Podcasts about cins

Sg2 Perspectives host Trevor DaRin is joined by colleagues Brian Esser and Ryota Terada for an in-depth discussion on physician alignment—a topic that remains as essential as ever in today's health system landscape. The group dives into the evolution of alignment strategies, examining why employment has become the default model, what opportunities still exist within clinically integrated networks (CINs), and how the strategic use of equity can reshape engagement. Drawing from fresh research and health system insights, they also discuss why legacy models may be underutilized and how systems can adapt to a shifting market where private equity's influence is cooling, and disruptor momentum has slowed.   We are always excited to get ideas and feedback from our listeners. You can reach us at sg2perspectives@sg2.com, or visit the Sg2 company page on LinkedIn.

Selon la dernière cartographie de la médecine générale réalisée par l'Observatoire de la Santé et du Social (Vivalis), en collaboration avec les Cercles de médecins généralistes bruxellois (FAMGB et BHAK), les médecins généralistes bruxellois sont inégalement répartis sur le territoire, ce en tenant compte des besoins des citoyens. Par ailleurs, la charge de travail des médecins généralistes est impactée par les demandes de consultation de patients non-bruxellois : ceux-ci représentent 18 % des consultations. On en parle avec Jonathan UNGER, chercheur à l'observatoire de la santé et du socia Merci pour votre écoute N'hésistez pas à vous abonner également aux podcasts des séquences phares de Matin Première: L'Invité Politique : https://audmns.com/LNCogwPL'édito politique « Les Coulisses du Pouvoir » : https://audmns.com/vXWPcqxL'humour de Matin Première : https://audmns.com/tbdbwoQRetrouvez tous les contenus de la RTBF sur notre plateforme Auvio.be Retrouvez également notre offre info ci-dessous : Le Monde en Direct : https://audmns.com/TkxEWMELes Clés : https://audmns.com/DvbCVrHLe Tournant : https://audmns.com/moqIRoC5 Minutes pour Comprendre : https://audmns.com/dHiHssrEt si vous avez apprécié ce podcast, n'hésitez pas à nous donner des étoiles ou des commentaires, cela nous aide à le faire connaître plus largement. Distribué par Audiomeans. Visitez audiomeans.fr/politique-de-confidentialite pour plus d'informations.

Navigating Pediatric Leadership and Mental Health: Insights from Dr. Sandy ChungIn the first episode of the year, the podcast host introduces Dr. Sandy Chung, a pediatrician and healthcare leader with over two decades of experience. The episode explores Dr. Chung's personal journey to becoming a pediatrician, her leadership roles, and the creation of the Virginia Mental Health Access Program (VMAP). Discussion topics include the formation and benefits of clinically integrated networks (CINs) and independent practice associations (IPAs), shared savings agreements, and the role of primary care in managing mental health and complex cases. The episode also covers the operational aspects of running a pediatric group and offers insights into the future challenges and opportunities in pediatrics.00:00 Introduction and Guest Introduction02:00 Dr. Sandy Chung's Background and Journey04:35 The Role of Pediatricians and Healthcare Leadership06:39 Insights on IPAs and CINs15:32 Challenges and Successes in Pediatric Healthcare19:03 The Impact of Preventive Medicine26:48 The Evolution of Pediatric Practice Models32:11 Understanding the Billing Process32:47 Building a Super Group: HR and Optimization33:19 Collaborative Coding and Billing Practices33:57 The Importance of Billing G221135:26 Leadership in Medical Organizations38:57 The Virginia Mental Health Access Program (VMAP)39:34 Challenges in Pediatric Mental Health Care47:58 The Role of Project ECHO in Pediatric Care51:42 Addressing Metabolic Disorders in Pediatrics01:01:34 Future of Pediatric HealthcareSupport the show

Today we're talking to CHESS Health Solutions own Tammy Yount who shares her experience as a former practice manager and AHEC practice support coordinator to provide insight on why independent primary care providers, their practices, and especially their patients, will benefit from partnering with the right clinically integrated network. Tammy Yount, welcome to the Move to Value podcast.Glad to be here, Thomas.Tammy, what are some of the primary reasons independent providers choose not to participate in Medicaid or why they might hesitate to increase their Medicaid patient population? Are there particular challenges they face in serving this group?I think one of the biggest barriers is that we still are in this productivity mindset where that time is money paradigm and the goal was to maximize the amount of patients you could see within an 8 to 10 hour day in 15 minute slots. And so, when you think about the reimbursement rates of Medicaid, they tend to be the lowest reimbursement rates coupled with the administrative burden and the regulatory requirements with that. And then oftentimes you have unreliable payment schedules and meaning there may be delays and payments, or whenever there's budgeting shortfalls, or if there's a delay in payment because the state doesn't settle on a budget. Then you also have patients who are high resource demand, and then you have limited resources. So, when you're dealing with patients who have complex health needs or they have social needs or you're dealing with patients who you might need a broader provider network in terms of specialist and those specialists don't accept Medicaid. So you really are looking at a lot of complex issues that when you're thinking about in terms of the overarching population, it is just sometimes maybe the, for lack of a better analogy, the juice isn't worth the squeeze and we don't want we don't want to think of it like that because our patients, it should be patients first, but oftentimes it's a lot of resource intensive and time intensive work.North Carolina's managed Medicaid program is a significant shift for many providers. Can you tell us why this new model represents an opportunity for independent providers, particularly when it comes to improving care quality and practice sustainability?So really, as we move away from this productivity model of healthcare into this paying for value, the Medicaid managed care model has incentivized providers to provide quality care. And they reward them for meeting performance metrics and improving patient outcomes. And the model also allows for per member per month care management fees. So advanced medical homes who meet certain requirements are able to receive these care management fees. And they're able to address the medical, behavioral and social needs that align with the holistic care delivery model. And then also they have included some enhanced reimbursement models and shared savings models where they're allowing for value based payments and risk based contracts that can provide for more, like, predictable revenue streams and then the backbone of all of this is the infrastructure and access to resources that we didn't have prior to Medicaid managed care launched and the plans now offer support for population health management in the form of like data sharing. We have claims data, we have risk data, we have pharmacy lock in data, all of these data sharing has allowed us to be able to risk stratify the patients, align our efforts to those patients who need more intensive care management. We've also have some innovative models like the healthy opportunity pilots that allow the plans to pay for social determinant interventions, things that we weren't able to pay for before. So really it is moving to a more holistic and accountable and value-based care models.That's interesting. Well, from your perspective,...

Send us a textIn today's episode, we dive deep into the world of value-based care with Dr. TJ Reddington, founder and CEO of the Reddington Group. Known for his expertise in clinically integrated networks (CINs), Dr. Reddington shares insights into how healthcare systems can drastically reduce costs and improve patient care by adopting risk-based models.From his groundbreaking work at Christ Hospital to his time as Ohio's Medicaid director, Dr. Reddington has successfully pioneered strategies to save healthcare systems millions—without sacrificing patient care. In this episode, he discusses the strategies behind CINs, challenges of value-based care, and his vision for the Reddington Group.Key Takeaways:Cost Reduction through CINs: Dr. Reddington explains how hospitals can save millions by identifying high-cost patients and improving their care coordination.The Role of Data in Value-Based Care: Learn about the crucial role of electronic medical records and encounter data in predicting high-cost cases and how CINs utilize existing data systems.Future of Value-Based Care in Healthcare: Dr. Reddington discusses the slow adoption of value-based care and why CINs might be the key to faster, more impactful results in the industry.Join us for this enlightening conversation on how hospitals can transform financial losses into sustainable savings through clinically integrated networks!

This year, 2024, presented significant challenges for clinically integrated networks (CINs) delivering value-based care, with the disruption from Medicare Advantage reaching widespread levels. As we look toward 2025, it is crucial for CINs to reflect and gear up for success in the coming year by focusing on risk-based contracting, engaging specialists, and investing in care management. In this episode of Value-Based Care Insights, Dan Marino sits down with Dr. Will Faber, to tackle several challenges, including the lack of structure among commercial payers to effectively handle value-based contracts and obstacles in negotiating such contracts with specialty providers. Gain insights into strategies and data utilization that will position your provider organization for success in 2025.

Episode 115 Will Faber - Evolving Clinically Integrated Networks to Prepare for Value-Based Care in 2025 This year, 2024, presented significant challenges for clinically integrated networks delivering value-based care, with the disruption from Medicare Advantage reaching widespread levels. As we look toward 2025, it is crucial for CINs to reflect and gear up for success in the coming year by focusing on risk-based contracting, engaging specialists, and investing in care management. On this episode Dan sits down with Dr. Will Faber, to tackle several challenges, including the lack of structure among commercial payers to effectively handle value-based contracts and obstacles in negotiating such contracts with specialty providers. Gain insights into strategies and data utilization that will position your provider organization for success in 2025. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Nikki Gemmell An explosive, contemporary literary thriller from international bestselling author Nikki Gemmell -Wing is Lord of the Flies meets Picnic at Hanging Rock meets Promising Young Woman.Students from an elite girls' school go on a camping trip into the Australian bush. Four of them - a girl gang, a group of best friends dubbed 'The Cins' by the teachers - become separated from the main group. A male teacher volunteers to look for them.None of the five come back.Nikki has done it again enthralled us with her storytelling capturing the essence of the female lense Deborah's Instagram: https://www.instagram.com/what.ive.learnt/Mind, Film and Publishing: https://www.mindfilmandpublishing.com/Apple Podcast: https://podcasts.apple.com/au/podcast/what-ive-learnt/id153556330Spotify: https://open.spotify.com/show/3TQjCspxcrSi4yw2YugxBkBuzzsprout: https://www.buzzsprout.com/1365850

In this episode we hear from Chris Weathington, Director of Practice Support for North Carolina Area Health Education Centers, about how his organization provides training and resources to enable practices to focus on value rather than spending time on administrative burdens, thereby freeing up providers to better focus on patient care.Chris Weathington, welcome to the Move to Value podcast.Well, thank you for having me.Great. So Chris, for our listeners that may not be familiar with you, can you give us a little bit, tell us a little bit about yourself and your background?Sure. Well, I, I'm the director of practice support at North Carolina Area Health Education Centers, otherwise known as NCAHEC. I'm originally from Eastern North Carolina in small town called Winterville in Pitt County. My background is I've been working in Health Administration for a very long time, mostly working in a large health system but working largely with primary care and in the field of practice management and business development over the years. I've worked extensively in rural health helping providers figure out how best to survive and thrive with value-based care. So my educational background is about a master's in Health Administration and Bachelor of Science in public health from UNC Gillings School of Public Health. So, I'm a true Tar Heel, but I've been in North Carolina my entire life.Great. That's great background, Chris. Thank you. And go Heels. So, you mentioned currently you're the director of NCAHEC practice support. Tell us about NCAHEC. Give us a little bit more and specifically what your role is and what your team that you ever see does.Sure. Well, North Carolina, AHEC was established in the early 1970s. It's been around for about 50 years. It's a state agency. Our program office is based out of the UNC School of Medicine and we have 9 regional AHEC centers located throughout the state, many of them part of large health systems and some that are independent 501c3 not-for-profits. So they're geographically dispersed in Asheville, Charlotte, Winston Salem, Greensboro, Raleigh, Wilmington, Greenville, Rocky Mountain, Fayetteville, and Greensboro. And the mission of AHEC is to recruit, train and retain the state's health workforce. As you know, we have significant health workforce challenges if we didn't have them already prior to COVID. So practice support is one of several offerings or service lines, if you will, to fulfill that mission. So in practice support, we are committed to helping train and retain the state's health workforce. So working largely with practices in rural and underserved areas, primary care safety net providers such as FQHCs and rural health clinics and health departments, specialist and behavioral health providers, helping them to stand on their own two feet and working in doing that in partnership with accountable care organizations and CINs such as yourself over at CHESS. So that's really what we're all about. And in the value-based world, while practices are working in the Fee-for-service model, which still is around maybe a little bit less, but it's still largely there, helping practices not only function in that environment, but also survive and thrive with value based care. And that's hard and it's hard work, but that's what we're committed to do.That's a great mission and, and you guys do great work. I love meeting with you and hearing about how things are going throughout the, the state and healthcare. You guys have a great pulse on that always. And as you mentioned, one of the things that you guys or one of the areas you really focus on really is in the rural communities. And as you know, much of the care in North Carolina is...

What if you could transform healthcare quality and reduce costs simultaneously? Join us in this riveting episode as we welcome Dr. Will Faber, a family practice doctor and former hospice director, to unravel the complexities and potentials of Clinically Integrated Networks (CINs) in healthcare, particularly for hospice and palliative care providers. Dr. Faber shares his wealth of experience, shedding light on how these legal entities empower independent providers to collaborate effectively, meet Federal Trade Commission criteria, and stand strong against larger, for-profit healthcare entities.Creating a successful CIN is no small feat. Listen to Dr. Faber discuss the critical steps beyond basic mergers, from establishing robust legal and operational frameworks to developing clinician-led governance structures. We emphasize the importance of a unified culture, inclusivity, and collaborative goal-setting in fostering true integration. Dr. Faber also highlights the rewarding nature of this endeavor and the importance of a supportive, non-punitive environment to achieve high-quality outcomes.As we shift focus to driving quality within CINs, Dr. Faber explores the evolving landscape of healthcare goals, from the triple aim to the quintuple aim. We delve into the dynamic interplay between large organizations and disruptive innovators, and discuss the impact of for-profit motives on hospice care quality. Finally, we underscore the importance of measurement in leadership and management, sharing thought-provoking insights from industry experts on how effective metrics can lead to positive, tangible results in healthcare. Tune in for an episode packed with valuable insights and actionable strategies for building and sustaining high-quality, cost-effective healthcare networks.Host:  Chris Comeaux, President / CEO of TCN/TCGGuest:  Dr. Will Faberhttps://www.teleioscn.org/tcntalkspodcast/is-your-organization-truly-clinically-integratedTeleios Collaborative Network / https://www.teleioscn.org/tcntalkspodcast

Amerikalı feminist ve felsefe kuramcısı Judith Butler, “toplumsal cinsiyet” teorisini temellendirdiği kitaplarında, birer “biçim” olarak pedofili ve ensesti de savunur. Kendisi de lezbiyen olan ve kaleme aldığı ‘Cinsiyeti Çözme' isimli kitap dünyada en çok okunanlar arasına giren Butler, kadın ve erkek kimliğinin tarihsel bir hastalık olduğunu ileri sürer. Birkaç ay önce bu köşede söyleştiğimiz Psikiyatr Mustafa Merter, Judith Butler için “üçüncü feminizm akımının mimarı” demişti. “Toplumsal cinsiyet eşitliği” ya da artık “ideolojisi” olarak kodlanması gereken bu kavramı son yıllarda çok fazla duyuyoruz. Son olarak CHP Genel Başkanı Özgür Özel katıldığı yayında, iktidara gelmeleri halinde mevcut Aile ve Sosyal Hizmetler Bakanlığını kaldıracaklarını, yerine Kadın ve Cinsiyet Eşitliği Bakanlığı kuracaklarını açıkladı. Dikkat ediyorsanız aileyi ortadan kaldırmaya yönelik, kurumsal ve yapısal olarak yok sayan politik bir vaatte bulunuyor Özgür Özel. Kesin, net ve kararlı! Cinsiyet eşitliği kavramına dönecek olursak; sempatik, insani ve kulağa sıcak geliyor. Farklı düzlemlerde kadın ve erkek arasında sosyal eşitlik sağlanacağının teminatı olarak sunuluyor. Ancak perde gerisindeki manzara öyle değil. Toplumsal cinsiyet (gender) kavramı, cinsiyetin biyolojik farklılıklardan ayrı olarak toplumsal ve kültürel faktörler tarafından şekillendiğini vurgulayan anlayışı ifade eder. Bu anlayışa göre; “cinsiyetler birer psikolojik duyumdan ibaret olup kişinin öz algılayış biçimlerine göre değişkenlik gösterebilmektedir.” Kavramın kökenleri, 1960'larda ve 1970'lerde cinsiyet çalışmaları ve feminist hareketin yükselişiyle bağlantılı. Judith Butler gibi toplumsal cinsiyet ideolojisine katkı sağlayan feminist düşünce üreticilerinin söylemleri iyi irdelenirse bugün karşı karşıya kalınan dayatmaların asıl amacı görülebilir. Isaac Madison Bentley, 1945 yılında toplumsal cinsiyet kavramını kullanan ilk kişi olarak; bugün maalesef nüfus cüzdanlarımızda da cinsiyetin İngilizce karşılığı olarak yer alan ‘gender' ifadesini, "cinsiyetin (İngilizcede “sex”) toplumsallaştırılmış tarafı" olarak tanımlıyor. Yine feminist düşünür Simone de Beauvoir 1949 yılında cinsiyetin yalnızca biyoloji ile açıklanamayacağı ve biyolojik faktörlere indirgenemeyeceğini, kişilerin toplumsal, kültürel etkileşimlerle şekillenen bir kimlik geliştirebileceğini vurgulayarak toplumsal cinsiyet ideolojisine zeminler inşa ediyor. Kaleme aldığı ‘İkinci Cins' adlı kitabında "kadın doğulmaz, kadın olunur" tanımlamasını yapan Beauvoir verdiği bir söyleşide ise "Hiçbir kadına evde kalıp çocuklarını büyütme yetkisi verilmemelidir. Toplum tamamen farklı olmalıdır. Kadınların böyle bir seçeneği olmamalıdır çünkü böyle bir seçenek olursa, çok sayıda kadın bunu yapacaktır” diyor. Yani kadınların, fıtratlarından gelen dürtülerinden, başta da annelik vazifelerinden uzaklaştırılması gerektiğini savunuyor. Burada, kadınları anneliklerinin yaşayabilecekleri ev ortamından uzaklaştırmak isterken, kitabında sunduğu “kadın doğulmaz, kadın olunur” tezini yani kendisini de yalanlamış oluyor aslında.

Türkiye'nin en büyük medya gruplarından biri olan, çalışmaya başladığım ilk günden beri de bir parçası olmaktan büyük mutluluk duyduğum Albayrak Medya Grubu'nun sosyal sorumluluk projelerinden birini daha hayata geçirdiğini mutlulukla beyan etmek üzere kaleme alıyorum bugün yazımı. Önce biraz geriden alayım her zamanki gibi. Albayrak Medya Grubu'nun Türkiye'nin en önemli “bütünleşik medya markalaması” olduğuna hiç şüphe yok. Grubun amiral gemisi Yeni Şafak'a yıllar içerisinde öyle önemli markalar eklendi, bu markalarla öyle önemli sonuçlar elde edildi ki hani anlatmakla bitmez denilecek bir “medya başarısı” elde edildi. TVNET televizyonunun kurulması ve “ciddi bir haber mecrası” olarak kurumsallığını tamamlamasının ardından neredeyse paralel bir ilerlemeyle hem büyük bir dergi açılımı hem de taraflı-tarafsız herkesin “abi, siz ne yaptınız öyle” diyeceği bir dijital medya açılımı gerçekleştirdi grup. Cins'ten Derin Tarih'e, Post Öykü'den Skyroad'a, Bilge Minik'ten Genç Motto'ya kadar genişleyen dergi açılımı ile birlikte medya bölümlerinde ders olarak okutulacak denli başarılı bir dijital medya açılımı da gerçekleştirildi. Bugün hem Yeni Şafak dijital hem de GZT ve tüm alt markaları “kendi mecralarının yıldızları” olarak yol alıyor. Tabii burada, kuruluşunun bir parçası olmaktan da büyük mutluluk duyduğum, kısa sürede Türkiye'nin en saygın yayınevlerinden biri haline gelen ve en son Londra yapılanmasını da tamamlayarak uluslararası açılımını da tamamlayan Ketebe Yayınları'na “pozitif ayrımcılık” yapacağım izninizle. Koca koca bankaların, koca koca kurumların “nasılsa parayla oluyor bu işler” yanılgısına düşerek ellerine yüzlerine bulaştırdığı yayıncılık işini, Ketebe, “bu iş birikimle, ilgiyle, çabayla yapılır” diyerek ortaya koyuyor. Ben bir şey kaçırmadıysam grubun son medya açılımı TVNET Radyo oldu. “Bir şey kaçırmadıysam” diyorum çünkü o arada yeni bir dergi çıkarmış, yeni bir dijital medya mecrasını hayata geçirmiş olabiliriz yani. Bu hususta bir not daha bırakmam lazım buraya. Albayrak Medya Grubu tüm markalarını aynı zamanda “Yeni Şafak kafası” diyebileceğimiz bir zihinsel anlam dünyasının içinden sunuyor. Bu iç tutarlılık zaten beraberinde hem söylem birliğini hem de kaliteyi getiriyor bence. Gelelim “bu da bizim mutluluğumuz” dediğim yere. Efendim, geçtiğimiz cumartesi, Albayrak Medya Grubu'nun Osman Turhan kaptanlığında yoluna devam eden şahane çocuk dergisi Bilge Çocuk “Uzayda Hayat Kısa Hikâye Yarışması”nın final törenini tam altı bin çocuğun katılımıyla Vialand Tema Parkı'nda düzenledi. Ne yalan söyleyeyim, program görüntülerini görünce hem son anda bir işim çıkıp da programa gidemediğim için üzüldüm hem de o güzel etkinliği, o şahane atmosferi görünce “senelerdir fırsat bulup da hayata geçiremediğimiz Bi Cins Festival işini “nasıl yapsak da yapsak” dedim kendi kendime. Gıpta ettim bildiğiniz.

Torrey Snow reacts to the comments made by Baltimore City State's Attorney Ivan Bates that the CINS process doesn't work for juveniles in Baltimore City.

köpek veya insan

sevinçliyiz. Gazetemiz, “Türkiye'nin Birikimi” Yeni Şafak tam 30 yaşına girdi çünkü. Bu 30 yılın 12 yılına fiilen şahitlik eden bir köşe yazarı olarak, cümlenin gerçek anlamıyla “burada, bu gazetede olmaktan gurur duyuyorum.” Bu gururun pek çok nedeni var ama birkaçını burada sıralamak isterim. Öncelikle Yeni Şafak, yayın çizgisini 30 yıldır “ana cadde”den hiç çıkarmayan bir gazete. Ne demek bu? Türkiye'nin en geniş kesimini temsil eden “dindar, mütedeyyin ve ötekileştirilmiş halk”ın sözcülüğünü yapmaktan da, Türkiye'den yana olmaktan da hiç vazgeçmemiş demek. Diğer yandan da, verdiği kavganın aslında ne olduğunun da hep ayırdında olmuş. O kavga bir yandan muazzam bir kimlik kavgasıdır, bir yandan da Türkiye'nin “Türkiye” olarak kalmasının kavgası. 28 Şubat'ın karanlık dehlizlerinde de, 2002-2010 arası süregiden vesayet rejiminde de, 17-25 Aralık süreciyle başlayan ve 15 Temmuz'a taşınan FETÖ ihaneti serüveninde de Yeni Şafak hep “hakikatin hatırı âlâdır” demenin bir yolunu bularak ve sürekli “tarihin doğru tarafında durarak” bir sergüzeşt yürüttü. Gazetemizi, daha doğrusu TVNET'ten GZT'ye, Cins'ten Nihayet'e, ismini saydığım ya da sayamadığım tüm Albayrak Medya'nın bütün medya kuruluşlarını “yandaş medya” parantezine alıp “etki alanı daraltması” uygulamak isteyenlerin atladığı yalın gerçek şu: Yeni Şafak, herhangi bir iktidara göre hizalanan bir gazete değil. Temsil ettiği değerleri temsil ettiğini düşündüğü iktidarları destekleyen bir gazete. Bu iki destek biçiminin arasındaki ince fark aslında Yeni Şafak'ın durduğu yeri göstermesi bakımından çok kritik. Yeni Şafak'ın asıl etki alanı da tam olarak bu kritik farktan kaynaklanıyor. İlkelerinin dışına taşmadan yayıncılık yapmayı sürdürmek Yeni Şafak'ı Yeni Şafak yapan şeyin adı bana kalırsa. Bir de işin şurasını anlatmam lazım. Benim 12 yıllık köşe yazarlığı hayatımda birlikte çalıştığım iki genel yayın yönetmeni oldu gazetede. Geçmişte İbrahim Karagül ve şimdi de Hüseyin Likoğlu. İki genel yayın yönetmenimden de herhangi bir yazımla ilgili herhangi bir müdahale gördüğümü, bana “bunu yayınlayamayız” dediklerini hiç hatırlamıyorum. Yeni Şafak'ta yazmak benim açımdan hep “dilediğimi yazmak” anlamına geldi. Tabii, “dilediğimi yazmak” aynı zamanda başımı da gönlümce belaya sokmam manasına geldi. Hem Türkiye'deki muhalefet kanadından, hem de iktidarın içindeki bazı isimlerden gelen tepkileri (dikkat isterim: “baskı” demedim. Gördüğüm kadarıyla Yeni Şafak'a baskı yapabilecek babayiğit daha anasının karnından doğmadı çünkü) her seferinde yazarlarının lehine olacak şekilde bertaraf ettiler. Eminim ki bazı tepkileri Hüseyin Likoğlu ağabey bana ulaşmasına bile izin vermeden bertaraf ediyordur. Bundan o kadar eminim ki. Bir yazar daha ne ister ki? Burada bir parantez daha açmam icap eder.

Notre correspondante au Royaume Uni Emeline VIN, nous parle de la grève des médecins en Angleterre Merci pour votre écoute Matin Première, c'est également en direct tous les jours de la semaine de 6h à 9h sur www.rtbf.be/lapremiere Retrouvez tous les épisodes de Matin Première sur notre plateforme Auvio.be : https://auvio.rtbf.be/emission/60 Et si vous avez apprécié ce podcast, n'hésitez pas à nous donner des étoiles ou des commentaires, cela nous aide à le faire connaître plus largement.

Episode en partenariat avec Insomnia.La plateforme propose plus de 80 films d'horreur ! Elle est disponible sur Canal+ dans l'offre Ciné Séries et Rat +, ainsi que sur Free et Prime vidéo channel.Découvrir InsomniaDécouvrir InsomniaSource : https://www.reddit.com/r/nosleep/comments/5iwkod/why_i_dont_celebrate_christmas_anymore/Pour m'envoyer vos histoires danslenoirpdcst@gmail.comPour participer à cette émission horrifique, écrivez à Dans Le Noir sur les réseaux sociaux, j'accepte tout le monde !Mon Instagram HorrifiquePATREONLE seul podcast qui fait peur !Armez-vous de votre casque ou de vos écouteurs !Podcast Horreur, Podcast Surnaturel, Podcast Paranormal & Podcast Creepypasta mais surtout un podcast qui fait peur !Bonne semaine horrifique à tous !

Dört şey bedeni kuvvetlendirir: 1. Et yemek. 2. Güzel kokular sürünmek. 3. Cinsî münasebette bulunmadan yıkanmak. 4. Keten elbise giymek. Dört şey bedeni zayıflatır: 1. Fazla cinsî münasebette bulunmak. 2. Fazla düşünmek. 3. Aç karnına çok su içmek. 4. Çok ekşi yemek. Dört şey gözün nûrunu azaltır: 1. Pisliğe bakmak. 2. Asılmış insanın ölüsüne bakmak. 3. Kadının fercine bakmak. 4. Otururken arkasını kıbleye çevirmek. Dört türlü uyuma şekli vardır: 1. Sırtüstü uyumak; peygamberler uykusudur. Onlar, göklere bakarak bunların yaratılışı üzerine düşünürler. 2. Sağ omuz üzerine yatmak, âlimler ve âbidlerin uykusudur. 3. Sol omuz üzerine yatmak, padişahların uykusudur. Hazmı kolaylaştırır. 4. Yüzüstü yatmak, bu da şeytanlar uykusudur. Dört şey aklı çoğaltır: 1. Fazla ve lüzumsuz konuşmamak. 2. Misvâk kullanmak. 3. Sâlihlerle berâber olmak 4. Âlimler ile düşüp kalkmak. Dört şey ibâdet sayılır: 1. Dâima abdestli gezmek. 2. Çok secde etmek. 3. Camilere devam etmek. 4. Çokça Kur'ân okumak. (İmâm Gazâli, İhyâ-u Ulûmi'd-din, c.2, s.53) BUNLARI BİLİYOR MUYDUNUZ? İslâm'ın sünnetlerinden biri de herkesin içinde hiç kimseyi yüzüne karşı ayıplamamak, gücendirmemek, azarlamamaktır. Zîra Resûlullâh (s.a.v.) bu gibi hallerde: “Bu insanların hâli nedir, niye böyle yapıyorlar!” buyururdu. Yine bir hadîs-i şerîfte: “Tevbe ettiği halde bir günâh işleyen müslümânı daha önce işlediği günâhtan ötürü kötüleyen kimse, aynı hatâya düşmeden ölmez” (Tirmizî) buyurulmuştur.

Cela faisait longtemps qu'on ne vous avait pas parlé des nouveautés de Polar+ disponible dans le bouquet Ciné Séries de Canal+, donc c'est le moment de mettre en avant trois titres récents. Témoin numéro 3 En provenance de Channel 5, ce thriller anglais saura en fasciner plus d'un·e. Dans Témoin numéro 3, Jodie, mère célibataire et propriétaire d'un salon de coiffure, voit sa vie basculer en une fraction de seconde, en jetant un coup d'œil par la fenêtre. Témoin clé dans une affaire de meurtre, ce fameux numéro 3, elle devient la cible d'un gang redoutable. Une mini­-série policière britannique en quatre épisodes, portée par Nina Toussaint­ White et saluée par la critique outre­-Manche. Habitant dans le sud-est de Londres, Jodie pensait initialement que participer à l'enquête de police était un peu amusant, déçue que son nom et son adresse ne figurent pas sur la déclaration de témoin. La suite va la mettre au cœur du danger dans cette affaire quand les deux premiers témoins prennent peur et qu'elle devient la seule prête encore à coopérer. Les codes de l'horreur sont explorés en plus d'être un strict thriller. https://youtu.be/bdoBLL0gFOM?si=cfiwDLW0Hrk4fQk3 [bs_show url="witness-no3"] Reindeer Mafia On passe du côté de la Finlande cette fois-ci, avec Reindeer Mafia. La mort causée par le cancer d'une matriarche, propriétaire de vastes terres en Laponie, et, surtout son surprenant testament, plonge ses proches dans une lutte acharnée pour le pouvoir. Entre coups tordus et sombres secrets de famille, cette série finlandaise en huit épisodes, teintée d'humour noir et réalisée à la façon de Fargo des frères Coen, distille une bonne dose de suspense. D'après le roman Poromafia (le titre originel) de Mikko­ Pekka Heikkinen. On est dans un mélange de nordic noir teinté de comédie sur fond de drame familial par le réalisateur Mika Kurvinen. Dans cette réalité alternative de la Laponie, on peut voir l'influence américaine des années 80 dans l'architecture et les véhicules. https://youtu.be/O9NcFrR7xBU?si=PbMHSnCaclFKk-VG [bs_show url="poromafia"] The Calling Un détective de la police de New York, Avraham Avraham (Jeff Wilbusch), guidé par un sens profond de la spiritualité, commence à remettre en question son humanité lorsqu'une enquête apparemment routinière bouleverse ses certitudes. Créée par David E. Kelley, The Calling est un cop show au duo atypique. Adapté du roman de 2011, The Missing File de Dror Mishani, on saupoudre le classique procédural d'un soupçon de religion. Un peu de mentalisme, beaucoup d'intuition, Avraham est un héros charismatique et attachant, qui peut aussi paraître pénible. Évidemment, la relation avec sa partenaire Janine (Juliana Canfield) fait aussi la force de la série, avec la relation un peu subie entre les deux. Il s'agit d'un procédural assez classique avec son affaire de la semaine avec un fil rouge de saison. https://youtu.be/bpvMwtYU9PE?si=-8e7hyi4bhoNUFY2 [bs_show url="the-missing-2022"]

Cela faisait longtemps qu'on ne vous avait pas parlé des nouveautés de Polar+ disponible dans le bouquet Ciné Séries de Canal+, donc c'est le moment de mettre en avant trois titres récents. Témoin numéro 3 En provenance de Channel 5, ce thriller anglais saura en fasciner plus d'un·e. Dans Témoin numéro 3, Jodie, mère célibataire et propriétaire d'un salon de coiffure, voit sa vie basculer en une fraction de seconde, en jetant un coup d'œil par la fenêtre. Témoin clé dans une affaire de meurtre, ce fameux numéro 3, elle devient la cible d'un gang redoutable. Une mini­-série policière britannique en quatre épisodes, portée par Nina Toussaint­ White et saluée par la critique outre­-Manche. Habitant dans le sud-est de Londres, Jodie pensait initialement que participer à l'enquête de police était un peu amusant, déçue que son nom et son adresse ne figurent pas sur la déclaration de témoin. La suite va la mettre au cœur du danger dans cette affaire quand les deux premiers témoins prennent peur et qu'elle devient la seule prête encore à coopérer. Les codes de l'horreur sont explorés en plus d'être un strict thriller. https://youtu.be/bdoBLL0gFOM?si=cfiwDLW0Hrk4fQk3 [bs_show url="witness-no3"] Reindeer Mafia On passe du côté de la Finlande cette fois-ci, avec Reindeer Mafia. La mort causée par le cancer d'une matriarche, propriétaire de vastes terres en Laponie, et, surtout son surprenant testament, plonge ses proches dans une lutte acharnée pour le pouvoir. Entre coups tordus et sombres secrets de famille, cette série finlandaise en huit épisodes, teintée d'humour noir et réalisée à la façon de Fargo des frères Coen, distille une bonne dose de suspense. D'après le roman Poromafia (le titre originel) de Mikko­ Pekka Heikkinen. On est dans un mélange de nordic noir teinté de comédie sur fond de drame familial par le réalisateur Mika Kurvinen. Dans cette réalité alternative de la Laponie, on peut voir l'influence américaine des années 80 dans l'architecture et les véhicules. https://youtu.be/O9NcFrR7xBU?si=PbMHSnCaclFKk-VG [bs_show url="poromafia"] The Calling Un détective de la police de New York, Avraham Avraham (Jeff Wilbusch), guidé par un sens profond de la spiritualité, commence à remettre en question son humanité lorsqu'une enquête apparemment routinière bouleverse ses certitudes. Créée par David E. Kelley, The Calling est un cop show au duo atypique. Adapté du roman de 2011, The Missing File de Dror Mishani, on saupoudre le classique procédural d'un soupçon de religion. Un peu de mentalisme, beaucoup d'intuition, Avraham est un héros charismatique et attachant, qui peut aussi paraître pénible. Évidemment, la relation avec sa partenaire Janine (Juliana Canfield) fait aussi la force de la série, avec la relation un peu subie entre les deux. Il s'agit d'un procédural assez classique avec son affaire de la semaine avec un fil rouge de saison. https://youtu.be/bpvMwtYU9PE?si=-8e7hyi4bhoNUFY2 [bs_show url="the-missing-2022"]

Episode en partenariat avec Insomnia.La plateforme propose plus de 80 films d'horreur ! Elle est disponible sur Canal+ dans l'offre Ciné Séries et Rat +, ainsi que sur Free et Prime vidéo channel.Découvrir InsomniaDécouvrir InsomniaSource : https://www.reddit.com/r/nosleep/comments/g4vtoq/my_mom_sent_me_some_old_home_videos_for_my/Pour m'envoyer vos histoires danslenoirpdcst@gmail.comPour participer à cette émission horrifique, écrivez à Dans Le Noir sur les réseaux sociaux, j'accepte tout le monde !Mon Instagram HorrifiquePATREONLE seul podcast qui fait peur !Armez-vous de votre casque ou de vos écouteurs !Podcast Horreur, Podcast Surnaturel, Podcast Paranormal & Podcast Creepypasta mais surtout un podcast qui fait peur !Bonne semaine horrifique à tous !

Join the conversation with C4 and Bryan Nehman as they discuss a tool that State Senator Jill Carter says can be used for juvenile justice for kids under the age of 13 and that the "media" is not talking about it enough. Sam Cogen joins the show to discuss how the Sheriff's Department is supporting the Baltimore Police Department. Also, Ms. Clarice Mitchell Wheatley(C4's Mother) joins the show to discuss the 60th anniversary of the historic Civil Rights March on Washington D.C. C4 and Bryan Nehman live every weekday from 5:30-10:00 a.m. ET on WBAL News Radio 1090, FM101.5, and the WBAL Radio App.

Here's a quote from Rolling Stone magazine: “A supergroup is a very fragile thing. Rock bands are always about balancing huge egos, but when those egos are oversized from the get-go it can lead to huge problems. That's why supergroups like Blind Faith often fail to go beyond a single album, and why long-lasting ones like CSNY had drama that never seemed to end.” Hmmm … that's apropos because, turns out, super ACOs (accountable care organizations) may have some similar issues. A super ACO means multiple ACOs or CINs (clinically integrated networks) which are each comprised of multiple practices or provider organizations, and it's all under different ownership. Said another way, there are multiple levels of competitors—frenemies, if you will—trying to work together or not work together as the case may be. There's a lot of infrastructure complexity and process complexity and, frankly, inefficiency. There's trust issues. There's the problem that rule #1 of change management is to create “quick wins” so that everyone can smell potential success and realize it's possible, so momentum happens. But if doing anything is hyper-complicated, then it's really tough to have a quick win. Today in this summer short, this is what I am chatting about with Eric Gallagher. We talk about how Ochsner evolved from a super ACO or super CIN into its current form. This summer short is a 13-minute clip that went a little far afield from the main topic of episode 405, which was the full episode with Eric Gallagher, and therefore, I cut it. But as I always do when I cut an actually pretty great section from a show for reasons of time, I have been on the edge of my seat to share it with you. This show is actually a very nice follow-on to the one with Dan Serrano (EP410) from last week. As Eric describes Ochsner's history and its path forward, it is a case study of some of the recommendations that Dan mentioned. This summer short also really echoes some of the themes in episode 409, which was the one with Larry Bauer, and also one upcoming with Jodilyn Owen. What will work in one local market, don't count on it working elsewhere—or not work as well at a minimum. Healthcare is local. This is a lesson many investors and entrepreneurs looking for rapid scaling prototypes have learned the hard way, and listening to Eric, it's really easy to catch the why for that. If this topic intrigues you, also listen to the show with Dr. Amy Scanlan (EP402). Also episode 349 with Lisa Trumble. And lastly, I would recommend the show with David Carmouche, MD (EP343). Dr. Carmouche was talking about Ochsner's work improving patient outcomes with a Medicare Advantage plan. One final note/point to ponder: scale. To really get value-based contracts, you need it. You need it to afford the infrastructure, and you need it to demand a seat at the table. But yeah with that … everything in moderation, I guess, because any scale that starts to approach monopoly proportions seems to invite bad behavior. You have to get big enough to matter in the market but not so big that your big footprint squashes market dynamics, because it seems like many succumb to the siren song at that point of putting profits over patients.   You can learn more at Ochsner Health Network. Eric Gallagher, chief executive officer for Ochsner Health Network (OHN), is responsible for directing network and population health strategy and operations, including oversight of performance management operations, population health and care management programs, value-based analytics, OHN network development and administration, strategic program management, and marketing and communications. Prior to joining Ochsner in 2016, Eric held leadership positions in healthcare strategy and execution—including roles at Accenture, Tulane University Health System, and Vanderbilt University and Medical Center. A New Orleans native, Eric earned a bachelor's degree in human and organizational development from Vanderbilt University and an MBA from Tulane University.   04:23 How Ochsner Health went from a super ACO to their current value-based care model. 06:09 What signs did Ochsner Health see that helped them recognize that the clinically integrated networks they were building wouldn't help them achieve the outcomes goals they were aiming for? 07:42 Why Ochsner Health's story is a classic example of change management. 08:41 What tough decision did Ochsner Health have to make that's ultimately led to much higher success rates? 10:46 “Really … it's about changing the economic model.” 11:03 Why was CMS a driver of change? 13:00 What's the more sustainable business model in Ochsner Health's market? 15:09 How has Ochsner Health been ahead of the game in the healthcare market?   You can learn more at Ochsner Health Network.   Eric Gallagher of @OchsnerHealth discusses #valuebasedcare and #superACOs on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Dan Serrano, Larry Bauer, Dr Vivek Garg (Summer Shorts 3), Dr Scott Conard (Summer Shorts 2), Brennan Bilberry (Summer Shorts 1), Stacey Richter (INBW38), Scott Haas, Chris Deacon, Dr Vivek Garg, Lauren Vela  

This week on Sg2 Perspectives, we're talking about clinically integrated networks (CINs) with Sg2 Associate Principal Joseph Maher. Joe discusses how CINs have evolved; their challenges and advantages; and how they can help improve health outcomes, patient experience and costs. We are always excited to get ideas and feedback from our listeners. You can reach us at sg2perspectives@sg2.com, find us on Twitter as @Sg2HealthCare, or visit the Sg2 company page on LinkedIn.

- Radyoya Swêdê bea kurdî

As health systems, integrated provider networks, clinically integrated networks (CINs), and accountable care organizations (ACOs) engage in population health initiatives, aligning technology with value-based contracts' performance goals is a key success factor. The lack of alignment can be attributed to a disjointed vision, fragmented operations, and misaligned information technology (IT). In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Julie Bonello, Founder of Integrate Health, along with Brian Bentley and Nick Frenzer from Epic Health Technologies, to explore how to optimize value-based technologies and drive a higher level of population health performance. Insights To drive successful performance of value-based contracts, health care organizations must have an aligned vision, operations, and IT systems, including the electronic health record The structure and leadership of the organization must be led through a clinical lens to achieve results in population health There are critical foundational factors that provider organizations must consider as they adopt technology --- Send in a voice message: https://anchor.fm/lumina-health-partners/message

As health systems, integrated provider networks, clinically integrated networks (CINs) and accountable care organizations (ACOs) engage in population health initiatives, aligning technology with value-based contracts' performance goals is a struggle. The struggle can be attributed to three causes: a misaligned vision, misaligned operations, and misaligned information technology (IT). Host Daniel J. Marino is joined by Julie Bonello, Founder of Integrate Health, along with Brian Bentley and Nick Frazer from Epic Health Technologies to discuss how to optimize value-based technologies to drive population health performance. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio.” Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.02.16.528842v1?rss=1 Authors: Laflamme, O. D., Markin, S. N., Banks, R., Zhang, Y., Danner, S. M., Akay, T. Abstract: Crossed reflexes (CR) are mediated by commissural pathways transmitting sensory information to the contralateral side of the body, but the underlying network is not fully understood. Commissural pathways coordinating the activities of spinal locomotor circuits during locomotion have been characterized in mice, but their relationship to CR is unknown. We show the involvement of two genetically distinct groups of commissural interneurons (CINs) described in mice, V0 and V3 CINs, in the CR pathways. Our data suggest that the exclusively excitatory V3 CINs are directly involved in the excitatory CR, and show that they are essential for the inhibitory CR. In contrast, the V0 CINs, a population that includes excitatory and inhibitory CINs, are not directly involved in excitatory or inhibitory CRs but down-regulate the inhibitory CR. Our data provide insights into the spinal circuitry underlying CR in mice, describing the roles of V0 and V3 CINs in CR. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

Hey, thanks so much to kwebs14 for your super nice review on iTunes the other day. Kwebs wrote: [I have] learned so much, shared so many episodes with colleagues, clients … and gained so much value from regularly listening to [Relentless Health Value]. … Thank you … for providing the platform for so many that believe that we can consistently do better in healthcare. Thanks much for writing this. I think our Relentless Tribe is a unique group, and every day of every week I admire your willingness to hear some things that might be pretty hard to hear because they may hit pretty close to home. Dr. Benjamin Schwartz was talking about the podcast on LinkedIn the other day, and he said he doesn't always agree with guests or the discussion but he always learns something and each episode stimulates and challenges his thoughts and opinions. Yes … to all of this. This is our goal in a nutshell: to help those who want to do better in healthcare to have the insight, the information, the other side of the story, the differing opinion, whatever you need to conceive of the action that you want to take. So, thank you so much to everybody who listens. You are the ones who are going to make a difference, and I thank you from the bottom of my heart for doing what you do every day for patients and communities. Alright, so in this healthcare podcast, we are going to answer an FAQ—a listener question I have gotten a lot lately in various forms. Let me common denominator the inquiry: What does it mean to be clinically integrated, and how does a provider organization/practice/CIN (clinically integrated network) know if they are actually clinically integrated or not? Also, the corollary to this question, which is how do CINs—or anybody, really—know if they are clinically integrated enough to start thinking about taking on downside risk? I asked David Muhlestein this question, and then we talk about his answer for 25 minutes. So, like most things in healthcare, it is filled with nuance; but if I was going to oversimplify his answer in one sentence, it's this: Did the practice change how they are practicing medicine in order to drive predetermined outcomes? This is the litmus test for whether care is integrated. Did practice patterns change within participating entities from whatever they were before to a new way of working? Did the team(s) reorient with a goal to attain some documented patient outcomes, be those outcomes patient satisfaction and/or clinical endpoints and/or functional endpoints? If no sort of fundamental change happened, probably it's a no on the clinical integration question. Another litmus test question I've also heard is this: Is the practice looking to get paid more for successes they've already had in upside risk arrangements with kind of little or no desire to transform the practice into a new practice model? If yes, then again, it's gonna be a no on the clinical integration question. The thing is with all of this … well, let me quote Dr. John Lee, who said this pretty succinctly on LinkedIn recently. He said, “Downside risk fundamentally changes how you have to think as a physician and how you manage your patient cohort. You start thinking about team-based care and using analytics.” Yes … interesting. The point Dr. Lee is making — which is kind of inferred, actually, in the listener questions, so let me just state the obvious, which is so obvious it could easily be overlooked — if you are able to take on downside risk and succeed, you're probably clinically integrated. If you're not, you probably aren't. Said another way (this might get a little chicken and egg-y), do you clinically integrate so that you can get the kind of risk-based contracts that enabled Iora, for example, to represent 5% of One Medical's patient base and 50% of its revenue? I have heard similar profitability stories about ChenMed and Oak Street. They all have capitated downside risk accountable care contracts. And have you seen what some of their leadership teams are minting? Obviously, the capitated downside risk when you're integrated gig can be highly profitable. But ... seems like also the community and outcomes are kind of great. Are they doing well by doing good? I'll grant you I might be convinced based on what I've seen. Galileo is another one. Cityblock. But the fundamental question is, do you integrate first and then go after the contracts? Or is it best to wait until there's a decent accountable opportunity on offer and then, sufficiently incented, change the practice? I do not know. I do know, however, what Scott Conard, MD, said in episode 391. I will poorly paraphrase. He said that if better patient outcomes are desired, there must be clinical integration and practice pattern changes. He said his practice went ahead and instituted these changes to improve patient care and did so within a pretty full-on FFS (fee-for-service) environment. My conclusion with all of this? It takes strong leadership with team-building skills and a strong family/community-centric mission to pull off a successful foray into accountable care with downside risk. These same talented and mission-driven leaders probably could manage to improve patient care and lower costs in an FFS environment as well. The converse of this is also likely true: Weak and ineffectual leaders can make a quadruple nothing burger mess in even the best VBC (value-based care) model. Yes … lots to unpack there. I am interested in your thoughts. In this episode, as mentioned, I am speaking with David Muhlestein, who is the chief research and innovation officer with Health Management Associates, or HMA. He has spent the past decade-plus studying ACOs (accountable care organizations) and value-based care, trying to understand what works, what doesn't, and how you change the business models to be successful under these new models of payment. Here is a short version of David's advice to clinically integrate and be ready for downside risk: ·       Step 1: Understand where you are—this includes doing a very clear-eyed self-assessment. ·       Step 2: Assess the needs of your patient population and focus on things where your capacity meets the needs of the population that you serve in the most impactful way. ·       Step 3: Take the outcome of step 2—which is basically whatcha gonna do to fix the most consequential problems that your patients have—and identify the processes by which you will do this. ·       Step 4: Do not boil the ocean. Start with a subset of patients and figure out the exact plan to do better to manage that population—easier said than done, of course. (Betsy Seals, by the way said something along these exact same lines in the shows giving advice to Medicare Advantage plans. And Karen Root [EP381] also alludes to something similar as she talks about how to socialize innovation. So clearly, this advice can be universalized.) You can learn more by emailing David at dmuhlestein@healthmanagement.com and by connecting with him on LinkedIn.     David Muhlestein, PhD, JD, is chief research and innovation officer for Health Management Associates (HMA). He is responsible for the firm's self-directed research and supports strategic planning and innovation. David's research and expertise center on healthcare payment and delivery transformation, understanding healthcare markets, and evaluating how the broader healthcare system is changing. He is a self-identified data nerd and regularly speaks and writes about healthcare system evolution. David joined HMA via its acquisition of Leavitt Partners in 2021, where he was the chief strategy and chief research officer. Additionally, David is a visiting policy fellow at the Margolis Center for Health Policy at Duke University, adjunct assistant professor at The Ohio State University College of Public Health, and a visiting fellow at the Accountable Care Learning Collaborative. He previously served as adjunct assistant professor of The Dartmouth Institute (TDI) at the Geisel School of Medicine at Dartmouth College. David earned his PhD in health services management and policy, JD, MHA, and MS from The Ohio State University and a BA from Brigham Young University.   07:57 What does it mean to be clinically integrated? 10:23 How does changing practice patterns count as becoming clinically integrated? 11:11 How do you change the delivery of care to get better outcomes? 12:05 What does it mean to see better outcomes when becoming clinically integrated? 14:46 EP176 with Dr. Robert Pearl. 17:42 “Their structure is dictating what they are going to prioritize.” 19:02 “How do you care for the patients that have yet to come and see you?” 20:16 EP391 with Scott Conard, MD. 22:38 “When you're integrated, you realize you're not alone.” 25:50 Why does clinically integrating require a significant mindset change? 28:55 What does this country need to do from a policy perspective for this change? 30:24 EP326 with Rishi Wadhera, MD, MPP.   You can learn more by emailing David at dmuhlestein@healthmanagement.com and by connecting with him on LinkedIn.   @DavidMuhlestein of @HMAConsultants discusses #integratedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth   Recent past interviews: Click a guest's name for their latest RHV episode! Nikhil Krishnan (Encore! EP355), Emily Kagan Trenchard, Dr Scott Conard, Gloria Sachdev and Chris Skisak, Mike Thompson, Dr Rishi Wadhera (Encore! EP326), Ge Bai (Encore! EP356), Dave Dierk and Stacey Richter (INBW37), Merrill Goozner, Betsy Seals (EP387), Stacey Richter (INBW36), Dr Eric Bricker (Encore! EP351), Al Lewis, Dan Mendelson, Wendell Potter, Nick Stefanizzi, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375)      

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.02.03.526887v1?rss=1 Authors: Mancia Leon, W. R., Steffen, D. M., Dale-Huang, F., Rakela, B., Breevoort, A., Romero-Rodriguez, R., Hasenstaub, A. R., Stryker, M. P., Weiner, J. A., Alvarez-Buylla, A. Abstract: Cortical function critically depends on inhibitory/excitatory balance. Cortical inhibitory interneurons (cINs) are born in the ventral forebrain and migrate into cortex, where their numbers are adjusted by programmed cell death. Previously, we showed that loss of clustered gamma protocadherins (Pcdh{gamma}), but not of genes in the alpha or beta clusters, increased dramatically cIN BAX-dependent cell death in mice. Here we show that the sole deletion of the Pcdh{gamma}c4 isoform, but not of the other 21 isoforms in the Pcdh{gamma} gene cluster, increased cIN cell death in mice during the normal period of programmed cell death. Viral expression of the Pcdh{gamma}c4 isoform rescued transplanted cINs lacking Pcdh{gamma} from cell death. We conclude that Pcdh{gamma}, specifically Pcdh{gamma}c4, plays a critical role in regulating the survival of cINs during their normal period of cell death. This demonstrates a novel specificity in the role of Pcdh{gamma} isoforms in cortical development. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

-- . Nûçeyên giring yên Swêdê îro 08.12.2022 ji vê podkasta beê kurdî yê Radyoya Swêdê. Pêkevan Zekî Aydin û Producent Lorîn Berzincî

F ıkıh kitaplarımızda “hunsâ” diye bilinen ve kendisinde erkeklik ile dişilik organlarının birlikte bulunduğu veya ikisinin de belirli olarak bulunmadığı kimseler ile cinsiyetlerini değiştirenlerin dinî durumları son zamanlarda sıklıkla sorulmaya başladı. Bu neviden bir soru listesini maddeler halinde cevaplandıracağım: 1. Benim bilgime ve soruşturmalardan aldığım sonuca göre yaratılıştan (biyolojik ve fizyolojik özellikleri itibariyle) kadın olan bir kimse ameliyatla erkek, erkek olan bir kimse de ameliyatla kadın olamıyor; yani bazı organlarını kestirip aldırsa ve bazı organlarında değişiklik yaptırsa da bütün fonksiyonları ve özellikleri ile cinsiyetini değiştiremiyor. Hele hele erkek iken kadına dönüştürülenler asla çocuk sahibi olamıyor, keza kadın iken erkeğe dönüştürülenler de bir kadını hamile bırakamıyor. 2. Allah Teâlâ Kitabında insanoğlunu erkek veya dişi olarak yarattığını bildiriyor, bu iki özelliği birden taşıyan bir üçüncü insan nev'i yarattığını bildirmiyor. Şu halde fıtraten (yaratılıştan) insan ya erkektir yahut da dişidir. Bu iki cinsiyetin belirleyici organ ve işaretlerini birlikte taşıyanlar, ikisine birden sahip olanlar, bir mânâda fıtrata aykırı, sakat, eksik veya fazlalıklı doğanlar gibidirler. İnsanın iki kulağı, bir burnu, iki ayağı, on parmağı... vardır; bir çocuk bu organlarında bir fazlalık veya eksiklik ile doğarsa bunu “Allah böyle

-- . Nûçeyên giring yên Swêdê îro 16.11.2022 ji vê podkasta beê kurdî yê Radyoya Swêdê. Derhîner: Lorin IbrahimPêkêkar: Sidki Hirori

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.11.06.515335v1?rss=1 Authors: Mohebi, A., Collins, V. L., Berke, J. D. Abstract: Motivation to work for potential rewards is critically dependent on dopamine (DA) in the nucleus accumbens (NAc). DA release from NAc axons can be controlled by at least two distinct mechanisms: 1) action potentials propagating from DA cell bodies in the ventral tegmental area (VTA), and 2) activation of {beta}2* nicotinic receptors by local cholinergic interneurons (CINs). How CIN activity contributes to NAc DA dynamics in behaving animals remains unclear. We monitored DA release in the NAc Core of awake, unrestrained rats while simultaneously monitoring or manipulating CIN activity at the same location. CIN stimulation rapidly evoked DA release, and in contrast to slice preparations, this DA release showed no indication of short-term depression or receptor desensitization. The sound of food delivery evoked a brief joint increase in CIN population activity and DA release, with a second joint increase as rats approached the food. In an operant task, we observed fast ramps in CIN activity during approach behaviors, either to start the trial or to collect rewards. These CIN ramps co-occurred with DA release ramps, without corresponding changes in the firing of VTA DA neurons. Finally, we examined the effects of blocking CIN influence over DA release through local NAc infusion of DH{beta}E, a selective antagonist of {beta}2* nicotinic receptors. DH{beta}E dose-dependently interfered with motivated approach decisions, mimicking the effects of a DA antagonist. Our results support a key influence of CINs over motivated behavior via the local regulation of DA release. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

If you listened to the show with Dan O'Neill (EP359), you would know this already. But let me tell you: If you're a provider, even a provider very confident in your office's ability to confer better patient health, you will still have a super hard time getting off the fee-for-service (FFS) hamster wheel. Why? Because it's hard to find payer contracts out there which will reward you (the provider) for actually taking care of your patients and to be accountable for the value of healthcare that you deliver. This is a tangled web we weave because, despite some payers offering risk-based contracts, a lot of times there's some IPA (independent physician association) or other “holder of the actual payer contract” who does not pass along these contract terms. These IPAs or health systems even sometimes just keep paying docs or provider offices FFS even if they themselves have a risk-based or capitated or value-based-of-any-kind agreement. If I actually kept track of the issues raised in the emails I receive from docs, there's one thing that I would likely find amongst the most frequently cited points of consternation: Physicians or practices or CINs (clinically integrated networks) or ACOs (accountable care organizations) want contracts where they can do right by patients. These are the good docs. These are the ones burned out and suffering from moral injury because physicians, PAs (physician assistants), nurses, clinicians who actually follow up and coordinate care and spend time making accurate diagnoses instead of cramming in more procedures … these are the clinicians who want to do the right thing and are also the ones who are getting dinged on performance reports and paid less. Bottom line here, for a physician practice to transform itself from an FFS machine cranking out volume but not necessarily health or care, the office has to have a high enough percentage of their patients in value-based arrangements to make it actually feasible to transform. It is only when they hit a tipping point of enough volume, enough patients in risk-based contracts that they can afford to be accountable for their results. At that point, yeah, everybody wins—doctors, patients, actually the entire community wins because when a local practice transforms, all of their patients tend to benefit at some level from the new processes and procedures and standardizations and pop health systems that get put in place. So, let's move forward with this with all haste, shall we? Why aren't we? What's the problem here? Well, there are lots of problems, don't get me wrong. But a big one is self-insured employers on the whole are not offering any sort of accountable care arrangements to the providers in their community. This is 150 million patient lives we're talking about here—a huge chunk of many providers' patient panels. Self-insured employers have a really big opportunity to level up the care in their whole community due to the spillover effect when a provider practice transforms itself because it has enough patients to do so. But these employers are stuck. They are paralyzed. They are doing the same thing this year that they've done last year, and therefore their whole community is equally stuck in a smorgasbord of suboptimal FFS goings-on. So, offering accountable care contracts is one thing (a very big consequential thing) that is also one of the five things self-insured employers can do to improve employee health that I talk about in this healthcare podcast with Dan Mendelson. Dan Mendelson, my guest today, also wrote a Forbes article listing out these five things. Here are all five things that Dan mentions in one handy list: Expand availability of accountable care models to improve the care experience, quality, and affordability at a local level. For a deep dive on this, listen to the show with Dave Chase (EP374). Invest in the data access needed to assess health outcomes. For a deep dive on this, listen to the show with Cora Opsahl (EP372). Align employees' health benefits with pop health outcomes. For a deep dive on this, listen to the show with Mark Fendrick, MD (Encore! EP308). Prioritize care models that can meet employees wherever they are. For a deep dive on the DEI (diversity, equity, and inclusion) aspect of this, listen to the show with Monica Lypson, MD, MHPE (EP322). Make care navigation a central part of the benefits package and experience. I am looking for an expert to take a deep dive on care navigation who does not work for a care navigation company. Hit me up if you know someone (again, who does not work for a care navigation company). My guest today, Dan Mendelson, is CEO of Morgan Health at JPMorgan Chase. He previously founded Avalere Health. Before that, Dan served as associate director for health at the Office of Management and Budget. Besides exploring the why and the what for each of the five things employers should do right now, I also wanted to find out from Dan what's going on at Morgan Health and how they are looking to help self-insured employers who want to do these five things actually do them.   You can learn more at the Morgan Health Web site. Dan Mendelson is the chief executive officer of Morgan Health at JPMorgan Chase & Co. He oversees a business unit at JPMorgan Chase focused on accelerating the delivery of new care models that improve the quality, equity, and affordability of employer-sponsored healthcare. Mendelson was previously founder and CEO of Avalere Health, a healthcare advisory company based in Washington, DC. He also served as operating partner at Welsh Carson, a private equity firm. Before founding Avalere, Mendelson served as associate director for health at the Office of Management and Budget in the Clinton White House. Mendelson currently serves on the boards of Vera Whole Health and Champions Oncology (CSBR). He is also an adjunct professor at the Georgetown University McDonough School of Business. He previously served on the boards of Coventry Healthcare, HMS Holdings, Pharmerica, Partners in Primary Care, Centrexion, and Audacious Inquiry. Mendelson holds a Bachelor of Arts degree from Oberlin College and a Master of Public Policy (MPP) from the Kennedy School of Government at Harvard University.   05:53 Why did Dan direct his article about health benefits at CEOs? 06:56 What does an accountable care model mean to a self-insured employer? 08:50 “This alignment of value will never work … if the 150 million Americans … getting their health insurance through their employer are not also aligned in the same way.” 12:21 “We're offering them a higher level of service.” 12:32 “Everything that we do is intended to be scalable and not just for us.” 13:01 “We have an obligation to do better for our employees.” 15:44 “Employers need to understand, the only way to get outstanding care is locally.” 18:21 Encore! EP206 with Ashok Subramanian and EP358 with Wayne Jenkins, MD. 19:10 Why is getting quantitative metric data important? 19:42 Encore! EP308 with Mark Fendrick, MD. 21:50 “This is a much broader vision of accountable care than … primary care.” 23:41 “Until everything is aligned, the employer is just not going to be providing an optimal product.” 24:32 “There are substantial issues with … health equity, and employers are paying for the care of 150 million Americans in this country.” 26:15 Is digital health access important for creating meaningful relationships between patients and providers? 30:43 What is the myth that employers need to tackle? 31:10 Why is care navigation important for employees? 32:37 EP334 with Sunita Desai, PhD. You can learn more at the Morgan Health Web site. @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast Why did Dan direct his article about health benefits at CEOs? @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast What does an accountable care model mean to a self-insured employer? @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast “This alignment of value will never work if the 150 million Americans getting their health insurance through their employer are not aligned in the same way.” @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast “We're offering them a higher level of service.” @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast “Everything that we do is intended to be scalable and not just for us.” @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast “We have an obligation to do better for our employees.” @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast “Employers need to understand, the only way to get outstanding care is locally.” @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast Why is getting quantitative metric data important? @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast “This is a much broader vision of accountable care than … primary care.” @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast “Until everything is aligned, the employer is just not going to be providing an optimal product.” @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast “There are substantial issues with … health equity, and employers are paying for the care of 150 million Americans in this country.” @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast Is digital health access important for creating meaningful relationships between patients and providers? @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast What is the myth that employers need to tackle? @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast Why is care navigation important for employees? @dnmendelson of @JPMorgan discusses #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast Recent past interviews: Click a guest's name for their latest RHV episode! Wendell Potter, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.10.27.514125v1?rss=1 Authors: Gangal, H., Xie, X., Cheng, Y., Wang, X., Lu, J., Zhuang, X., Essoh, A., Huang, Y., Smith, L. N., Smith, R. J., Wang, J. Abstract: The mechanisms underlying the reduction in cognitive flexibility associated with reinforcement of addictive substance use are unknown. This reinforcement is mediated by substance-induced synaptic plasticity in direct-pathway medium spiny neurons (dMSNs) that project to the substantia nigra (SNr). Cognitive flexibility is mediated by cholinergic interneurons (CINs), which receive extensive local inhibition from the striatum. Here, we report that cocaine or alcohol administration caused a long-lasting potentiation of local inhibitory dMSN-- greater than CIN transmission in the dorsomedial striatum (DMS), a brain region critical for goal-directed behavior and cognitive flexibility. This dMSN-- greater than CIN potentiation reduced CIN firing activity. Furthermore, chemogenetic and time-locked optogenetic inhibition of DMS CINs suppressed cognitive flexibility in an instrumental reversal learning task. Importantly, rabies-mediated tracing and physiological studies revealed that SNr-projecting dMSNs, which mediate reinforcement, sent axonal collaterals to inhibit DMS CINs, which mediate flexibility. Our findings demonstrate that the local inhibitory dMSN-- greater than CIN circuit mediates a reinforcement-induced reduction in cognitive flexibility. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.09.09.507130v1?rss=1 Authors: Chantranupong, L., Beron, C. C., Zimmer, J. A., Wen, M. J., Wang, W., Sabatini, B. L. Abstract: Within the basal ganglia, striatal dopamine (DA) and acetylcholine (Ach) are essential for the selection and reinforcement of motor actions and decision making. In vitro studies have revealed a circuit local to the striatum by which each of these two neurotransmitters directly regulates release of the other. Ach, released by a unique population of cholinergic interneurons (CINs), drives DA release via direct axonal depolarization. In turn, DA inhibits CIN activity via dopamine D2 receptors (D2R). Whether and how this circuit contributes to striatal function in vivo remains unknown. To define the in vivo role of this circuit, we monitored Ach and DA signals in the ventrolateral striatum of mice performing a reward-based decision-making task. We establish that DA and Ach exhibit multiphasic and anticorrelated transients that are modulated by decision history and reward outcome. However, CIN perturbations reveal that DA dynamics and reward-prediction error encoding do not require Ach release by CINs. On the other hand, CIN-specific deletion of D2Rs shows that DA inhibits Ach levels in a D2R-dependent manner, and loss of this regulation impairs decision-making. To determine how other inputs to striatum shape Ach signals, we assessed the contribution of projections from cortex and thalamus and found that glutamate release from both sources is required for Ach release. Altogether, we uncover a dynamic relationship between DA and Ach during decision making and reveal modes of CIN regulation by local DA signals and long-range cortical and thalamic inputs. These findings deepen our understanding of the neurochemical basis of decision making and behavior. Copy rights belong to original authors. Visit the link for more info Podcast created by PaperPlayer

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.09.09.507300v1?rss=1 Authors: Krok, A. C., Mistry, P., Li, Y., Tritsch, N. X. Abstract: External rewards like food and money are potent modifiers of behavior. Pioneering studies established that these salient sensory stimuli briefly interrupt the tonic cell-autonomous discharge of neurons that produce the neuromodulators dopamine (DA) and acetylcholine (ACh): midbrain DA neurons (DANs) fire a burst of action potentials that broadly elevates DA levels in striatum at the same time as striatal cholinergic interneurons (CINs) produce a characteristic pause in firing. These phasic responses are thought to create unique, temporally-limited conditions that motivate action and promote learning. However, the dynamics of DA and ACh outside explicitly-rewarded situations remain poorly understood. Here we show that extracellular levels of DA and ACh fluctuate spontaneously in the striatum of mice and maintain the same temporal relationship as that evoked by reward. We show that this neuromodulatory coordination does not arise from direct interactions between DA and ACh within striatum. Periodic fluctuations in ACh are instead controlled by glutamatergic afferents, which act to locally synchronize spiking of striatal cholinergic interneurons. Together, our findings reveal that striatal neuromodulatory dynamics are autonomously organized by distributed extra-striatal afferents across behavioral contexts. The dominance of intrinsic reward-like rhythms in DA and ACh offers novel insights for explaining how reward-associated neural dynamics emerge and how the brain motivates action and promotes learning from within. Copy rights belong to original authors. Visit the link for more info Podcast created by PaperPlayer

Late in May of this year, three-ish months ago, I did an inbetweenisode that explores the “why with the no collaboration” amongst healthcare stakeholders and what the lack of collaboration signifies. That episode got a lot of traction and engagement.   This episode that follows is a pretty good approximation of a presentation that I made at the MTVA (Moving to Value Alliance) symposium that happened in Connecticut this past June. If you listened to the earlier show about collaboration, this one is slightly different, shorter, and more to the point. So, let's start here: When you listen to any patient with a chronic condition talk about their challenges with the healthcare industry—and yes, if a patient has a chronic condition, more often than not, that is what they will talk about, their challenges … I went on Twitter just now, and it took me literally 13 minutes to collect what I'm going to say are 300+ Tweets written by patients and their caregivers complaining about their chronic care journey. That's the sad part. I don't mean to kick this off talking about problems; however, if you're gonna solve for something, it is important to understand what problem you are solving for. You do not want to be a solution looking around for a problem. So, let's fix this, this rampant problem problem that chronic care patients seem to have. Many of the patient challenges in the 300 Tweets that I just collected can be grouped into two major categories. And these two major challenge groups can really only be solved for with collaboration amongst healthcare stakeholders. So, let's dig in here. The first major patient challenge is what I'm gonna call the care gap problem. I was talking to someone at a provider organization the other day, and she had 8000 known care gaps with patients and [insert overwhelm here]. And these were just the care gaps that showed up on somebody's radar because they added up to a quality metric, which is sometimes the definition people use for what is a care gap. But if we think about all the other holes in patient care, the typical care gaps that are identified probably come not even close to the total number of actual care gaps: patients who can't see their specialist because they can't get ahold of their records from the local health system or no coordination of care. Coordination is probably another synonym for collaboration. This is a huge deal. People literally die because their clinician cannot get their biopsy results or whatever from somebody else. That's a care gap as deep as a grave. Or patients who keep showing up in the ER because they aren't getting the help or the meds or the accurate diagnoses or the treatment plan that they need to stay out of the ER ... My grandfather had heart failure. At the end of his life, he was probably in the ER once a month. It was sad and painful and expensive and totally unnecessary. But his PCP didn't seem to be collaborating with the specialists, and the ER I don't think was telling anybody what was going on. Right? Or patients who can't get a drug they need approved by their insurance, so they wind up in crisis. Crappy prior auth processes create care gaps. All of these things are gaps in care. Carly Eckert, MD (EP361), was on the podcast; and she made a crucial point for me. In fact, I tried to get her to come on the podcast originally to talk about care gaps and closing care gaps; but she categorically refused. Chronic care management, she said, should not be a game of whack-a-mole. It may be better than nothing, a game of whack-a-mole; but it is certainly not ideal.   Chronic care management by care gap is like cooking with a fire extinguisher. If we want to eliminate care gaps for reals, let's just not have care gaps. So, how do you go about not having care gaps, then? The goal should be to craft a non-fragmented patient journey. Let's figure out what a great care journey looks like ahead of time and then try to keep the patient on it. That is the best way to eliminate care gaps: proactively. You don't have them. Immediately, because I am a person of action, I went into my filing cabinet; and I actually found an example of a patient journey map amongst my papers that I had worked on years ago. You have probably seen one of these and may have some of your own patient journey maps tucked away in a binder in your office somewhere. Most people have them. There are a few things that they all have in common, irrespective of the disease state or the organization or anything. The things that they have in common are they are complicated flowcharts with a lot going on. Besides just being complicated, the other thing that patient journey maps all have in common is that there are multiple parties mentioned with roles in that patient journey. You're gonna have a PCP, a specialist or two, a hospital, a payer, a pharma company more than likely, a PBM maybe, maybe a community organization … Here's a quote that kinda sums that up from Dr. William Bestermann: “Improving chronic disease management is an enormous problem that requires multiple stakeholders coming together to combine new science, new systems, and new payment models in a comprehensive solution. No one person or organization can make progress that matters. The problem is too big.”   Is this obvious? I think it's pretty obvious. But yet, collaboration in general at the organizational level is less than common. With uncommon exceptions, you not only don't have multiple providers working together but—heaven forbid!—you have payers and providers or other entities working together. But just taking this back to the thrust of this conversation, the first major patient challenge can only be solved for with collaboration to create a non-fragmented patient journey, which reduces care gaps by avoiding care gaps in the first place. So, collaboration is a rate critical for a non-fragmented patient journey to eliminate care gaps that patients have big issues with. So now, let's move on now to the second big problem category that chronic care patients were Tweeting about in those Tweets that I collected: They can't afford their care. This crisis of affordability is a huge patient challenge that, it's not the only thing, but we can't solve for it without being collaborative, without having collaborative relationships along the patient journey. I don't really want to get into how much healthcare prices have skyrocketed, but healthcare prices have been inflating at 4x the cost of everything else. This causes mental health issues; it causes stress. There's a show with Wayne Jenkins from Centivo where we dig into this deeply. Listen to EP358.   It is inarguable at this point that financial toxicity is clinical toxicity. I have a folder on my computer where I chuck references for this statement, and at this point, I probably have 400 studies and articles that all say the same thing in different ways with different patient populations. Most of these patients are insured. By the way, just because you have insurance doesn't mean that you can afford to use it. And patients who cannot afford their care have worse clinical outcomes. Period. End of sentence. Minor sidebar because I was really like head exploding emoji this morning: I saw somebody in a forum today lashing out at patients suffering with crippling medical debt saying that these people really should take some personal responsibility for the financial choices that they have made. WTH? The entity not taking responsibility for people losing their life savings and their homes simply because they had the fortune of getting sick or injured, the entity that should be taking some responsibility here is a broken, profit-driven healthcare industry. Let me just add some fidelity to what I mean when I say “the healthcare industry,” which really should take some responsibility here for the financial toxicity that they themselves are creating. Consider that a lot of medical debt is of a balance bill nature and the people being pursued generally signed a contract which they did not understand the consequences of, because most of them had “insurance” and they certainly weren't given a quote up-front so that they could make a rational economic choice. So, let's add some fidelity: How do we make healthcare more affordable? Or how do we make the charges not a complete surprise at a minimum? How do we do that? Lots of ways, big and small, are required; but let's talk about one of them: Navigate patients to high-quality providers charging a fair price. Navigate patients to providers who do not do low-value things and who have practice patterns that are aligned with evidence-based medicine (ie, get employers and providers to direct contract, especially in non-FFS ways, especially as it relates to primary care where there are measurable outcomes or quality). ACOs or CINs (clinically integrated networks) who know how to refer to high-value specialists or hospitals is another example of a collaboration that can help with affordability. Some health plans and TPAs (third-party administrators) are starting to get really data-driven about how they go about this. Point being, to coordinate care to or amongst high-value providers, multiple parties have to be involved (ie, collaboration). So, in sum, we talked about two common and major patient problems, which are probably not a surprise to anyone listening. The two are a lack of coordinated care (patients falling into gigantic care gaps) and then also a lack of affordability. We know how to solve for both of these issues. Defragment care and steer patients to high-quality provider organizations/hospitals/CoEs with competitive prices. Collaborate in these two ways. So, why are so few doing it, then? You can always count on me to say the quiet part out loud, so here we go: The business model of most, many, lots of healthcare organizations, both for-profit and tax-exempt, is revenue maximization. As Kevin Schulman, MD, said on the podcast (EP366), it's not A or B; we have a dysfunctional healthcare benefits system in this country.   But nonetheless, if we want to identify a root cause for why with the no interoperability, why with the info blocking to prevent network leakage, why with the no collaboration … it's not a technical problem at its core. It's not a HIPAA concern, really, at its core. It's a business case problem. And I don't say this as any sort of castigation. I say this because it's actionable information. Tiptoeing around a thing that we all know just clutters our ability to come up with a solution that is actually going to work. Really understanding a pretty big root cause behind why needed collaborations don't happen is necessary. This level of introspection is required for those who are mission driven to find others who are similarly mission driven to get a collaboration over the line. But the good news is success stories abound. It's my belief the healthcare industry won't be transformed in one giant turn of some flywheel. It's gonna be transformed one local market at a time. And there's a lot of great stuff happening in local markets. Listen to the show with Dave Chase (EP374) for a bunch of examples. There's a show with Cora Opsahl (EP372) that has some great examples of this. There's the one with Doug Hetherington (EP367). We also have a show coming up in October with Nick Stefanizzi from Northwell Direct.   All of these great examples are stakeholders harnessing the power of collaboration to defragment patient journeys and get patients into high-value care settings so that the overall cost of care is in range for employers, taxpayers, patients, and American families. I'm so excited, honestly, about that because the healthcare industry is a legacy that we will leave behind to children and grandchildren. I have a vision in my head about what I want the healthcare industry to look like in 25 years. Maybe you do, too. Listen to the show with David Muhlestein, PhD, JD (EP364), for more on that. But the point is, if this vision is going to come true, we need to—like, right now—start building the roadmap to get to that goal. And a lot of this involves facilitating collaboration. Actually collaborating, for reals. There's real momentum behind that in organizations such as the Moving to Value Alliance in Connecticut, where I originally gave a version of this same talk. Thanks, by the way, to Steve Schutzer, MD, for moderating the collaboration panel that I was a part of at aforementioned MTVA symposium. Not only is he a great moderator, but he also has done a great service for patients through his ability to get a whole bunch of surgeons—who are pretty competitive as a general rule—to collaborate and form a Center of Excellence. 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. 01:41 What are the two major patient challenges in chronic patient care that can only be solved by collaboration? 01:56 What is the “care gap” problem? 03:19 “Crappy prior auth processes create care gaps.” 03:25 EP361 with Carly Eckert, MD.  04:00 How do you eliminate care gaps proactively? 06:46 EP358 with Wayne Jenkins.  08:21 What is one way to make healthcare more affordable? 09:49 Why aren't more healthcare entities collaborating? 10:04 EP366 with Kevin Schulman, MD.  11:13 EP374 with Dave Chase. 11:18 EP372 with Cora Opsahl.  11:22 EP367 with Doug Hetherington.  11:25 Upcoming episode with Nick Stefanizzi. 12:00 EP364 with David Muhlestein, PhD, JD.   For more information, go to aventriahealth.com.   Our host, Stacey Richter, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast What are the two major patient challenges in chronic patient care that can only be solved by collaboration? Our host, Stacey Richter, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast What is the “care gap” problem? Our host, Stacey Richter, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast “Crappy prior auth processes create care gaps.” Our host, Stacey Richter, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast How do you eliminate care gaps proactively? Our host, Stacey Richter, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast What is one way to make healthcare more affordable? Our host, Stacey Richter, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Why aren't more healthcare entities collaborating? Our host, Stacey Richter, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O'Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan    

-- . Nûçeyên giring yên Swêdê îro 29.08.2022 ji vê podkasta beê kurdî yê Radyoya Swêdê.

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.08.25.505358v1?rss=1 Authors: Becchi, S., Chieng, B., Bradfield, L., Capallan, R., Leung, B., Balleine, B. W. Abstract: The loss of neurons in parafascicular thalamus (Pf) and of their inputs to dorsomedial striatum (DMS) are associated with Lewy body disease (LBD) and Parkinsons disease dementia (PDD) and have been linked to the effects of neuroinflammation. In rats, these inputs regulate the function of striatal cholinergic interneurons (CINs) that are necessary for the flexible encoding of the action-outcome (AO) associations for goal-directed action. We found that these inputs modify the encoding, not retrieval, of new AO associations and cause burst-pause firing of CINs in the DMS during AO remapping. These adaptive effects were abolished by neuroinflammation in the Pf, resulting in the loss of goal-directed control when the rats were required to update AO associations after a change in contingency. We found that the neuronal and behavioral deficits induced by inflammation in the Pf were rescued by administration of selegiline, a MAO-B inhibitor that we found also enhances ATPase activity in CINs, suggesting a potential treatment for cognitive deficits associated with inflammation affecting the function of midline thalamic nuclei and related structures. Copy rights belong to original authors. Visit the link for more info Podcast created by PaperPlayer

In INBW32, I talked about telehealth. In this episode, I'm talking about collaboration between healthcare stakeholders or the lack thereof. My grandfather suffered from heart failure. This was many years ago now. But when I say suffered, I mean it. As many of you know, when heart failure is uncontrolled, it is painful to go through or even watch a loved one go through. There was that one time when I accompanied my grandfather (and my grandma was there, too) on a trip to the emergency room, you know, because he was drowning in his own lung fluid and could barely breathe. And when we arrived, they were going to wheel him into one of the exam rooms. But my grandmother put her foot down. She did not want to go into that one exam room because the TV was broken in there. Yes, the two of them had been in the ER so many times that they were familiar with the pros and cons of the various exam rooms. The end of my grandfather's life was almost unbearable, and I can't even begin to estimate the hundreds of thousands of dollars racked up in ER visits and inpatient stays. He was in the ER once a month at a minimum, and he would come home disoriented and confused. Now, as everybody listening to this show knows, this anecdote is also a data point that is, dare I say, all too common. But to that end, let me just talk about heart failure data for a second. Patients with heart failure generate a third of Medicare spending and 40% of Medicare fee-for-service deaths. They are also responsible for 55% of Medicare readmissions. You'd think that if there were any chronic condition that we'd be looking to improve outcomes on, it'd be this one. So, everybody's on it, right? Oh, wait … heart failure readmissions have actually gone up in recent years.   I just want to point out that in between ER visits and inpatient stays, my grandfather received effectively no education, no PCP or cardiology follow-ups, no community support. He did not get a case manager. He got no coaching. He got 25 pages of tiny, printed instructions just before the door hit him in the butt on his way out to the parking lot. Obvious point here, but to do any of this in-between stuff would have required collaboration between the hospital and others. And it was conspicuous in its absence. Look, this is sad and I'm not telling the story because I think it's unique. If I asked who else has a story like this one where a family member or a loved one got lost in the gaps between their care, I am suspecting that everyone would raise their hands—even those of you who have medical degrees. No matter how much any of us know or care or try to help, stories like my grandfather's are painfully and unequivocally common in this country today. OK, so how to improve care, especially for chronic care patients. At its core, and I am not telling anyone listening something that you probably have not already thought about at great length, but there are two important contributors to patient outcomes. Not the only contributors for absolutely sure, but here are two important ones: Nonfragmented patient journeys that adhere to evidence-based best-practice care. My grandfather and anyone with a chronic condition requires a patient journey that isn't a game of whack-a-mole. Carly Eckert, MD, says this so well in EP361. Steering patients to the best care setting, which is required to get the highest-value best-practice care and also reduce financial toxicity. Short but important sidebar: We know that financial toxicity is clinical toxicity. There was just a study that came out that said in 2030, a leading cause of death will be noncompliance to treatment due to patients abandoning care because it costs too much. Wayne Jenkins, MD, from Centivo (EP358) talks about other implications of financial toxicity for a half-hour. Also, there's another paper that, again, is just more on this point. At this juncture, it is not arguable. Financial toxicity is clinical toxicity. So, we need to get patients, people, customers to the next place that is the highest value for them. Doing either or both of these things—nonfragmenting the patient journey and making sure patients get to the next care setting—it requires collaboration. Let me quote Dr. Steve Klasko, who, until recently, was president and CEO over at Jefferson Health in Philly. He said—and this is an adaptation of an old Steve Jobs mantra—but Steve Klasko said that for hospitals, our old math was inpatient revenue, outpatient revenue, and in-person tuition and funding. The new math is going to be strategic partnerships around this healthcare at any address model. Right? But good collaborations don't just improve patient outcomes. Here's another benefit: They also make happier clinicians or employees. If every outside interaction is a friction point, where employees, clinicians, doctors, nurses are rubbed raw because every interaction becomes a battle, if that's the ecosystem that any given party has created for themselves, patients aren't happy and clinicians aren't happy. And since everything in healthcare spirals around that one relationship, the one between the patient and their clinicians, this could not be more vital. There's that famous Richard Branson quote, which I'll paraphrase: If you want to keep the customers happy, keep the employees happy. How anyone thinks that patients are going to get amazing care when those providing the care are miserable is just the very definition of magical thinking. All right … so, let's get into the hard thing about hard things: why with the lack of collaboration across the industry there are a lot of excuses for why parties cannot collaborate. For example, interoperability, HIPAA, legal, cyber, bureaucracy … Also, people are busy, COVID response, being overworked and burned out is a big deal. And I'm not saying that some of these are not valid, but the elephant in the room is this: In healthcare today, most (if not all) big organizations for sure and a lot of small ones have a business model that is built on revenue maximization. Look, when I'm referring to organizations as revenue maximizers, maybe I'm not talking specifically about specific departments and people working hard in those departments within any given organization. Organizations are not one-celled organisms, after all. But what I am saying is that, as a whole, healthcare organizations—the vast majority and certainly every so-called incumbent payer and health system—when you factor in the actions of the CFO, the actions of the billing department, the group that sets premiums, the one that sets prices, the group that incentivizes brokers, the group that sells to employers, the group that lobbies politicians, the group that writes the contract terms … if you factor in the whole organization, what you get is an organization who acts to maximize outcomes—financial outcomes, that is. As per my normal MO, I'm gonna say the quiet part out loud here. One big reason why parties do not collaborate is because they are thinking they are going to maximize their revenue by info blocking to prevent network leakage, or not sharing data with an employer because then the employer might steer the employee to an infusion center for their chemo, or drugs will get switched from the profitable one to the not profitable one. I just saw another article the other day, entitled “The Many Barriers to Payer-Provider Alignment on Value-based Care.” Two entities vital for a nonfragmented frictionless patient journey cannot figure out how to align incentives, share data, or even figure out what good looks like. Speaking industry-wide here, but if patient outcomes were the top of either the payer or the provider's organizational lists of priorities, I do not think that this would be the case decades later. Listen to the show with Kevin Schulman, MD (EP366); Scott Haas (EP365); or an upcoming one with Autumn Yongchu and Erik Davis coming out in a few weeks that just drives this point home.   So, can you do well by doing good? Yes, you can. I have a degree from a business school, after all; but there is a line that gets crossed when maximizing revenue harms patients. And I'll tell you how you can tell if you're over the line. And again, I'm talking organizations here who have power and control in their local markets. I would say that a lack of collaboration is a symptom. If we all agree that collaboration is essential and some organization is not doing it, maybe it is a sign. It is an actionable bit of information that I hope, if relevant, gets contemplated. For example, back to my grandfather for a sec, it's pretty well known how to reduce heart failure revisits. There are more than a few care models that have definitely been shown to work. Here is one of them, and this was talked about in Dr. William Bestermann's Substacks. There was a nurse in the Carolinas—and I talked about this before—but there was a nurse in the Carolinas who decreased heart failure readmissions markedly by simply calling up heart failure patients and making sure they were doing OK and that they understood how to take care of themselves. She was caring, and she had relationships with these patients. That's all she did.   So, hospital collaborates with a payer case manager or a CBO (community-based organization) or an MSO (management services organization), or maybe the hospital has pop health capabilities internally. I mean, we can manage to transplant important organs in this country, and most healthcare organizations cannot figure out how to work together well enough that a nurse calls up a bunch of patients? Is this some arcane or highly complex thing to do? No, it's not. But most are not doing anything even close to this because revenue maximization is the goal of one or more of the entities who would need to be a party to this, and everything else is just an excuse. If anyone is thinking interoperability right now, I've heard Don Lee say on The #HCBiz Show! often enough that there's lots of evidence at this point that interoperability has been solved from a technical standpoint. It's been solved for years. The problem is a business case problem. No one wants to be interoperable because … revenue maximization All right … aspirationally here, despite all of this, great collaborations happen every single day—collaborations that are bright spots and that definitely improve patient outcomes and reduce financial burdens short-term and long-term. Let me give you some examples: what 32BJ is doing in New York City (upcoming episode with Cora Opsahl talking about the cool things that they are doing with Mount Sinai); CINs (clinically integrated networks), like Lisa Trumble, who talks about SoNE HEALTH in EP349.   There are MSOs that work with ACOs (accountable care organizations) and others. Listen to Shawn Rhodes (EP354); also what Nicole Bradberry and Kelly Conroy are doing in Florida (EP324).   In an upcoming episode, Dave Chase from Health Rosetta: He's got one great story after another about how employers these days are teaming up with provider organizations, pharmacies, and their communities to put a serious dent in costs while raising patient outcomes and satisfaction. Doug Hetherington's episode (EP367) talks about direct contracting with hospitals. Katy Talento (EP350) talks about this also. Steve Schutzer, MD, talks about collaborating with other local orthopedic surgeons to stand up a now nationally recognized center of excellence in Connecticut (EP294). We also have some pharma companies who are developing some pretty great disease-centric resources for providers. Some pharma companies and some internal teams at those companies can actually be fair and good community players. Mike Levitt and the work that he has done on the Accountable Care Learning Collaborative, which is headed up by Dr. Eric Weaver, who has been on the show (EP277); or I'm sure after this show airs, I'm gonna hear about more. Please send them my way.   Now, look … let's get real here. These collaborations may have been initiated with, let's just say, other beneficial side effects; but they all improve care and reduce costs. If I were gonna list some common and appealing side effects that could motivate some prospective collaborators to come to the table, some of the usual suspects are proposing that the collaboration will, for example, improve HCAHPS scores, quality metrics, star ratings; improve predictable spend; reduce shock claims; avenge your common competitor and steal their market share; gang up against a payer or some consolidated health system; improve OR utilization; or improve efficiency in some way. What I would say, though, is that if leveling up patient care happens and costs do not rise as a result, that's the shared priority I'd focus on. If someone gets some beneficial side action, this is kind of the definition of doing well by doing good. All right, so let's talk about the different kinds of collaboration just briefly. I'm gonna say that there's three kinds of collaboration: Collaboration along the patient journey by multiple parties who are all along the patient journey Collaboration by parties who can help inform the patient journey, but they're not necessarily on the patient journey themselves Collaboration by parties who can help navigate the patient journey I am mentioning these three because there's often sort of this insinuation that collaborators should have equal stature in the care journey or have similar roles, that if you're not actually on the clinical journey, then you don't have any responsibility or accountability for the clinical journey and, therefore, are not a worthy collaborator. That is limiting if you are trying to figure out who you might be able to collaborate with to help you. The patient journey is not like a movie showing all the minutes a patient spends in clinic, and then all the gaps in between visits are edited out. Care can be improved at the population level, at the community level. Care can be improved at the disease or the condition level when clinicians get needed insights or information or tools. I mean, frankly, to my mind, it shouldn't be considered a plus when a pharma company or a payer actually does something in the service of improving patient outcomes. It should almost be a requirement that they do. I don't mean by delivering care in any way. And for the record, most prior auth programs are the opposite of collaborative. Payers can collaborate by supplying data, as just one example. Heck, external collaborations are great, but we also could think about collaborating internally, like invite the CFO or maybe the gang rewarding brokers with sales competitions. I don't know. I'd consider ethically dubious: Invite them to come to some meeting where oncology patients are choosing to die rather than bankrupt their families. Communication is the first step to collaboration, after all. That's a place to start. Or life science types: They can supply knowledge and expertise about specific diseases or conditions with the purpose of improving patient outcomes. Informing the patient journey could be a collaboration with some of these amazing patient efficacy organizations or CBOs that are out in the community. Now, I think one barrier to collaboration that we all need to get over is the whole, I call it, stakeholder prejudice thing. Here's what Colton Ortolf wrote on Twitter the other day. He tweeted, “Hospitals are the Lance Armstrong of healthcare. Pissed [off] at all the [crappy] things they do economically, but also grateful for all the lives they save.” If we're gonna eliminate everybody in healthcare who has revenue maximization as their organizational goal, as aforementioned, there is going to be basically no one left standing. As Ge Bai, PhD, CPA, said in EP356, there's no angels and no demons in healthcare. Everybody is both.   If we're talking about stakeholder prejudice, though, I would be remiss not to single out Pharma. When I mentioned them a sec ago, I bet some of your eyebrows went up. Here's my take on it. Consider Pharma's potential role in leveling up disease-/condition-specific outcomes. I mean, there are thousands, millions probably, of diseases and conditions and health problems out there that any given doctor or clinician has to be familiar with. Pharma has huge infrastructures and physicians and smart people who focused on, like, six of them. They know more about those six than anybody else. We pay a ton also for their drugs. It's my view that people along the patient journey should ask for what they want and need relative to the expertise that Pharma possesses. It should be about helping those providing care on the patient journey to level up the standard of care. Frankly, I'd expect collaboration from some of these entities. Ask for it on your own terms, and if all you get back is a sales pitch, you deserve better than that. Find somebody higher up on the food chain to talk to. And also, outcomes-based contracts … yeah, we need to figure out how to operationalize them so that really good drugs that actually produce outcomes like overall survival get paid for and those that do not do not. Point of note must be said: Colluding and conflict of interest is not cost neutral. If someone is getting things bought for them and then thinking, falsely, that it does not impact prescribing, that is not collaboration. Any of these revenue-maximizing hookups are not included in my definition of collaboration. So, in sum, ultimately, what we're talking about here is our legacy. As David Muhlestein, PhD, JD, talks about really well in EP364, we got to ask ourselves, What do we want to leave behind to our children and our grandchildren? Some of this is generational change, for sure. But seriously, talking about today, I mean, who wants to sign their family member up for what my grandfather went through? Right now, across the country, there are heart failure patients going through exactly what he did; and there are other patients with care journeys so dysfunctional that lives are shattered.   Chronic care patients, oncology patients … and this isn't going to change unless we contemplate, first of all, what we can do today—right now. Even little things can matter a lot, but then also to really consider what we want healthcare to look like in 20 or 25 years and then start working back from that vision and collaborating today so that, slowly and surely, we reach a place with better care that is not financially toxic. Check out the 8-Step Collaboration Roadmap for more resources to operationalize a collaboration. 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. 03:07 How do we improve care, especially for chronic care patients? 03:18 What are two important contributors to patient outcomes? 03:40 EP361 with Carly Eckert, MD. 03:56 “We know that financial toxicity is clinical toxicity.” 04:09 EP358 with Wayne Jenkins, MD. 06:05 Why can't parties across the healthcare industry seem to collaborate? 08:05 EP366 with Kevin Schulman, MD. 08:07 EP365 with Scott Haas. 08:10 Upcoming episode with Autumn Yongchu and Erik Davis. 08:34 “I would say that a lack of collaboration is a symptom.” 10:10 There's lots of evidence that interoperability has been solved. It's been solved for years. 10:37 Upcoming episode with Cora Opsahl. 10:46 EP349 with Lisa Trumble. 10:53 EP354 with Shawn Rhodes. 10:57 EP324 with Nicole Bradberry and Kelly Conroy. 11:04 Upcoming episode with Dave Chase. 11:19 EP367 with Doug Hetherington. 11:25 EP350 with Katy Talento. 11:28 EP294 with Steve Schutzer, MD. 11:50 EP277 with Eric Weaver, DHA, MHA. 13:00 What are the three kinds of collaboration in healthcare? 13:23 Do collaborators need to have equal status in a collaboration? 13:57 “Care can be improved at the population level, at the community level … at the disease or the condition level.” 15:10 How is stakeholder prejudice holding healthcare back? 15:42 EP356 with Ge Bai, PhD, CPA. 16:55 “Outcomes-based contracts … we need to figure out how to operationalize them.” 17:08 “Colluding and conflict of interest is not cost neutral.” 17:30 EP364 with David Muhlestein, PhD, JD.   For more information, go to aventriahealth.com.   Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab How do we improve care, especially for chronic care patients? Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab What are two important contributors to patient outcomes? Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab “We know that financial toxicity is clinical toxicity.” Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab Why can't parties across the healthcare industry seem to collaborate? Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab “I would say that a lack of collaboration is a symptom.” Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab There's lots of evidence that interoperability has been solved. It's been solved for years. Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab What are the three kinds of collaboration in healthcare? Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab Do collaborators need to have equal status in a collaboration? Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab “Care can be improved at the population level, at the community level … at the disease or the condition level.” Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab How is stakeholder prejudice holding healthcare back? Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab “Outcomes-based contracts … we need to figure out how to operationalize them.” Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab “Colluding and conflict of interest is not cost neutral.” Stacey discusses #healthcarecollaboration on our #healthcarepodcast. #healthcare #podcast #healthcollab Recent past interviews: Click a guest's name for their latest RHV episode! Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O'Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms  

We're back and we're in a new format! WOO! It's been a chore but Cins and Stac finally figured out how to edit their podcast to discuss 2021's epic Candyman.   Bear with us, peeps. We're learning as we go!Listen for info on our new format, stay for the foul language.  Listen here!

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)

¡Estrenamos este 2022 con este episodio sobre Mitos y la Diversidad e Inclusión en la Iglesia!  David López, quien es uno de los pastores de la iglesia CDO, en San Francisco del Rincón, León, Guanajuato, México, además de ser esposo y padre, también es comunicador, coach espiritual y podcaster. Él nos comparte su experiencia personal y en el pastorado caminando hacia esa apertura a la Diversidad y la Inclusión. Escucharán sobre sus dificultades y logros. Todo con experiencias de vida e información sobre otras interpretaciones de esos versículos bíblicos que se han utilizado tanto para excluir.  En la cápsula podrán escuchar a la pastora Cin Sánchez celebrando la equidad e igualdad desde Job 2:28-29. Esperamos les sea un tiempo provechoso y que disfruten este episodio.  ¡Aprovechemos este 2022 para seguir construyendo con AMOR un Reino de Dios Diverso e Inclusivo!  Links de Referencia de Episodio:  Iglesia CDO: https://cdoiglesia.com/  Podcasts:  Añejado en Barricas: https://sptfy.com/7fba  Místico&Práctico: https://sptfy.com/7fbd  ¿Dice así?: https://sptfy.com/7fbf  Links de Referencia de Cápsula:  Valientemente Podcast: https://sptfy.com/7fbk  Somos Caos: https://sptfy.com/7fbo  . . . #LasDeMagdala #CDO #Igualdad #Diversidad --- Send in a voice message: https://anchor.fm/las-de-magdala/message

İslâmiyet, temizliğe büyük önem vermiş, onu bir kısım ibâdetlerin vazgeçilmez şartı, başlangıcı ve anahtarı yapmıştır. İslâm, tam bir temizlik dinidir. Beden ve kalb temizliği, İslâm'ın temeli ve en mühim bir esasıdır. Nitekim Resûlullâh (s.a.v.) Efendimiz: “İslâm, temizlik temeli üzerine bina edildi.” meâlindeki hadîs-i şerîfleriyle bu iki hususa işâret buyurmuştur. İslâm, namaz için her gün birkaç defa abdest almayı emretmiştir. Kur'ân-ı Kerîm'de: “Ey inananlar, namaza kalktığınız zaman yüzlerinizi, dirseklere kadar ellerinizi yıkayın, başlarınızı meshedin ve ayaklarınızı da topuklara kadar (yıkayın)” buyurulmaktadır. (Mâide s. 6) Cinsî münasebetten sonra yıkanmayı emretmiştir. “Eğer cünüp iseniz iyice yıkanarak temizlenin.” (Mâide s. 6) “Allâh çok tevbe edenleri sever, çok temizlenenleri sever.” (Bakara s. 222) Hz. Peygamber (s.a.v.) de şöyle buyurmuştur: “Temizlik imanın yarısıdır.” (Müslim) “Her müslümanın haftada bir kere yıkanması, o günde başını ve bedenini yıkaması Allâh'ın onun üzerindeki hakkıdır.” (Buhârî) “Beş şey fıtrattandır: Sünnet olmak, etek tıraşı olmak, koltuk altlarındaki kılları temizlemek, tırnakları kesmek ve bıyığı kısaltmak.” (Buhârî)“Eğer ümmetime zor gelecek olmasaydı, her abdest alışta (misvâk kullanmayı emrederdim).” (Buhârî) Allâhü Teâlâ “Elbiseni temizle” (Müddessir s. 4) buyurmuş ve Hz. Peygamber (s.a.v.) de Ashâbı (r.a.e.)'e şöyle buyurmuştur: “Siz kardeşlerinizin yanına gidiyorsunuz. Elbiselerinizi temizleyin, bineklerinizin eğerini düzeltin ki insanlar arasında örnek olasınız. Allâh çirkin sözü ve fiili sevmediği gibi mübalağalı ve zoraki bir şekilde konuşmayı da sevmez.” (Ebû Dâvud)

Many industry insiders believe that health system-led ACOs are inherently disadvantaged to demonstrate value-based care in an environment where most revenue is still generated in fee-for-service. In moving to value, hospitals must contend with demand destruction on their fee-for-service lines of business as they reduce admissions, emergency department visits, and procedures. Physician-led ACOs, they argue, simply do not have this dichotomy; therefore, they have a clearer pathway to financial benefits from reducing hospital costs outside of the physician practice. This premise often appears correct as we often see “low-revenue” ACOs, typically led by physicians who mostly provide outpatient services, have better results than “high-revenue” ACOs, generally led by hospitals that provide both inpatient and outpatient services. Lisa M. Trumble, President and Chief Executive Officer at Southern New England Healthcare Organization (SOHO Health) respectfully disagrees. She believes that “Clinical Integration is the Answer” in this race to value, and she has the results to prove it!  As one of the leading CIN executives in the country, Lisa Trumble has shown how clinical integration can enhance communication between providers and improve on the outcomes and excessive costs that are commonly seen in an uncoordinated care delivery model. This week's episode features Lisa M. Trumble, the President and CEO of SOHO Health, a new ACO and CIN that is a partnership between Saint Francis Healthcare Partners and Trinity Health of New England. With 30 years of experience in health care leadership, Lisa shares powerful insights on clinical integration and challenges healthcare executives to “buckle up” on this race to value. Bookmarks: 3:45 Lisa comments on what it was like to start a new job as CEO right when the pandemic started! 6:30 Leading change during an important inflection point in the industry as it shifts towards value 6:45 The fragility of the FFS model during the throes of a pandemic 7:08 Lisa reflects on prior work in value-based transformation in Massachusetts and how that state differs from Connecticut in its commitment to health value 7:42 SOHO Health and Trinity Health of New England are committed to (and invested in) this transition to value-based care 8:15 Remaining on a FFS chassis is not sustainable.  Negotiating increases in FFS will not be tolerated in the future. (“Buckle up and look out!”) 8:45 Direct-to-Employer contracting 9:03 Partnering with physicians and creating JVs for Centers of Excellence and Bundled Payments 10:50 Hospitals needing to evaluate core business and how to reduce infrastructure cost to create a “survive-able” margin 11:09 Reducing utilization for unnecessary services and preventing leakage within a CIN 12:00 Despite reductions in inpatient services in VBC models, utilization is still growing in ambulatory surgery 12:20 Developing a bundled payment model with physicians in ASCs where financial incentives are aligned 12:50 Employers will no longer tolerate paying for surgeries that cost twice as much when performed in an inpatient setting 13:15 Value-based care is a difficult situation for health systems. At the same time you are losing business, you also have to transform and make key investments. 13:25 “If you don't commit to value-based care, you will slowly work your way out of the market and be uncompetitive. The market will find a way to figure it out with others.” 15:15 PHOs, IPAs, ACOs, and CINs all are struggling to figure out the best way pursue clinical integration 16:00 The beauty of a design of a Clinically Integrated Network is that it isn't limiting you to only one area of care delivery -- “Clinical Integration is the answer to how to perform well in a value-based environment.” 17:30 Multidisciplinary collaboration is important to providing the appropriate level of care 19:25 Lisa explains how SOHO is approaching colla...