurance—good news! Pharmacist checks the computer and sees that this patient should be charged, I don't know, $50 for drug X. The patient's insurance carrier picks up, say, $30 of the $50 cost; and the patient is left with, say, a co-pay of $20. Who did that little math there in the computer? The PBM (the pharmacy benefit manager) did that math. That's their thing, these PBMs. They adjudicate claims. That's what this math is called. Anybody who goes into a pharmacy with a prescription, it's the PBM on the back end who figures out how much the patient owes and how much their insurance will pay and what the patient responsibility is, etc. Goodness, you might say. How much are the PBMs being paid to perform this useful service? Turns out, it's free. That's right … the Big Three PBMs do all this adjudication for free. No charge to plan sponsors. Isn't that nice? Except it's actually not free if you dig into it. The PBM is certainly getting paid by means of arbitrage. They're taking a little something something out of the middle of every single transaction. Here's what that looks like in the example aforementioned. Recall the patient's insurance paid $30, and the patient themselves paid $20. The question is, how much did that drug cost the PBM? Remember, that's commerce: Buy low, sell high, and all that. You buy something, and then you sell it for more than you bought it for. OK, so we're talking about a generic drug here. They're cheap (usually). So, let's just say drug X costs, I don't know, $5. The PBM pays the pharmacy $5 for that generic script—and you can see how much money the PBM just made right there. The patient and their plan sponsor got charged $50, and the PBM's cost of goods was $5. Multiply that profit margin by the billions of generic prescriptions in this country that run through insurance, and you have a tidy little business model there. UHG, the parent company of OptumRx, made $24 billion in profit in 2021. Not all of that was from generic drug arbitrage (ie, taking advantage of spread pricing), but some of it was. And $24 billion is an awfully big amount when you consider whose paychecks all those pennies were lifted from. PBM services are anything but free. PBMs are collecting massive windfalls in the so-called spread between what the patient and the plan pay and what the PBM is actually buying those drugs for. Here's another wrinkle: When a PBM contracts with a pharmacy, part of their contractual terms is that the pharmacy's list price for drugs cannot be lower than a certain amount usually having something to do with the PBM's rates. So, pharmacy list prices become artificially high as a result, meaning that cash-pay patients who just wander into a pharmacy and try to pay cash pay an artificially high price. Into this mess swoops GoodRx with a killer idea. They see all that money on the table that PBMs are cleaning up in that spread. They want a piece of that action. And in the beginning, PBMs were fully on board with this. They were fully on board because the market GoodRx was going after was the uninsured market, meaning untapped turf for PBMs. And because PBMs make so much money off of each transaction, PBMs are always hungry for more transactions (the Big Three PBMs, anyway). They love more transactions. The more more more with the transactions, the more more more with the money. So, GoodRx goes to the PBMs and says, “Hey … if a cash-pay patient shows up in a pharmacy, what price would you charge them for you to adjudicate that claim? You know how much money you have to pay the pharmacy, so what can the patient price be? What spread are you willing to accept? GoodRx will take a little off the top, but you can keep your spread on this new frontier of patients that you haven't historically had access to because … uninsured. Oh, by the way, we, GoodRx … we're gonna go around to all your competitors, too (just saying)—the other two PBMs—and we're gonna show their prices, too, in our GoodRx app at different pharmacies. So, you're gonna have to compete with other PBMs in this model.” This is why GoodRx cash prices for generics are so very very often less than what the patient will pay if they use their insurance. In the GoodRx app, PBMs have competition. So, by not using their insurance, patients often pay less for generic drugs—which, by the way, are 90% of the scripts written in this country—and also, as an added bonus, patients don't have to jump through all the weird and arduous prior auths or step therapies or other hurdles that a PBM might toss in the mix. So, from a patient perspective, using GoodRx could save money, save time, and you could get your drugs faster because you don't have to wait around for some prior auth to go through. But this was not what PBMs had originally thought they were signing up for. They were working with GoodRx to gain new market share from the uninsured market, not lose market share to more and more patients forgoing their insurance, meaning forgoing shelling out to the PBM their spread on the transaction. Cue my conversation today with Dr. Ge Bai. Ge Bai, PhD, CPA, is a professor of accounting at Johns Hopkins Carey Business School and a professor of health policy and management at Johns Hopkins Bloomberg School of Public Health. In this healthcare podcast, Ge Bai and I discuss the reactions of the Big Three PBMs to consumers getting all consumer-y when it comes to buying their generic drugs—despite the fact that, in my interview with Dr. Sunita Desai (EP334), she said that studies have shown that 67% of patients are unaware that they might be able to get a better price by not using their insurance and shopping around on GoodRx or Amazon or at a cost-plus pharmacy like Blueberry in Pittsburgh or Mark Cuban's new thing. Despite that, it means 33% (one-third) of patients are aware that they can price shop and potentially get a better price not using their insurance on generic drugs; and apparently, it's making some people at some PBMs nervous. Check the ESI (Express Scripts) blog post about their new prescription benefit that automatically applies discounts. Hmmm … sounds like a defensive play to me? What do we make of this? That's my first question to Dr. Ge Bai in this episode. Also, if you're really intrigued by generic drug goings-on, go back and listen to the show with Dr. Steven Quimby (EP344) when you have a chance. It's about the high cost of generic drugs, and we go deep into supply chain machinations. You can learn more on Ge's Web site at Johns Hopkins University. You can also connect with her on LinkedIn. Ge Bai, PhD, CPA, is 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. She is an expert on healthcare pricing, policy, and management. Dr. Bai has testified before the House Ways and Means Committee, written for the Wall Street Journal, and published her studies in leading academic journals such as the New England Journal of Medicine, JAMA, JAMA Internal Medicine, Annals of Internal Medicine, and Health Affairs. Her work has been widely featured on ABC, CBS, NBC, Fox News, CNN, and NPR and in the Los Angeles Times, New York Times, Wall Street Journal, Washington Post, and other media outlets and used in government regulations and congressional testimonies. 08:45 What is ESI doing by automatically applying discounts to generic drugs? 10:00 Why are PBMs losing money when consumers don't use their benefit? 10:46 “GoodRx disrupted the ongoing game.” 11:04 How are PBMs using the Amazon discount card to discourage their patients from moving away from using their benefits? 12:13 Amazon pricing versus GoodRx pricing. 12:50 How much money is a PBM really making? 14:00 EP344 with Steven Quimby, MD.14:29 EP334 with Sunita Desai, PhD.14:43 How is future fear playing into the PBM business model? 16:55 Is there a negative consequence to subtracting from the bottom line in a PBM model? 17:50 “I think to have strong PBMs does not mean necessarily bad things for patients.” 19:39 What happens if everyone uses Amazon for drugs? 22:40 If every PBM gets their own discount cards, what will happen? 25:38 “We are actually witnessing a potential sea change.” 26:25 How do cost-plus pharmacies factor into the current market? 29:16 Is a profit shortfall inevitable? 29:35 “PBMs have to give a slice of their profit back to consumers. That's just reality.” 30:11 Can anything be done on the PBM side to generate a higher margin in the generic space? 31:41 “Naive plan sponsors are a big problem.” You can learn more on Ge's Web site at Johns Hopkins University. You can also connect with her on LinkedIn. @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing What is ESI doing by automatically applying discounts to generic drugs? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing Why are PBMs losing money when consumers don't use their benefit? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing “GoodRx disrupted the ongoing game.” @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing How are PBMs using the Amazon discount card to discourage their patients from moving away from using their benefits? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing Amazon pricing versus GoodRx pricing. @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing How much money is a PBM really making? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing How is future fear playing into the PBM business model? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing Is there a negative consequence to subtracting from the bottom line in a PBM model? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing “I think to have strong PBMs does not mean necessarily bad things for patients.” @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing What happens if everyone uses Amazon for drugs? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing If every PBM gets their own discount cards, what will happen? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing “We are actually witnessing a potential sea change.” @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing How do cost-plus pharmacies factor into the current market? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing Is a profit shortfall inevitable? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing “PBMs have to give a slice of their profit back to consumers. That's just reality.” @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing Can anything be done on the PBM side to generate a higher margin in the generic space? @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing “Naive plan sponsors are a big problem.” @GeBaiDC of @JohnsHopkins discusses #PBMs on our #healthcarepodcast. #healthcare #podcast #healthcarepricing Recent past interviews: Click a guest's name for their latest RHV episode! Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335)

EP355: The 5 Business Models of Digital Health Companies, With Nikhil Krishnan

Play Episode Listen Later Feb 17, 2022 35:09

My guest in this healthcare podcast is Nikhil Krishnan, who is the founder of the Out-Of-Pocket newsletter. I was talking with Nikhil, and we identified—or, more accurately, he identified—five business models of digital health. What makes each model distinct is a few factors. If you weren't in the healthcare industry, you'd probably expect that I'm going to say that the biggest factor a business model must hinge on must have something to do with patient outcomes or care or something that has something to do with the hopes and lives of patients. Except no. Mostly, our models do not define themselves by attributes of their patients, except on one dimension: who is paying their bills. Who is paying has enormous downstream consequences that I don't think people outside of healthcare, or even people inside of healthcare, sometimes really appreciate. It's because of all of the perverse incentives. It's a tangled web we weave. For example, let's just say you're a start-up founder trying to cook up your unique selling proposition. You can't just decide you're gonna lower costs and improve patient care as general constructs. Because let's just say you do that—that's your USP (lower costs and improve patient care)—and then you try to sell your thing to Medicare Advantage plans or large provider organizations. Oh, right … Medicare Advantage plans or even commercial ones—they don't care about the total cost of care. Neither do provider organizations unless they take on sufficient risk to care, and many do not. In fact, as came out in that JAMA article the other day, it could be construed that entities such as these carrier health plans have a perverse incentive to see total costs of care go up. So right, you naively (you're the start-up founder again in this case study, don't forget) trot into some administrator's office with a great something or other to reduce total costs of care—and you'll get cast out upon your petard on the quick. Every single day of the year in my world, I see people make this same mistake over and over again: not tailoring their product market fit to any particular market, with the recognition that some in this healthcare industry have a vested interest to see costs going up and some have a vested interest in costs going down. Either way, if we're talking about large organizations here and even some small ones, the money wins over patient care. So sad to have to say that, but listen to EP351 with Dr. Eric Bricker and you'll get all the context you need on that point. Here's the thing, though. I don't know about you, but I can't tell you how many digital health start-ups I run across where I look at their decks or have a conversation with a founder, and I ask who their customer is. Is it employers or health plans or … ? And they don't know. They're gonna figure this out later. I don't get how to successfully do that. I'm indubitably wrong here given all of the pivots I hear about that seem to go OK, but the prospect of completely redefining my operational goals and operations and market positioning at some point in the future seems like a daunting and avoidable prospect. I would be remiss not to mention, however, the number of really good mission-driven healthcare companies out there really trying hard to figure out how to create a sustainable business, a fair profit, while at the same time serving patients really well. There are companies adding value commensurate with the dollars that they come by, and I certainly applaud everything that they are doing. At the same time, given all this, here's a message for all of you VCs and private equity etc—people with money—out there. Let me quote Dr. Vivek Garg here (@vgargMD on Twitter): “If you're financing care delivery without board-level focus on clinical outcomes, you're part of the problem.” So, let's talk about these five business models that health and healthcare start-ups eventually settle themselves into after they figure out who their customer is. Nikhil Krishnan, my guest today, and I discuss how they can be financially viable and if we think they'll actually be able to provide superior patient outcomes. [Trumpets play here] In no particular order, this is what we've got for our five business models: Completely avoiding incumbents, creating a cash-pay ecosystem Better middleware (being the pipes, as I've heard so many times these past couple of weeks) Companies serving incumbents either by being a virtual front door for them or disrupting the competitive landscape somehow Joint ventures Old-school digital health who are now incumbents in their own space My guest in this episode, Nikhil Krishnan, has a bunch of things going on. He might be best known for his newsletter, Out-Of-Pocket Health, which you should certainly subscribe to. He's also working on a healthcare 101 crash course to teach newcomers about the Wild West we call American healthcare. Besides all of this, Nikhil does some early-stage investing. You can learn more at outofpocket.health and with Nikhil's upcoming course. Nikhil Krishnan is the founder/thinkboi at Out-Of-Pocket, where he's trying to make the business of healthcare more easily understandable and (hopefully) entertaining. He runs a newsletter (yes, yet another one) and an online healthcare community and does some digital health investing on the side. He's “extremely online,” and you can find him firing off obscure healthcare memes plus the occasional insight on Twitter at @nikillinit. 05:31 What are the different models of digital health? 07:17 What are the different motives for cash-pay digital health models? 13:08 “One of healthcare's original sins is that every solution deployed has been a custom solution for the end user.” 13:31 How willing will these companies be to share their data with third parties? 17:20 “I don't think selling tech to large incumbents is going to move the needle.” 20:27 “These companies, most of them are actually getting extra money for the more expensive stuff.” 22:11 How did joint-venture digital health business models come about? 25:50 Why do you see partnerships more on the payer/provider side? 26:41 Who are the old-school digital health companies that could be considered incumbents? 28:48 Why do so many digital health start-ups have a hard time pinpointing who will pay for their services? 31:22 “The ability to go through the idea maze is way faster now.” 34:08 “The field is wide open to help teach people how healthcare works.” You can learn more at outofpocket.health and with Nikhil's upcoming course. @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast What are the different models of digital health? @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast What are the different motives for cash pay digital health models? @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast “One of healthcare's original sins is that every solution deployed has been a custom solution for the end user.” @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast How willing will these companies be to share their data with third parties? @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast “I don't think selling tech to large incumbents is going to move the needle.” @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast “These companies, most of them are actually getting extra money for the more expensive stuff.” @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast How did joint-venture digital health business models come about? @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast Why do you see partnerships more on the payer/provider side? @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast Who are the old-school digital health companies that could be considered incumbents? @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast Why do so many digital health start-ups have a hard time pinpointing who will pay for their services? @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast “The ability to go through the idea maze is way faster now.” @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast “The field is wide open to help teach people how healthcare works.” @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast Recent past interviews: Click a guest's name for their latest RHV episode! Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai

EP354: 7 Vital Success Factors to Stand Up a CIN (Clinically Integrated Network), With Shawn Rhodes

Play Episode Listen Later Feb 10, 2022 32:44

In this healthcare podcast, we're gonna talk about the realities of setting up a clinically integrated network, otherwise known as a CIN. If only the whole process was unicorns and rainbows, but—as you likely suspected—it's not. Setting up a clinically integrated network is hard work, but the payoff for patients and clinicians alike can be worth fighting for. First of all, what is a clinically integrated network? It is a kind of ACO (accountable care organization). It is a legal entity that is a form of an ACO. So, every CIN is an ACO. But not all—in fact, most—ACOs are not CINs. CINs enable coordinated care. Everybody in the network gets together to figure out how to enable clinicians to (for reals) follow their patients through multiple care settings and plan for an entire care journey. It can really help the patients navigate our crazy healthcare industry by giving them a trusted team that plots out a proactive path toward better healthcare outcomes and then make sure the patient stays on that path. It can be a really beautiful thing. Listen to EP349 with Lisa Trumble for real-world examples of the patient outcomes and experience a CIN can generate. All this for the patient while, at the same time, the total cost of care for Medicare patients goes down, I've heard, about 10% on average; but it can be more, as Lisa Trumble also talks about in episode 349 as aforementioned. Alright … as we all know in healthcare, what's best for the patient doesn't, in so many cases, mean higher reimbursements. Sadly. So, what financial advantages does going through the time and trouble to create a CIN bring? There are basically four financial opportunities that can be realized with a CIN. I learned some of this from my guest today, Shawn Rhodes, who called strategically managing these four possible financial incentives “a delicate balance”; and as I get into some of them, you will see why. CIN Financial Opportunity #1: Similar to an ACO, if you're a CIN (because you are an ACO), you can participate in the Medicare Shared Savings Program, otherwise known as MSSP. The Medicare Shared Savings Program (MSSP) is the way that ACOs get paid a little something extra if they achieve savings goals for Medicare. The provider shares in the savings. Get it? And CINs are generally well equipped to realize these shared savings goals because to obtain the quality that you have to to pull off the shared savings, being clinically integrated really helps. CIN Financial Opportunity #2: Getting a gang of providers (doctors) together, you can do collective bargaining. So, back to basics with this one. You get a bunch of docs together in a region, then you all go to the big BUCAH plan—meaning the Blue Cross, the Cigna, the Aetna, Anthem, Humana—you go to them together and make your contracting demands, as opposed to each little doc practice going in all by yourself and trying to negotiate David and Goliath style. Now, what the payer might want from your collective crew there, the payer might insist on some kind of value-based agreement. Even if it's an FFS (fee-for-service) contract chassis, they'll attach some kind of quality or outcome component. So again, being organized in a CIN is a bonus either way. CIN Financial Opportunity #3: Your CIN can try to do direct contracting with local employers. Check out EP350 with Katy Talento for more on direct contracting. Actually, Lisa Trumble also mentions this in EP349. CIN Financial Opportunity #4: Lastly, you can work with local hospitals' quality and efficiency programs. From a hospital financial perspective, they might be interested in the care that happens after an inpatient stay. If the outpatient care at an integrated skilled nursing facility, for example, is good, then the hospital could, for example, reduce readmissions. Now, caveat: I asked (maybe grilled is a better word) our guest in this episode, Shawn Rhodes, about this whole “prevent a readmission” business. Because on one hand, oh wow, you get a couple points back from having lower readmissions—which you can game all day long, by the way. Listen to the show with Dr. Rishi Wadhera (EP326) for more on how to not get dinged for readmissions even if you effectively have readmissions. So, said another way, the crafty, albeit dubious, power move here if you're a hospital to maximize revenue is to let patients come back to the hospital after discharge but just don't call it a readmission. Call it, I don't know, observational. Then bill fee for service for the whole thing and get the reducing readmission financial incentives. At this point in the time-space continuum, everybody knows this stuff. This is not some kind of secret that I'm spilling here. Anyway, I bring this up because don't forget what I just said: The #4 CIN financial opportunity that Shawn Rhodes had mentioned is hooking up with a local hospital as part of their quality and efficiency program and the hospital looking to the CIN to reduce readmissions. Given the open secret on hospitals and readmissions, my Spidey sense just got really curious. So, when I pressed on this point, Shawn didn't talk about the CIN sharing any financial gains from the reducing readmission incentive program like I might have expected. Instead, he mentioned that having lower readmissions is a way for hospitals to get some negotiating leverage with payers. The next time your hospital's payer contract comes up, you can point to lower readmissions and then demand higher FFS fees. You also might be able to improve throughput of profitable service lines by reducing the number of patients who turn back up after their earlier procedure—which is another way, again, to increase FFS revenues, since the more patients you put through, the more revenue. This is why I like talking to people with a touchstone to the real world. You find out what the actual deal is. Now, I say all this to say that if patients get better care and their care journey is non-fragmented, it's a win-win. And CINs, like most ACOs, have been shown to trim the cost of care with great patient feedback. That's amazing. Just a quick spoiler here, but the seven parameters that Shawn Rhodes and I discuss in this episode which are essential for anyone who is looking to stand up a CIN or basically achieve success—and, I would guess, almost any value-based model—you gotta have an infrastructure that takes into account the following seven things: Patient-first and agile culture Interoperability Patient-centered processes Actionable information (not just data) Clinical integration Strategic planning and alignment of all stakeholders in the CIN Strong leadership My guest in this episode, Shawn Rhodes, has worked in performance and quality improvement for many years. He has worked at a CIN in Bowling Green, Kentucky; and he has overseen multiple value-based programs. Shawn currently serves as regional VP at Caravan Health. You can learn more at caravanhealth.com or connect with Shawn on LinkedIn. Shawn Rhodes serves as regional vice president at Caravan Health, a services and technology company that helps hospitals and physicians who care for underserved population succeed in value-based care. Shawn collaborates with clients to develop tailored population health strategies and support their efforts to deliver the highest-quality, patient-focused care at the lowest cost. Prior to Caravan Health, Shawn served as the director of clinical integration for a clinically integrated network, Med Center Health Partners, where he oversaw value-based agreements (commercial, Medicare Advantage, Medicaid, BPCI, and employer health plans) with various payers along with ACO activities and quality improvement initiatives within the network. Before his work in value-based care, Shawn served as director of education and organizational development at Baptist Health Hardin, focusing on leadership development and cultural change through Studer Group initiatives. The early part of Shawn's career was spent in industrial equipment design and progressed into the automotive manufacturing industry working with Toyota and Honda on quality and process improvement. He then transitioned to the healthcare industry where he worked for eight years as a consultant specializing in coaching and mentoring hospitals to achieve improved quality, efficiency, and financial performance through process improvement, LEAN techniques, and reengineering. Shawn has a bachelor's degree in mechanical engineering and a master's degree in business administration from Western Kentucky University. He resides in Bowling Green, Kentucky. 08:08 What are the seven parameters to consider when standing up a CIN? 08:25 “Culture trumps strategy.” 09:10 “Communication and education are key components to starting that … process.” 09:26 “How do you get the information to the right person at the right time and the right place?” 09:36 What does interoperability need to look like in a CIN? 10:29 How do organizations communicate with the patient in a CIN? 11:07 Can a clinically integrated network work if it's not patient-centric? 11:37 EP332 with Tony DiGioia, MD.11:49 What's a must-have for a clinically integrated network to be successful? 13:41 “What does that data mean?” 15:34 EP315 with Bob Matthews.15:52 “You really need a go-to person.” 18:57 “The thing with team-based care is, you also have to have team-based accountability.” 20:54 “You've got to build some infrastructure around what you want to do.” 24:37 “Alignment is not an easy task by any means.” 25:15 “There has to be a group decision-making process.” 25:34 EP343 with David Carmouche, MD.25:41 EP341 with Gary Campbell.26:18 How do you define leadership? 27:49 “Start small, get some successes, and it will build as you go.” You can learn more at caravanhealth.com or connect with Shawn on LinkedIn. Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork What are the seven parameters to consider when standing up a CIN? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “Culture trumps strategy.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “Communication and education are key components to starting that … process.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “How do you get the information to the right person at the right time and the right place?” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork What does interoperability need to look like in a CIN? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork How do organizations communicate with the patient in a CIN? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork Can a clinically integrated network work if it's not patient-centric? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork What's a must-have for a clinically integrated network to be successful? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “What does that data mean?” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “You really need a go-to person.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “The thing with team-based care is, you also have to have team-based accountability.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “You've got to build some infrastructure around what you want to do.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “Alignment is not an easy task by any means.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “There has to be a group decision-making process.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork How do you define leadership? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “Start small, get some successes, and it will build as you go.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork Recent past interviews: Click a guest's name for their latest RHV episode! Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333)

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EP352: Some Big Actionable Surprises About the Efficacy and Effectiveness of Specialty Pharmaceuticals, With Pramod John, PhD

Play Episode Listen Later Jan 27, 2022 28:22

As a country, we spend approximately $500 billion on prescription drugs. Specialty drugs account for less than 2% of prescriptions but will cost us over $250 billion (that's in 2021)—so, 2% of prescriptions but half the spend. Specialty is the fastest-growing segment of healthcare spend and is a dominant issue that self-funded employers and other purchasers face. But let's dig into that $250 billion being spent on specialty drugs, shall we? I have to say, personally, that if we spent $250 billion but saved more than that in medical costs or if the patient quality of life went up measurably or if life expectancy or overall survival or whatever metric you used to assess quality … if that big spend produced even bigger returns/results, I for one would be like, “OK, trade-offs. Let's discuss.” But the thing is, clinical trials and real-world evidence alike suggest that there's a lot of patients who don't really benefit from the expensive drugs that they are taking or were prescribed, and even those who benefit might not get the results that they're hoping for or even de minimis expecting. In this healthcare podcast, I am talking with Pramod John, CEO of VIVIO Health; and he makes a couple of great points about all of this that I'll repeat here and then he's gonna say them again later in this episode but in context—and probably better. There was some research done that showed for a really popular, really expensive drug, only 2% of patients who took it got the expected, maybe promised, benefits. But 100% of the patients who took that drug got bad, in some cases dangerously bad, diarrhea. This situation is really kind of typical. A drug will work great for some people, mediocre for other people/patients, and not at all for, say, the remaining what might be majority of patients. So, you'll have 2 patients where the results are out of the park, 23 patients where results are pretty darn good, 25 patients reporting meh results but something you can actually still point to, and then maybe 50 patients who see absolutely no improvement in anything. So, here's an important point: Maybe there's, let's just say, 3 drugs or 10 drugs in this therapeutic category, and that same patient distribution is true for all of them—except different drugs may work for different people. So, by enabling access to all the drugs, you can see that patients have a better chance of being in one of those first groups where they actually get results because there's more drugs that they can try and different drugs work differently in different people. But now, let's consider the way that we pay for specialty drugs: One or two of them get on formulary typically, and then all the others are excluded. That said, the purchaser, patient, and/or taxpayer is gonna pay a whole lot of money for those drugs regardless of how well they do or do not work. And with fewer drugs on formulary, there's less of a chance that results gold will be struck. But we're gonna pay a whole lot of money, also in terms of human life, to deal with the direct and cascading side effects of drugs whether they do or don't work. I have to admit, I kind of have a new appreciation for so-called me-too drugs after this conversation. Let me just add that here for the record. My guest today and next week is Pramod John, who is the founder and CEO over at VIVIO Health. VIVIO contracts with self-insured employers and helps their employees/members/patients (whatever you call them) get the right drug. They actually expand access, and the employer saves money. After what I just said, you might be cottoning on to why. The show this week concerns the reality of specialty drugs and what the terms efficacy and effectiveness really mean because they might not mean what you think they mean. As inconceivable as that might feel, I learned something. You might, too. And there are implications—big implications—for all of this for patients/members/employees. Or you and your family. In this episode, we also define and discuss the terms NNT (number needed to treat) and NNH (number needed to harm), which are really important and, in my humble opinion, do not get discussed enough—especially with patients who need to know these things to make informed choices. Next week's show is also with Pramod John, and we get into how what we talk about here intersects with rebates and formularies. Come back for that. It's probably a 400-level class in specialty pharmacy rebating, but some of you will appreciate it. You can learn more at viviohealth.com or by emailing Pramod at pramod@viviohealth.com. Pramod John, PhD, is the team leader of VIVIO, a public benefit corporation whose mission is to ensure that drugs work in the real world for the people on them and that their costs reflect the value provided. VIVIO's model has improved health outcomes and generated 35% to 40% savings on drug acquisition costs. It accomplishes this by answering three simple questions: (1) Is this the right drug? (2) Is it a fair price? and (3) Is it working for the patient? Before VIVIO, Pramod was founder of Oration PBC (acquired by PokitDok), which gave consumers control over their drug purchasing by capturing the prescription in the physician's office and providing real-time pricing options and automatic routing capabilities. Pramod was also vice president of strategy and innovation at McKesson, the world's largest healthcare company. At McKesson, Pramod helped develop solutions that leveraged advanced technologies and business process improvements to optimize healthcare delivery systems, infrastructure, and supply chains. Earlier, Pramod founded and served as CEO of PacketMotion, Inc, a venture-funded startup in the enterprise network information and policy management industry. VMware later acquired the company. In addition, Pramod founded netExaminer.com, a managed-vulnerability assessment company acquired by SonicWALL. Pramod earned his PhD in electrical engineering from the University of Illinois at Urbana-Champaign. He serves on the board of Wycliffe USA. He also serves on the advisory board of Folia Water and as a mentor at StartX. 05:34 What does a good response mean in pharmaceutical products? 06:06 “Different people get different utility out of something.” 06:31 Why doesn't efficacy mean what you think it means in terms of pharmaceutical products? 08:40 What is the difference between efficacy and effectiveness in Pharma? 09:10 Why aren't drugs' major side effects factored into a drug's efficacy and effectiveness? 10:14 “What's the benefit of this versus what's the harm in this?” 13:35 “Clearly as consumers, we all feel that we're special. But what about physicians?” 14:14 “The benefit itself—what does it have to be?” 15:18 EP334 with Sunita Desai, PhD.17:11 “We tend to think of things as a binary distribution—it works or it doesn't.” 18:22 “The default choice that we start with is often the wrong one.” 20:54 “It doesn't matter why if we can't fix the reason.” 22:02 “At some point, the question becomes, ‘Do we have any information?'” 22:36 Why do other developed countries pay less for their drugs? 24:21 How do we end up with crappy drugs on the market that don't really move the dial? 25:57 EP303 with Anna Kaltenboeck. 27:22 “We can build a better system. And that's what we do every day.” You can learn more at viviohealth.com or by emailing Pramod at pramod@viviohealth.com. Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs What does a good response mean in pharmaceutical products? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs “Different people get different utility out of something.” Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs Why doesn't efficacy mean what you think it means in terms of pharmaceutical products? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs What is the difference between efficacy and effectiveness in Pharma? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs Why aren't drugs' major side effects factored into a drug's efficacy and effectiveness? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs “What's the benefit of this versus what's the harm in this?” Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs “Clearly as consumers, we all feel that we're special. But what about physicians?” Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs “The benefit itself—what does it have to be?” Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs “We tend to think of things as a binary distribution—it works or it doesn't.” Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs “The default choice that we start with is often the wrong one.” Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs “It doesn't matter why if we can't fix the reason.” Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs “At some point, the question becomes, ‘Do we have any information?'” Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs Why do other developed countries pay less for their drugs? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs How do we end up with crappy drugs on the market that don't really move the dial? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs Recent past interviews: Click a guest's name for their latest RHV episode! Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis

ceo university phd healthcare illinois surprises effectiveness pharma actionable specialty pharmaceutical efficacy vmware pharmaceuticals urbana champaign mckesson pramod care plans sonicwall al lewis nnt peter hayes startx mike schneider katy talento brandon weber nnh nikki king pokitdok pramod john vivio health

EP351: Everybody in the Healthcare Industry Getting Up in Everyone Else's Business, With Eric Bricker, MD, From AHealthcareZ

Play Episode Listen Later Jan 20, 2022 36:00

In this healthcare podcast, I'm speaking with Eric Bricker, MD, about how so many entities in healthcare are getting up in other people's business and swimming in other people's traditional lanes. Consider last week's show with Katy Talento, for example. She mentions employers who are not only doing their own direct contracting (ie, cutting out the traditional carriers and negotiating directly with provider organizations) but also employee benefit consultants who are working on setting up their own hospital—an employer-owned hospital. That was episode 350, and while this hospital idea is a little future oriented, right now today, across the country, we have employers and also unions who are owning their own primary care clinics, which I discussed at some length with Mark Blum from America's Agenda (EP248). In this episode with Dr. Bricker, we start from the beginning. We kick off the conversation talking about the payer, PBM, and hospital system horizontal consolidation that has transpired over the past decades (that's plural). Horizontal consolidation is pretty much the easiest way to decimate all competition in your own swim lane so that you can charge more and not worry so much about patient/customer/member experience because the patients/customers/members have no better alternative. They effectively have nowhere, or few other places at best, to go if they leave you. So, what's the impact of horizontal consolidation? We get into this in the podcast, but subsequent to this recording, there was a study that came out in JAMA: “The Dysfunctional Health Benefits Market and Implications for US Employers and Employees.” This was by David Scheinker, PhD; Arnold Milstein, MD; and Kevin Schulman, MD. This study showed that commercial insurance costs have gone up 4x the rate of other benchmark goods and services. Bottom line, “It is assumed that insurers compete intensely to improve the value received by employers and employees by negotiating to keep prices down and advocating for employers and employees.” Ha ha … NOT. With peak horizontal consolidation, there is little meaningful competition—so ixnay on that premise. By the way, if anyone knows any of those authors that I just cited in that study, hit me up. I'd love to get one of them on the show. But let's spend a moment, shall we, on the human impact of all this extreme consolidation. The impact is your sister, your neighbor, your son, your friend. So many feel so much pressure financially in our country today because of healthcare costs. Even families earning significantly more than median household income are forgoing care because of costs. Again, this was in a recent paper. (The authors are Alyce S. Adams, Raymond Kluender, Neale Mahoney, Jinglin Wang, Francis Wong, and Wesley Yin.) But the direct observable financial toxicity resulting from high healthcare patient costs is really only the tip of the iceberg here. As Dave Chase from Health Rosetta has said a million times already, high healthcare costs have a multitude of effects on employers, big and small. One big one is, if healthcare costs more, then there's less money for salaries. Dave, citing lots of evidence, has long attributed wage stagnation in this country to accelerating healthcare costs, which became even more rampant during periods of industry consolidation. Dave Chase leads Health Rosetta, by the way. Here's another human toxicity: Listen to episode 337 with Oliva Webb on the impact on her life as a result of the undeniably and unquestionably common non-excellent treatment by the PBMs and SPPs that she has to deal with. Because, as Dr. Bricker also says, no competition means basically not a whole lot of concern about patient experience. Why should a for-profit business spend money to improve something when there's nothing really to be gained for them financially to do so? I mean, the best a patient can do most of the time is hop from the frying pan into the fire. That's what happens when there's no competition or no real competition. Also consider the burned-out clinicians who have to get stuck in the middle of this nobody-really-cares-at-the-monopoly customer service paperwork quagmire. By the way, here's a sidebar that might come as a surprise to some people, but please take this in the spirit with which it's intended. All of us innovators and lifelong learners, we want to update our beliefs when the facts show us an updated conclusion. So, I have learned that all of this consolidation was going on long before the ACA (Affordable Care Act). My point here is to please look into this well-documented trend line before reflexively tweeting that the ACA drove consolidation. Dr. Bricker and others like Dr. Mai Pham have told me that, in their opinion, low interest rates, cheap debt, and a desire to eliminate competition are wildly powerful drivers of consolidation. Anyway, about nine minutes into the interview with Dr. Bricker, if you're one of the ones who knows all you care to know about horizontal consolidation, we get into vertical integration, vertical consolidation—and this is where things get interesting. And when I say interesting, I mean it in a “we live in interesting times” kind of way. The vertical consolidation conversation segues into whose swim lane that the digital health and other innovators or, dare I say, disrupters are diving into and whose lunch they are aiming to eat. Dr. Bricker probably needs no introduction. He is the force behind AHealthcareZ, which you can find online, on Twitter, YouTube, and LinkedIn. He has worked as a clinician, in healthcare finance, and currently serves as a chief medical officer. If that weren't enough, he's also been an entrepreneur—a very successful entrepreneur, I might add. He started one of the first healthcare navigation firms called Compass Professional Health Services. Compass had something like 2000 employer clients serving about 1.8 million people when it was purchased in, I believe, 2018. You can connect with Dr. Bricker on Twitter at @DrEricB and on LinkedIn. Eric Bricker, MD, is an internal medicine physician and former cofounder and chief medical officer of Compass Professional Health Services. Compass is a healthcare navigation service that grew to 2000+ clients, including T-Mobile, Southwest Airlines, and Chili's/Maggiano's restaurants. Compass was acquired by Alight Solutions in July 2018. Alight is a 10,000-person employee benefits and HR outsourcing company that separated from Aon in 2017. Dr. Bricker has since started AHealthcareZ.com, with 170+ healthcare finance videos with approximately 90,000 views per month across all platforms. He is also the author of Healthcare Money Campfire Stories. 06:30 What is this “megatrend” happening in healthcare right now? 07:52 How has consolidation changed the healthcare landscape? 10:22 What is vertical integration within healthcare? 11:48 Why doesn't inorganic growth benefit patients? 13:33 “What is best for the patient does not necessarily make the most money.” 14:43 “It's not that it's above the law … it is just intentionally obscured.” 18:58 “Healthcare is glacial. It is slow.” 23:23 “The largest source of healthcare costs is hospitals.” 25:48 EP330 with John Marchica.29:17 “What have the historical priorities been of the administrators of those hospitals?” 29:32 “Every hospital CFO knows that they need sick people.” 30:18 EP343 with David Carmouche.30:59 “The payment change has to come first.” 32:17 “The money wins.” 34:12 “You've got to put the financial incentives in place … to make people actually behave the way that they should.” You can connect with Dr. Bricker on Twitter at @DrEricB and on LinkedIn. @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth What is this “megatrend” happening in healthcare right now? @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth How has consolidation changed the healthcare landscape? @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth What is vertical integration within healthcare? @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth Why doesn't inorganic growth benefit patients? @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “What is best for the patient does not necessarily make the most money.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “It's not that it's above the law … it is just intentionally obscured.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “Healthcare is glacial. It is slow.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “The largest source of healthcare costs is hospitals.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “What have the historical priorities been of the administrators of those hospitals?” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “Every hospital CFO knows that they need sick people.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “The payment change has to come first.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “The money wins.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “You've got to put the financial incentives in place … to make people actually behave the way that they should.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth Recent past interviews: Click a guest's name for their latest RHV episode! Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica

EP350: Employers Direct Contracting With Hospitals, in Real Life, With Katy Talento

Play Episode Listen Later Jan 13, 2022 35:31

In this healthcare podcast, I'm talking about direct contracting IRL (in real life) with Katy Talento. This is a conversation that's more about the reality of direct contracting than the theory of direct contracting, and this was not an accident. So much of healthcare transformation is really easy to say and much harder to actually do. So … direct contracting. In the context we discuss in this episode, generally direct contracting means when an employer or their benefits consultant, more likely, hooks up with a provider organization, lots of times a hospital or a health system. Moving forward here, I'm just gonna say employer when I sort of really mean the employer and their TPA and their repricer, the constellation of consultants and other vendors that are working with the employer. So, just for simplicity, the employer says to the provider organization, “Hey, let's cut out the middleman here” (middleman likely being some insurance carrier). “I will just pay you directly, and it will be a win-win because no one is sucking out up to 15% to 20% right out of the middle, and also I'll steer my employees/patients/members your direction, which is great for us as a self-insured plan because money saved and also because I've done some quality analytics and I think you're relatively good at delivering care … so I'm happy to help my members find you.” The employer will, in general broad strokes, pay the provider organization some percentage over the Medicare rate for procedures or codes or bundles. By the way, the dollar amount over Medicare for the bundles or procedures or codes can vary depending on factors like what service line it is because, unlike RBP (reference-based pricing), direct contracting is a negotiation. It's a two-way deal. RBP, a lot of times, is the payer/employer deciding what they're gonna pay and then paying it—without sitting around a table with the provider figuring all this out together. So, if only from this one dimension, direct contracting is something that you'd think that hospitals/health systems/providers would be kind of into and up for. One thing that I didn't really understand before this conversation is that, if we're talking about an employer direct contracting with, say, a hospital, the list of direct-contracted procedures or codes or bundles might include pretty much all of the services that the hospital can perform; but, in general, the employer is only going to steer members there or make it financially attractive to go to the hospital for, for example, emergency or unavoidable procedures. Why? Because no employer wants patients going to the hospital for things that they could get a whole lot cheaper in an outpatient setting with no less quality. So, unless a hospital is willing to compete on price with other care settings, then an employer is not going to steer their members there. If you're a hospital, you might take this as a con. But, on the other hand, consider that if there's a few hospitals in the area, the general direction will be to go to the one with the direct contract. Furthermore, if a plan is gonna steer members, they're gonna steer them whether they have a direct contract with you or not. Katy makes one point early and often throughout this conversation. From a hospital perspective, doing a direct contract is and should be pretty easy. From an employer perspective, too, there should not be a lot of disruption or friction for employees. There doesn't need to be. Done right, it should be a win-win for the employer, provider, and, most of all, the patient who doesn't get stuck with high bills, balance bills, and lower-quality care than might be available to them through their benefits. Katy goes through the steps to create a direct contract and the challenges she has faced along the way. We also get into the wonderful world of payviders, so you could consider this an extension to the episode with Jeb Dunkelberger (EP348) from last month. My guest today, Katy Talento, started out as an infectious disease epidemiologist (which I did not realize). She ended up doing public health policy. She's worked on Capitol Hill for various senators and, in the last administration, as health policy lead. Katy is the CEO of AllBetter Health and works with the Health Rosetta organization. She is a benefits advisor for employers who are looking to create better health plans that reduce costs dramatically while, at the same time, improving benefits. I mean, you can only do that in healthcare, right?—where there's basically no relationship between price and quality. You can learn more at allbetter.health or contact Katy directly at katy@allbetter.health. Katy Talento is an infectious disease epidemiologist, a veteran health policy advisor, and healthcare consultant. She is CEO of AllBetter Health, an insurgent benefits advisory firm building innovative health plans for employers that are free of misaligned financial incentives. Katy served as the health policy lead in the White House on the Domestic Policy Council where her portfolio included public health issues such as eliminating domestic HIV/AIDS, ending secret healthcare prices, lowering prescription drug prices, expanding health IT interoperability, combating the opioids and other drug addiction crisis, and promoting bioethics in the life sciences. Katy has appeared on or been published in a number of media outlets, including CNN, Sky News, Newsmax, The New York Times, The Hill, The Morning Consult, RealClearPolitics, and others. Prior to her White House appointment, Katy served five U.S. Senators over a 15-year period, including as top health advisor and manager of legislative staff and oversight investigators. She also worked in the private sector helping multinational energy companies protect their global workforce from infectious diseases and on the research faculty at Georgetown University Medical School. Katy served as the director of speechwriting for the Republican National Committee and has written a number of published opinion pieces, Web copy, and video scripts. She spent two years as a Catholic nun and has worked with the poorest of the poor from East Africa to industrial Russia and inner-city America. Katy received a master of science degree in infectious disease epidemiology from the Harvard School of Public Health and an undergraduate degree in sociology from the University of Virginia. 05:21 Why are employers direct contracting? 06:37 “When you directly contract … you don't have to chase patients.” 07:43 Why the growing 501(r) movement is making direct contracting more enticing. 10:16 “They're going to be giving better rates, whether they want to or not.” 11:46 “I think it's the future hospitals want, too.” 12:58 What is the primary driver of increased healthcare costs? 14:56 “The fixed costs that the hospitals … have may not be so fixed.” 15:08 “A hospital should not be a freestanding profit center. … The hospital is a failure of healthcare. It alone should not be profitable.” 15:35 “We have the system we have, but why do we have to live with it? We don't have to.” 17:15 What's step 1 of direct contracting? 24:12 What's the TPA's role in direct contracting? 25:21 What's the repricer's role in direct contracting? 33:28 “I think the thing that makes all this work is having a benefits advisor that knows how to do all this.” You can learn more at allbetter.health or contact Katy directly at katy@allbetter.health. @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth Why are employers direct contracting? @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth “When you directly contract … you don't have to chase patients.” @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth Why the growing 501(r) movement is making direct contracting more enticing. @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth “They're going to be giving better rates, whether they want to or not.” @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth “I think it's the future hospitals want, too.” @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth What is the primary driver of increased healthcare costs? @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth “The fixed costs that the hospitals … have may not be so fixed.” @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth “A hospital should not be a freestanding profit center. … The hospital is a failure of healthcare. It alone should not be profitable.” @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth “We have the system we have, but why do we have to live with it? We don't have to.” @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth What's step 1 of direct contracting? @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth What's the TPA's role in direct contracting? @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth What's the repricer's role in direct contracting? @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth “I think the thing that makes all this work is having a benefits advisor that knows how to do all this.” @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth Recent past interviews: Click a guest's name for their latest RHV episode! Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly

INBW33: Thank You, and a Few Thoughts

Play Episode Listen Later Jan 6, 2022 14:00

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

health new york city thanksgiving google americans speaking race healthcare web twenty twelve pas gdp sixteen pharma jama digital health caa node healthtech andreessen horowitz bricker healthimpact healthcare marketing stat news don lee new healthcare care plans marshall allen al lewis peter hayes linda garcia pharmacy podcast network mike schneider chad jackson john lynn aaron mitchell pharmacy podcast joe connolly julie yoo brian decker listserv brandon weber robert matthews jeff hogan nikki king brian klepper john marchica hcbiz show

INBW32: The Ultimate Impact of Telehealth: A Thought Experiment

Play Episode Listen Later Dec 30, 2021 18:47

This episode is a little bit of a thought experiment, so hang with me as I bumble my way through it and then hit me up with your comments. The plan is to do another episode in the future where some of you with thoughts share your version of your own thought experiment. Here's the topic: The ultimate impact of telehealth—in 20 minutes or less. In my version of this thought experiment, I want to do something a little bit different (maybe) than everybody who seems to be putting up a poll on Twitter right now. I want to look at telehealth as a leading indicator, not as a trend. The goal here is not to inform you of things that you don't already know because I am entirely confident that much of what I'm gonna say right now the majority of you are already eminently familiar with—probably more familiar with than I am, frankly. So, the goal here is to put this information into a context that maybe is new—at least I hope it's new. The goal of that is to hopefully inspire some of you to take action, right now, with all haste. This whole telehealth thing started in the middle of one of the many conversations I've had lately about what will be the future of telehealth. You have probably had similar chats about the future of telehealth and know what I am going to say. They all seem to devolve into someone ticking off all of the states who have extended temporary telehealth measures and the 1000 telehealth bills pending in state legislatures that might mandate public and private payers cover it. Anyway, in the middle of one of these “let's all study this updated spreadsheet” exercises, I started to wonder if we were missing the bigger takeaway. So, let me tick through a few background points which are all pillars in my “what's the ultimate impact of telehealth” contemplation and the realization that telehealth in and of itself has no impact. What has impact is who is using it and whether their goals are reactionarily (if that's a word) short term and/or shortsighted, or if there's anything that approximates a strategic long game in that mix. For more information, go to aventriahealth.com. Each week on Relentless Health Value, Stacey uses her voice and thought leadership to provide insights for healthcare industry decision makers trying to do the right thing. Each show features expert guests who break down the twists and tricks in the medical field to help improve outcomes and lower costs across the care continuum. Relentless Health Value is a top 100 podcast on iTunes in the medicine category and reaches tens of thousands of engaged listeners across the healthcare industry. In addition to hosting Relentless Health Value, Stacey is co-president of QC-Health, a benefit corporation finding cost-effective ways to improve the health of Americans. She is also co-president of Aventria Health Group, a consultancy working with clients who endeavor to form collaborations with payers, providers, Pharma, employer organizations, or patient advocacy groups. 02:30 Should provider organizations be getting rid of telehealth? 02:40 EP330 with John Marchica. 04:36 EP349 with Lisa Trumble. 05:07 Should telehealth be viewed as a threat? 05:40 “Virtual is a ‘head in the bed at the hospital' demand destroyer.” 06:45 “‘Virtual' is the scapegoat.” 07:42 Patients/Consumers: Is in person really better? 10:42 EP338 with Nikki King; EP347 with Ian Tong, MD; EP320 with Christian Milaster; and EP302 with Blake McKinney, MD. 11:06 How one VP of finance justifies a facility fee for a telehealth visit. 11:54 Do patients actually act like consumers in the digital age? 12:12 Why are virtual-first entities steering patients to clinically integrated networks? 13:08 How is telehealth changing healthcare costs? 14:21 “It adds up to telehealth being inexorable. It's a done deal. It's not a trend.” 15:17 “If telehealth is a leading indicator, anybody in the care delivery business who isn't … trying to figure out how to make telehealth work in their core business is gonna find themselves … in a very problematic position.” 16:50 “When will tele-whatever become an existential problem for laggard traditional provider organizations?” For more information, go to aventriahealth.com. Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth Should provider organizations be getting rid of telehealth? Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth Should telehealth be viewed as a threat? Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth “Virtual is a ‘head in the bed at the hospital' demand destroyer.” Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth “‘Virtual' is the scapegoat.” Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth Patients/Consumers: Is in person really better? Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth Do patients actually act like consumers in the digital age? Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth Why are virtual-first entities steering patients to clinically integrated networks? Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth How is telehealth changing healthcare costs? Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It adds up to telehealth being inexorable. It's a done deal. It's not a trend.” Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth “If telehealth is a leading indicator, anybody in the care delivery business who isn't … trying to figure out how to make telehealth work in their core business is gonna find themselves … in a very problematic position.” Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth “When will tele-whatever become an existential problem for laggard traditional provider organizations?” Our host, Stacey Richter, discusses the impact of #telehealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth Recent past interviews: Click a guest's name for their latest RHV episode! Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye

americans healthcare virtual md pharma telehealth digital health healthtech thought experiments care plans marshall allen al lewis peter hayes mike schneider joe connolly brandon weber nikki king john marchica

Encore! EP294: Building a Center of Excellence: A Playbook for Physician Entrepreneurs, With Steve Schutzer, MD

Play Episode Listen Later Dec 23, 2021 33:52

Believe me, filling in for the uncontested master of podcasts, Stacey Richter, is just a tad unnerving! My name is Dr. Steve Schutzer. I'm an orthopedic surgeon specializing in joint replacement surgery, and I think it's fair to say that I'm more comfortable, in my own lane, doing complex surgery than doing this introduction to our encore podcast 294 entitled “Building a Center of Excellence: A Playbook for Physician Entrepreneurs,” which aired originally in October 2020. But when Stacey graciously offered me the honor of doing so, I said to myself (sic: Steve, suck it up) what an opportunity to share with the devoted listeners of this show my humble perspectives on the prominent position COEs (also known as Centers of Excellence) are playing in this rapidly accelerating, evolving, and exciting healthcare landscape. So, there's an ancient Chinese proverb that goes like this: “When the wind of change blows, some build walls, and others build windmills”—or in this case, Centers of Excellence! And the winds of change in healthcare are blowing, maybe even reaching gale force. In the year since episode 294 aired, there's been unambiguous upsurge of activity, in part fueled by the pandemic, that has collectively and finally moved the healthcare value agenda across the chasm, over the inflection point—and there's no turning back. Unaccountable fee for service as the predominant payment model for healthcare services is, well, shall we say, on its last legs—being replaced by reimbursement models that are aligned with the clinical and financial outcome of the services actually delivered to our patients. For COEs, that's characteristically in the form of predictable bundled payments and fully warrantied episodes of care. Question: Where do COEs fit in this new landscape? Answer: COEs are the common pathway for all healthcare purchasers (whether they're self-funded employers, advanced primary care groups, Medicare Advantage—all of them) to steer agnostically to high-quality specialists focused on a defined set of healthcare services and who are willing to assume total cost of care for their product. And the favorable impact of COEs on the ROI for purchasers has now moved beyond the realm of theory to indisputable. Take, for example, the recent report by the RAND Corporation published earlier this year in Health Affairs: A study of over 2300 patients who had either total joint, spine, or bariatric surgery done under the Carrum Health program at one of their COEs. Carrum Health is a value-based national COE platform that connects self-insured employers with top providers under standardized bundled payment arrangements. And now in full disclosure, I serve as medical advisor for the company; and our program, the Connecticut Joint Replacement Institute in Hartford, Connecticut, is actually a Carrum COE. But in this independent RAND analysis of two years of medical claims data, the savings per procedure when the surgery was done at a Carrum COE was over $16,000 per procedure. Readmission rates were reduced 80% on average. Out-of-pocket cost to the patient? Zero. And an astonishing 30% of patients who were in the queue awaiting surgery ultimately were treated nonoperatively! Peter Hayes is president and CEO of the Healthcare Purchaser Alliance of Maine and a frequent guest on this podcast. His organization has been under contract with Carrum for approximately two years and recently reported an ROI of 58% and plan savings approaching $1 million. And these data also closely reflect that reported in the Harvard Business Review two years ago by Ruth Coleman and colleagues from their experience with Walmart COEs. Finally, you know, I heard Stacey say of COEs in one of her podcasts, “This is not something you can do on a Tuesday.” Agree. Prescient advice. As you will hear once again in just a moment, this takes work. But physician leaders and entrepreneurs, take heed. Although you won't be able to stand this up on a Tuesday, there's no reason why you can't begin next Monday. You can contact Dr. Schutzer at steve.schutzer@gmail.com and learn more at the Novel Healthcare Solutions website. Steven F. Schutzer, MD, graduated with honors from Union College and the University of Virginia School of Medicine. Following a surgical internship at the University of Rochester, he served as lieutenant in the Medical Corps of the United States Navy. After his tour of duty, Dr. Schutzer did his general surgical training at the University of Rochester and then completed his orthopedic residency at the University of Connecticut. He was then a fellow in adult hip and reconstructive surgery at the Massachusetts General Hospital, after which he entered practice in Hartford, Connecticut. Dr. Schutzer is a founding member and medical director of the Connecticut Joint Replacement Institute (CJRI), a Center of Excellence at Saint Francis Hospital in Hartford, where he served as medical director between 2007 and 2021. He is currently the physician executive for the orthopedic service line at Trinity Health of New England. He is on the staff of Saint Francis Hospital and a member of Advanced Orthopedics New England. In 2014, Dr. Schutzer and two colleagues, Ms. Steph Kelly and Ms. Maureen Geary, launched a consulting company, Novel Healthcare Solutions, whose mission is to establish effective and trusting business relationships between physicians and hospital partners—and then create orthopedic Centers of Excellence. Dr. Schutzer is also vice president and co-founder of Upswing Health, a health technology start-up whose charge is to help 10 million lives alleviate suffering from musculoskeletal pain by the end of 2023. 04:52 Why would competitive physician groups gang together? 09:02 “Even if you never … bundle, going through the implementation process … will yield incredible unrecognized value.” 10:19 “It demands an end-to-end care redesign process.” 11:40 “The value of a COE is really unquestionable.” 11:48 “For every dollar saved [in a COE], two-thirds was in the quality side, and one-third was in the price point.” 14:38 Slide deck discussing the definition of a COE and its seven building blocks.15:06 “I'm talking about business relationships between the physicians … these are the most fundamental [relationships].” 16:24 “It is all about trust.” 16:49 What is the most central issue as to why a COE does well or fails? 17:26 “It's not just data. It has to be actionable data because physicians naturally don't trust data.” 22:55 “Employers are definitely taking note to patient-reported outcomes.” 23:38 What is the seventh element that is necessary for a COE, and what is fundamental to that element? 24:28 Where will fee-for-service doctors be in 2 to 3 years? 25:46 “The only way that we can accrue the value that we deserve is through these types of relationships.” 26:12 “The supreme motivator is opportunity.” 28:03 How do physicians and providers begin a transformation of the marketplace they're in? 28:38 “What they need from us is product. They need products to disrupt the status quo.” 31:27 “The problem is that there are vendors who are working at the margin.” You can contact Dr. Schutzer at steve.schutzer@gmail.com and learn more at the Novel Healthcare Solutions website. @SSchutzer of @THOfNewEngland discusses #centersofexcellence on this week's #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech Why would competitive physician groups gang together? @SSchutzer of @THOfNewEngland discusses #centersofexcellence on this week's #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech “It demands an end-to-end care redesign process.” @SSchutzer of @THOfNewEngland discusses #centersofexcellence on this week's #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech “The value of a COE is really unquestionable.” @SSchutzer of @THOfNewEngland discusses #centersofexcellence on this week's #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech “It's not just data. It has to be actionable data because physicians naturally don't trust data.” @SSchutzer of @THOfNewEngland discusses #centersofexcellence on this week's #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech “Employers are definitely taking note to patient-reported outcomes.” @SSchutzer of @THOfNewEngland discusses #centersofexcellence on this week's #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech Where will fee-for-service doctors be in 2 to 3 years? @SSchutzer of @THOfNewEngland discusses #centersofexcellence on this week's #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech How do physicians and providers begin a transformation of the marketplace they're in? @SSchutzer of @THOfNewEngland discusses #centersofexcellence on this week's #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech Recent past interviews: Click a guest's name for their latest RHV episode! Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried

EP349: How Integrated Is a Clinically Integrated Network, Actually? With Lisa Trumble

Play Episode Listen Later Dec 16, 2021 31:15

This interview with Lisa Trumble is mostly about clinically integrated networks (CINs)—what they are, how they work, how data get shared. Furthermore, we talk about hybrid CINs, meaning, for example, a virtual front door that might lead to in-person care. After that, we talk about the potential impact of direct contracting, which Lisa says could significantly change the healthcare marketplace. The hybrid talk, by the way, is toward the middle of the show; and we talk about direct contracting—that's near the end if you're short on time and you want to skip around. But before we go there, let's just level set a little bit, shall we, on the topics of accountability and integration as general constructs. Specifically, what's the impact, or lack thereof at times, when the provider is not accountable for patient results? I'm talking here about fee for service, in general, where the provider is not accountable for patient results. Like, if we're talking about a fee-for-service world and what it incents, it goes like this: Transaction happens. Somebody sends a bill. The end. I mean, in a fee-for-service world, the patient encounter may be the highest- or the lowest-value patient-doctor transaction in the history of humankind; but either way, the payment is the same. So, the incentive is to figure out how to encounter lots of patients and/or upcode wildly, I guess. The incentive is not to coordinate care or teach a patient how to take advantage of a telehealth offering to mitigate some social determinant of health or spend 10 minutes doing some education or shared decision making or establishing rapport and being culturally sensitive. Any docs who are doing that stuff are doing it on their own time in an FFS world. Here's the good news and the bad news—and I don't often hear it spelled out this bluntly, so I'll do the honors: If anyone wants to get paid to create patient health, they have to be accountable for the outcomes created—upside and downside. Frankly, when an organization is super worried about the downside, that could be—not in all cases, but it certainly could be—a clue that maybe their approach is a little bit more transactional and/or inefficient than perhaps they would like to admit. There's been much talk over the years about the importance of giving patients so-called “skin in the game,” but what might work out better is to mandate that providers have so-called skin in the game. Providers have to be accountable so good providers can reap rewards and bad ones don't. The episode with Sunita Desai (EP334) is all about how providers have proven to actually be better “consumers” than “consumers,” so there could be a constellation of rationales here. Now, if you're accountable for care, you must actually create outcomes, as just discussed. And to actually create outcomes, there must be integration. Integration is necessary. Care coordination is necessary both with internal and external other providers and entities. There are very, very few cases where a chronic condition can be appreciably improved by a random assortment of 7- to 15-minute patient encounters. Managing chronic conditions requires a longitudinal journey that weaves together most often more than one doctor, also nurses and a PA and a speech pathologist and a nutritionist and a Certified Diabetes Educator and maybe a physical therapist or two. Considering that 85% of healthcare spend in this country has to do with chronic conditions also ... yeah, integration is really required. And, yeah, how many decades later, we're still talking about interoperability. Here's a tidbit I found kinda apropos: Female doctors make $2 million less, apparently, over a 40-year career than their male counterparts. That's per research in Health Affairs, recently reported in the New York Times. More men become surgeons, and women have been shown to spend more time with their patients, leading to fewer services that can be billed for. What's the actionable takeaway there, I wonder? In this healthcare podcast, I have the honor and pleasure of speaking with Lisa Trumble. Lisa is president and CEO of a CIN, a clinically integrated network, called the Southern New England Healthcare Organization, or SoNE. SoNE was formed in January 2020 to integrate three ACOs [accountable care organizations] in two states. The CIN manages a population of over 200,000 patients—about $1.5 billion in total costs of care. Previously, she worked at Cambridge Health Alliance building their pop health and value-based structure to the point where about 60% of their business was in some form of risk or alternative payment models. There is one disclaimer that I would just ask you to keep in mind when listening to any conversation about value-based care—and there are lots of them going on right now—but I just want to tuck this in here because I'd be remiss not to mention it at some point. Dr. Mai Pham (EP325) has put this better than I ever would. She said recently, “After a decade of value-based payment contract negotiations in both public and private sectors, I would like to point out that [health systems] can talk a good value game, but if their ... organizations push for ever-higher unit prices, the word value is meaningless. I've seen trends in unit prices for a given health system outstrip the legitimate savings it produces by reducing volume, which was the plan all along.” Dr. Pham is currently writing a piece about this exact topic that's going to appear in AJMC soon, so definitely look out for that. You can learn more at sonehealthcare.com. Lisa M. Trumble, MBA, president and CEO of SoNE HEALTH, has had a career showcased by successes in generating strong clinical and financial operating results for healthcare organizations. She has 30+ years' experience at integrated delivery systems and physician organizations. Prior to joining SoNE HEALTH, Lisa served as senior vice president of accountable care at Cambridge Health Alliance (CHA); the scope of her responsibility included systemwide duties for accountable care and population health management, incorporating payer contracting, financial medical economics, regulatory compliance, and administrative and clinical programming. Under her leadership, the organization realized significant improvements in clinical and financial outcomes. Lisa joined CHA from Berkshire Health Systems, where she served as vice president of physician services and executive director of the Berkshire Health Systems Physicians Organization. She was instrumental in transforming physician operation, restructuring provider employment agreements and provider compensation plans, and enhancing patient satisfaction. Prior to Berkshire Health Systems, she served as the vice president of finance and operations at the Cambridge Health Alliance Physician Organization, where she achieved similar outcomes. Previously, Lisa was administrative director for anesthesia and surgery services lines at North Shore Medical Center and chief financial officer of North Shore's Physicians Organization, a subsidiary of North Shore Medical Center. Additionally, she held positions in operations and finance at Commonwealth Health Management Service and Independent Physicians Association. Lisa holds a bachelor's degree in business administration from North Adams State College and a master's degree in business administration and healthcare finance from Western New England University. 06:20 Why do accountability and integration go hand in hand? 08:56 “Aggregation just for the point of aggregation doesn't necessarily produce better outcomes.” 09:18 What questions should we be asking when considering aggregation? 09:45 Does aggregation equal integration? 11:42 What exactly is a clinically integrated network? 12:26 What is the intention of a clinically integrated network? 13:22 Are all CINs ACOs? Are all ACOs CINs? 17:22 What entities make up a clinically integrated network? 19:26 “We want providers that are able to generate the outcomes that we're expecting.” 20:44 “There is a lot of work that goes into data integration.” 23:14 What is a hybrid CIN model? 25:22 Encore! EP206 with Ashok Subramanian.26:53 “Everyone is sitting around the table proactively.”—Stacey 29:37 What kind of structure could move the Medicare market quickly? You can learn more at sonehealthcare.com. Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN Why do accountability and integration go hand in hand? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN “Aggregation just for the point of aggregation doesn't necessarily produce better outcomes.” Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN What questions should we be asking when considering aggregation? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN Does aggregation equal integration? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN What exactly is a clinically integrated network? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN What is the intention of a clinically integrated network? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN Are all CINs ACOs? Are all ACOs CINs? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN What entities make up a clinically integrated network? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN “We want providers that are able to generate the outcomes that we're expecting.” Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN “There is a lot of work that goes into data integration.” Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN What is a hybrid CIN model? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN “Everyone is sitting around the table proactively.” Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN What kind of structure could move the Medicare market quickly? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN Recent past interviews: Click a guest's name for their latest RHV episode! Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera

EP348: Your Burning Questions About Payviders Answered! With Jeb Dunkelberger

Play Episode Listen Later Dec 9, 2021 32:03

The discussion to follow is probably a 400-level class in payviders. If I just said the word payvider and you're scratching your head wondering where you may have heard that term before, this show is probably not the best place for you to start. I'd go back and get some context by listening first to the episodes with Steve Blumberg from GuideWell (EP304) and/or the one with John Moore from Chilmark (EP172); and for a really retrospective lookback, check out the one episode with Dr. Kris Smith from Northwell (EP127) from back when they were still trying to become an insurance carrier. It's like a time capsule into their ambitions. OK, if you're still with me, in this episode I'm looking forward to digging into payviders with Jeb Dunkelberger, who is the CEO of Sutter Health | Aetna. Sutter Health | Aetna is the payvider joint venture between, you guessed it, Sutter Health and Aetna. Not only is Jeb one who would obviously know a whole lot about payviders and how they operate given his role, but he's also super articulate and thoughtful in terms of the potential impacts that this type of entity can have on patients and the surrounding healthcare ecosystem. I started to get really curious about payviders and what they're up to because the term keeps coming up in conversations, number one. And the more it came up, the more it started to become really obvious that payvider is one of those terms that everybody tosses around and may or may not define it the same way. Jeb refers to a payvider as an entity that delivers care but also writes insurance products and takes risk for them—not just taking capitated payments or doing direct contracting. While it's the employer who actually takes the risk, this is the definition of payvider that we explore in this healthcare podcast. Two kinds of interesting points that Jeb makes, which I'll just underscore here: One is “demand destruction.” I like the idea of the term because it brings a really obvious point into stark focus. Bottom line, taking on risk or value-based programs is easier if you are a smaller percentage of the healthcare spend. The bigger a percentage of the healthcare spend that gets cha-chinged into your cash register, the more you destroy your own demand by creating value-based programs that minimize downstream costs. Those downstream costs are your revenue, after all. Value-based care is all about demand destruction at its core. In the last question of this interview (so, this is the second thing I'm underscoring here), I ask Jeb if he thinks payviders will ultimately lower healthcare costs; and he comes back with a reframe of my question. He says if we take costs out of the system, will hospitals close? And if the hospitals close, then people get laid off. Fair point, since in many places the health system is one of the biggest employers in town if not the biggest—and also a political tour de force. So, there's more nuances here; but you'll have to either get to or skip to almost the end of the episode to hear them. Jeb Dunkelberger began his career as a health economist and consultant. He became the CEO of Sutter Health | Aetna to focus on alternative reimbursement models and value-based care. Jeb also wrote a book called Rich & Dying. You can learn more at sutterhealthaetna.com. You can also connect with Jeb on LinkedIn and follow him on Twitter. Jeb Dunkelberger, MSc, MHCI, currently serves as CEO of Sutter Health | Aetna (SH|A), a commercial insurance plan serving Northern California. The health plan aims to combine the value of retail, provider, and payer via its partnerships with CVS, Sutter Health, and Aetna. Prior to SH|A, Jeb led growth for two bay-area healthcare start-ups: Cricket Health and Notable Health. Jeb has also held executive roles at Highmark, McKesson, and EY. Jeb holds healthcare-related degrees from Virginia Tech, The London School of Economics, Cornell University, and University of Pennsylvania. 03:58 What all does Sutter Health | Aetna entail? 04:31 What does it mean to be a “performance network”? 04:48 What does it mean to be a payvider? 06:35 How common are payviders? 07:31 “We are writing direct risk.” 09:21 How does the fully insured product work? 12:30 “You want to hold their feet to the fire, from a value-based perspective.” 12:42 What's the incentive for providers to partner with payers? 15:25 “It's just math. It's the amount of lives times the amount of utilization multiplied by your unit costs.” 20:58 “You have to have a day of reckoning, and that only comes from financial incentives creating that gateway out.” 24:55 How do we think about reform and taking money out of the healthcare system? 26:58 “We also have to talk about repurposing the workforce.” 27:27 “We need to upskill our workforce.” 30:14 “Can a health system survive as the largest employer, year over year, if they give unit cost concessions, year over year? … The answer is no.” You can learn more at sutterhealthaetna.com. You can also connect with Jeb on LinkedIn and follow him on Twitter. @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth What all does Sutter Health | Aetna entail? @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth What does it mean to be a “performance network”? @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth What does it mean to be a payvider? @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth How common are payviders? @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth “We are writing direct risk.” @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth How does the fully insured product work? @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth “You want to hold their feet to the fire, from a value-based perspective.” @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth What's the incentive for providers to partner with payers? @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It's just math. It's the amount of lives times the amount of utilization multiplied by your unit costs.” @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth “You have to have a day of reckoning, and that only comes from financial incentives creating that gateway out.” @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth “We also have to talk about repurposing the workforce.” @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth “We need to upskill our workforce.” @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth “Can a health system survive as the largest employer, year over year, if they give unit cost concessions, year over year? … The answer is no.” @Jeb_Dunk discusses #payviders on our #healthcarepodcast. #healthcare #podcast #digitalhealth Recent past interviews: Click a guest's name for their latest RHV episode! Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham

ceo university pennsylvania healthcare economics bottom northern california cornell university provider msc london school virginia tech cvs ey burning questions digital health payer aetna jeb john moore mckesson sutter health care plans marshall allen highmark al lewis kris smith peter hayes mike schneider joe connolly cricket health brandon weber nikki king john marchica

6: Brokers for Better Benefits with Brandon Wells, Co-founder and CEO, Nava

Day Zero

Play Episode Listen Later Dec 7, 2021 20:47

Meet Brandon Weber:Brandon Weber is the co-founder and CEO of Nava, a benefits brokerage firm that facilitates high quality healthcare to employers. He is a co-founder and advisor for VTS and serves on the board of Directors for WiredScore. Additionally, Brandon is an Advisor for CityBldr and he previously founded and was CEO of Hightower Inc. Brandon earned degrees in Computer Information Systems and Human Computer Interactions from Carnegie Mellon University. Key Insights:When founders become truly obsessed about a problem, the solution is therapeutic. That's how Brandon Weber feels about the ever-increasing cost of healthcare, and Nava scratches that itch.Bottleneck. There is a huge explosion of innovation on the supply side of healthcare, but it is not reaching buyers. Part of the bottleneck is in the benefits brokerage industry, which Nava hopes to change. Brandon thinks the future might already be here, it's just not evenly distributed.(1:11)Strong Beliefs, Held Loosely. Entrepreneurs need to have an unwavering conviction that a problem exists, but listen to the data and consumers to develop solutions. (13:23)Be the Change. Brandon is passionate about convincing founders to take the leap. From family stories to subreddit anecdotes, many Americans have experienced healthcare events that adversely impacted their health or finances. There is no shortage of problems to solve. (16:29)This episode is hosted by Marcus Osborne. He is a member of the Advisory Council for Day Zero and the former Senior Vice President for Walmart Health.Relevant Links:Learn more about NavaFollow Brandon on TwitterListen to the podcast “Disrupting the healthcare benefits industry with Nava's Brandon Weber” by Authentically Successful

ceo director entrepreneur change americans co founders benefits senior vice president advisor disrupting carnegie mellon university brokers advisory council nava bottleneck day zero computer information systems vts wiredscore brandon weber

EP347: Rolling Out Healthcare Initiatives That Actually Get Uptake With the Populations You Aim to Serve, With Ian Tong, MD, About the Black Community Innovation Coalition

Play Episode Listen Later Dec 2, 2021 34:29

I attended the STAT Summit last week and heard the heart-wrenching story told by Charles Johnson, who is the founder of 4Kira4Moms, which is a group dedicated to improving maternal health equity. Charles's family is African American. After a planned C-section, his otherwise-healthy wife died an avoidable death because 10 hours after the clinical team was alerted that she had internal bleeding—10 hours later—they got around to wheeling her into surgery. At that point, she had three liters of blood in her abdomen. She bled out and died, leaving her newborn infant motherless. This all went down at a large, incredibly well-respected integrated delivery network. One of the biggest issues in healthcare today … well, there are many issues, so maybe I should start again. One of the biggest issues in healthcare that is going to be discussed on this podcast today is how to engage those patients or members or employees or consumers who might need our healthcare industry to work better on their behalf. This is especially a problem (a well-known problem) when we consider those patients who our healthcare system in so many ways does not serve well: many minority patients, Black people, other people of color, the LGBTQ community, people who do not speak English as their first language. These patient cohorts emerge on the other side of our healthcare industry sporting patient outcomes that are even worse than our usual not-so-great average patient outcomes. In this healthcare podcast, we're gonna talk about a new coalition formed by Walmart and six other employers, plus Included Health, which is the combined entity of Grand Rounds and Doctor On Demand. (They merged recently.) So, there was a coalition that was formed. It's called the Black Community Innovation Coalition, and in short, it's a new virtual-care program aimed at combating health disparities among African American workers. I wanted to learn more about this coalition, so in this episode I'm speaking with Ian Tong, MD, about the aforementioned Black Community Innovation Coalition—the how and also the intent. Dr. Tong is the chief medical officer over at Included Health and also a clinical assistant professor and adjunct faculty in the medical school at Stanford. One reason I was so intrigued is that the Black Community Innovation Coalition leverages ERGs (employee resource groups) in a way I thought was different. If you're unfamiliar, ERGs or, as I said, employee resource groups, used to be called employee affinity groups. Many big companies have them. These ERGs bring together groups with shared identities, shared experiences, shared interests. What I thought was worth contemplating if you're interested in improving health equity, health outcomes … through these existing ERG organizations, it might be possible to pull the healthcare system and these patients closer together to create healthcare benefits and care delivery models that are designed with them in mind. So, what I think might be actionable to others relative to this coalition and its methodology is the best practice of building the engagement mechanism into the design of the initiative. So often it's an afterthought if you think about it. We build the thing, and then we wonder how to “market” it—like the “marketing” is this separate and sequential function. It's not. And marketing is also probably a limiting misnomer. This is especially true, though, when contemplating minority populations for a whole bunch of reasons that we get into in this conversation. So that's number one: Build the engagement mechanism into the program design. But here's number two: Consider the engagement mechanism relative to existing channels of engagement, re: ERGs or otherwise. Other links on the show include: Rebecca Etz, PhD (EP295) talking about some best ways to measure primary care quality. The Harvard Implicit Bias Test You can learn more by checking out the Implicit Bias Test, the CDC REACH site, and includedhealth.com. Ian Tong, MD, is chief medical officer at Included Health (formerly Doctor On Demand and Grand Rounds Health). In this role, Ian leads all clinical care delivery, including clinical products and service lines, clinical quality, and practice performance of the clinical staff. Prior to Doctor On Demand, Ian held leadership roles including chief resident of Stanford Internal Medicine and co-medical director of the Arbor Free Clinic. He also founded and was medical director of The Health Resource Initiative for Veterans Everywhere (THRIVE), honored with the Award for Outstanding Achievement in Service to Homeless Veterans in 2008 by the US Secretary of Veterans Affairs. A national collegiate champion in rugby at the University of California at Berkeley, Ian was named to the All-American Team in 1994. He graduated from Berkeley with a bachelor's degree in English, then earned his medical degree from The University of Chicago Pritzker School of Medicine. He completed residency and chief residency at Stanford Hospital and Clinics and is currently a clinical assistant professor (affiliated) at Stanford University Medical School. He is board certified in internal medicine. Ian has dedicated his career to improving equity in, and access to, high-quality care. He lives in the San Francisco Bay area. 04:33 What is the Black Community Innovation Coalition? 05:06 Who are the partners behind the Black Community Innovation Coalition? 06:23 How is the Black Community Innovation Coalition focusing on patients? 08:05 “If you take a one-size-fits-all approach to your employees, that is not going to be adequate or complete.” 08:56 How the Black Community Innovation Coalition is incorporating engagement into its core foundation. 13:18 “There's a great deal of hesitancy around engaging care, and there's a high level of avoidance.” 15:26 EP338 with Nikki King, DHA.16:34 “The technology is not making that experience worse. It's a bad experience, and it's broken already.” 23:27 “I feel very strongly that everyone should probably have a virtual primary care clinician.” 27:20 EP295 with Rebecca Etz, PhD.28:15 “We really want to pay attention to that encounter being the best encounter possible because that … might be the only chance you get to engage that patient.” 29:00 Why is virtual care important for self-insured employers? 32:08 “We cannot afford to have low-value encounters.” You can learn more by checking out the Implicit Bias Test, the CDC REACH site, and includedhealth.com. @Driantong discusses the Black Community Innovation Coalition on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth What is the Black Community Innovation Coalition? @Driantong discusses community health initiatives on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth Who are the partners behind the Black Community Innovation Coalition? @Driantong discusses community health initiatives on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth How is the Black Community Innovation Coalition focusing on patients? @Driantong discusses on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth “If you take a one-size-fits-all approach to your employees, that is not going to be adequate or complete.” @Driantong discusses the Black Community Innovation Coalition on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth “The technology is not making that experience worse. It's a bad experience, and it's broken already.” @Driantong discusses the Black Community Innovation Coalition on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth “I feel very strongly that everyone should probably have a virtual primary care clinician.” @Driantong discusses the Black Community Innovation Coalition on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth “We really want to pay attention to that encounter being the best encounter possible because that … might be the only chance you get to engage that patient.” @Driantong discusses the Black Community Innovation Coalition on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth Why is virtual care important for self-insured employers? @Driantong discusses the Black Community Innovation Coalition on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth “We cannot afford to have low-value encounters.” @Driantong discusses the Black Community Innovation Coalition on our #healthcarepodcast. #healthcare #podcast #healthcareinitiatives #pophealth Recent past interviews: Click a guest's name for their latest RHV episode! Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy

Encore! EP288: The “Big Three” PBMs Spinning Up GPOs—What? With Mike Schneider

Play Episode Listen Later Nov 25, 2021 29:53

Over the holiday season here, we're running some of our favorite episodes from years past. This one is with Mike Schneider, who actually has taken another role since this show was recorded. Other than that, the information that Mike shares during this episode from 2020 is all good. So, let's do this thing. 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. I talk with Mike Schneider. 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 by connecting with Mike on LinkedIn. Mike Schneider is an experienced healthcare executive with over 20 years of experience in the pharmaceutical manufacturer, pharmacy benefit manager, and payer side of healthcare. 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 healthcare, 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. 02:48 What does a GPO add to a PBM? 05:23 Rebates vs driving more revenue. 10:39 PBMs vs safe harbors. 12:25 The net impact on the commercial side. 14:07 PBMs vs pharmaceutical manufacturers. 14:54 How the “Big Three” PBMs compete with each other, and how employers would choose between them. 15:56 What the net-net is here. 18:06 How PBMs are shifting their models. 20:42 How GPOs may be making things even less transparent. 21:31 “The PBM world as a whole is not very transparent.” 25:00 “One of the biggest beneficiaries of this whole rebate [system] is the government.” 25:46 “The question is, ‘Who's paying those costs?'” 26:02 EP216 with Chris Sloan.27:00 A better way to move money from Pharma to employers and plan sponsors. 28:04 “Put your money where your mouth is.” You can learn more by connecting with Mike on LinkedIn. Check out our newest #healthcarepodcast with Mike Schneider as he discusses #PBMs and #GPOs. #healthcare #podcast #digitalhealth #healthcarefinance #pharma What does a GPO add to a PBM? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma Rebates vs driving more revenue. Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma PBMs vs safe harbors. Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma What is the net impact on the commercial side? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma PBMs vs pharmaceutical manufacturers. Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma How do the “Big Three” PBMs compete with each other? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma How do #employers choose between the “Big Three” PBMs? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma What's the net-net here? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma How are PBMs shifting their revenue models? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma How are GPOs making things even less transparent? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma “The PBM world as a whole is not very transparent.” Mike Schneider 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 discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma “The question is, ‘Who's paying those costs?'” Mike Schneider 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 discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma “Put your money where your mouth is.” Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma Recent past interviews: Click a guest's name for their latest RHV episode! Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis

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EP346: How Did Health Systems Get Addicted to the Inflated Prices They Charge Employers and Some Patients? 2021 Update, With Peter Hayes, President and CEO of the Healthcare Purchaser Alliance of Maine

Play Episode Listen Later Nov 18, 2021 36:15

In this healthcare podcast, I speak with Peter Hayes, who is president and CEO at the Healthcare Purchaser Alliance of Maine and a national presence in healthcare strategy, innovation, and a frequent keynote speaker. One thing, among many, that Peter said during our conversation struck me. He said it will take a village to fix what ails the healthcare industry in this country. There are too many interdependencies. This point obviously resonates around these parts because it's the rationale for the Relentless Health Value podcast. We started this show on the recognition that if you want to achieve anything in healthcare, you cannot do it without collaboration/cooperation/grudging acquiescence of other stakeholders in the patient journey or the payment journey. And when I say, “You can't do anything,” I mean you can't sell anything, you can't improve patient care, and, most relevant to this particular episode, you can't contain prices. If we're talking about health systems (for example, hospitals and the like), they are not going to curtail their price hikes or improve the value of care delivered or safety or infection control really unless patients and employers and CMS and others demand that they do—and unless employers and others do some of the five things that Peter Hayes mentions at the end of our conversation. Spoiler alert there. For context to this discussion, let's check in with some of the biggest, most powerful health systems in this country. If I limit this comment to the “nonprofit” ones—and I say “nonprofit” with air quotes because what does that mean exactly?—look, I know there are many health system execs that listen to this show, but there's some inalienable facts here. And let's talk about them with the intent of fixing them because nothing is going to get fixed that isn't talked about. It's not my nature to mince words, so I won't. Many hospitals are, by almost every account, pretty darn inefficient. And they don't do cost accounting, but then they'll scream and claim to be losing money when paid the exact same prices for certain services that other hospitals can get paid and make a fair profit. Crappy workflows cost money. Talk to anybody who has watched even the trailer to a Six Sigma course. Another thing that costs money is when all the burned-out doctors quit and you have to recruit new ones, but that's a topic for a different day. Listen the EP323 with Arshad Rahim, MD. But there's also inefficiencies in how many health systems purchase supplies. (Listen to EP281 with Rob Austin for more on that.) Further, paying the C-suite millions of dollars but maybe underpaying or understaffing nurses has consequences. There's complaints about Medicare payer mixes, but then somehow there's enough spare shekel to put a waterfall in the lobby. Nonprofit hospitals also don't pay any taxes, keep in mind, which is a huge financial windfall, especially when they provide vanishingly small amounts of charity care compared to revenue. See the top 10 health system hall of shame in this category here. Here's another point to ponder: Amongst the hundreds, thousands, of requests I get from PR firms pitching guests to come on this show, there are plenty from what appears to be a pretty large cottage industry that I had never heard of before. I'll call it the real estate for nonprofit hospitals cottage industry. From what I can gather by the promo copy, this involves buying up medical office buildings, not paying any real estate taxes, and then leasing out the space. I should have one of these guys come on the show just to shine some light on whatever this apparently pretty common shenanigan is. As Vikas Saini, MD, from the Lown Institute has said, “No margin, no mission” can become an excuse for all kinds of questionable behavior. So bottom line, we have employers, employees, taxpayers, cash-pay patients whose federal and/or state and/or local taxes are going to support these nonprofit hospitals—but then there's this double tax. Because they claim to be losing money on Medicare patients, they justify cost shifting some pretty big bucks onto the commercially insured patients, who are then paying, on average, some wildly inflated prices for healthcare services. This might be considered a double tax if you think about it: tax dollars going to the IRS directly and then after-tax dollars buying that knee replacement for $125,000 that should cost $25,000. Consider that a $100,000 double tax. But why should a hospital with a motive to maximize margins quit it with their questionable and secretive billing practices if employers just pay whatever the bill is no fuss no muss? Short answer: They won't. So, it's going to be up to someone else in the village to make it untenable to continue. It's going to be up to another party to slow that roll. In this conversation, Peter Hayes talks about the RAND Hospital Price Transparency Study. One last thing that may or may not be relevant here, but I can't resist a good sidebar. New catchphrase I have been hearing lately: the “deconstruction of hospitals.” Have you heard it, too? In fact, I was listening to Zeev Neuwirth's podcast recently that featured Raphael Rakowski. Raphael said that the average fixed cost of any given brick-and-mortar hospital is 65% of revenue. So, just having the building, the physical plant, and paying for all the things you need to pay for to run that physical plant is really high. I heard Jason Wells say in a HealthIMPACT forum the other day that it costs a million dollars to build a bed in California due to all the regulatory requirements. Add to that something Christin Deacon highlighted the other day on LinkedIn about how operating rooms are empty 30% of the time. So, it makes me wonder whether some of the issues that hospitals have when they claim that they are losing money on Medicaid or Medicare is because their fixed costs are out of whack. This potentially disproportionate situation, however, is one reason why hospitals really have to watch it for hospitals at home or virtual offerings. After all, this is exactly how Amazon ate everybody's lunch. Erase 65% of your costs, or even 50% of your costs, and that cost-plus profit threshold becomes a weapon of mass destruction. At the end of this podcast—the very end, so if you're in a rush, jump to 28 minutes or something [32:45]—Peter gives five ideas for employers to limit the ability for hospitals to take advantage. If you're a hospital exec that's listening, I would urge you to please help your local employers do these things. Let's all get on the same team here to improve the health of our communities with pricing and business models that are reasonable and fair. Don't be like the hospital that Katy Talento is going to talk about in an upcoming episode who won't do direct contracting with employers because the coding is kind of a hassle. Seriously now. You can learn more at purchaseralliance.org. Peter Hayes is president and CEO of the Healthcare Purchaser Alliance of Maine and formerly a principal of Healthcare Solutions and director of associate health and wellness at Hannaford Supermarkets. He has been in innovative, strategic benefit design for the past 20+ years. During the past several years, Hannaford has received numerous national awards in recognition of the company's commitment to working collaboratively with healthcare providers and vendors in delivering health benefits that are focused on value (high-quality efficient care). Hannaford Supermarkets has been successful in this arena by focusing on innovative solutions for patient advocacy, chronic disease management, and health promotion programs. Hannaford was recognized by receiving the National Business Group on Health Platinum Award for the health promotion and wellness programs three years in a row. These programs, along with healthcare delivery strategies, contributed to a flat trend line over five years. Peter has also been involved in healthcare reform leadership roles on both the national and regional levels with organizations like the Center for Health Innovation, Care Focused Purchasing, and Leapfrog. He's also cofounder of the Maine Health Management Coalition (now Healthcare Purchaser Alliance of Maine) and has been appointed by two different Maine Governors to serve on Health Care Reform Commissions to recommend public policies to improve the access and affordability of healthcare for Maine citizens. 07:51 Who are the commercial payers? 08:48 Are hospitals actually losing money on Medicare and Medicaid? 11:26 Is cost inversely connected to quality when it comes to hospital care? 13:46 “A lot of hospitals don't do cost accounting.” 13:59 If hospitals don't know their costs, how does Medicare know their costs? 15:52 “In the hospital financial world … they start the budget upside down.” 18:48 “There's plenty of accountability to spread around for where we are.” 20:30 Do employers have any options in the current health system situation? 21:39 “If this market's going to change, purchasers have to step up and start demanding more accountability, more transparency.” 26:21 How is the new transparency legislation impacting plan sponsors and employers? 29:41 EP342 with Christin Deacon.32:38 “I think the whole dialogue around how we pay for hospital services is going to really change.” 32:45 What is Peter's advice to employers? You can learn more at purchaseralliance.org. @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth Who are the commercial payers? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth Are hospitals actually losing money on Medicare and Medicaid? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth Is cost inversely connected to quality when it comes to hospital care? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “A lot of hospitals don't do cost accounting.” @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth If hospitals don't know their costs, how does Medicare know their costs? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “In the hospital financial world … they start the budget upside down.” @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “There's plenty of accountability to spread around for where we are.” @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth Do employers have any options in the current health system situation? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “If this market's going to change, purchasers have to step up and start demanding more accountability, more transparency.” @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth How is the new transparency legislation impacting plan sponsors and employers? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “I think the whole dialogue around how we pay for hospital services is going to really change.” @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth Recent past interviews: Click a guest's name for their latest RHV episode! Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim

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EP345: Can Pharma Imagine How Our Health System Will Look in the Future? With Paul Simms

Play Episode Listen Later Nov 11, 2021 31:36

At the beginning of 2021, my guest in this healthcare podcast, Paul Simms, had come up with a set of predictions for 2021. Some came true; some didn't. But I was fascinated by a bunch of things, one of them being Paul's sort of implicit and explicit assessment of the context of these predictions. Right now, Pharma is in a weird moment: It's a confluence of technology, consumer expectations, changes in care delivery accelerated by the pandemic, policy at the state and federal level, and the financial realities of where we're at today. So, if you meet patients or providers or payers where they were last year or the year before that, you're gonna potentially be pretty far off the mark. There's also the financial realities which Pharma kind of exacerbated for themselves when some, many, spent the past however many years making their numbers by raising prices on existing drugs and developing drugs for mostly rare diseases but then, at the same time, not innovating antibiotics or for other diseases that impact so many lives. I mean, no comments on these strategies, but is it safe to then assume that an environment that allows for this sort of thing will continue indefinitely? Not only from an “Is this really the most patient-centric thing we can do?” standpoint, especially when you consider how many patients are being left behind as a result of both the narrow focus and also the price points—upwards of 40% of Americans have said they've abandoned meds due to cost, after all—but potentially also from a business continuity standpoint. Right now could be a decent time to start getting creative and experiment with new models and new ways to reach and engage. My guest in this episode, Paul Simms, is the former chairman of eyeforpharma, which ran the largest events in the pharmaceutical space for a number of years. His new company, Impatient Health, helps a very conservative industry find ways to deliver and provide patient value. During our conversation, Paul made a bunch of thought-provoking points; but one of them I keyed onto was a counterpoint to the ye old pharmaceutical conventional wisdom that high drug prices are needed for innovation. He said that actually all the money sloshing around could inhibit R&D innovation. Here's the thinking: If you can make a ton of money not being super innovative, then why be innovative? If you can make a ton of money not really improving OS (overall survival) in a meaningful way and not really helping a whole lot of patients, then why bother doing anything else, especially if the “anything else” might require risk or new business models that are going to take time and determination? During our chat, the work of Clay Christensen comes up more than once. Just to remind you, Clay Christensen is the one who coined the term disrupters. He wrote The Innovator's Dilemma back in the 1990s. Keep in mind that the main point of that whole book is that if you're a big incumbent, it's pretty easy to cruise along thinking everything is great until you get kneecapped by a competitor who takes advantage of a new business model or consumer preference or technology or law—all of which are coming out of the woodwork right now. Paul Simms has put it this way: When the habitat changes, evolution happens and entities that are able to adapt will thrive. I've also heard it put this way: It's not IQ or even EQ that matters most when change is afoot. It's AQ—the ability to adapt. You can learn more by connecting with Paul on LinkedIn. Paul Simms is known as the “pharma provocateur” for his efforts to realize the unfulfilled potential of the life sciences industry. His journey started in 2003 with eyeforpharma, an organization which he quickly grew into the pharmaceutical industry's most influential and largest event organizer, acquired by Reuters in 2019. He has since set up a think tank and consultancy called Impatient Health. Paul counts the industry's CEOs and innovators amongst his friends and is a regular speaker, host, author, and commentator. 05:04 “We're at that catalyst point where we could go one way or the other.” 05:39 How can the analogy of Web 1.0 vs Web 2.0 be applied to the future of healthcare business models? 07:06 “People need to improve their awareness at the very least as to a new generation of companies coming forward.” 08:31 “What now is the new business model that can exist in that world?” 09:07 Is there a stage pre-agility that will allow pharma companies to pivot to future markets? 12:08 What are the new ways to think about things in the future of healthcare business? 14:09 “The mind boggles at what is possible but is not yet being achieved.” 16:11 Why could prices falling actually spark more innovation? 16:49 EP300 with Bruce Rector, MD.21:36 “It's these companies that have this data-driven consumer relationship that I think are very interesting.” 25:16 “I just think that it's a mindset change first.” 25:38 “I'm not here to be right or wrong. I'm just here to enable the conversation.” 25:56 “What I find is that companies make significant efforts and that they don't quite gain the same traction as quickly as they might like to.” 26:20 “It seems to be this great impatience that companies can turn around these non-medicine initiatives more quickly.” 29:42 “It seems to me that the pharmaceutical industry's reaction to the pandemic has been, ‘We need to double down.'” You can learn more by connecting with Paul on LinkedIn. @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth “We're at that catalyst point where we could go one way or the other.” @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth “People need to improve their awareness at the very least as to a new generation of companies coming forward.” @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth “What now is the new business model that can exist in that world?” @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth Is there a stage pre-agility that will allow pharma companies to pivot to future markets? @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth What are the new ways to think about things in the future of healthcare business? @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth “The mind boggles at what is possible but is not yet being achieved.” @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth Why could prices falling actually spark more innovation? @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth “It's these companies that have this data-driven consumer relationship that I think are very interesting.” @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth “I just think that it's a mindset change first.” @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth “I'm not here to be right or wrong. I'm just here to enable the conversation.” @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth “What I find is that companies make significant efforts and that they don't quite gain the same traction as quickly as they might like to.” @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth “It seems to be this great impatience that companies can turn around these non-medicine initiatives more quickly.” @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth “It seems to me that the pharmaceutical industry's reaction to the pandemic has been, ‘We need to double down.'” @xpablo of @HealthImpatient discusses the future of #pharma in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharmahealth Recent past interviews: Click a guest's name for their latest RHV episode! Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson

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EP344: The High Cost of Generic Drugs, With Steven Quimby, MD

Play Episode Listen Later Nov 4, 2021 33:27

I was on LinkedIn, and someone was saying, “Oh, there's no real money in generic drugs. It's not a huge issue if patients are paying 10 bucks instead of 93 cents for something. It's not like anyone is getting rich off of that, and it's not like patient impact here is super meaningful.” This is a pretty common refrain, actually; and from a conventional wisdom perspective, I get it, especially for those living comfortable middle- or upper-middle-class lives where an extra $9.07 for a prescription isn't a huge deal—except there are big-time issues with the generic supply chain that are worth billions and billions of dollars and that have a major impact on patient health. So, let's discuss. I started casting my eye over to what was going on on the generic drug front mainly because of the huge lawsuits in the news lately that were either filed and/or settled. Generic drug manufacturers are and have been the defendants in these lawsuits, accused of price collusion amongst other things. These lawsuits aren't fighting over chump change either, unless you consider hundreds and hundreds of millions of dollars as chump change, that is. The number of zeros on the table in these lawsuits may strike you, as they did me, as a factor of interest. I mean, we're talking about generic drugs here. The cost of goods on these drugs—there was a WHO study on this—and the cost of goods to manufacture a small molecule generic is, a lot of times, pennies. Further, there's no innovation undertaken by generic manufacturers in their manufacture of generic meds. Just so no one gets confused here, the rationale branded pharma manufacturers tout for high-cost branded (ie, new) drugs is that branded pharma manufacturers have to spot the R&D (research and development) dollars to come up with the new therapies and they take a lot of risk therein. Generic manufacturers, on the other hand, are getting a recipe that has been handed down to them. There is no R&D. There is no innovation. So, to restate the situation analysis, we have generic manufacturers spending no money on innovation and enjoying, many times, a low cost of goods. If the price were set using a cost plus methodology, you'd expect the prices paid by payers and patients to be correspondingly low—except they aren't. Depending on what study you look at, somewhere between 29% and 44% of patients who have been prescribed a med say they aren't taking it because it is unaffordable. Considering that 90% of the prescriptions written in this country are for generics, one could logically assume that there's some generics in that mix that are unaffordable due to their high prices. But there's a compounding factor here: The patient affordability problem has another aspect to it beyond just patients having to pay a portion, or all, of the price of generic meds that may be, let's just say, higher than one might expect them to be given the cost of goods. But here's this other factor: The share of patient out of pocket is weirdly high when it comes to generics. Consider that generics and branded generics account for 19% of invoice-level spending but represent 65% of patient out-of-pocket costs (IQVIA National Prescription Audit, 12/2020). So, that seems out of whack. But keep in mind, as I mentioned earlier, that 90% of prescriptions written in this country are for generics. That's five billion scripts a year. As my guest in this healthcare podcast, Steven Quimby, MD, says, generic medications touch many more lives than new branded drugs. Obviously, GoodRx comes up in the conversation in this episode. If you want to learn more about pharmacy list prices and how GoodRx makes money, listen to the conversation I had with Ge Bai (EP306 and AEE13). Several people actually mentioned on LinkedIn and Twitter that hers was one of the best explanations they had heard on these topics, so I recommend those shows. The show also with Vinay Patel dives pretty deeply into the “what's the what” between PBMs and pharmacies (EP241) if you're looking for more on that. Dr. Quimby also mentions how important it could be for providers to know at the point of prescribing what the cost of medications are for a patient and get this information right in their EHR system. Refer to the episode with Carm Huntress (EP284) for more info on that. My guest, as I said, Steven Quimby, MD, is an author and newly retired physician. His father was a pharmacist with a little drugstore that thrived in the late 1960s and early 1970s, so he literally grew up in the business. Dr. Quimby recently wrote a book called Billions in Your Generic Drugs. In sum, it's a supply chain where not only is nobody watching the henhouse, but everybody within that supply chain has a very, very vested interest to see prices go up. This is kind of a theme in healthcare, but nonetheless. Oh, and one last point to ponder before we get started here: Dr. Quimby mentions at one point that 86% of Americans believe that their health insurance plan always offers the lowest price for a generic and 67% (two-thirds) of people in this country have never heard of GoodRx or other shopping tools. So, yeah … really makes you realize you live in a bubble. You can learn more by reading Dr. Quimby's book Billions in Your Generic Drugs. You can also reach Dr. Quimby on Twitter and LinkedIn. Steven Quimby, MD, is a physician who has worked in academic medicine at the Mayo Clinic and in private practice. He has been involved in drug treatment studies, including major pharmaceutical trials, and maintained an active interest in the interface of corporate business, pharmacy, and medicine for over 50 years. Dr. Quimby is concerned escalating prices for generic drugs, which fill 90% of our prescriptions, threaten access to needed medications and patients going without treatment risk worsening of their medical conditions and further costs. Too often controversies over high new drug prices and the funding of new drug development and innovation obscure addressable problems in the generic drug supply and financing chain. 05:54 What are the current lawsuits involved in the generic drug space right now? 06:52 How is price fixing happening in the generic drug space? 07:58 “If I was the major payer for drugs … I'd want to know answers.” 08:06 What's the scale on new and generic drugs? 09:02 What's the problem with using price tools for generic drugs? 10:22 “I think right now, virtually everyone should be checking [those sites vs] their insurance price.” 10:47 Are payers paying too much for generic drugs? 11:53 Who are these generic manufacturers? 12:10 “They're distinctly different corporations than those that we have called Big Pharma.” 13:55 Why is it important to have adequate numbers of manufacturers for generic drugs? 17:03 “We just can't get legitimate acquisition and then sale prices of the actual drugs.” 17:17 “The industry's opaque to all of these things.” 19:39 “The prices that patients are getting at the prescription counter are so high that some studies say a third of them or more are walking away without buying the drug.” 20:02 AEE13 with Ge Bai, PhD, CPA, on the GoodRx model.20:50 EP241 with Vinay Patel.22:05 What and who should be on formulary? 26:24 “If they'd give us the numbers, we could see when it happens.” 28:58 How can we overcome the challenges of these high generic drug costs? 30:38 EP284 with Carm Huntress.30:46 EP334 with Sunita Desai, PhD. 31:26 “How can we judge value when we don't know price?” You can learn more by reading Dr. Quimby's book Billions in Your Generic Drugs. You can also reach Dr. Quimby on Twitter and LinkedIn. @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing How is price fixing happening in the generic drug space? @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing “If I was the major payer for drugs … I'd want to know answers.” @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing What's the problem with using price tools for generic drugs? @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing Are payers paying too much for generic drugs? @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing “They're distinctly different corporations than those that we have called Big Pharma.” @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing Why is it important to have adequate numbers of manufacturers for generic drugs? @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing “We just can't get legitimate acquisition and then sale prices of the actual drugs.” @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing “The industry's opaque to all of these things.” @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing “The prices that patients are getting at the prescription counter are so high that some studies say a third of them or more are walking away without buying the drug.” @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing “If they'd give us the numbers, we could see when it happens.” @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing “How can we judge value when we don't know price?” @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing Recent past interviews: Click a guest's name for their latest RHV episode! Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco

americans phd healthcare md cpa depending billions big pharma mayo clinic refer pharma r d high cost generic ehr pbms goodrx quimby generic drugs care plans marshall allen al lewis lee lewis joe connolly vinay patel brandon weber nikki king nicole bradberry john marchica

EP343: What Provider Leadership Teams Need to Know to Operationalize Value-Based Care, With David Carmouche, MD

Play Episode Listen Later Oct 28, 2021 30:10

Most people who have been in the healthcare industry for a while have heard by now the metaphor about the two canoes. Provider organizations or health systems with some of their payments coming from a fee-for-service (FFS) payment model and some of them coming from value-based arrangements have the challenge of one foot in the FFS canoe and one foot in the value-based canoe. They're probably going through a lot of metaphorical pants is the main takeaway that often comes to mind for me. But wardrobe malfunctions aside, this is a really difficult organizational challenge. That's what I'm talking about in this healthcare podcast with Dr. David Carmouche: how to deal with the operational challenges, the cultural challenges, maybe even (very arguably) the generational challenges here. Top line (very top line), to succeed in value-based care, you gotta have three things aligned: The payment model, the construct of the contract. No kidding, you have to have value-based contracts to succeed in value-based care. The big problem here—which is not to be underestimated—is that there are some areas of the country where it's really tough to find somebody, or enough somebodies, willing to offer a capitated, prospective value-based contract. That would be really frustrating to want to go forward (if you're a provider) in a value-based way but to not have a willing payer partner and/or employer partner to do so. So please step up, payers, policy makers, and employers in those areas of the country. But the construct of the value-based contracts can also not be overlooked. Toward the end of this interview, Dr. Carmouche gets into the different results that were achieved between two patient populations: one served by a Medicare Advantage (MA) plan and one in an MSSP (Medicare Shared Savings Program) model. So, the same provider network, the same environment, same geography, same number of lives, different payment model. Stick around for that part of the conversation. It's pretty eye-opening. The second of the three things to be aligned to be successful in value-based care are physician/administrative incentives and the employment models. Seriously, who is thinking that anyone's gonna succeed managing downstream risk when the physicians making the decisions about downstream services used are bonused by how much downstream costs they can drive and everyone is eating what they kill? If culture eats strategy for breakfast, incentives eat culture for lunch, as they say. Leadership skills. Leaders who are going to succeed in a world moving from FFS to VBC have to be mission driven toward that cause. They have to be strategic enough in their approach to take potential short-term revenue hits in pursuit of the longer-term goal—even the medium-term goal, honestly, if you think about the whole context of what's going on here. Leaders also need the skill and aptitude to pull off the change management and adjustments to the organizational culture that are needed. Staffs and teams really need systematic support. Value-based care is a team sport, and teams require leadership. Here's one example of where not having great leadership trickles down to bad results: If nurses or social workers or, in general, people of color or women in an organization feel demeaned or not valued by a critical mass of those in power—and maybe here I mean physicians or other physicians that they work with—then patient safety scores diminish and quality goes down. There's enough studies on the impact of having and not having psychological safety that it's getting harder to dispute what I just said. And if this environment becomes as toxic as the stories that you read about often enough, that's on the C-suite to fix. If the C-suite has value-based aspirations, that C-suite really might want to reprioritize their to-do lists. So, think about stuff like this because toxic environments make consistently delivering high-value care and satisfied patients difficult at best for many reasons. Here's a timely side note: I heard someone say the other day that in light of the pandemic and the FFS inpatient and outpatient volume fluctuations that plummeted and rose at various points during the pandemic, compounded with Medicare FFS rates that some institutions claim are not profitable or profitable enough … someone said that, given these factors, the best way to de-risk is to take on more risk. That's interesting to think about on a number of levels. In this healthcare podcast, as I mentioned, I'm talking about all this and more with Dr. David Carmouche. Dr. Carmouche was recently the executive vice president of value-based care and network operations at Ochsner, which is a very big integrated delivery network in Louisiana. You heard it here first, folks, but Dr. Carmouche will take on a new role in November 2021. He will oversee Walmart's expanding clinical care offerings and operations, including Walmart Health MeMD and its social determinants of health line of business. Here's a quote from the announcement about Dr. Carmouche's move that I thought was interesting: “Connecting with patients in more places and creating a seamless, personalized patient experience is a crucial component in the new healthcare environment, and a space where Ochsner—as well as retail leaders like Walmart—will continue to invest.” Dr. Carmouche has been on this podcast before (EP316 and AEE15), so if you'd like to hear more from him, go back and listen to those two shows. Also, if you're looking for another episode that digs into the importance of leadership, listen to the one two weeks ago with Gary Campbell (EP341). You can learn more by visiting Dr. Carmouche's LinkedIn page or by reading From Competition to Collaboration by Tracy Duberman and Robert Sachs. David Carmouche, MD, views healthcare from three distinct perspectives: as a physician provider, an executive for an insurance company, and as a leader in a health system. Specifically, he built a large, multidisciplinary internal medicine and preventive cardiology practice in Louisiana; served as the chief medical officer for Blue Cross Blue Shield of Louisiana; and has a triad of responsibilities with Ochsner Health, the largest nonprofit academic healthcare system in the Gulf South. He was promoted to serve as executive vice president of value-based care and network operations in addition to his duties as president of the Ochsner Health Network and executive director of the Ochsner Accountable Care Network. He is known as an expert in value-based care. He led one of the top 15 performing accountable care organizations in the United States, managing billions in care spend and generating millions in year-over-year shared savings. Dr. Carmouche earned a bachelor's degree from Tulane University and a medical degree from Louisiana State University School of Medicine in New Orleans. He completed his residency in internal medicine at the University of Alabama at Birmingham. 06:31 How do you operationally deal with conflicting FFS and VBC processes? 07:23 “It's pretty clear in Medicare that our strategy in the future … is one of value.” 11:31 “I think a bigger challenge, though, is that in many markets, there are just no opportunities to have experienced value-based care.” 13:18 “How do we engage in collaborative relationships that would allow us to move into value?” 14:01 “No one wants to rush through their day in a series of seven-minute visits.” 15:53 “In a fee-for-service environment … you're forced to bring people into the office to create an encounter who don't necessarily need to be there.” 19:22 “We haven't really changed how we select and train physicians … in the last hundred years.” 20:32 “We, as physicians, were taught to be accountable for outcomes; and we create probably an unnecessary and unfair burden on ourselves.” 21:30 “In the value-based care world, a physician does have to recast themselves as part of a team.” 22:30 “It is an enormous cultural shift … but ultimately, it's one that the facts … mandate.” 26:58 “You have to have a compelling vision and belief that value-based care offers benefits to all of the actors in the healthcare ecosystem.” 27:24 “You have to be able to communicate effectively across sectors.” 27:43 “You have to have courage.” 28:29 What are the leadership skills required to make value-based care work? You can learn more by visiting Dr. Carmouche's LinkedIn page or by reading From Competition to Collaboration by Tracy Duberman and Robert Sachs. @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare How do you operationally deal with conflicting FFS and VBC processes? @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare “It's pretty clear in Medicare that our strategy in the future … is one of value.” @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare “I think a bigger challenge, though, is that in many markets, there are just no opportunities to have experienced value-based care.” @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare “How do we engage in collaborative relationships that would allow us to move into value?” @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare “No one wants to rush through their day in a series of seven-minute visits.” @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare “In a fee-for-service environment … you're forced to bring people into the office to create an encounter who don't necessarily need to be there.” @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare “We haven't really changed how we select and train physicians … in the last hundred years.” @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare “We, as physicians, were taught to be accountable for outcomes; and we create probably an unnecessary and unfair burden on ourselves.” @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare “In the value-based care world, a physician does have to recast themselves as part of a team.” @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare “It is an enormous cultural shift … but ultimately, it's one that the facts … mandate.” @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare “You have to have a compelling vision and belief that value-based care offers benefits to all of the actors in the healthcare ecosystem.” @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare “You have to be able to communicate effectively across all platforms.” @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare What are the leadership skills required to make value-based care work? @CarmoucheMd discusses #vbc on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcare Recent past interviews: Click a guest's name for their latest RHV episode! Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15)

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Disrupting the healthcare benefits industry with Nava's Brandon Weber

Authentically Successful

Play Episode Listen Later Oct 21, 2021 54:05

In this episode, your host Carol Schultz talks with Brandon Weber, Co-founder & CEO of Nava, a benefits brokerage on a mission to disrupt and transform how healthcare is found and purchased by businesses. A great number of Americans receive healthcare insurance through their employers (about 168M people) and Nava is navigating how to bring the benefits that a F500 employer can provide its employees into the SMB market. Though it shouldn't come as a surprise to anyone that our healthcare system is broken, Brandon and his Co-founder, Donald DeSantis, realized the inefficiencies of how this is currently accomplished. There is a lack of transparency for employers putting together benefits plans and a lack of support for employees trying to navigate the system, so Nava is using tech to help employers and employees be smarter shoppers and users of healthcare. Listen as Brandon describes his shift from commercial real estate to healthcare and the mistakes he made hiring employees in his first startup and the lessons he learned and has implemented at Nava. A couple of these lessons learned are the value of outside advisors, the impact of hiring the wrong people, and the impact of hiring the right people and putting them in the wrong place in the organization. He also discusses "chasing shiny objects" and the damage this can do to a startup, a mistake many first-time founders make. You can find them at: https://www.nava.io/ (https://www.nava.io/) You can find more information and all episodes at https://verticalelevation.com/podcast/ (Vertical Elevation) and you can find Carol on Twitter https://twitter.com/CarolBSchultz (@carolbschultz).

ceo americans disrupting smb nava f500 healthcare benefits carol schultz brandon weber vertical elevation

EP342: How the Consolidated Appropriations Act (CAA) and ERISA Fiduciary Requirements Are an Anchor for Self-insured Employers to Navigate the Complexity of Healthcare, With Christin Deacon

Play Episode Listen Later Oct 21, 2021 36:38

This episode's conversation is about the new Consolidated Appropriations Act (CAA), the fee disclosure part of it, as well as ERISA and the fiduciary responsibility that self-insured employers are responsible to comply with under the law. Don't worry, the first thing my guest in this healthcare podcast, Christin Deacon, does is explain these terms, what they actually mean, and how they can be a tool actually in CEOs' or CFOs' toolboxes to get access to the employer's own claims data, which is a linchpin here that we'll talk about in a sec. But suffice to say here that the ERISA fiduciary responsibility has a few provisions and, in general, self-insured employer health plan administrators kind of tend to off-load worrying about these provisions to their brokers and consultants. The problem with this is that brokers and consultants do not bear the ERISA fiduciary responsibility. They do not bear the responsibility of complying with the CAA either. The employer does. You'd think that, given this, more self-insured employers would dig in hard to do their own due diligence to check whether or not their plan is compliant. But they don't. I asked Parker Edman from Leavitt Partners why, and he said he thought that it's likely a combination of the “old boy's network” and a fear of the massive lift that switching up plan designs or even looking at this might entail. But here's another facet: There's a contingent of plan advisors and carriers who have a very vested interest in self-insured employers not knowing what's going on with their spend. And they actually even have a magic trick that they have developed to beat back inquiries. In this magic trick, HIPAA is the abracadabra. Let me give you an example role-play. Self-insured employer: I need my claims data. Carrier: HIPAA. Self-insured employer: Nooo, not the HIPAA. I stand down. Forget I mentioned it. Here's a pro tip: Actually read HIPAA. Pull it up on your computer. It's easy to find. Spoiler alert: You know what you'll discover? Ninety percent of it is a love note to the carriers themselves that govern the data they must possess and the structure of that data. Ten percent of it is about the privacy of that data, and in that 10%, it specifies clearly that a self-insured employer is a covered entity and, therefore, falls under the umbrella of who can have access to claims data, especially if it is deidentified. Of course, said employer has obligations as to how to treat that data, but yeah, just don't be fooled by the HIPAA when it's wielded like sorcery. The only reason that word has any power is because so many C-suites let it have power. Also now, there's some provisions in the Consolidated Appropriations Act, the CAA (which was passed in 2020), which really ups the ante here. My guest, Christin Deacon, explains all of this and more, including what's up with the CAA, which is good because I could barely remember the name of it throughout the course of this interview. Christin Deacon is a healthcare leader and public-sector entrepreneur. She is a former deputy attorney general, a “recovering attorney” as she calls herself. Earlier this year, 2021, she left her role running the state health and school health benefits plan for about 800,000 New Jersey public employees. Now, she's just transitioned to the private sector where she serves as an executive VP at 4C Health Solutions. You can learn more by emailing Christin at cdeacon@4chealthsolutions.com. You can also connect with her on LinkedIn. Christin Deacon is a healthcare thought leader who brings with her a wealth of experience in both public and private sector. Driven by her passion to change the healthcare system to truly benefit patients and payers, she focuses on bringing solutions and agency to self-funded and government-sponsored health plans. 04:10 What is ERISA, and what does it stand for? 05:40 What is a fiduciary obligation for an employer? 08:18 “We're now at a point of spending 17.7% of our GDP on healthcare costs.” 09:39 “You absolutely have the keys to … controlling that spend.” 13:35 “You have to own your data.” 15:04 “If you don't have your claims data, how do you know you're paying reasonable fees?” 15:31 “If your carrier is telling you, ‘Oh, HIPAA … you can't look at your data,' you need to pull out that red BS card.” 16:25 How do employers navigate carriers refusing to share claims data? 21:36 “It has only as much teeth as the self-funded employer is … willing to learn about it and … willing to push back.” 22:22 “This is not aspirational; this is an absolute floor.” 24:11 “What does value mean?” 27:41 “Become familiar with HIPAA beyond just the privacy piece.” 29:30 “At the end of the day, it's about people.” 29:38 “If you're not paying reasonable fees, you're using plan assets to enrich others.” 32:21 “The self-insured market … they hold the keys to unlocking value. And they're holding them; they just have to use them.” 34:10 Marshall Allen's new book. You can learn more by emailing Christin at cdeacon@4chealthsolutions.com. You can also connect with her on LinkedIn. @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth What is ERISA, and what does it stand for? @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth What is a fiduciary obligation for an employer? @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth “We're now at a point of spending 17.7% of our GDP on healthcare costs.” @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth “You absolutely have the keys to … controlling that spend.” @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth “You have to own your data.” @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth “If you don't have your claims data, how do you know you're paying reasonable fees?” @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth “If your carrier is telling you, ‘Oh, HIPAA … you can't look at your data,' you need to pull out that red BS card.” @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth How do employers navigate carriers refusing to share claims data? @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It has only as much teeth as the self-funded employer is … willing to learn about it and … willing to push back.” @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth “This is not aspirational; this is an absolute floor.” @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth “What does value mean?” @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth “Become familiar with HIPAA beyond just the privacy piece.” @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth “At the end of the day, it's about people.” @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth “If you're not paying reasonable fees, you're using plan assets to enrich others.” @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth “The self-insured market … they hold the keys to unlocking value. And they're holding them; they just have to use them.” @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster

spoilers new jersey healthcare anchor bs ceos driven navigate employers requirements gdp complexity ninety hipaa digital health cfos caa healthtech fiduciary insured erisa consolidated appropriations act care plans marshall allen al lewis lee lewis joe connolly leavitt partners brandon weber nikki king nicole bradberry john marchica

EP341: How to Cut Administrative Waste AND Attract and Retain Doctors and Nurses, With Gary Campbell

Play Episode Listen Later Oct 14, 2021 32:50

First, let's talk about reducing administrative waste in the US healthcare system. There was a pretty famous 2019 study by Shrank et al. that estimated about 25% of the $3.6 trillion the US spends on healthcare annually is potentially wasteful. This is each person spending $2500 unnecessarily. Robert Kocher wrote a really interesting article about getting rid of administrative waste and inefficiencies, and he said that it is the “safest form of health care cost savings; virtually no one argues that administrative costs should remain high. Reducing administrative waste should be the highest priority … [because] everyone, including patients and clinicians, would benefit from lower health care costs.” In my mind, “everyone” means payers, policy makers, and also providers who are or want to take some accountability for the total cost of care here. To talk about the possibilities, I have the perfect guest: Gary Campbell, who is the CEO of Johnson Health Center, which is an FQHC, a Federally Qualified Health Center, in Lynchburg, Virginia. Why is the CEO of an FQHC a great person to talk about cutting out administrative waste with? Well, first of all, the patient population is what many would consider challenging at an FQHC. Second, they really have to cut out as much waste as possible because there is zero potential to cost shift. They do not have the option to charge their commercial lives 4x Medicare or whatever and effectively cost shift the impact of inefficiencies. There basically are no commercial lives. You either figure out how to be efficient, or the patient population does not get care. As Gary and I were talking, however, it became clear that when you cut out administrative waste, you wind up actually with the potential to become a great place to work. One reason for this just has to do with the process of cutting out waste, which requires culture and process. And a by-product of a great culture and a great process means a great place to work. You might be thinking, as I was thinking, that this show, which is supposed to be about cutting administrative waste, is going to be all about how to do lean and Six Sigma and pretty much go peak MBA. Spoiler alert: It's not. When I asked Gary how to be operationally efficient, it all ladders up to organizational leadership: leaders who commit to putting patients first, to have core values with the expectation to actually achieve them (for reals—not just in the marketing). Because without effective, accountable, committed leadership, patient first, lowering the cost of care, removing administrative waste … it ain't gonna happen. Leaders should be visible, have a vision, a strategic plan, project plans, and be inspirational. They also need to not be afraid to “move along,” as they say, people who are pulling the team down and holding it back—maybe even if a short-term revenue hit will transpire. Before we get started here, let's talk about FQHCs for a sec just in case you're unfamiliar. Besides the acronym giving me fits of dyslexia—my brain always wants to invert the letters, so I have a Post-it Note here and I'm staring at it so, hopefully, I'll be able to keep this straight—FQHCs (Federally Qualified Health Centers) are usually nonprofits that are oriented to take care of the underserved. Today they serve upwards of 30 million people in the United States, and that's a growing number. There's something like 1500 of them across all 50 states. They're federally funded. They are a safety net really for individuals out there who may not be able to access care anywhere else. There's generally bipartisan support for FQHCs and often a real purpose and passion to really care for people regardless of their ability to pay. They also tend to offer a lot of resources under one roof (eg, medical care, dental care, other things, mental health care), which can add substantially to the operational complexity. Gary Campbell, my guest in this healthcare podcast as I said, is the CEO of an FQHC. Gary has a procurement and operations background, and this background informs how he approaches leadership and care delivery in ways that I find inspirational—and I hope that you do, too. Some of the conversation that we had in this episode reminded me of the interview with Tony DiGioia, MD, in EP332; so if you want to dig further into this topic, go back and listen to that episode. That interview is very specifically about how to create a patient-centric value system, which Dr. DiGioia says should be the new OS for healthcare delivery. During this show, I also mention my conversation with Jerry Durham (EP297), where we talk about streamlining the front desk. I didn't mention this in the show, but another episode that would be great to go back and listen to if this topic intrigues you is the one with Matt Anderson, MD, MBA, talking about how things get better when the scrubs and the suits collaborate (EP266). You can learn more at impact2lead.com. Gary Campbell is the founder and owner of Impact2Lead, LLC, and the CEO of Johnson Health Center (JHC), where he has enjoyed a career centered on leading for-profit/not-for-profit organizations and helping to unleash potential in others along the way. In 2011, he left Bayer and came to JHC; and in 2013, he launched Impact2Lead to provide transformation-consulting services to other firms across the United States. Since joining JHC, the center has enjoyed unprecedented success and growth by transforming the culture using his Impact Leadership model and becoming the first Federally Qualified Health Center to be recognized as an Employer of Choice by Employer of Choice International, Inc. The health center has achieved multiple workplace and community awards since that time and has enjoyed exponential growth during his seven years as the CEO. Gary currently speaks and consults nationally on leadership, workplace strategies, and motivational topics. 05:15 Why is there no opportunity to cost shift in an FQHC? 05:46 What happens when an FQHC is operating inefficiently? 06:12 “Have you workflowed it out? … You can overstaff yourself in a way that your cost per patient goes way up.” 06:37 Why is taking a lean approach not an excuse to cut staff? 08:05 “The nurses are linchpins to everything.” 09:05 How does standardizing care lead to personalization of care? 10:28 “Our clinical teams see that we care.” 10:48 “If you don't have a vision for where you want to be two and three years down the road, you're struggling.” 11:03 “I want everybody to understand, What is their why?” 20:10 “They don't teach leadership in most medical schools.”—Dr. Robert Pearl 21:19 “Get to know these clinicians … sincerely.” 23:11 “From a core values perspective, you can make every single decision … on core values.” 23:35 “We always start with those values. … They're embedded in everything we do.” 24:16 “You have to project plan things out that you want.” 25:09 How does an FQHC or private practices that are patient-oriented attract talent? 30:45 “First and foremost, be visible.” You can learn more at impact2lead.com. @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth Why is there no opportunity to cost shift in an FQHC? @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth What happens when an FQHC is operating inefficiently? @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth “Have you workflowed it out? … You can overstaff yourself in a way that your cost per patient goes way up.” @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth Why is taking a lean approach not an excuse to cut staff? @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth “The nurses are linchpins to everything.” @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth How does standardizing care lead to personalization of care? @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth “Our clinical teams see that we care.” @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth “I want everybody to understand, What is their why?” @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth “Get to know these clinicians … sincerely.” @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth “We always start with those values. … They're embedded in everything we do.” @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth “You have to project plan things out that you want.” @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth How does an FQHC or private practices that are patient-oriented attract talent? @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth “First and foremost, be visible.” @Impact2Lead discusses #administrativewaste and #healthcareemployment on our #healthcarepodcast. #healthcare #podcast #digitalhealth Recent past interviews: Click a guest's name for their latest RHV episode! Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell

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EP340: How Digital Front Doors Can Enable Value-Based Care, With Kristin Begley

Play Episode Listen Later Oct 7, 2021 32:06

There's a next generation of digital front doors being created that open up to a patient/member experience that folds in payer, provider, and employer data—plus behavioral data the patient themselves generates when they browse through content in there. Because that's what it takes for a so-called personalized experience or patient journey to ensue. This is what I'm talking about in this healthcare podcast with Kristin Begley, PharmD. In an ideal world, you'd have, for example, a member/patient/customer who goes to their doctor and is handed a tablet to fill out an intake form. When they hit submit, they get access to a digital front door that leads to a vast Web portal inhabited by the doctor as well as the patient's payer and their employer. This personalized Web portal then knows this patient has asthma and is nonadherent to their maintenance medication and is using their rescue med a lot, because it's in the payer PBM (pharmacy benefit manager) data. The portal also knows the patient is searching a lot on content like what to do when you have a terrible asthma attack. Further, the portal knows that the patient's current doctor visit, the one where they're filling out the intake form, is about a respiratory chief complaint, because it's in the doctor data and also on that intake form, which, by the way, was immediately uploaded with structured insights available to all parties sharing the portal data. Now, everybody who needs to know knows this patient is at obvious rising risk. What can happen now? Lots of things. Because the portal knows what's included in the patient's benefit plan, there can be a proactive reach-out to get that patient into an available whole longitudinal program before they wind up in the ER. Maybe that's a point solution. Maybe that's a high-quality doctor offering a bundle. Which leads me to the whole value-based care part of this. Front doors are not only for patients to get steered to the best provider—maybe one with a value-based arrangement—but also, in a way, a front door for providers and payers to work together. A portal can be the “hub,” if you will, the shared neutral interoperable space for all the parties who need to share space for their value-based arrangement to work out. In fact, some of these portals are taking on risk themselves. Like, you guys all use our portal for your value-based arrangements, and we'll guarantee this level of performance in those arrangements. Portals sharing risk and taking upside becomes even more relevant when the portal comes with its own network of existing provider users, for example—provider users who want to be paid for value and also with EHR (electronic health record) data and direct access and influence over patient care. It's the old network effect. But besides helping make sure the patient gets the right care at the right time, digital front doors also have the potential to ease patient administrative burden. While there's lots of well-placed attention on affordability, patient administrative burden means delayed or foregone care. That's as per a new study by Michael Anne Kyle, PhD, and Austin Frakt, PhD. Kristin Begley is chief commercial officer at Wildflower Health right now, but she started out as a pharmacist before she defected to the business world. She has spent time in the pharmacy space with big companies and small companies before transitioning into the value-based, risk-based world. She's now at Wildflower leading sales and account management, and she knows a whole lot about digital front doors. You can learn more at wildflowerhealth.com. Kristin Begley, PharmD, is a proven leader in the healthcare space with 20 years of experience in health information technology and the pharmaceutical supply chain, focusing on innovative solutions and software. She currently serves as the chief commercial officer of Wildflower Health, a modular digital-enablement care company that activates women and their families within the healthcare ecosystem. Wildflower's software, hardware, and humanware amplify and personalize available resources to women, breaking down silos of care between payers and clinicians while fueling the shift from fee-for-service to value-based care. Wildflower supports the whole person by helping clinicians address both clinical and social determinants of health needs and empowering women to confidently navigate and access care for the family. Kristin is a founding member of All Tru Health, a consulting organization dedicated to improving quality and lowering healthcare costs for Americans, with an emphasis on emerging technology and high-value clinical care. She also served as the chief commercial officer at EmpiRx Health, a pharmacy care manager with a model rooted in payer alignment through at-risk management and concierge service. Prior to that, Kristin was the chief pharmacy officer of Truveris, a healthcare technology company that sheds light on the inner workings of the pharmaceutical supply chain, serving all segments, including consumers. She also led Hewitt's national pharmacy practice, where she managed Rx benefit strategy for Fortune 500 employers. Kristin holds a doctor of pharmacy degree from Samford University. 04:20 What do we mean by “digital front door” in healthcare? 05:27 “In healthcare, the next generation of digital front door is connecting all those stakeholders that try to help patients stay healthier.” 06:20 “What we're trying to migrate to is … walk into any front door.” 07:24 Why is engagement the hardest part? 10:24 “Are they digital providers … or are they healthcare providers?” 12:25 “When we live in a capitalistic healthcare system, we all have a price tag on our head.” 14:01 “How will providers and payers ever be successful in value-based care if we don't have activated, educated, motivated patients?” 16:36 “I don't know how … we succeed in value-based care without having … personalized content for everyone.” 18:24 “What does a consumer want?” 26:52 How does Wildflower Health achieve their value-based care network effect? 29:54 What do stakeholders want relative to value-based care? You can learn more at wildflowerhealth.com. Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare What do we mean by “digital front door” in healthcare? Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare “In healthcare, the next generation of digital front door is connecting all those stakeholders that try to help patients stay healthier.” Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare “What we're trying to migrate to is … walk into any front door.” Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare Why is engagement the hardest part? Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare “Are they digital providers … or are they healthcare providers?” Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare “When we live in a capitalistic healthcare system, we all have a price tag on our head.” Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare “How will providers and payers ever be successful in value-based care if we don't have activated, educated, motivated patients?” Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare “I don't know how … we succeed in value-based care without having … personalized content for everyone.” Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare “What does a consumer want?” Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare What do stakeholders want relative to value-based care? Kristin Begley of @wildflowerhlth discusses #digitalhealth and #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedcare Recent past interviews: Click a guest's name for their latest RHV episode! David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard

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AEE17: Employers and Reference-Based Pricing—David Contorno's Latest Thinking

Play Episode Listen Later Oct 5, 2021 9:20

Reference-based pricing, the way that most employee benefit consultants use the term anyway, refers to a methodology used by employers to pay providers for services. Usually we're talking within a fee-for-service (FFS) environment here. The way it typically works ... there are different flavors, but how it typically works is this: Reference-based pricing (RBP) means that an employer starts with some reference-based price. Many times, it's the Medicare rate. Medicare will pay X dollars for something. The employer—and when I say employer, I mean the vendor/company the employer is using to run this whole thing mainly—but the employer will decide that they're willing to pay some percent over the Medicare rate to providers who render that service to the employee. Maybe it's 10% over the Medicare rate or 20% to 50% as David Contorno talks about in this healthcare podcast. One of the biggest pushbacks against RBP schemes has been that it results in balance bills for employees, meaning that an employee goes to the hospital, the employer decides to pay some RBP amount for that service to the hospital, but the hospital hasn't necessarily agreed to accept that amount. There's no contract in place. So, the hospital decides to bill whatever their chargemaster rate is—which, as we all know, is redonkulous—and the employee gets a giant out-of-network balance bill. For the most part, this doesn't have to happen if you do it right; and David Contorno discusses all of this and more on this An Expert Explains. You can learn more at epoweredbenefits.com. You can also connect with David on LinkedIn. David Contorno is founder of E Powered Benefits. As a native of New York, David began his career in the insurance industry at the age of 14 and has since become a leading expert in the realm of employee benefits over the last 22 years. David was Benefits Selling magazine's 2015 Broker of the Year, and in March 2016, Forbes deemed him “one of America's most innovative benefits leaders.” More recently, he received the 2017 Leadership Award at ASCEND, the annual conference of The Association for Insurance Leadership, which recognizes those whose leadership in support of improving the value and performance of employee benefits has significantly advanced the industry. David is a member of the board of directors for both the Charlotte Association of Health Underwriters and HealthReach Community Clinic. He served on the NC Insurance Commissioners Life and Health Agent Advisory Committee, as well as participated in the Technical Advisory Group that helped with the market reforms required under the Affordable Care Act in North Carolina. He is a longtime member of the Lake Norman and South Iredell Chambers of Commerce as well as the National, North Carolina, New York, and Long Island Associations of Health Underwriters. David contributes to numerous publications, including Forbes, Benefits Selling magazine, Business Leader magazine, and Insurance Thought Leadership. David is committed to giving back to his community and actively participates in the membership drive for the United Way, assisting the local chapter of Habitat for Humanity, and supporting The Dove House Child Advocacy Center. When he is not working, he enjoys boating and traveling. 01:37 What does good reference-based pricing look like? 01:57 What is the pricing methodology that 97% of healthcare is using? 04:25 How has E Powered Benefits minimized the noise around reference-based pricing? 04:55 “You're getting what we view as balance bills all the time.” 06:47 “What very few people really recognize is that hospitals have multiple revenue streams.” 07:36 “Which is the highest price? The answer is, commercial.” You can learn more at epoweredbenefits.com. You can also connect with David on LinkedIn. @dcontorno discusses #employers and #referencebasedpricing on our #healthcarepodcast. #healthcare #podcast What does good reference-based pricing look like? @dcontorno discusses #employers and #referencebasedpricing on our #healthcarepodcast. #healthcare #podcast What is the pricing methodology that 97% of healthcare is using? @dcontorno discusses #employers and #referencebasedpricing on our #healthcarepodcast. #healthcare #podcast How has E Powered Benefits minimized the noise around reference-based pricing? @dcontorno discusses #employers and #referencebasedpricing on our #healthcarepodcast. #healthcare #podcast “You're getting what we view as balance bills all the time.” @dcontorno discusses #employers and #referencebasedpricing on our #healthcarepodcast. #healthcare #podcast “What very few people really recognize is that hospitals have multiple revenue streams.” @dcontorno discusses #employers and #referencebasedpricing on our #healthcarepodcast. #healthcare #podcast “Which is the highest price? The answer is, commercial.” @dcontorno discusses #employers and #referencebasedpricing on our #healthcarepodcast. #healthcare #podcast Recent past interviews: Click a guest's name for their latest RHV episode! David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard, Josh LaRosa

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EP339: Helping Employers Navigate the Perilous Medical-Industrial Complex, With David Contorno

Play Episode Listen Later Sep 30, 2021 30:46

Let's just start here: As a general construct, insurance carriers have every incentive for health insurance premiums to go up every year. If you're an employer, that is a material fact. Is it counterintuitive? Maybe. Except if you're an employer and your premiums are going up year after year, it begs the question why, every single year, the already-extravagant amount you pay continues to go up way more than the inflation rate. You'd think that if your broker and your plan administrator were so great at their fiduciary responsibility over your self-insured plan that this wouldn't be happening. Oh right, whosever PPO network you're using, they don't have any fiduciary responsibility over your self-insured plan. You do, all you CFOs and CEOs and benefit professionals out there. Wait, I misspoke. Plan administrators do have fiduciary responsibility—to their shareholders. The CEO of CVS/Aetna made $36 million in 2019. He's clearly very good at that job. The rest of them are, too. I'm not singling anyone out here. And also, this podcast is not investment advice. In short, as previously stated, most major insurance carriers and the brokers they pay commissions to have every incentive for your premiums to go up every single year. That's where we're at, folks. It's an open secret, yet so many are just getting so wildly taken advantage of by carriers and brokers whom they have really put their trust in. If you work for a self-insured employer, tell your CFO/CEO to listen to this show. Or if you are a CEO/CFO or a benefits professional in charge of healthcare benefits, welcome. I hope this information is helpful. My guest in this healthcare podcast, David Contorno, has been in the benefits industry longer than he hasn't been in the benefits industry. I think he started working in a benefits brokerage when he was 17 or something. Currently, he's the founder of E Powered Benefits. In this episode, we talk about the keys for self-insured employers that lead to better health for their employees at something like 20% or more lower costs. Here's some of the imperatives for employers that David digs into in this episode: Advanced primary care—really valuing primary care providers who do not work for hospital systems and, therefore, are not subjected to the ball and chain of perverse incentives that David talks about at some length. Getting cost and quality data so you can make prospective choices and not get hit in the back of the head with an after-the-fact “gotcha” in the form of an overpriced bill that you are now obligated to pay. Let me bring up all the articles lately in the New York Times and elsewhere … people paying hundreds of thousands of dollars for something that should cost a fraction of that. Most of them have “good” insurance (keep that in mind) from their employer. Also keep in mind that most of these stories that hit the news are the ones where some poor employee got stuck with a bill—not the metric ton of other examples where the self-insured employer was on the hook. If you're an employer, you can get ahead of these “gotcha” moments. It's textbook risk mitigation if nothing else. Create benefit designs to help employees find and incent them to use the highest-quality providers charging a fair price. Listen to EP334 with Sunita Desai for more on the topic of incenting consumerism. Know how your broker gets paid. If someone is paying your broker a commission and it isn't you, then your broker makes more money when your premiums and rates go up. They are a sales rep getting paid to make someone else money off of you. Get a handle on your pharmacy spend. David gets into some nuances here which are super interesting. You can learn more at epoweredbenefits.com. You can also connect with David on LinkedIn. David Contorno is founder of E Powered Benefits. As a native of New York, David began his career in the insurance industry at the age of 14 and has since become a leading expert in the realm of employee benefits over the last 22 years. David was Benefits Selling magazine's 2015 Broker of the Year, and in March 2016, Forbes deemed him “one of America's most innovative benefits leaders.” More recently, he received the 2017 Leadership Award at ASCEND, the annual conference of The Association for Insurance Leadership, which recognizes those whose leadership in support of improving the value and performance of employee benefits has significantly advanced the industry. David is a member of the board of directors for both the Charlotte Association of Health Underwriters and HealthReach Community Clinic. He served on the NC Insurance Commissioners Life and Health Agent Advisory Committee, as well as participated in the Technical Advisory Group that helped with the market reforms required under the Affordable Care Act in North Carolina. He is a longtime member of the Lake Norman and South Iredell Chambers of Commerce as well as the National, North Carolina, New York, and Long Island Associations of Health Underwriters. David contributes to numerous publications, including Forbes, Benefits Selling magazine, Business Leader magazine, and Insurance Thought Leadership. David is committed to giving back to his community and actively participates in the membership drive for the United Way, assisting the local chapter of Habitat for Humanity, and supporting The Dove House Child Advocacy Center. When he is not working, he enjoys boating and traveling. 04:20 How do you ensure better care for patients? 05:10 “What's required to correct those things is not really a massive degree of intellect or even innovation.” 05:38 What's the road map for self-insured employers who want to take control of their healthcare costs? 10:06 “Higher costs equal more profit and more revenue.” 14:03 “The problem with devalued primary care is … that most people pass over the primary care provider and go right to the specialist.” 19:41 “Every employer should have every broker sign a compensation disclosure form.” 20:06 “If you think there's perverse incentives on the medical side … it gets even worse on the pharmacy side.” 21:01 What changes do employers find when they follow the road map to taking control of their healthcare costs? 21:44 “It's not uncommon for us to reduce total healthcare spend for an employer by between 20% and 40% at the end of the first year.” 22:09 “I can't change [the] outcome without changing the path you walked to get there.” 22:41 “Going self-funded is where the journey starts, not where it ends.” 24:47 “If most employers truly understood how badly these carriers and health systems are taking advantage of them … [it's almost like] Stockholm syndrome.” 27:09 “The only legitimate fear that employers should have is, How do they message these changes … to the employees?” 29:21 “This has to happen, and if it doesn't happen, the system's going to break and … be picked up by entities that are, I think, only going to make the situation worse.” You can learn more at epoweredbenefits.com. You can also connect with David on LinkedIn. @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits How do you ensure better care for patients? @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits “What's required to correct those things is not really a massive degree of intellect or even innovation.” @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits What's the road map for self-insured employers who want to take control of their healthcare costs? @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits “Higher costs equal more profit and more revenue.” @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits “The problem with devalued primary care is … that most people pass over the primary care provider and go right to the specialist.” @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits “Every employer should have every broker sign a compensation disclosure form.” @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits “If you think there's perverse incentives on the medical side … it gets even worse on the pharmacy side.” @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits What changes do employers find when they follow the road map to taking control of their healthcare costs? @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits “It's not uncommon for us to reduce total healthcare spend for an employer by between 20% and 40% at the end of the first year.” @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits “I can't change [the] outcome without changing the path you walked to get there.” @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits “Going self-funded is where the journey starts, not where it ends.” @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits “If most employers truly understood how badly these carriers and health systems are taking advantage of them … [it's almost like] Stockholm syndrome.” @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits “The only legitimate fear that employers should have is, How do they message these changes … to the employees?” @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits “This has to happen, and if it doesn't happen, the system's going to break and … be picked up by entities that are, I think, only going to make the situation worse.” @dcontorno discusses #employers and the #medicalindustrialcomplex on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthbenefits Recent past interviews: Click a guest's name for their latest RHV episode! Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard, Josh LaRosa, Dr David Carmouche (EP316)

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EP338: Ideas to Meet Rural Healthcare's Tough Challenges, With Nikki King, DHA

Play Episode Listen Later Sep 23, 2021 34:28

My overarching thought throughout a lot of this interview was that improving rural health will take everyone remembering to not let perfect be the enemy of the good. If I live in rural America, there's no subspecialists. Forget about even seeing a garden-variety kind of specialist. I might have to drive hours to even get to a PCP. There are NPs (nurse practitioners) in a lot of these remote communities, but everybody's fighting over whether to let them practice independently, even in places where there's zero PCPs for hundreds of miles, effectively leaving everyone in the vicinity with basically zero access to any care. Or here's another issue: Maternal mortality in this country is not only heartbreaking—a mother dying in what should be a precious moment—it's also embarrassing as an industrialized nation to be so far in last place. I don't know this for a fact, really, but women who have to drive literally hours to see a provider during their pregnancy or—God forbid!—they go into labor unexpectedly … is that a factor in our horrific maternal mortality rates? Consider that in Canada, which has, by the way, substantially better maternal mortality rates than the USA, PCPs and NPs deliver babies in low-risk pregnancies even in areas that have access to ob-gyns, unlike a lot of rural America. When do we start wondering if we're letting perfect be the enemy of the good? When do we start considering if no access to care is worse than some access, even if the “some” access is not with, perhaps, the ideal type of provider? These are not questions with easy answers, so we need data. We need to think in shades of gray—not in binary terms where good and bad have static definitions unaltered by wildly different circumstances. That said, one way to potentially make many parties happy might be to do something like the Nuka system has done for Native Americans in rural Alaska. Listen to EP312 for more info on that. It's pretty cool. But let's just back up a sec with a little situation analysis: The thing with rural hospitals closing—and they are surely running in the red and closing—is the very pernicious cycle that develops. A hospital closing is kind of a bellwether for a community caught in a downward spiral in ways I did not realize until my conversation with Nikki King in this healthcare podcast. The main industry shuts its doors—maybe coal, or I grew up in a steel town when they were “closing all the factories down.” That was a Billy Joel quote there, and I spent a few years as a kid in the very same Allentown that song is about. Community trauma is no joke. Oh, and also, now there's no commercial lives. So, say the hospital in that town isn't prepared for this new payer mix reality and it closes. Then maybe a few hundred doctors and nurses move away, along with their spending habits, so other jobs go away. Then the more affluent senior citizens don't move back to their hometown to retire because who wants to live in a town with no hospital? Also, young families who have a choice might choose to go elsewhere. Former population centers start to disperse, and now there's not even a population big enough to support a hospital even if one would decide to go there. And when that hospital goes, so does its maternity department—and likely, even OB/GYN practices. Forget about a laborist. You then will have local PCPs leave town because, right, a PCP connected to a hospital can make twice as much as an indie. Reference the huge number of PCPs in this country who are employed by a health system. Most of these employed PCPs will not work in rural communities where their employer health system has no facilities to refer to. There's no jobs there for an employed physician. Obviously, no specialists can stay in business in this environment either. Things go from bad to worse: Child abuse rises, and multigenerational diseases of despair start to set in. And there's no healthcare to treat these diseases or prevent them. Things go from bad to worse to even more worse. In this healthcare podcast, I am honored and thrilled to talk with Nikki King, DHA, who offers up three community-centric ideas around solving the crisis of access that people in rural communities face. In short, these ideas include: Freestanding ERs (ERs that have the financial discipline to not take advantage of the communities they claim to serve, that is) Telehealth that recognizes broadband issues, which is possible Expanding nurse practitioner rights and maybe even the scope of PCP practices to, for example, include maternity care for low-risk pregnancies in areas that have zero or very minimal access to healthcare otherwise Here's the shorter-than-short version: Perfect can't be the enemy of the good when we're talking about some of these communities that have no healthcare options. Nikki King grew up in Kentucky in the coalfields of central Appalachia. She managed a behavioral health and addictions unit at a critical access hospital and also worked in biostatistics. She is on the board of directors of the Indiana Rural Health Association and has developed policies as a member of the National Rural Health Association, among a whole list of other achievements. Nikki is innovative and compassionate, and she understands the culture of those she serves. She talks about a few things that she worked on during the pandemic that are truly inspirational. You can learn more by emailing Nikki at king.nikki2014@gmail.com. You can also connect with her on LinkedIn and follow her on Twitter. Nikki King, MHSA, DHA, was born and raised in the coalfields of Southeastern Kentucky. Prior to working in the healthcare industry, she worked for the Center of Business and Economic Research studying models of sustainability in rural communities with a single economic engine. She has been working at Margaret Mary Health since 2015, occupying roles in clinical statistics, as well as currently managing the behavioral health and addiction services department. In addition to her role at Margaret Mary, Nikki completed her DHA at the Medical University of South Carolina and her MHSA from Xavier University. She currently serves on the Indiana Rural Health Association's Board of Directors, the American Hospital Association's Opioid Stewardship Advisory Group, and the National Rural Health Association's Policy Congress and Government Action Committee, and as the Board Chair of Rural Health Leadership Radio Board of Directors. 05:57 How dire is the rural hospital situation right now? 06:18 How could freestanding ERs be a potential solution for rural hospitals? 08:21 What are other potential rural health access solutions? 09:25 Why is broadband a roadblock to telehealth as a solution for rural health access? 14:06 The “hot potato” of nurse practitioners in the healthcare world. 15:05 “The number of residencies for physicians each year is not increasing, but the population … is increasing.” 19:06 EP312 with Douglas Eby, MD, MPH, CPE, of the Nuka System of Care. 20:41 What's the issue with maternity care in rural America? 22:53 “As healthcare becomes more and more specialized, [the] ability to treat high-risk cases is better, but access gets worse.” 26:50 How is mental health care affected in rural communities? 27:23 “Rural communities are trying very hard to hang on to what they have.” 28:49 “When you look at the one market plan that's available in a rural community, you probably can't afford it.” 30:39 What's the single biggest challenge to moving to a model that incentivizes keeping people healthy? 31:33 “The easiest low-hanging fruit … is having national Medicaid and have that put under the same hood as Medicare.” You can learn more by emailing Nikki at king.nikki2014@gmail.com. You can also connect with her on LinkedIn and follow her on Twitter. @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth How dire is the rural hospital situation right now? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth How could freestanding ERs be a potential solution for rural hospitals? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth What are other potential rural health access solutions? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth Why is broadband a roadblock to telehealth as a solution for rural health access? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth The “hot potato” of nurse practitioners in the healthcare world. @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth “The number of residencies for physicians each year is not increasing, but the population … is increasing.” @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth What's the issue with maternity care in rural America? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth “As healthcare becomes more and more specialized, [the] ability to treat high-risk cases is better, but access gets worse.” @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth How is mental health care affected in rural communities? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth “Rural communities are trying very hard to hang on to what they have.” @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth “When you look at the one market plan that's available in a rural community, you probably can't afford it.” @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth What's the single biggest challenge to moving to a model that incentivizes keeping people healthy? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth “The easiest low-hanging fruit … is having national Medicaid and have that put under the same hood as Medicare.” @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth Recent past interviews: Click a guest's name for their latest RHV episode! Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard, Josh LaRosa, Dr David Carmouche (EP316), Bob Matthews

EP337: A Patient-First Specialty Pharmacy, Not a Money-First Specialty Pharmacy, With Olivia Webb

Play Episode Listen Later Sep 16, 2021 32:37

Here's the cold hard truth: The whole specialty pharmacy operational model is not built to serve patients, a fact that becomes crystal clear when you're a patient. Instead, the specialty pharmacy model is, rather, pretty blatantly dedicated to the power struggle for revenue and captive patient populations. It's war between providers and the whole PBM/insurer/specialty pharmacy vertical consolidations. Employers and pharma manufacturers are, of course, on the battlefield as well. The patient, meanwhile, gets to be more the product than the customer if you think about. It's probably more similar than anyone would like to admit to the way that Facebook or Twitter users are the product, not the customer. This analog is not entirely parallel, but there's unsettling similarities if you think about it. What is a drug that qualifies to be a specialty pharmacy drug? Usually, these drugs are complicated to store, dispense, to use, and/or they're expensive—generally, really expensive. Lots of zeros, completely unaffordable to pay cash for them as an individual. No one is using a GoodRx card and not using their insurance to pay for these puppies. They can cost as much as a house. Biologics, for example, usually considered specialty drugs—lots of cancer and immunology therapies, injectable medications, IV/infused medications—all these are usually considered specialty drugs. There's no one definition of a specialty drug. It's more that someone somewhere decided to not run the drug through your traditional retail pharmacy for any number of reasons. The problem with the current status quo, wherein the patient gets tossed around while everybody fights over them, is that some basic needs are not being met—like if a patient asks the person administering the drug maybe even a pretty simple question about the drug or its side effects. It's way more likely than it should be that the nurse or whomever doesn't know the answer. Not knocking nurses here at all but definitely knocking a system that allows that to happen. I mean, really now. We're injecting a six-figure therapy in someone's arm that will impact their body in a myriad of maybe frightening ways, some of which are a problem and some of which are not. Said another way, there's a really good financial and clinical use case for making sure that we're patient-centric at a specialty pharmacy point of service—if you care about the patient and cost efficiency, that is. But I guess therein lies the root cause of the trouble. In this healthcare podcast, I'm talking with Olivia Webb about what it would take and be like to create a “patient-first specialty pharmacy,” as she has coined the term—a specialty pharmacy dedicated to patients not only having a half-decent experience but also one that might actually create better patient outcomes. Olivia Webb is author of the Acute Condition newsletter. I would certainly recommend subscribing. Coming up, we're doing a few more shows on this topic wherein we cover the whole brown bagging, white bagging, clear bagging extravaganza. Also, hospitals opening up their own PBMs, which is a fascinating wrinkle. One last thing: If you're following the whole PBM/insurer/specialty pharmacy vertical integration skullduggery, keep an eye on a bunch of lawsuits against these combined entities (three examples here, here, and here) alleging that they are doing some not super upright and honest things with their massive market power. (Say it isn't so!) You can learn more at acutecondition.com. Olivia Webb, PharmD, is a healthcare strategist and writer. She publishes the weekly healthcare newsletter Acute Condition, in addition to writing freelance pieces. She also works as a senior communications manager at the specialty care start-up Thirty Madison. In the past, Olivia has worked on healthcare policy and hospital consulting at Economic Liberties, Massachusetts General Hospital, and Advisory Board Company. 04:11 Why did Olivia start thinking about a patient-centric specialty pharmacy? 05:33 “There's really no layer on top of it to make it look nice.” 06:23 “You're kind of dealing with this vertical stack that doesn't really deal with patients frequently.” 06:35 Is the specialty model more patient friendly or less? 07:08 What would a patient-centric specialty pharmacy look like? 07:58 “There's a lot of fragmentation; there's a lot of friction.” 08:11 What's unique to specialty pharmacy prescriptions? 10:38 Why can infusion centers be a high-drama place? 12:15 What's “the question” around specialty pharmacy? 12:42 Who has the vested interest in ensuring patients take their medications correctly in specialty pharmacy? 14:39 “It's really just a unique area of healthcare where the people that I think of as the good guys and the bad guys completely flips.” 16:05 Why might the time be ripe for disruption in the specialty pharmacy area? 19:56 “There's no one with a clear incentive to cap the prices.” 20:09 What are the barriers in specialty pharmacy? 20:31 “The patient just isn't at the center, the financial incentive, in any direction.” 29:22 “I think people who are designing these things need to see how patients are actually doing it.” 29:50 “I think there's a lot of money here; I think this market is going to only increase in size.” 30:10 “I think you need scale.” 30:20 AEE15 with David Carmouche, MD, of Ochsner. You can learn more at acutecondition.com. @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth Why did Olivia start thinking about a patient-centric specialty pharmacy? @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth “There's really no layer on top of it to make it look nice.” @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth “You're kind of dealing with this vertical stack that doesn't really deal with patients frequently.” @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth Is the specialty model more patient friendly or less? @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth What would a patient-centric specialty pharmacy look like? @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth “There's a lot of fragmentation; there's a lot of friction.” @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth What's unique to specialty pharmacy prescriptions? @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth Why can infusion centers be a high-drama place? @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth What's “the question” around specialty pharmacy? @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth Why might the time be ripe for disruption in the specialty pharmacy area? @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It's really just a unique area of healthcare where the people that I think of as the good guys and the bad guys completely flips.” @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth “The patient just isn't at the center, the financial incentive, in any direction.” @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth “I think people who are designing these things need to see how patients are actually doing it.” @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth “I think there's a lot of money here; I think this market is going to only increase in size.” @OliviaWebbC of @thirtymadison and the #acutecondition newsletter discusses #patientfirst #specialty on our #healthcarepodcast. #healthcare #podcast #digitalhealth Recent past interviews: Click a guest's name for their latest RHV episode! Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard, Josh LaRosa, Dr David Carmouche (EP316), Bob Matthews, Dr Douglas Eby (AEE14)

money healthcare patients md iv employers webb pharma digital health massachusetts general hospital pharmd biologics pbm pbms goodrx ochsner care plans marshall allen al lewis specialty pharmacy lee lewis joe connolly bob matthews brandon weber nicole bradberry john marchica

EP336: The Barbarians at the Gate—Who Are They and How Do They Cause Trouble for the Healthcare Industry Status Quo? With Brandon Weber

Play Episode Listen Later Sep 9, 2021 32:37

I was listening to a panel discussion and heard Brandon Weber use the phrase the “barbarians at the gate” of the healthcare industry. I think I reached out to invite him to come on the podcast before the end of the segment. But at risk of spoiler alerts, let me sum up what I think is so interesting about Brandon's insights, which he talks about on the show. First of all, it isn't an “oh, heavens, some companies out there are trying to disrupt the status quo,” like this is some sort of news flash that hasn't been tossed out with police lights and sirens however many times already over however many years. Brandon gets into the sheer magnitude of what's going on, right now, from a capital investment standpoint but also from a human capital standpoint. How many crazy smart proven disrupter-type people have come along with that capital? Brandon also touches on something I've been thinking about lately: coalition building, for lack of a better word for it. If we have status quo behemoths with market caps of a third of a trillion dollars out there, some start-up who is super happy to have scored a however-many-million-dollar seed round is not a threat in and of themselves. But if many of these littles are aligned and working together in win-win ways that ultimately take market share from the big dogs, now things get interesting. So, while much attention is focused on point solutions that disrupt some aspect of care delivery, we might want to take another look at the less visible entities that are putting platforms underneath: the companies that are building out services that offer economies of scale, that create “pipes” helping patients connect with appropriate solutions that make this emerging market just work better. It's these platform companies, combined with a general willingness to collaborate, that make ganging up a sort of natural strategy to build a really flourishing ecosystem. And it's that whole ecosystem that I would consider the most likely disrupter within an industry very much designed for the big to get bigger. Anecdotally, I see both of these ecosystem-building factors happening (ie, the platforms and then also a really unprecedented level of collaborative, all-boats-rise kind of thinking). There are communities like the one that Brian Klepper runs for benefits professionals or Health Tech Nerds or outofpocket.health. But based on what I see in these groups and elsewhere, the sharing and helpfulness is really encouraging and heartwarming if you're not an incumbent, I guess. My guest in this podcast, as mentioned, is Brandon Weber, who is the CEO and founder of Nava. This is one of those foundational-type upstarts. Brandon's company Nava is a benefits brokerage but one that's built on a platform that crochets together everything it takes to support a best-practice employer health plan. For example, point solutions have to be easy to buy and fold in, while on the back end, all of those point solutions and others need access to the right data so that appropriate employees can be engaged and make the most of the benefits offered. If you think about it, it's easy to see how having a really strong foundation here amplifies the value that can be delivered and accelerates change management. Coming up also, stay tuned because I'm interviewing Kristin Begley about optimal digital front doors, which is sort of an extension of the conversation that you'll hear in this episode. You can learn more at nava.io or by visiting their LinkedIn page. Brandon Weber is the cofounder and CEO at Nava, a modern benefits brokerage on a mission to provide high-quality, affordable access to healthcare to all Americans. By melding cutting-edge tech solutions with deep industry expertise, Nava aims to fix healthcare, one benefits plan at a time. Prior to Nava, Brandon cofounded VTS, a tech-driven leasing and asset management platform that transformed the commercial real estate marketplace. Trusted by over 45,000 brokers and asset managers around the globe, it's now used in over 50% of all office buildings in the United States and is consistently ranked one of New York's best places to work. Outside of work, he enjoys retreating into nature and is passionate about backcountry skiing, mountaineering, and trail running. 04:13 What does it mean to have “barbarians at the gate” of healthcare? 05:32 What is the overly complex gate to healthcare? 07:28 “No one can make the argument that we've seen this before.” 08:37 Are the “barbarians” in healthcare going to expand the system that already exists? 09:25 What is the number one pain point in healthcare? 13:25 “Typically, the innovation doesn't come from the incumbents.” 17:16 “We were actually just blown away by the amount of innovation that is already happening … [in] care delivery.” 17:58 “The future is actually here; it's just not evenly distributed.” 18:08 Why is there a need for a distribution layer in healthcare? 20:57 “Everyone is vying to be that one app in the pocket that acts as the aggregator, the hub, the steering point.” 26:32 “If you build it, they will come … that is absolutely not true in [healthcare].” 29:46 “The benefits broker is likely the most underappreciated stakeholder in the healthcare industry.” You can learn more at nava.io or by visiting their LinkedIn page. @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation What does it mean to have “barbarians at the gate” of healthcare? @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation What is the overly complex gate to healthcare? @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation “No one can make the argument that we've seen this before.” @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation Are the “barbarians” in healthcare going to expand the system that already exists? @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation “Typically, the innovation doesn't come from the incumbents.” @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation What is the number one pain point in healthcare? @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation “We were actually just blown away by the amount of innovation that is already happening … [in] care delivery.” @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation “The future is actually here; it's just not evenly distributed.” @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation Why is there a need for a distribution layer in healthcare? @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation “Everyone is vying to be that one app in the pocket that acts as the aggregator, the hub, the steering point.” @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation “If you build it, they will come … that is absolutely not true in [healthcare].” @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation “The benefits broker is likely the most underappreciated stakeholder in the healthcare industry.” @BrandonGWeber, CEO and founder of @NavaBenefits, discusses the gatekeepers of #healthcare on our #podcast. #healthcarepodcast #digitalhealth #healthinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard, Josh LaRosa, Dr David Carmouche (EP316), Bob Matthews, Dr Douglas Eby (AEE14), Dr Sheldon Weiss

united states ceo new york americans gate trusted status quo barbarians nava healthcare industry anecdotally vts care plans marshall allen al lewis lee lewis joe connolly bob matthews brandon weber brian klepper nicole bradberry john marchica

Episode 48 - Stories Of Hope: Hope Africa Collective (with Brandon Weber)

Julle Mense

Play Episode Listen Later Aug 10, 2021 54:27

Continuing our intermittent Stories of Hope series, Alphonso and John sat down with Brandon Weber from Hope Africa Collective to talk about their work in youth development and community transformation. Listen in as they discuss the holistic, multidimensional nature of poverty; the role which our history and our context play in the narratives we believe about ourselves and each other, and how these narratives continue to entrench and perpetuate poverty. The effects of perpetual stress disorder on the self-perception of value among young people. The role of the church in extending the rule and the reign of God to restore all that has been distorted in society. What would it mean to create a pipeline of value with churches and NGOs working together to serve the marginalised and change the structures of inequality in our country? SHOWNOTES: 1. Find out more about the work of the Hope Africa Collective here: https://hopeafrica.com/ 2. Donate to the work of Hope Africa Collective https://hopeafrica.com/give/ 3. Get involved and volunteer with Hope Africa Collective here https://hopeafrica.com/get-involved/ 4. Audio produced by Exilic Music www.exilic.co.za 5. The work of Isiphambano, including Julle Mense, is advanced through the generous donations and support of those who resonate with a vision of a reconciled and just South Africa. Please consider becoming a partner in this ministry by financial giving either through a one-off gift or regular monthly giving. Donate by following this link www.payfast.co.za/donate/go/isiphambano

god stories africa south africa collective ngos stories of hope hope hope alphonso brandon weber

Mark 11:1-26 - Brandon Weber

Play Episode Listen Later Jul 5, 2021 44:37

Join us as we hear the Gospel preached during these unprecedented times.

gospel mark 11 brandon weber

Mark 10:32-52 - Brandon Weber

Play Episode Listen Later Jun 30, 2021 40:22

Join us as we hear the Gospel preached during these unprecedented times.

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Mark 9 vs 14-29 - Brandon Weber

Play Episode Listen Later Apr 26, 2021 43:42

Join us as we hear the Gospel preached during these unprecedented times.

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MSP Weekly - Are Servers Dying in the SMB

Play Episode Listen Later Apr 26, 2021 72:04

Marco Chaffiotte, Brandon Weber, and Ray Cline --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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Origins - Week 7 - Brandon Weber

Play Episode Listen Later Mar 29, 2021 47:13

Join us as we hear the Gospel preached during these unprecedented times.

gospel origins brandon weber

MSP Weekly Chris Azer Episode 1

Play Episode Listen Later Mar 22, 2021 77:28

Brandon Weber, Marco Chaffiotte, and Ray Cline chat with Chris Azer of Soteria Technology Group https://www.instagram.com/soteria.inc/ --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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MSP Weekly - Onboarding and Offboarding Clients

Play Episode Listen Later Feb 28, 2021 66:56

Brandon Weber, Ray Cline, and Marco Chaffiotte talk about onboarding and offboarding clients --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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MSP Weekly With Special Guest Tom L.awrence Part 1

Play Episode Listen Later Dec 22, 2020 79:42

Brandon Weber and Ray Cline chat with Tom Lawrence of Lawrence Systems https://www.youtube.com/user/TheTecknowledge --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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MSP Weekly Where It All Started

Play Episode Listen Later Dec 8, 2020 39:21

Brandon Weber, Blake Urmos, and Ray Cline share their stories on how they got started in IT --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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MSP Weekly Rountable Recurring Revenue

Play Episode Listen Later Nov 16, 2020 78:26

Brandon Weber https://www.tscit.co/ Ray Cline https://libertasllc.net/ Marco Chaffiotte https://enterprisecc.com --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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Mark 7 - Brandon Weber

Play Episode Listen Later Nov 2, 2020 33:11

Join us as we hear the Gospel preached during these unprecedented times.

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MSP Weekly The Sky is Falling

Play Episode Listen Later Oct 23, 2020 78:19

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Mark 6:14-29 - Brandon Weber

Play Episode Listen Later Sep 28, 2020 62:30

Join us as we hear the Gospel preached during these unprecedented times.

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MSP Weekly Cris's Tech Repair

Play Episode Listen Later Sep 21, 2020 99:05

Brandon Weber of TSC IT chats with Cris Rivera of Cris's Tech Repair --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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MSP Weekly Mike Smith White Space

Play Episode Listen Later Sep 2, 2020 59:05

Brandon Weber interviews Mike Smith of WhiteSpace http://whitespacebt.com/ --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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MSP Weekly Round Table: Willie Howe Part 2

Play Episode Listen Later Aug 20, 2020 68:54

Round table discussion with Brandon Weber, Willie Howe, Ray Cline, and Marco Chaffiotte Check out Willie Howe Technology: https://williehowe.com/ --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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MSP Weekly Round Table: Willie Howe

Play Episode Listen Later Aug 4, 2020 61:25

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8.2 MSP Weekly Nick Francoeur & Brandon Weber

Play Episode Listen Later Jul 18, 2020 71:34

Brandon Weber interviews Nick Francoeur of HTx Services https://www.linkedin.com/in/nicholas-francoeur-33412019/ --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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7.6 MSP Weekly Ray Cline Marco Chaffiotte Brandon Weber Round Table

Play Episode Listen Later May 26, 2020 78:04

Brandon Weber, Ray Cline, and Marco Chaffiotte discuss MSP's during this round table discussion. --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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7.3 MSP Weekly Reilly Chase HostiFi

Play Episode Listen Later Apr 27, 2020 52:25

Brandon Weber chats with Reilly Chase, Founder of HostiFi https://hostifi.net https://www.linkedin.com/in/reillychase --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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7.2 MSP Weekly Marco Chaffiotte EnterpriseCC

Play Episode Listen Later Apr 22, 2020 107:38

Brandon Weber chats with Marco Chaffiotte of EnterpriseCC https://www.enterprisecc.com/ --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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Good News At Last - Week 4: Brandon Weber

Play Episode Listen Later Mar 5, 2020 39:06

2000 years ago, the Jewish nation was waiting, hoping and expecting good news. Good news about the promised messiah and king. All of us, just like 2000 years ago, are looking to the future, waiting, hoping and expectant for some good news. In this series we'll be spending 5 weeks studying the first chapter of Mark. We'll see the very beginning of Jesus' ministry, who he was as a man and what he did while here on Earth. This series asks and answers some of life's biggest questions. Who is Jesus? Why did he come to Earth and Why is this such Good News? In a world that too often feels like it's on the brink, finally we can dive in and get some Good News At Last!

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6.5 MSP Weekly Ray Cline Libertas Consulting

Play Episode Listen Later Feb 23, 2020 71:54

Brandon Weber and Blake Urmos talk with Ray Cline of Libertas Consulting https://libertasllc.net/ --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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6.4 MSP Weekly Episode 4 Ed Tatsch ETS Networks

Play Episode Listen Later Feb 15, 2020 63:22

Brandon Weber interviews Ed Tatsch, owner of ETS Networks, and MSP out of Western North Carolina. --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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5.7 MSP Weekly Episode 2 Chris Tiffany SprinterIT

Play Episode Listen Later Dec 24, 2019 65:23

Brandon Weber and Blake Urmos talk to Chris Tiffany about SprinterIT and the state of MSP's from the software and hardware side. https://www.instagram.com/all.it.usa.llc/ --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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5.4 MSP Weekly Episode 1 Cramer Snuggs Cascade Tech

Play Episode Listen Later Dec 13, 2019 58:55

Cramer Snuggs of Cascade Tech talks to Brandon Weber and Blake Urmos about active ransomware protection, backups, and setting the gold standard in the MSP world. --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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5.2 MSP Weekly Episode 0

Play Episode Listen Later Dec 6, 2019 17:42

Brandon Weber and Blake Urmos kick off the MSP Weekly Podcast where we talk about the state of technology as it relates to MSP's. We are also going to interview MSP owners and executives. --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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5.0 Brandon Weber TSC IT Fireside Chat

Play Episode Listen Later Dec 1, 2019 56:20

Brandon Weber and Blake Urmos talk about MSP's, Passportal, Datto, Autotask, and Binary Defense. https://www.instagram.com/tsc.it/ --- Send in a voice message: https://anchor.fm/lowvoltagenation/message Support this podcast: https://anchor.fm/lowvoltagenation/support

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Brandon Weber and Anthony Wells.

Better Each Day Podcast Radio Show with Bruce Hilliard

Play Episode Listen Later Nov 15, 2019 29:29

Labor historian/author Brandon Weber and the premiere of SSEU Local 371’s new podcast, Studio 371, featuring SSEU Local 371 President Anthony Wells.

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Ethan Bell Talks Band with Bruce Hilliard–Ep100

Play Episode Listen Later Nov 6, 2019 28:04

The Ethan Bell Band is what happens when retro-pop and country music bump boots in the back of the honky tonk. With bar bashing, boy band belting, flashy stage move dancing, and story telling that your grandma would pass out candy for, Ethan Bell, Eric Smith, Brandon Weber and Jonny Gifford have become known as one of the hardest working bands in the Chicagoland area. (http://bettereachday.me/wp-content/uploads/2019/10/ETHAN1019-1267-2.jpg) They keep audiences captivated with their mashups of pop, hip hop and country songs that you love from your radio, while swooning you with their romantic ballads and introspective songwriting. They bring a Nashville flavor to Chicago that keeps them busy all year round playing 180 plus shows a year at casinos, bars, music venues, corporate events, weddings and divorces. (http://bettereachday.me/wp-content/uploads/2019/10/ETHAN1019-6169-3.jpg) Their debut self titled album dropped in August of 2019 and is available on Spotify and Itunes. The band is currently making trips back and forth from Nashville, Tennessee as they prepare to put out their next batch of songs in 2020, while also grinding away playing anything, anywhere for anyone just to keep the lights on. The Ethan Bell Band Website (https://ethanbellband.com/) The Ethan Bell Band Facebook (https://www.facebook.com/EthanBellOfficial/) On Spotify (https://open.spotify.com/artist/5ozPM0EP7dAiUv0YxoEc2S)

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Ethan Bell Talks Band with Bruce Hilliard–Ep100

Better Each Day Podcast Radio Show with Bruce Hilliard

Play Episode Listen Later Nov 6, 2019 28:04

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Erika Boll and Brandon Weber

Play Episode Listen Later Oct 11, 2019 29:29

Erika Boll, Exec. Dir. of The David Prize elaborates on the annual award for NYC “boldest visionaries.” Labor historian/author Brandon Weber discusses the impeachment of past U.S. presidents.

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Mark Torres and Brandon Weber

Play Episode Listen Later Sep 16, 2019 29:29

Mark Torres on his new book, “Adeline.” Labor historian Brandon Weber on the history of Labor Day.

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S 2 Ep 7 | Brandon Weber and Richard Lundie on Land

Living Social Justice

Play Episode Listen Later Jul 11, 2019 34:47

As we grapple with the big topic of land in South Africa, we have to be listening to the stories of people who have been affected by this. It is so easy to get caught up in political statements, economics, legal arguments and statistics. The big idea about this podcast series is to help us listen to people in our midst. We want to hear the heart of this matter and allow it to shape our response. Now we can’t interview every person and we know that every story and situation is unique. So we are not trying to summarize every story, or draw generalizations from one to another. Instead, we are simply listening, learning and engaging. Welcome to the Living Social Justice podcast series on Land.

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Brandon Webber - Crash Test Dummy

Crime and Justice News

Play Episode Listen Later Jun 14, 2019 69:23

20 year old Brandon Weber was shot and killed by the US Marshals on a Chase from Mississippi to Memphis Tennessee many have claimed that Police murdered him and a right is sued right after the incident allegedly brand whether Weber was accused of shooting a victim and taking their vehicle will talk more hi

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Heather Booth and Brandon Weber