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In this episode, Mon-Chaio and Andy discuss the Capability Maturity Model (CMM) and its implications for software development organizations. They explore why CMM was chosen for this episode and its connection to previous topics such as the Team Software Process. The conversation delves into the maturity levels defined by CMMI, from 'incomplete' to 'optimizing,' and explores whether the lack of a 'why' behind processes affects the model's utility. The discussion detours into how modern tools like Large Language Models (LLMs) and Copilot can impact software development, highlighting both their benefits and limitations. It ends with reflections on continuous improvement and how organizations can leverage CMM and LLMs for better outcomes.ReferencesCapability Maturity Model for Software, Version 1.1Capability Maturity Model® Integration (CMMI), Version 1.1The Capability Im-Maturity Model (CIMM)
In this episode of The Daily Windup, I interview a guest who shares their career journey from being a software developer to transitioning into business development in the government contracting industry. The guest discusses their experience managing a CSO (Customer Service Operations) and how it led to an opportunity to work for a government contracting company. We delve into the process of joining an 8(a) company that was graduating from the 8(a) program and acquiring CMMI Level 3 certification, which ultimately attracted the attention of GDIIT (General Dynamics Information Technology). We also got insights into the motivations behind GDIIT's acquisition of the company they worked for, including the value of the acquired company's CMMI certification and its strong presence in the civilian market. Also we talk about our guest's own aspirations of future acquisition and passing on the business to their sons. We also highlighted the importance of mentorship and the mentors who played a pivotal role in their transition from program management to business development, learning how to craft effective pitches for different audiences, and gaining confidence in their abilities.
Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Senior Deputy Editor Rob Lott interviews Dr. Meena Seshamani, the incoming Maryland Secretary of Health, to discuss her time as the director of Medicare at the Centers of Medicare & Medicaid Services and what the future holds in her new role. Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone. Subscribe to UnitedHealthcare's Community & State newsletter.
This week's episode features Moser's Director of Quality, Alphia Stephens, who joins us to discuss audits and auditing. Alphia leads a dynamic team that thrives on the principles of continuous process improvement and exceptional service delivery. With deep expertise in information technology and a passion for service delivery and customer satisfaction, she has strategically integrated best practices to boost efficiency and quality. The team's dedication to excellence is reflected in their impressive CMMI rating and ISO 9001 certification. Aligned with the organization's culture of excellence, Alphia and her team are committed to delivering innovative solutions that consistently exceed client expectations.
ISO 9001 Certification: 5 Key Questions Every Boss Should Learn
Do you want to learn about the CMMI training and certification programs for beginners? If yes, read the blog now! Click here! https://www.quality-assurance.com/blog/what-to-consider-for-cmmi-training-and-certification-programs.html
In our final episode of season 4, we look ahead to 2025 and beyond, with AMRPA's policy team. Our guests are Kate Beller, President of Government Relations and Policy, Troy Hillman, Director of Quality and Health Policy, and Joe Nahra, Director of Government Relations and Regulatory Policy. Read more about AMRPA's Policy Priorities on our website. This episode is hosted by Patricia Sullivan, AMRPA Director of Content & Marketing.
In today's episode we have Chitra in conversation with Lekha Bajpai where she shares –Tech veteran of 30 plus yearsStarted her career in Calcutta with Deep Tech across many sectors like manufacturing, commercial apps, engineering aps and supply chainInspired by her father to study engineeringFirst project on inter machine communication protocols, the excitement of innovation Working on an experiment to build a control system to ship coalShowcasing use cases to the businessSupply chain software solutions – building was easy, convincing users and allaying their fears was the big challenge to roll out the solution across 350 locations in IndiaDeveloped strong experience with ERP implementations leading to building of data warehouses, BI reporting and monitoring apps for execsExperience at Kantar with challenges in data preparation and processing, working with just CPU's, expensive cloud resourcesHelping apps scale, developing market research products to support the entire data life cycle from collection to dashboardsEncouraging POC's and learning with data techniques Approaching AI today – Bring Your Own AI to work, encourage usage, take risks and also take care of Data privacy, protection, governance & complianceData bias challenges for IndiaAdvice to young folks aspiring for a career in AI – discover different AI personas, understand business catalysts, use AI tech, drive adoption of AI, besides only aspiring to build/develop AIM.Tech BIT Messra, Greenbelt Six Sigma, Strategic IT Management (IIM Ahmedabad), Enterprise Architecture, Certified Process Professional, Certified Data ScientistWith over 30 years of technology leadership experience, Lekha has been a thought leader and mentor in driving digital transformation and process automation across end-to-end processes and analytics.As a CIO/CTO and a Strategic Leader, she has led technology strategy functions for multiple units in APAC and MENA, as a member of the Executive Committee of Kantar IMRB. Delivered technology products and solutions to global & local clients, transforming IT into a strategic business partner.Worked on cutting-edge Technology adoption and Innovation, including cloud, big data environments, data warehouses & data lakes, to drive business improvements. Expertise spans across IT Strategy development & execution, Product & Application management for large scale applications & products on mobility, e-commerce, business analytics, social text analytics, chatbots, and image analysis using AI/ML and deep learning algorithms. Has Architected enterprise platforms for analytics delivery across diverse domains – Supply chain management, Logistics, Warehousing and freight forwarding, Chemical consultancy, Civil contracting, Manufacturing, Market research, Media and digital research, Social media analytics, Digital marketing and EdTech & Job Tech.Achieved Process Excellence within multiple organization and setup measure to monitor business process and growth. Achieved IT security processes like ISO27001 across various organizations. Streamlined IT services delivery across APAC using ITIL processes, Agile methodology & CMMI framework emphasizing on service availability and performance measurement.Accreditations and Contributions:Awarded the “Innovation Leader” Award by World Innovation Congress, featured in CIO Magazine “Top 30 – Ones to watch”, CIO & Leader Magazine as “11 Most Powerful Women in Tech in India” and a few others. Case study published in CIO Decisions & Network Computing, Logistics Magazine, Dataquest, & CIO Magazine. Presented technology papers at the Market Research Society of India (MRSI) on new age Technologies and won awards on “Best Analytics product” & “Best E2E Process Automation”. Actively involved as a technology expert speaker on multiple tech forums and colleges, project guide, evaluator, mentor for data science & technology students.
In today's episode we have Chitra in conversation with Lekha Bajpai where she shares -Tech veteran of 30 plus yearsStarted her career in Calcutta with Deep Tech across many sectors like manufacturing, commercial apps, engineering aps and supply chainInspired by her father to study engineeringFirst project on inter machine communication protocols, the excitement of innovation Working on an experiment to build a control system to ship coalShowcasing use cases to the businessSupply chain software solutions - building was easy, convincing users and allaying their fears was the big challenge to roll out the solution across 350 locations in IndiaDeveloped strong experience with ERP implementations leading to building of data warehouses, BI reporting and monitoring apps for execsExperience at Kantar with challenges in data preparation and processing, working with just CPU's, expensive cloud resourcesHelping apps scale, developing market research products to support the entire data life cycle from collection to dashboardsEncouraging POC's and learning with data techniques Approaching AI today - Bring Your Own AI to work, encourage usage, take risks and also take care of Data privacy, protection, governance & complianceData bias challenges for IndiaAdvice to young folks aspiring for a career in AI - discover different AI personas, understand business catalysts, use AI tech, drive adoption of AI, besides only aspiring to build/develop AIM.Tech BIT Messra, Greenbelt Six Sigma, Strategic IT Management (IIM Ahmedabad), Enterprise Architecture, Certified Process Professional, Certified Data ScientistWith over 30 years of technology leadership experience, Lekha has been a thought leader and mentor in driving digital transformation and process automation across end-to-end processes and analytics.As a CIO/CTO and a Strategic Leader, she has led technology strategy functions for multiple units in APAC and MENA, as a member of the Executive Committee of Kantar IMRB. Delivered technology products and solutions to global & local clients, transforming IT into a strategic business partner.Worked on cutting-edge Technology adoption and Innovation, including cloud, big data environments, data warehouses & data lakes, to drive business improvements. Expertise spans across IT Strategy development & execution, Product & Application management for large scale applications & products on mobility, e-commerce, business analytics, social text analytics, chatbots, and image analysis using AI/ML and deep learning algorithms. Has Architected enterprise platforms for analytics delivery across diverse domains - Supply chain management, Logistics, Warehousing and freight forwarding, Chemical consultancy, Civil contracting, Manufacturing, Market research, Media and digital research, Social media analytics, Digital marketing and EdTech & Job Tech.Achieved Process Excellence within multiple organization and setup measure to monitor business process and growth. Achieved IT security processes like ISO27001 across various organizations. Streamlined IT services delivery across APAC using ITIL processes, Agile methodology & CMMI framework emphasizing on service availability and performance measurement.Accreditations and Contributions:Awarded the “Innovation Leader” Award by World Innovation Congress, featured in CIO Magazine “Top 30 - Ones to watch”, CIO & Leader Magazine as “11 Most Powerful Women in Tech in India” and a few others. Case study published in CIO Decisions & Network Computing, Logistics Magazine, Dataquest, & CIO Magazine. Presented technology papers at the Market Research Society of India (MRSI) on new age Technologies and won awards on “Best Analytics product” & “Best E2E Process Automation”. Actively involved as a technology expert speaker on multiple tech forums and colleges, project guide, evaluator, mentor for data science & technology students.
In this episode of the Quality Hub podcast, Xavier Francis interviews experts from CORE, including Lori Engle, Renee Ferry, and Kevin Metz, about the role of ISO certifications in driving business growth and marketing success. They discuss how certifications like ISO 9001 can differentiate businesses by showcasing their commitment to quality & reliability. They also talk about maintaining these certifications and how it requires ongoing effort and leadership involvement, which also supports customer trust. They emphasize that ISO standards, such as ISO 9001 and CMMI, can be crucial for securing contracts in fields like government contracting. A success story highlighted also illustrates how strategic certifications can boost revenue and strengthen market positioning. Helpful Resources: Contact us at 866.354.0300 or email us at info@thecoresolution.com A Plethora of Articles: https://www.thecoresolution.com/free-learning-resources ISO 9001 Consulting: https://www.thecoresolution.com/iso-consulting
Last week on Radio Advisory, we broke down what healthcare leaders need to know for 2025 and beyond following the recent elections. But before we move on from 2024 completely, we have to acknowledge that there's been a lot moving in the policy space this year, and frankly, there have probably been a few important policy areas on your radar that we haven't discussed. That's why this week, host Abby Burns invites Advisory Board experts Gina Lohr, Sarah Roller, and Paul Trigonoplos to dive into three major policy areas of the last year: Medicare drug negotiations, changes to physician employment and payment, and an emerging mandatory bundled payment model called TEAM. The experts unpack how these policies are affecting the industry, how the elections outcomes may impact them, and, critically, how much attention leaders should be paying them going forward. In other words, should leaders consider each policy a big deal, a little deal, or no deal? Links: Ep. 230: Elections results are in: What healthcare leaders need to know State-level healthcare ballot measures that passed (and failed) CMS' TEAM payment model is here. How should hospitals prepare? Your guide to CMS' 14 value-based payment models Medicare announces 10 new drug prices following negotiations A federal judge just blocked FTC's noncompete ban The Hospital Benchmark Generator Market Scenario Planner Get exclusive, early access to Advisory Board's annual “What CEOs need to know” briefing. 2 ways labs can embrace innovation to drive revenue and accelerate growth Market Scenario Planner A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.
In this episode of "The Quality Hub," Xavier Francis and Rick Krick discuss "What is CMMI Part 2?" They start by covering the advanced levels of the Capability Maturity Model Integration (CMMI) framework, focusing on levels four and five, which involve quantitative management and continuous process improvement. Rick explains that implementing CMMI poses challenges, such as the need for accessible, active projects, and more. Effective leadership is crucial, as it supports resource allocation, barrier removal, and other needs. Achieving CMMI certification allows, among other things, organizations to bid on government contracts and enhances process efficiency. Despite its complexity, Rick assures that CMMI is accessible to businesses of all sizes and can significantly improve organizational structure and competitiveness. Helpful Resources: https://www.thecoresolution.com/cmmi-ml2-ml3-consulting-services https://www.thecoresolution.com/what-is-the-difference-between-cmmi-dev-and-cmmi-svc https://www.thecoresolution.com/cmmi-maturity-levels-2-and-3 https://www.thecoresolution.com/cmmi-v3-update-explained Contact us at 866.354.0300 or email us at info@thecoresolution.com A Plethora of Articles: https://www.thecoresolution.com/free-learning-resources ISO 9001 Consulting: https://www.thecoresolution.com/iso-consulting
In this episode of the Quality Hub Podcast, Xavier Francis interviews Rick Krick from Core Business Solutions about What is CMMI (Capability Maturity Model Integration), a process improvement framework. Unlike ISO 9001, which focuses on quality processes, CMMI emphasizes evidence-based project management. Rick discusses the basics of CMMI and then outlines the first three of CMMI's five maturity levels: Level 1 (Initial) Level 2 (Managed) and Level 3 (Defined). Most companies aim for levels 2 or 3, while levels 4 and 5, which require extensive data monitoring, will be covered in “What is CMMI Part 2” next week. Helpful Resources: https://www.thecoresolution.com/cmmi-ml2-ml3-consulting-services https://www.thecoresolution.com/what-is-the-difference-between-cmmi-dev-and-cmmi-svc https://www.thecoresolution.com/cmmi-maturity-levels-2-and-3 https://www.thecoresolution.com/cmmi-v3-update-explained Contact us at 866.354.0300 or email us at info@thecoresolution.com A Plethora of Articles: https://www.thecoresolution.com/free-learning-resources ISO 9001 Consulting: https://www.thecoresolution.com/iso-consulting
Discover the transformative changes on the horizon for orthopaedic coding and payment models with our esteemed guest, Dr. Adam Bruggeman. Covered are the new CMS-mandated procedural-based bundles, specifically the "team" bundle affecting 25% of US hospitals. Dr. Bruggeman sheds light on the financial and administrative hurdles these mandates bring and compares them to the cost-saving success of physician-led bundles.Prepare yourself for an in-depth exploration of the evolving landscape of hospital-based healthcare bundles and their profound implications for orthopaedic surgeons. The conversation reveals how these new regulations might shift financial risks between hospitals and doctors, leading to a rare alignment of interests in opposing mandatory bundles. We also dive into the CMMI's push for value-based care and its potential impact on the sustainability of Medicare, putting a spotlight on the delicate balance of cost and care quality.Join us as Dr. Bruggeman shares his expert views on the future of medical coding, particularly within the contexts of fee-for-service models and ambulatory surgery centers. From CPT and ICD-10 codes to the Resource-Based Relative Value Scale (RUC), we cover the complexities that define this space. We also discuss the slow shift towards value-based care and the promising, albeit underused, concept of condition-based bundles. This episode is packed with insights and foresight into the future of orthopaedic surgery and healthcare reimbursement models.
In this episode we're taking a closer look at Capability Maturity Model Integration, or CMMI—a game-changing framework that helps organizations streamline processes, reduce risks, and improve performance. If you've ever felt like your projects are all over the place, or you're constantly fighting fires instead of driving growth, CMMI can be your roadmap to maturity. From assessing where you are now to building a structured path to excellence, CMMI helps you level up—step by step. We're going to break down how this model works, why it matters, and how you can apply it to your own team or organization. So, whether you're new to CMMI or looking to deepen your understanding, stick around as we explore how to measure what matters and elevate your capabilities to the next level.
The Ilumed team is noted for their expertise in risk management and a deep commitment to putting patients first, which is evident throughout the company. In this episode, Melissa Conboy, Marketing Director at Ilumed, discusses how the company partners with physicians and health systems to transition patients to value-based care. She highlights CMMI's temporary but promising program, which aims to improve patient health outcomes and reduce Medicare spending. Mel shares a recent case study from a rural health clinic in West Virginia that saw increased annual wellness visits and better patient outcomes. She also explains why the illumed team is praised for their expertise in risk management and their deep commitment to patient care. Join us and discover the growing importance of value-based care in healthcare's future! Resources: Watch the entire interview here. Connect and follow Melissa Conboy on LinkedIn. Learn more about Ilumed on their LinkedIn and website.
My conversation today is with Will Shrank, MD. Dr. Shrank led the evaluation group at CMMI (Center for Medicare and Medicaid Innovation). He has spent time in the private sector, first at CVS Health and UPMC (University of Pittsburgh Medical Center) as chief medical officer of the health plan in Pittsburgh, and then as the chief medical officer for Humana. Now he is a venture partner at Andreessen Horowitz and doing some consulting for CMMI. To read the full article and show notes which include mentioned links, visit the episode page. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. We start out this conversation talking about waste in healthcare. In fact, Dr. Shrank was on a team who did a study about waste in the US healthcare system. (The article is, unfortunately, paywalled.) In that study, it says estimates suggest we have upwards of a trillion dollars of waste a year. This waste can be categorized into administrative and clinical failures. Dr. Shrank emphasizes the need for aligning incentives with higher quality care, paying for patient outcomes, and highlights the potential rising power of PCPs. The discussion covers the progress made towards value-based care, the challenges faced by the current fee-for-service model, and the future landscape of primary care and healthcare delivery. In sum, we have a waste problem in this country. Aligning incentives might be one way to curb that waste. 06:54 Can we cut healthcare waste while improving patient care? 07:33 What does “healthcare waste” consist of? 07:46 What are the six categories of “healthcare waste”? 10:23 EP363 with David Scheinker, PhD. 10:37 How much money does Dr. Shrank estimate is wasted each year in healthcare? 13:09 Where is that healthcare waste going, and why does it happen? 20:07 Uncaring by Robert Pearl, MD. 21:18 “We've built a backbone of extraordinary waste on a fee-for-service chassis.” 22:16 EP409 with Larry Bauer, MSW, MEd. 24:24 EP359 with Dan O'Neill. 26:02 Dr. Shrank's warning to providers out there. 30:03 Summer Shorts 2 with Scott Conard, MD. 31:41 Why there might be a generational shift among younger providers looking to work with different models.
In this episode Amanda Freed talks about how her body was so foreign to her she had to count hers steps as a child. That journey took her on a truth seeking path to be able to full embody her humanness and help others claim their primordial power. More About Amanda Amanda Freed LMT,RYT,CMMI has been a bodyworker, yoga, meditation, and mindfulness teacher for over 30 years. She has helped thousands of groups and individuals achieve freedom in body, mind, and spirit through nervous system reset yoga, simple meditation practices, and intuitive coaching. Amanda's current focus is helping women reclaim their Primordial Power. Contact Amanda on Fb, IG @afyoga25, youtube -Amanda Freed meditation https://youtube.com/@amandafreedmeditation6711?si=yocqBEOBxifYgDie
Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs Editor-in-Chief Alan Weil welcomes Liz Fowler, Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services, to A Health Podyssey to discuss the future of health care payments, CMMI's specialty care strategy, mandatory models versus voluntary alternative payment models, CMS' newly-proposed Medicare Physician Fee Schedule for 2025, and more!Related Articles from Liz Fowler on Health Affairs:The CMS Innovation Center's Strategy To Support Person-Centered, Value-Based Specialty Care: 2024 UpdateAdvancing Health Equity Through Value-Based Care: CMS Innovation Center UpdateUpdate On The Medicare Value-Based Care Strategy: Alignment, Growth, EquityOrder the July 2024 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone. Subscribe to UnitedHealthcare's Community & State newsletter.
Medicare is betting that taking care of the caregiver will help dementia patients stay at home longer. Patients and their caregivers are often left to navigate the confusing world of dementia by themselves, but Medicare is launching a new program to change that.Guests:Malaz Boustani, MD, PhD, Founding Director, Sandra Eskenazi Center for Brain Care Innovation; Professor of Aging Research, Indiana University School of Medicine Rosanne Corcoran, Caregiver Liz Fowler, PhD, JD, Director of CMMI and Deputy Administrator, Centers for Medicare and Medicaid Services Cindi Hart, Caregiver Alex Olgin, Reporter/Producer, Tradeoffs Lauren Sullivan, Care Coordinator, Eskenazi Health Learn more and read a full transcript on our website.Want more Tradeoffs? Sign up for our free weekly newsletter featuring the latest health policy research and news.Support this type of journalism today, with a gift.Follow us on Twitter. Hosted on Acast. See acast.com/privacy for more information.
This series aims to demystify Medicaid, starting with insights from federal and state agencies, FQHCs, and managed care organizations, before exploring successful founders' strategies. It will start with a primer on the key players and innovations, evolving with new posts featuring interviews and insights. Read more about this series here. Today, we're excited to get to know Eliot Fishman, a director at CMMI who focuses on policy and programs that affect Medicaid beneficiaries. Eliot comes to us with a long history of impact in public health policy. Eliot started his career as a policy associate at Mt. Sinai Health System in NYC and then went on to Manatt, Phelps & Phelps. He transitioned into a management policy role on the provider side again at MJHS, a large health system in the New York Area before he left to join the government. Eliot then served at NJ Department of Health and Senior Services and Centers for Medicare and Medicaid Services for several years across different groups on Medicaid, Medicare and CHIP. Eliot also served in consulting roles at Health Management Associates and at nonprofits like Families USA. In this episode, we learn about payment models within CMMI that attempt to foster innovation in care delivery for Medicaid, program and payment integrity and value-based care models as well as how the Federal government collaborates with State governments to improve care delivery.
Welcome to another episode of "The Art of Consulting Podcast" with your hosts, Andy Fry and Cat Lam. As seasoned IT consultants, CPAs, and professional development connoisseurs, we aim to bring you inspiring messages to help you discover the X factor in your professional field, leading to the success you truly deserve in your career and life. Welcome back, the one and only Edmund Metera. Edmund Metera is a senior project manager at CWB Financial Group in Canada. He firmly believes that the keys to delivering successful projects are not only founded upon expert project management and business analysis competencies but on recognizing, tailoring and applying the best-suited methodologies and techniques to suit the unique technologies, constraints and opportunities at hand. Topic Overview: Focus on what a trusted advisor needs when embarking on a consulting engagement. Insights derived from Ed Matera's book and his work at processmodellingadvisor.com. Types of Consultants: External Consultants: Advise client organizations. Internal Consultants: Advise different business areas within the same organization. Key Points Discussed: Importance of Deliverable Schedule and Effort Budget: Deliverable Schedule: Highly important. Effort Budget: Less important for the advisor; focus is on meeting the schedule rather than the budget. Project Stakeholders and Relationships: Critical for understanding stakeholder perspectives and pain points. The advisor acts as an advocate for the business within the project. Relationships vary from one engagement to another but are always crucial. Organizational Assets: Includes specialized tools, prior work, and training (e.g., SAP tools). External consultants bring their own assets and tools, which are essential. Organizational assets are important but secondary to interpersonal relationships and stakeholder understanding. Episode Highlights: Why Discuss Simple Concepts? Importance of asking the right questions early in a project or consultation. Being mindful and diligent upfront acts like insurance, preventing future issues. Preparation and Diligence: Taking initial steps to understand the project helps tailor the approach. This preparation keeps consultants out of potential pitfalls and allows them to leverage their knowledge effectively. Using a Checklist: Ed discusses a checklist available on his website, processmodellingadvisor.com. The checklist helps in tailoring your approach from one engagement to the next. Resources: The checklist can be found on the homepage of processmodellingadvisor.com. It is also published in BA Times, Modern Analyst, and IRM Connects. Conclusion: The episode delves into the balance between internal and external resources, the critical nature of stakeholder relationships, and the varying importance of schedules and budgets in consulting engagements. Ed Metera believes that philosophy is loud and clear in Ed's book: Universal Process Modeling Procedure: The Practical Guide to High-Quality Business Process Models. He has taught and mentored project managers and business analysts in best practices for professional organizations such as PMI, IIBA, and CMMI. He teaches IIBA-registered business analysis courses and serves as an advisor to the Northern Alberta Institute of Technology's Corporate and International Training department's Business Analysis Certificate Program. He is also the founder of www.ProcessModelingAdvisor.com and a regular BATimes, Modern Analyst and IRM Connects contributor.
Optum Rx serves more than 62 million people, processes 1.6 billion prescriptions and generates more than $110 billion of revenue annually. Dr. Patrick Conway, CEO of Optum Rx, is the third and final guest in a series of Healthcare is Hard episodes exploring the transformation of the pharmacy business – following conversations with Mark Cuban and Dr. Troyen Brennan.Dr. Conway brings an expansive view of the healthcare system to this discussion and his role leading one of the most influential organizations in the pharmacy space. He became CEO of Optum Rx in August 2023 and before that, served as CEO of Care Solutions at Optum for more than three years. He was president and CEO of Blue Cross and Blue Shield of North Carolina for two years and spent more than six years at the Centers for Medicare and Medicaid Services where he held several positions including Chief Medical Officer, Director of CMMI, and Deputy Administrator for Innovation and Quality. Before joining CMS, he oversaw clinical operations and quality improvement at Cincinnati Children's Hospital Medical Center, and he is still a practicing pediatrician in Boston where he occasionally works at an area medical center on weekends.Some of the topics Dr. Conway discussed with Keith Figlioli in this episode of Healthcare is Hard include:VBC – A way or THE way. As someone who has spent a significant portion of his career focused on improving cost and quality in the U.S. healthcare system, Keith starts the interview asking Dr. Conway for his perspective on value-based care. Dr. Conway says we can either figure out VBC, or raise taxes and reduce benefits, noting that the American public would not be happy about the latter. He firmly believes that VBC is THE way through. He discussed the positive impacts he's witnessed from VBC, and how he believes it's been a major contributor to slowing the growth of healthcare costs over a significant period of time. However, he's concerned about how the transition to VBC has slowed.Affordable innovation. When discussing the extremely high cost of new specialty drugs, Dr. Conway points out that innovation is useless if it's unaffordable and inaccessible to people. He shared personal stories contrasting very difficult conversations he's had with parents in the past about the failing health of their children, and a more recent experience where Optum Rx delivered a new gene therapy to a child with a rare disease who will now live a full life. With therapies like that one costing $3 million, Dr. Conway discussed his views on some of the public and private financing options that could help improve access to life-changing therapies while still rewarding the innovators.Choice and transparency. Dr. Conway explains some of the solutions Optum Rx has brought to market to serve its customers, and areas where the company is exploring new solutions to keep customer satisfaction high. While customers are happy with Optum Rx, he makes it clear that continuously developing new solutions to stay ahead of a fast-evolving market is essential. During this discussion, customer choice – for both patients and the employers who fund their benefits – is a recurring theme and a major focus.To hear Dr. Conway and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.
Hosts Tod Ibrahim and David White discuss the Center for Medicare and Medicaid Innovation's recently announced Increasing Organ Transplant Access (IOTA) Model proposed rule.
Hosts Tod Ibrahim and David White discuss the Center for Medicare and Medicaid Innovation's recently announced Increasing Organ Transplant Access (IOTA) Model proposed rule.
Welcome to another episode of "The Art of Consulting Podcast" with your hosts, Andy Fry and Cat Lam. As seasoned IT consultants, CPAs, and professional development connoisseurs, we aim to bring you inspiring messages to help you discover the X factor in your professional field, leading to the success you truly deserve in your career and life. About Our Guest Today: Edmund Metera is a senior project manager at CWB Financial Group in Canada. He firmly believes that the keys to delivering successful projects are not only founded upon expert project management and business analysis competencies but on recognizing, tailoring and applying the best-suited methodologies and techniques to suit the unique technologies, constraints and opportunities at hand. That philosophy is loud and clear in Ed's book: Universal Process Modeling Procedure: The Practical Guide to High-Quality Business Process Models. He has taught and mentored project managers and business analysts in best practices for professional organizations such as PMI, IIBA, and CMMI. He teaches IIBA-registered business analysis courses and serves as an advisor to the Northern Alberta Institute of Technology's Corporate and International Training department's Business Analysis Certificate Program. He is also the founder of www.ProcessModelingAdvisor.com and a regular BATimes, Modern Analyst and IRM Connects contributor. Episode Summary: In this episode, Our host Cat Lam and our special guest for today, Ed Metera delve into the world of project management, specifically focusing on the PRINCE2 methodology. They explore the significance of shifting the focus from activities to products, and how this approach enhances project effectiveness and delivery. Key Points Covered: Introduction of Guest: Ed Matera Highlighting Ed's extensive experience in project management, including his roles as a book author, conference speaker, tutor, and senior project manager at Canadian Western Bank. Emphasizing Ed's dedication to advancing the practice of process modeling through ProcessModelingAdvisor.com. Understanding PRINCE2 Methodology Comparison with the Project Management Institute's Body of Knowledge (PMI BOK). Exploring the seven philosophies of PRINCE2, particularly the principle of "Focus on Products." Ed's personal experience as a certified PRINCE2 practitioner and its impact on his project management approach. Product-Focused Project Management Defining products within a project lifecycle, emphasizing tangible deliverables over activities. Illustrating the product-oriented approach through the example of implementing a mobile application. Assigning clear responsibilities to specialists based on product delivery, enhancing accountability and efficiency. Integrating the product-focused mindset into project planning, scheduling, and communication strategies. Addressing challenges and dependencies within the project by prioritizing critical path products. Managing risks and issues by aligning discussions with product delivery milestones. Overcoming Resource Overlap Mitigating resource overlap by assigning single individuals responsible for specific products. Ensuring clarity in roles and responsibilities to minimize disruptions and prioritize product completion. Product-driven Approach: Instead of focusing solely on activities, Prince2 emphasizes being product-driven. Each project team member is clear on their responsibility for a specific product or activity within the project. Collaboration is encouraged, but accountability remains paramount. Accountability: Prince2 advocates for appointing one spokesperson or accountable individual for each micro-product or aspect of the project. This ensures clarity and efficiency in decision-making and progress tracking. The question of "Is it done yet?" becomes pivotal in assessing progress and meeting objectives. Defining Success Criteria: Success criteria vary based on the type of product being delivered. For software products, success may entail functionality without defects. Paper-based or consulting products may require acceptance by stakeholders or consumers. Understanding the consumer's needs and expectations drives product quality and acceptance. Early Definition of Products: Prince2 emphasizes defining products and specifications early in the planning phase. A clear understanding of each product's attributes and requirements facilitates effective project management. Consensus among team members regarding product definitions is crucial for project success. Decision-Making Criteria: A simple decision-making framework in Prince2 assesses whether an issue is on the critical path and its impact on project timelines. Not all issues require immediate attention; those on the critical path demand urgency. This approach allows project managers to prioritize resources and efforts efficiently. Shift in Focus: Traditional process modeling often follows a sequential flow, but Ed emphasizes a shift towards a product-driven approach. Processes are seen as collaborative networks of services, initiating in response to events and leading to expected outcomes. Universal Process Modeling Procedure: Ed introduces the Universal Process Modeling Procedure, offering a modern framework for business process modeling. The procedure emphasizes understanding initiating events, expected outcomes, and consumers of those outcomes. Benefits of the Approach: By focusing on outcomes, organizations can optimize processes more effectively. This approach saves time and resources by aligning efforts with desired results, rather than merely automating activities. Practical Application: Ed encourages listeners to apply the principles of universal process modeling in various domains, from project management to personal interactions. Catherine highlights the importance of starting with the end in mind and understanding the cause-effect relationships in all activities. Conclusion: Catherine concludes the episode by inviting listeners to explore more about Ed Matera's work and the Universal Process Modeling Procedure. The conversation leaves a lasting impression on the significance of reimagining process modeling for enhanced efficiency and effectiveness in today's dynamic environments. The episode concludes with a reaffirmation of the transformative power of product-focused project management in enhancing project outcomes and stakeholder satisfaction. The Prince2 methodology offers a structured framework for project management, focusing on product delivery, accountability, and decision-making. Integrating Prince2 principles with existing methodologies enhances project outcomes and fosters a culture of clarity and efficiency.
Today we sit with Roberto Ibarra, co-founder and CTO of Expediente Azul. Roberto shares how he transitioned from a software development company to building a product-focused business, driven by the need to solve a specific problem in the financial sector. Expediente Azul streamlines the loan onboarding process by automating the collection and verification of documents and data. As the platform evolves, it focuses on extracting data directly from reliable sources and creating documentation from that data. The ultimate vision is to create a digital marketplace for lenders to share opportunities and data, fostering trust and speeding up loan processes globally. As Expediente Azul gained traction and more customers, the team realized that the real value lay not in the documents themselves, but in the data they contained. Financial institutions didn't want the documents; they wanted the data for analysis. This realization led to a shift in focus from gathering documents to extracting and utilizing the data within them. The platform began integrating with third-party tools that connected to tax authorities' databases, allowing for the extraction of accurate and up-to-date income data directly from the source. This eliminated the need for customers to provide physical or scanned copies of their tax records. Instead, the platform automatically retrieved the necessary data, ensuring its accuracy and reducing the risk of fraud If your company is looking to scale its AI initiatives, head over to Tesoro AI (www.tesoroai.com). We are experts in AI strategy, staff augmentation, and AI product development. Founder Bio: Roberto Carlos Ibarra Rabadán entered the world of computing over 25 years ago assembling and selling personal computers. He went on to start a software development services company called Innox, being the 9th company in Mexico with a CMMI 4 quality rating (military/medical grade) with over 70 employees which was sold in 2013. Later, Roberto developed various apps with millions of downloads, two of them nominated the best in the world during the Mobile World Congress in Barcelona. During his sabbatical year, Roberto created the podcast Vidaentrepeneur.com where he interviewed over 290 Latin American inspiring entrepreneurs. Today he is the founder of the Fintech company Expediente Azul or Blue File in English, a software platform that simplifies the document-gathering process for large loans and other KYC processes currently operating in Mexico, Brazil, Ecuador, Colombia, Perú, the Caribbean, and South East Asia. Roberto was educated by the Tec de Monterrey, IPADE Business School, Harvard, and Oxford and was nominated by CNN as one of Mexico's 30 promises as well as a Young Global Leader by the World Economic Forum. Time Stamps: 03:07 Introduction and background of Roberto Ibarra 05:37 Transition from software development to a product Company 08:14 Finding a Problem worth solving 13:55 Scaling loan brokerage business with automation 18:07 Product evolution from document gathering to data sharing 26:27 Countries Expediente Azul operating today 27:46 Bringing in the right talent to build the initial version 30:38 Investing in sales over tech 33:32 The importance of thinking beyond the happy path 37:04 Building a lean and efficient tech team 42:02 Building a multilingual platform 44:23 Funding journey and resourcefulness 49:21 How to get in contact with the Expediente Azul team Resources Company website: https://bluefile.expedienteazul.com/ LinkedIn: https://www.linkedin.com/company/xpazul/ Facebook: https://www.facebook.com/xpAzul] Twitter: https://twitter.com/AzulExpediente Email: ribarra@expedienteazul.com
In this episode of the Global Medical Device Podcast, host Etienne Nichols sits down with Kim Kaplan from ISACA at the MD&M West trade show in Anaheim, California, to discuss the pivotal Voluntary Improvement Program (VIP). This conversation sheds light on how the program, stemming from FDA's Case for Quality initiative, utilizes the Capability Maturity Model Integration (CMMI) to push medical device companies beyond compliance, towards excellence. Kaplan elucidates the history of VIP, its benefits, and how it aligns with the FDA's vision for a more innovative and quality-focused MedTech industry.Key Timestamps:[00:00:30] Introduction of Kim Kaplan and the Voluntary Improvement Program[00:05:00] Explanation of CMMI and its adoption in the medical device industry[00:15:45] Distinctions between CMMI and other quality methodologies[00:25:30] In-depth discussion on the specifics and benefits of the Voluntary Improvement Program[00:40:00] How companies can implement change based on VIP insights[00:50:00] FDA's perspective and regulatory opportunities tied to VIP participationNotable Quotes:“Organizations that are compliant aren't necessarily avoiding the types and numbers of issues faced by non-compliant ones.” - Kim Kaplan“CMMI focuses on the 'what' to do rather than the 'how,' allowing for a framework that compliments existing processes.” - Kim Kaplan“The Voluntary Improvement Program isn't just about compliance; it's about embracing continuous improvement as a culture.” - Kim KaplanKey Takeaways:Understanding VIP: The program aims to elevate quality and operational efficiency through a collaboration involving FDA, MDIC, industry stakeholders, and ISACA.CMMI's Role: CMMI's flexible, globally adopted framework helps MedTech companies identify and implement best practices in product development and project management.Benefits of Participation: Beyond improving quality, VIP participation can streamline regulatory processes, fostering quicker innovation and market access.Practical Tips for Listeners:Engage with CMMI: Consider how CMMI's framework could complement your company's existing quality and project management processes.Explore VIP: Assess your organization's readiness and potential benefits from enrolling in the Voluntary Improvement Program.Continuous Improvement: Embrace continuous improvement, not just for compliance, but as a cornerstone of your company culture.Future Questions:How will the integration of AI and digital health technologies impact the criteria for CMMI and VIP?In what ways might the Voluntary Improvement Program evolve to further incentivize innovation in MedTech?How will FDA's regulatory framework adapt to the rapid advancements in medical device technologies?References and Resources:Etienne Nichols on LinkedInKim Kaplan on LinkedInFDA's Final Guidance on the Voluntary Improvement ProgramISACA's overview of FDAs Voluntary Improvement Program (VIP)Regulatory opportunities of the...
In this episode of the Global Medical Device Podcast, host Etienne Nichols sits down with Kim Kaplan from ISACA at the MD&M West trade show in Anaheim, California, to discuss the pivotal Voluntary Improvement Program (VIP). This conversation sheds light on how the program, stemming from FDA's Case for Quality initiative, utilizes the Capability Maturity Model Integration (CMMI) to push medical device companies beyond compliance, towards excellence. Kaplan elucidates the history of VIP, its benefits, and how it aligns with the FDA's vision for a more innovative and quality-focused MedTech industry.Key Timestamps:[00:00:30] Introduction of Kim Kaplan and the Voluntary Improvement Program[00:05:00] Explanation of CMMI and its adoption in the medical device industry[00:15:45] Distinctions between CMMI and other quality methodologies[00:25:30] In-depth discussion on the specifics and benefits of the Voluntary Improvement Program[00:40:00] How companies can implement change based on VIP insights[00:50:00] FDA's perspective and regulatory opportunities tied to VIP participationNotable Quotes:“Organizations that are compliant aren't necessarily avoiding the types and numbers of issues faced by non-compliant ones.” - Kim Kaplan“CMMI focuses on the 'what' to do rather than the 'how,' allowing for a framework that compliments existing processes.” - Kim Kaplan“The Voluntary Improvement Program isn't just about compliance; it's about embracing continuous improvement as a culture.” - Kim KaplanKey Takeaways:Understanding VIP: The program aims to elevate quality and operational efficiency through a collaboration involving FDA, MDIC, industry stakeholders, and ISACA.CMMI's Role: CMMI's flexible, globally adopted framework helps MedTech companies identify and implement best practices in product development and project management.Benefits of Participation: Beyond improving quality, VIP participation can streamline regulatory processes, fostering quicker innovation and market access.Practical Tips for Listeners:Engage with CMMI: Consider how CMMI's framework could complement your company's existing quality and project management processes.Explore VIP: Assess your organization's readiness and potential benefits from enrolling in the Voluntary Improvement Program.Continuous Improvement: Embrace continuous improvement, not just for compliance, but as a cornerstone of your company culture.Future Questions:How will the integration of AI and digital health technologies impact the criteria for CMMI and VIP?In what ways might the Voluntary Improvement Program evolve to further incentivize innovation in MedTech?How will FDA's regulatory framework adapt to the rapid advancements in medical device technologies?References and Resources:Etienne Nichols on LinkedInKim Kaplan on LinkedInFDA's Final Guidance on the Voluntary Improvement ProgramISACA's overview of CMMI and the tailored MDDAP for the medical device industryQuestions for the Audience:Poll: Which area of MedTech do you believe will benefit most from VIP and CMMI in the next five years? Email us your thoughts at
The government's thinking toward value-based care has evolved in recent years thanks to innovative partnerships between healthcare stakeholders and payers, Katy Lanz said. Thanks to healthcare entities successfully assuming risk for seriously ill populations, the Center for Medicare and Medicaid Innovation (CMMI) has taken the stance that it wants to continue to drive value-based partnerships, said Lanz, former chief clinical officer of Aspire Health. CMMI models such as the Value-Based Insurance Design (VBID) Model and Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model are examples of this. The models, which involve providers assuming risk, have proven to save money and avoid unwanted, unnecessary hospitalizations and care. Traditional home care firms would be wise to initiate “strategic refreshes” and find opportunities to partner with at-risk providers. Lanz, who advises healthcare organizations on growth and innovation, talked about one of her large-scale clients, Dollar General. The retailer is interested in value-based care because it is concerned about its female shoppers not being able to afford or access healthcare. Also, during the podcast, Lanz clarified that when she talked recently about providers having to “show me the money,” she was talking about sharing in upside and downside risk, not receiving money for referrals.Follow us on social media:Twitter: @McKHomeCareFacebook: McKnight's Home CareLinkedIn: McKnight's Home CareInstagram: mcknights_homecareFollow TopSight Partners on social media:LinkedIn: Katy Lanz
The transformation of healthcare is a seemingly insurmountable challenge, yet overcoming any obstacle in the journey begins with the belief that it is possible to win! It's not about the magnitude of the task; it is about the collective will to prioritize the wellbeing of every person we serve in our population. Perhaps when approached with the audacity to imagine a healthier and more equitable future for all, we'll actually get there. And that is just what the Physicians of Southwest Washington (PSW) is realizing as they navigate a successful transition from volume to value. Our guest on the Race to Value this week is Melanie Matthews, the dynamic, creative, and innovative CEO of PSW. She leads a population health company that has been around for three decades. Melanie is not only leading their ACO and managing their progression in the adoption of full-risk Medicare Advantage delegation; she has become a nationally recognized voice for value-based health policy. In listening to this interview, you will hear from a leader that has a real personal capacity for leadership and a clear focus on excellence. If you want to hear from someone that is at the absolute forefront of risk-based contracting and innovation, who understands the issues at a granular level, this episode with Melanie is a must-listen! Episode Bookmarks: 01:30 Introduction to Melanie Matthews and the Physicians of Southwest Washington (PSW) 04:30 PSW has evolved over the last three decades from an IPA to a diverse business that includes a national leading ACO and risk-bearing entity for MA. 06:00 "PSW is a story of independent physicians who, in a time of market consolidation, want to remain independent and focus on the patient relationship." 06:45 Achieving success in delegated risk and taking accountability for both quality and total cost of care. 07:00 The impact of MACRA on the long-term value-based care strategy of PSW. 08:30 Building an infrastructure and developing capabilities to move a value-based agenda. 09:00 Developing a business model for agility in responding to new rules ("a kayak in a sea of cruise ships") and engaging all types of physicians in the landscape. 09:30 "The value-based movement is important as the fee-for-service chassis is not realistic, has poor quality and outcomes, and rising costs." 10:00 Taking risk with physician partners and providing them with MSO services, leveraging a technical infrastructure and population health platform. 10:45 The glacial pace of scaling payment model transformation at CMS and CMMI's bold goal for 2030. 12:00 The increasing shift to home-based care delivery and the use of generative AI in reshaping care delivery. 13:00 How the flawed economic design of the fee-for-service system creates industry inertia. 14:00 Diverting to the known (i.e. fee-for-service care delivery) in times of stress is an unsustainable path forward. 15:00 Convincing the Board room on the tenets of VBC when it hasn't historically delivered on its promises. 16:00 Trends in consumer cost-shifting and the challenges of private insurers cross-subsidizing provider losses from public payers. 16:30 Unsustainable economics in employer-based healthcare and the looming insolvency of Medicare. 17:00 What does the CMMI 2030 Goal mean for future of the value movement? 18:30 An overview of the extensive services offered by PSW that empowers success in VBC. 19:30 The explosive growth of strategic transactions of physician groups and how mass consolidation is impacting the landscape. 21:00 Aligned incentives and access to a population health platform as keys to VBC success. 22:00 PE investment impacts on competition in an independent physician ecosystem. 23:00 Generational differences in the approach to the business of practicing medicine. 23:30 "Organizations that are convened with independent physicians are able to show better costs of care." (vs. employed or vertically integrated systems)
Chip and Dr. Liz Fowler, Deputy Administrator of CMS and Director of the agency's Center forMedicare and Medicaid Innovation (CMMI), discuss CMMI's mission to improve healthoutcomes, overcome the obstacles to health equity, and reduce care costs. They look back onwhat CMMS has accomplished in its first 10 years, what we have learned from thisexperimentation, and the future of care and payment innovation.Topics they examine include: CMMI's successes over the last decade and what programs have resonated most. Controversial CBO report that says CMMI's programs have increased federal spending –not lowered it. Performance of CMMI bundled payments and rationale behind a new mandatory bundledpayment program. Goals of the newly announced state-based AHEAD model and how it will interact withother ACO and value-based care programs. Dealing with the challenges created by massive growth in Medicare Advantage. How CMMI is addressing the broad issue of health equity.MORE:Dr. Fowler has the unique role of leading an agency she helped create. From 2008-2010, she wasChief Health Counsel to Senate Finance Committee Chair, Senator Max Baucus (D-MT), whereshe played a critical role in developing the Senate version of the Affordable Care Act. Theframework for the CMMI was embedded in the law – so now, after several roles in the private
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Maritime and Space organisations in Cyprus sign an MOU; who's pulling whose leg as regards infringements of the Akamas Plan? The forest department wants you to buy a Christmas tree in a pot so that you can use it again in the coming years.
In the realm of healthcare, the need for specialized care for Alzheimer's and Dementia patients has never been more pressing. As the world continues to grapple with the complexities of these conditions, innovations and shifts in care models are needed. In this podcast episode imagine a future where Alzheimer's and Dementia care is not just an afterthought but a priority. This episode will take you on an insightful journey into the world of Dementia care, spotlighting the groundbreaking work of MemoryCare, a nonprofit organization based in Asheville, North Carolina dedicated to empowering patients and caregivers. Our guests, Dr. Stelley Gutman, a seasoned geriatric specialist, and Elizabeth Lackey MSW, Lead Care Manager, guide us through the labyrinth of Alzheimer's and Dementia care, from diagnosis to innovative care models. Are you aware of the toll caregiving can take on one's health? We explore this with Dr. Gutman and Ms. Lackey, delving into the significant health impact of caregiving and the potential solutions offered by their program. They also shed light on their view on the collaborative role of hospice and palliative care for afflicted families and the patient. We also touch on the utilization of hospice facilities and their potential for respite care. In the final segment of our conversation, we discuss CMMI's proposed GUIDE model. Reflecting on the importance of collaboration in healthcare. Tune in to this enlightening episode and emerge with a richer understanding of Dementia care, the promising strides being made in the field, and most importantly for our listeners the potential collaboration opportunities. You won't want to miss this. Join us. Guest: Dr. Stelley Gutman, Staff Physician at MemoryCareElizabeth Lackey, Lead Care Manager, MemoryCare and The SECU Center for MemoryCare Host:Chris Comeaux, President / CEO of TCNTeleios Collaborative Network / https://www.teleioscn.org/tcntalkspodcast
Mike Pattwell, principal business advisor at Edifecs and Chair of the WEDI payment models work group, emphasizes the pandemic's impact on moving away from the fee-for-service model towards a value-based care model. Improving the administration of healthcare requires automation, new workflow solutions, and better data exchange to improve patient health. He mentions three organizations, including CMMI, WEDI, and CAQH, working towards creating interoperability and seamless communication between payers and providers. Mike explains, "We've been around for 26 years, and we've been developing solutions to help our clients, mostly payers and providers, and health systems, to operationalize and automate workflows to improve the administration side of healthcare so that they can focus on doing what they do well, which is taking care of members and patients." "Starting at the top, it would be The Center for Medicare and Medicaid Innovation (CMS) and the innovation center called CMMI. They're paving the future of healthcare for both payers and providers. They're supported by many other organizations. I'll briefly discuss three that I'm directly involved with and I believe are helping to develop and evolve healthcare. I call these three organizations “silent superheroes.” They are the invisible organizations doing the hard work of creating interoperability and seamless automation between payers and providers. For decades, they've been enabling the future of healthcare." #Edifecs #HealthInnovation #DIgitalTransformation #DigitalHealth #SDOH #Equity #HealthcareIT edifecs.com Listen to the podcast here
Mike Pattwell, principal business advisor at Edifecs and Chair of the WEDI payment models work group, emphasizes the pandemic's impact on moving away from the fee-for-service model towards a value-based care model. Improving the administration of healthcare requires automation, new workflow solutions, and better data exchange to improve patient health. He mentions three organizations, including CMMI, WEDI, and CAQH, working towards creating interoperability and seamless communication between payers and providers. Mike explains, "We've been around for 26 years, and we've been developing solutions to help our clients, mostly payers and providers, and health systems, to operationalize and automate workflows to improve the administration side of healthcare so that they can focus on doing what they do well, which is taking care of members and patients." "Starting at the top, it would be The Center for Medicare and Medicaid Innovation (CMS) and the innovation center called CMMI. They're paving the future of healthcare for both payers and providers. They're supported by many other organizations. I'll briefly discuss three that I'm directly involved with and I believe are helping to develop and evolve healthcare. I call these three organizations “silent superheroes.” They are the invisible organizations doing the hard work of creating interoperability and seamless automation between payers and providers. For decades, they've been enabling the future of healthcare." #Edifecs #HealthInnovation #DIgitalTransformation #DigitalHealth #SDOH #Equity #HealthcareIT edifecs.com Download the transcript here
In the Race to Value, we must recognize that quality of life is the ultimate currency of healthcare, and this aim is all the more important in senior living facilities. Transforming health outcomes for skilled nursing and senior living populations is not just a goal; it's a commitment to providing the care and dignity our elders deserve. This week, we profile a leader in the value movement who leads a company on a mission “to improve the health, happiness, and dignity of senior living residents”. We are joined by Mark Price, CEO of Curana Health – a leader who lives by the mantra that “extreme passion” is the single most important ingredient to reform the American healthcare system. Curana Health is a provider of value-based primary care services exclusively for the senior living industry, including in nursing homes, assisted/independent living facilities, CCRC/life plan communities and affordable senior housing communities. Curana Health serves more than 1,100 senior living community partners across 30 states and participates in the MSSP ACO, ACO Reach and Medicare Advantage programs with CMS. Backed by more than $300M in venture capital funding, the organization is poised to disrupt care delivery in senior living on a meaningful scale through innovative care models and applied analytics. In this episode, you will learn about how to transform health outcomes for skilled nursing and senior living populations through extreme passion. We cover such topics as how to leverage APMs such as MSSP and ACO REACH in the senior living setting, the performance results of Curana Health across their value-based portfolio, technology innovation, palliative care, the state of the nursing home industry, and future trends in the shift to home-based care delivery. Episode Bookmarks: 01:30 Introduction to Mark Price, CEO of Curana Health. 03:45 An estimated 27M more people are aging into the 75+ cohort through 2050, resulting in rising age and higher health acuity levels of residents moving into senior living. 05:00 Curana Health has achieved a 39% reduction in 30-day hospital readmissions and a 37% reduction in total hospital admissions among Medicare Advantage I-SNP members. 06:00 “There are many subsectors in the industry where value-based care can succeed. The important thing is ensuring that your people have an extreme amount of passion for making it work.” 07:00 Founding story of Curana Health based on how we would want our loved ones to be cared for at the end of life. 08:45 The majority of Americans will spend some time in senior living or skilled nursing in the final years of their life. 10:00 Elite Patient Care ACO performed in the top 1% of ACOs in its first year of operation, achieving PBPY savings amount of $2,235—the highest PBPY for any first-year MSSP ACO since 2012. 11:30 Curana Health also has one of the top performing ACO REACH and risk-based MA I-SNP programs in the country. 11:45 “Our core business is not a payment model. It is a clinical model that produces health outcomes which, in turn, enables affordability as well.” 13:00 Developing a population health playbook for the senior living space. 14:00 Success in developing a level of clinical integration within a senior living facility that is now owned by the company. 15:00 MA Institutional Special Needs Plans (I-SNPs) are designed to meet the needs of people living in long-term care settings such as long-term care nursing, skilled nursing facilities, and inpatient psychiatric facilities. 16:45 Facilities are taking an ownership position of MA plans for senior living and skilled nursing residents. 17:00 Mark provides perspective on I-SNPs and how the Curana Health clinical model is achieving results to improve clinical outcomes. 18:30 Performing well by recognizing the commonality between MSSP, ACO REACH, and Medicare Advantage. 20:00 How CMS and CMMI is incorporating innovation to value-based payment models (e.g.SNF 3-Day Rule Waiver).
My conversation today is with Will Shrank, MD. Dr. Shrank led the evaluation group at CMMI (Center for Medicare and Medicaid Innovation). He has spent time in the private sector, first at CVS Health and UPMC (University of Pittsburgh Medical Center) as chief medical officer of the health plan in Pittsburgh, and then as the chief medical officer for Humana. Now he is a venture partner at Andreessen Horowitz and doing some consulting for CMMI. We start out this conversation talking about waste in healthcare. In fact, Dr. Shrank was on a team who did a study about waste in the US healthcare system. (The article is, unfortunately, firewalled.) In that study, it says estimates suggest we have upwards of a trillion dollars of waste a year. There's two main groupings of said waste, turns out. The first is in administrative failures. There's three subcategories here: fraud, waste, and abuse; administrative complexity; and pricing failures. Then there's the clinical failures side of the waste house. There's three subcategories here as well, and they are failures in care coordination, failure in care delivery, and then low-value care. Dr. Shrank digs in a bit on each of these in the interview that follows, but I have to say, I go in fast for the now what. Great that we know where the waste is coming from, because gotta know the problems to solve for them. But really, what's the best way to solve for this waste? You know me by now, so I, of course, point out immediately that someone's waste is someone else's profit. So, that's a wrinkle. And it's a really rough wrinkle, because now you have groups lobbying to basically protect the waste. As just one example, what are pricing failures, after all, if not someone else's margin? Major spoiler alert here, but Dr. Shrank says one sort of broad-stroke solution is aligning incentives with higher-quality care, paying for the longitudinal patient journey, and paying for outcomes. If you do this, then at least the clinical failures side of the equation could improve. The implication here is that if the incentive is to be accountable for value—which is, you know, numerator quality denominator cost—then the supply chain has an incentive to reduce its own waste because effectively, at that point, it's coming out of their pocket as opposed to somebody else's. Will this resetting of the financial model happen overnight? That was a rhetorical question that we all know the answer to. Commercial payers are slow to change, and all but the best employers have been (historically, at least) busy making extremely lateral moves and going nowhere fast. Few seem super inclined to reward and pay for what they care about rather than just negotiating a price. I sort of say this to Dr. Shrank, and he says, yeah, true enough. I'm paraphrasing with a lot of creative license right now, but he says, let's reset our expectations with reality. We've actually come a pretty long way, baby, in not a particularly long time if you consider the whole value-based thing really only started not that long ago, relatively speaking. So, there will be problems to overcome and bumps in the road. We should expect that, and we haven't had the time to work them all out yet. I think a couple of other interesting insights for me, one was a little sidebar we go off on about the power that PCPs might find themselves wielding if they can gang up and harness it. And this is kind of starting. We'll see if it goes anywhere. I recently heard a story about a bunch of employed PCPs who went to their health system bosses and asked to stand up an APCP (advanced primary care practice) able to coordinate care, etc, do all the things that at this juncture we know are the right things to do for patients. Now they got shot down—bam!—with the backhands from above. I hope those engaged and activated PCPs quit and start up their own thing. Maybe they will. PCPs getting together here could be a way to solve for waste if they can gang up and harness it. And that's actionable if you happen to be a PCP or are looking to continue to employ them moving forward. The potential rising power of PCPs might cause some health systems to rethink some of the choices they are making (ie, the choice to employ PCPs as RVU [relative value unit] referral machines). PCPs, better than anyone, can see the harm inflicted by the business model that forces a drive-by PCP level of care. Moral injury is at an all-time high, and in addition, I just saw that study recently that showed to do all the administrative work of a PCP these days, it would take longer than 24 hours in a day. If you're a self-insured employer, I'd also kind of take note of this because it also could be actionable for you. Someone who would know told me recently that if enough employers demanded some value-based accountability, some advanced primary care going on, even a dominant consolidated health system would listen. So there seems to be some alignment here between employers and PCPs if these groups can come together and collaborate. In sum, we have a waste problem in this country. Aligning incentives might be one way to curb that waste. Can I just share with you some of the reviews that we got on iTunes recently? They make my heart so warm. I just want to acknowledge these individuals who took the time to write reviews. Here's the first one. It's from Jspeaks1987. He wrote, “[RHV is] my weekly go-to for smart takes on VBC [value-based care]. I have recommended this podcast to literally hundreds of people (including onstage at our recent customer success summit). Anyone who cares about the sustainability of our healthcare system owes it to themselves to give [Relentless Health Value] a permanent spot on their playlist. Always smart, often provocative, scrupulously fair [I like that … scrupulously fair], it's well worth the listen.” Thank you so much, Jspeaks1987. Here's another one. And this is from happygilmore80. I know who you are, happygilmore. “RHV is an amazing podcast and sorely needed in the healthcare community. I tell everyone about it. … I'm a recent listener and have learned so much from [episode] 399 and 400 [which are the manifestos]. Episode 410 was packed with knowledge, 407 was great, etc. Let's start a hundred RHV communities across the US where we implement small experiments so change is grassroots and ubiquitous. Then the status quo will concede.” And yeah, for sure with that. If anyone is interested in creating a meetup or something in your local area, reach out. I'll try to hook you up with others in the Relentless Tribe. Here's a third one, and this is by Miriam. Thank you so much for this, Miriam. Miriam says, “I scoured the podcast world to find a healthcare industry podcast that offers intelligent, relevant, clear information and dialogue. I found it. Stacey and RHV cover the US healthcare industry across all sectors while managing to go deep within those sectors. Most importantly, [RHV] highlights how all of those sectors interact, supposedly with the patient at the center, while performing as businesses that are really driven by capitalism.” Miriam says she never misses an episode. To the three of you, thank you so much. It's actually reviews like this that keep me and the team going over here. You can learn more by connecting with Dr. Shrank on LinkedIn. William H. Shrank, MD, MSHS, is serving as venture partner, bio and health, at Andreessen Horowitz. Previously, Dr. Shrank served as chief medical officer for Humana, where his responsibilities included implementing Humana's integrated care delivery strategy, with an emphasis on advancing the company's clinical capabilities and core objective of improving the health outcomes of its members. Dr. Shrank previously held the position of chief medical and corporate affairs officer, during which time he oversaw government affairs. From 2016 to 2019, Dr. Shrank served as chief medical officer, insurance services division, at the University of Pittsburgh Medical Center. Previously, Dr. Shrank served as senior vice president, chief scientific officer, and chief medical officer of provider innovation at CVS Health. Prior to joining CVS Health, he served as director of the Research and Rapid-Cycle Evaluation Group for the Center for Medicare and Medicaid Innovation. Dr. Shrank began his career as a practicing physician with Brigham and Women's Hospital in Boston and as an assistant professor at Harvard Medical School. He has published more than 270 papers on improving the quality of prescribing and the use of chronic medications. Dr. Shrank received his MD from Cornell University Medical College. He completed his residency in internal medicine at Georgetown University and his fellowship in health policy research at the University of California, Los Angeles. He also earned a master of science in health services from the University of California, Los Angeles, and a bachelor's degree from Brown University. 05:56 Can we cut healthcare waste while improving patient care? 06:35 What does “healthcare waste” consist of? 06:48 What are the six categories of “healthcare waste”? 09:25 EP363 with David Scheinker, PhD. 09:39 How much money does Dr. Shrank estimate is wasted each year in healthcare? 12:11 Where is that healthcare waste going, and why does it happen? 19:09 Uncaring by Robert Pearl, MD. 20:20 “We've built a backbone of extraordinary waste on a fee-for-service chassis.” 21:18 EP409 with Larry Bauer, MSW, MEd. 23:26 EP359 with Dan O'Neill. 25:04 Dr. Shrank's warning to providers out there. 29:04 Summer Shorts 2 with Scott Conard, MD. 30:43 Why there might be a generational shift among younger providers looking to work with different models. You can learn more by connecting with Dr. Shrank on LinkedIn. @WillShrank discusses #healthcarewaste, #vbc, and #PCPs on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare Recent past interviews: Click a guest's name for their latest RHV episode! Dr Carly Eckert (Encore! EP361), Dr Robert Pearl, Larry Bauer (Summer Shorts 8), Secretary Dr David Shulkin and Erin Mistry, Keith Passwater and JR Clark (Summer Shorts 7), Lauren Vela (Summer Shorts 6), Dr Jacob Asher (Summer Shorts 5), Eric Gallagher (Summer Shorts 4), Dan Serrano, Larry Bauer
The Congressional Budget Office released a report showing that the Center for Medicare and Medicaid Innovation, created under Obamacare to test new ways to pay for health care, will increase federal spending rather than reducing it. In 2010, CBO projected CMMI would reduce spending by $2.8 billion over 10 years, but current estimates show it increasing $1.3 billion from 2021 to 2030. Host Ben Leonard talks with Robert King about why.
Congress Averts Government Shutdown Sen. Wyden, Rep. Pallone to Investigate Medicaid MCOs' Use of Prior Authorization MA Premiums Set to Increase Sen. Cassidy Issues RFIs on Reforming CDC, NIH FDA Proposes LDT Enforcement Rule Administration to Begin Enforcement of Drug Price Reporting Requirements Medicare Drug Price Negotiations to Proceed CBO Issues Report on CMMI ARPA-H Announces Cambridge, Dallas as Latest Hubs Ways and Means Passes Legislation to Expand Use of HSAs Senate Committee Advances SAFER Banking Act Democrats Push for Opioid Settlement Fund Oversight Sen. Dianne Feinstein Dies at 90 NJ Democrat to Challenge Menendez for Senate Seat Insurers Commit to COVID Shot Coverage With No Cost Sharing and more...
Good morning from Pharma and Biotech Daily: the podcast that gives you only what's important to hear in the Pharma and Biotech world. Novartis has terminated its partnership with Beigene after the European Union approved Beigene's cancer drug, leaving Novartis without a PD-1 inhibitor. Histogen plans to wind down operations after failing to find a partner, resulting in the majority of employees being laid off. Kinnate is also laying off 70% of its staff and reorganizing its pipeline. The rollout of new RSV vaccines is posing a challenge as public health officials and drugmakers try to raise awareness among older adults at risk and convince them to get an additional respiratory shot alongside those for COVID-19 and flu.Boston Scientific has announced its plans to acquire Relievant Medsystems, a company that manufactures a treatment for chronic back pain, for $850 million. Johnson & Johnson (J&J) has begun a trial of its pulsed field ablation catheter with mapping feedback. GE Healthcare has received a $44 million grant from the Gates Foundation to develop AI tools for ultrasound technology. The FDA has released draft guidance for studying weight loss devices. MedTech Europe has called for "structural reform" of the new regulatory system established by the Medical Device Regulation (MDR) and In Vitro Diagnostic Regulation (IVDR). The FDA has finalized changes to its breakthrough device program in order to target health inequities.A new analysis by the Kaiser Family Foundation (KFF) has found that over 80% of nursing homes in the US fall short of the proposed staffing thresholds set by CMS. Ochsner Health has launched a pilot program that uses generative AI to draft messages to patients. The Bill and Melinda Gates Foundation has granted GE Healthcare $44 million to develop AI tools for ultrasound technology. Former employees of Tennessee Blue Cross Blue Shield (BCBS) have filed a lawsuit against the nonprofit health plan over its COVID-19 vaccine mandate. These developments highlight ongoing challenges in the healthcare industry, including staffing shortages in nursing homes and legal issues surrounding COVID-19 vaccine mandates.Novartis is returning the anti-PD-1 antibody, tislelizumab, to Beigene after facing regulatory roadblocks. Sanofi has sold 11 CNS assets to Pharmanovia. These developments in the pharmaceutical industry highlight the complexities and challenges faced by companies in drug development and commercialization.Voyager, a cloud-based scan comparison software developed by Lumafield, aims to revolutionize non-destructive testing in medical device product development. Rayzebio and Neumora have successfully priced some of the largest IPOs in the biotech sector this year. UK biotech company Alveogene has launched with plans to develop an inhaled gene therapy. Generate has raised $273 million in funding as its first drugs move into clinical testing. Precision medicine startup Actio has launched with $55 million in funding. AIRNA has emerged from stealth mode with plans to develop RNA editing therapies for rare diseases.Oracle is set to launch generative AI tools integrated with EHR that will automate notetaking and suggest next steps. A secret shopper survey found that hospitals often share different medical prices online compared to over the phone. Former employees have sued Tennessee BCBS over its COVID-19 vaccine mandate. Ascension has posted a net loss of $2.7 billion in fiscal year 2023. Public health officials and drugmakers are working on raising awareness about RSV among at-risk older adults. The CMMI has announced plans to launch new behavioral and maternal health models this year.The pharmaceutical industry has the potential to move towards animal-free research and development (R&D). Efforts are being made to spare horseshoe crabs from blood collection and alternative technologies are emerging that could replace the need for animal testing.Anthos Therapeutics has halted its phase II atrial fi
Sean O'Connor is the Director of Engineering at Datadog. Datadog is the essential monitoring and security platform for cloud applications. Sean discusses his transition from an individual contributor to management and shares why he chose Datadog, emphasizing the appeal of high-scale problems and the real business nature of the company. They delve into the importance of performance management and observability and cover the cultural and technical challenges Sean faces in managing a diverse, geographically spread team, and discuss the transition at Datadog from a decentralized model to more centralized platforms, the corresponding changes in both technical strategies and people management, and what excites him about Datadog's future, including the integration of security offerings into developers' daily experiences, and the evolution of Kubernetes and internal build and release tooling. __ Datadog (https://www.datadoghq.com/) Follow Datadog on LinkedIn (https://www.linkedin.com/company/datadog/), Instagram (https://www.instagram.com/datadoghq/), Youtube (https://www.youtube.com/user/DatadogHQ), or Twitter (https://twitter.com/datadoghq). Follow Sean O'Connor on LinkedIn (https://www.linkedin.com/in/seanoc/) or Twitter (https://twitter.com/theSeanOC). Visit his website at seanoc.com (https://seanoc.com/). Follow thoughtbot on Twitter (https://twitter.com/thoughtbot) or LinkedIn (https://www.linkedin.com/company/150727/). Become a Sponsor (https://thoughtbot.com/sponsorship) of Giant Robots! Transcript: VICTORIA: This is the Giant Robots Smashing Into Other Giant Robots Podcast, where we explore the design, development, and business of great products. I'm your host, Victoria Guido. WILL: And I'm your other host, Will Larry. And with us today is Sean O'Connor. He is the Director of Engineering at Datadog. Datadog is the essential monitoring and security platform for cloud applications. Sean, thank you for joining us. SEAN: Hi, thanks for having me on. VICTORIA: Yeah, I'm super excited to get to talking with you about everything cloud, and DevOps, and engineering. But why don't we first start with just a conversation about what's going on in your life? Is there any exciting personal moment coming up for you soon? SEAN: Yeah, my wife and I are expecting our first kiddo in the next few weeks, so getting us prepared for that as we can and trying to get as much sleep as we can. [laughs] WILL: Get as much sleep as you can now, so...[laughs] I have a question around that. When you first found out that you're going to be a dad, what was your feeling? Because I remember the feeling that I had; it was a mixed reaction of just everything. So, I just wanted to see what was your reaction whenever you found out that you're going to be a dad for the first time. SEAN: Yeah, I was pretty excited. My wife and I had been kind of trying for this for a little while. We're both kind of at the older end for new parents in our late 30s. So, yeah, excited but definitely, I don't know, maybe a certain amount of, I don't know about fear but, you know, maybe just concerned with change and how different life will be, but mostly excitement and happiness. [laughs] WILL: Yeah, I remember the excitement and happiness. But I also remember, like, wait, I don't know exactly what to do in this situation. And what about the situations that I have no idea about and things like that? So, I will tell you, kids are resilient. You're going to do great as a dad. [laughter] SEAN: Yep. Yeah, definitely; I think I feel much more comfortable about the idea of being a parent now than I may have been in my 20s. But yeah, definitely, the idea of being responsible for and raising a whole other human is intimidating. [laughs] VICTORIA: I think the fact that you're worried about it is a good sign [laughs], right? SEAN: I hope so. [laughs] VICTORIA: Like, you understand that it's difficult. You're going to be a great parent just by the fact that you understand it's difficult and there's a lot of work ahead. So, I think I'm really excited for you. And I'm glad we get to talk to you at this point because probably when the episode comes out, you'll be able to listen to it with your new baby in hand. So... WILL: Good. Excited for it. [laughs] VICTORIA: Yeah, love that. Well, great. Well, why don't you tell me a little bit more about your other background, your professional background? What brought you to the role you're into today? SEAN: Yeah. Well, like we mentioned in the beginning; currently, I'm a Director of Engineering at Datadog. I run our computing cloud team. It's responsible for all of our Kubernetes infrastructure, as well as kind of all the tooling for dealing with the cloud providers that we run on and as well as kind of [inaudible 02:54] crypto infrastructure. Within Datadog, I've always been in management roles though I've kind of bounced around. I've been here for about five and a half years. So, before this, I was running a data store infrastructure team. Before that, when I first came in, I was running the APM product team, kind of bounced around between product and infra. And that's kind of, I guess, been a lot of the story of much of my career is wearing lots of different hats and kind of bouncing around between kind of infrastructure-focused roles and product-focused roles. So, before this, I was running the back-end engineering and DevOps teams at Bitly. So, I was there for about five and a half years, started there originally as a software engineer. And before that, a lot of early-stage startups and consulting doing whatever needed doing, and getting to learn about lots of different kind of industries and domains, which is always fun. [laughs] VICTORIA: That's great. So, you had that broad range of experience coming from all different areas of operations in my mind, which is, like, security and infrastructure, and now working your way into a management position. What was the challenge for you in making that switch from being such a strong individual contributor into an effective manager? SEAN: Sure. You know, I think certainly there is a lot of kind of the classic challenges of learning to let go but still staying involved, right? You know, as a manager, if you're working on critical path tasks hands-on yourself, that's probably not a good sign. [laughs] On the other hand, if you come, like, completely divorced from what your team is doing, especially as, like, a team lead level kind of manager, you know, that's not great either. So, figuring that balancing act definitely was a bit tricky for me. Similarly, I think time management and learning to accept that, especially as you get into, like, further steps along in your career that, like, you know, it's not even a question of keeping all the balls in the air, but more figuring out, like, what balls are made out of rubber and which ones are made out of glass, and maybe keeping those ones in the air. [laughs] So, just a lot of those kind of, like, you know, prioritization and figuring out, like, what the right level of involvement and context is, is definitely the eternal learning, I think, for me. [laughs] WILL: I remember whenever I was looking to change jobs, kind of my mindset was I wanted to work at thoughtbot more because of the values. And I wanted to learn and challenge myself and things like that. And it was so much more, but those were some of the main items that I wanted to experience in my next job. So, when you changed, and you went from Bitly to Datadog, what was that thing that made you say, I want to join Datadog? SEAN: Yeah, that was definitely an interesting job search and transition. So, at that point in time, I was living in New York. I was looking to stay in New York. So, I was kind of talking to a bunch of different companies. Both from personal experience and from talking to some friends, I wasn't super interested in looking at, like, working at mostly, like, the super big, you know, Google, Amazon, Meta type of companies. But also, having done, like, super early stage, you know, like, seed, series A type of companies, having played that game, I wasn't in a place in my life to do that either. [laughs] So, I was looking kind of in between that space. So, this would have been in 2018. So, I was talking to a lot of, like, series A and series B-type companies. And most of them were, like, real businesses. [laughs] Like, they may not be profitable yet, but, like, they had a very clear idea of how they would get there and, like, what that would look like. And so, that was pleasant compared to some past points in my career. But a lot of them, you know, I was effectively doing, like, automation of human processes, which is important. It has value. But it means that, like, realistically, this company will never have more than 50 servers. And when I worked at Bitly, I did have a taste for kind of working in those high-scale, high-availability type environments. So, Datadog initially was appealing because it kind of checked all those boxes of, you know, very high-scale problems, high availability needs, a very real business. [laughs] This is before Datadog had gone public. And then, as I started to talk to them and got to know them, I also really liked a lot of kind of the culture and all the people I interacted with. So, it became a very clear choice very quickly as that process moved along. VICTORIA: Yeah, a very real business. Datadog is one of the Gartner's Magic leaders for APM and observability in the industry. And I understand you're also one of the larger SaaS solutions running Kubernetes, right? SEAN: Yep. Yeah, at this point. Five years ago, that story was maybe a little bit different. [laughs] But yeah, no, no, we definitely have a pretty substantial Kubernetes suite that we run everything on top of. And we get the blessings and curses of we get some really cool problems to work on, but there's also a lot of problems that we come across that when we talk to kind of peers in the industry about kind of how they're trying to solve them, they don't have answers yet either. [laughs] So, we get to kind of figure out a lot of that kind of early discovery games. [laughs] VICTORIA: Yeah. I like how exciting and growing this industry is around kind of your compute and monitoring the performance of your applications. I wonder if you could kind of speak to our audience a little bit, who may not have a big technical background, about just why it's important to think about performance management and observability early on in your application. SEAN: There can be a few pieces there. One of the bigger ones, I think, is thinking about that kind of early and getting used to working with that kind of tooling early in a project or a product. I think it has an analogous effect to, like, thinking about, like, compounding interest in, like, a savings account or investing or something like that. In that, by having those tools available early on and having that visibility available early on, you can really both initially get a lot of value and just kind of understanding kind of what's happening with your system and very quickly troubleshoot problems and make sure things are running efficiently. But then that can help get to a place where you get to that, like, flywheel effect as you're kind of building your product of, as you're able to solve things quickly, that means you have more time to invest in other parts of the product, and so on and so forth. So, yeah, it's one of those things where kind of the earlier you can get started on that, the more that benefit gets amplified over time. And thankfully, with Datadog and other offerings like that now, you can get started with that relatively quickly, right? You're not having to necessarily make the choice of, like, oh, can I justify spending a week, a month, whatever, setting up all my own infrastructure for this, as opposed to, you know, plugging in a credit card and getting going right away? And not necessarily starting with everything from day zero but getting started with something and then being able to build on that definitely can be a worthwhile trade-off. [laughs] VICTORIA: That makes sense. And I'm curious your perspective, Will, as a developer on our Lift Off team, which is really about the services around that time when you want to start taking it really seriously. Like, you've built an app [laughs]. You know it's a viable product, and there's a market for it. And just, like, how you think about observability when you're doing your app building. WILL: The approach I really take is, like, what is the end goal? I'm currently on a project right now that we came in later than normal. We're trying to work through that. SEAN: I haven't come from, you know, that kind of consulting and professional services and support kind of place. I'm curious about, like, what, if any, differences or experiences do you have, like, in that context of, like, how do you use your observability tools or, like, what value they have as opposed to maybe more, like, straight product development? VICTORIA: Right. So, we recently partnered with, you know, our platform engineering team worked with the Lift Off team to create a product from scratch. And we built in observability tools with Prometheus, and Grafana, and Sentry so that the developers could instrument their app and build metrics around the performance in the way they expected the application to work so that when it goes live and meets real users, they're confident their users are able to actually use the app with a general acceptable level of latency and other things that are really key to the functionality of the app. And so, I think that the interesting part was, with the founders who don't have a background in IT operations or application monitoring and performance, it sort of makes sense. But it's still maybe a stretch to really see the full value of that, especially when you're just trying to get the app out the door. SEAN: Nice. VICTORIA: [chuckles] That's my answer. What kind of challenges do you have in your role managing this large team in a very competitive company, running a ton of Kubernetes clusters? [laughs] What's your challenges in your director of engineering role there? SEAN: You know, it's definitely a mix of kind of, like, technical or strategic challenges there, as well as people challenges. On the technical and strategic side, the interesting thing for our team right now is we're in the middle of a very interesting transition. Still, today, the teams at Datadog work in very much a 'You build it, you run it' kind of model, right? So, teams working on user-facing features in addition to, like, you know, designing those features and writing the code for that, they're responsible for deploying that code, offering the services that code runs within, being on call for that, so on and so forth. And until relatively recently, that ownership was very intense to the point where some teams maybe even had their own build and release processes. They were running their own data stores. And, like, that was very valuable for much of our history because that let those teams to be very agile and not have to worry about, like, convincing the entire company to change if they needed to make some kind of change. But as we've grown and as, you know, we've kind of taken on a lot more complexity in our environment from, you know, running across more providers, running across more regions, taking on more of regulatory concerns, to kind of the viability of running everything entirely [inaudible 12:13] for those product teams, it has become much harder. [laughs] You start to see a transition where previously the infrastructure teams were much more acting as subject matter experts and consultants to, now, we're increasingly offering more centralized platforms and offerings that can offload a lot of that kind of complexity and the stuff that isn't the core of what the other product-focused teams are trying to do. And so, as we go through that change, it means internally, a lot of our teams, and how we think about our roles, and how we go about doing our work, changes from, like, a very, you know, traditional reliability type one on one consultation and advising type role to effectively internal product development and internal platform development. So, that's a pretty big both mindset and practice shift. [laughs] So, that's one that we're kind of evolving our way through. And, of course, as what happens to kind of things, like, you still have to do all the old stuff while you're doing the new thing. [laughs] You don't get to just stop and just do the new thing. So, that's been an interesting kind of journey and one that we're always kind of figuring out as we go. That is a lot of kind of what I focus on. You know, people wise, you know, we have an interesting aim of...There's about 40 people in my org. They are spread across EMEA and North America with kind of, let's say, hubs in New York and Paris. So, with that, you know, you have a pretty significant time zone difference and some non-trivial cultural differences. [laughs] And so, you know, making sure that everybody is still able to kind of work efficiently, and communicate effectively, and collaborate effectively, while still working within all those constraints is always an ongoing challenge. [laughs] WILL: Yeah, you mentioned the different cultures, the different types of employees you have, and everyone is not the same. And there's so many cultures, so many...whatever people are going through, you as a leader, how do you navigate through that? Like, how do you constantly challenge yourself to be a better leader, knowing that not everyone can be managed the same way, that there's just so much diversity, probably even in your company among your employees? SEAN: I think a lot of it starts from a place of listening and paying attention to kind of just see where people are happy, where they feel like they have unmet needs. As an example, I moved from that last kind of data store-focused team to this computing cloud team last November. And so, as part of that move, probably for the first two or three months that I was in the role, I wasn't particularly driving much in the way of changes or setting much of a vision beyond what the team already had, just because as the new person coming in, it's usually kind of hard to have a lot of credibility and/or even just have the idea of, like, you know, like you're saying, like, what different people are looking for, or what they need, how they will respond best. I just spend a lot of time just talking to people, getting to know the team, building those relationships, getting to know those people, getting to know those groups. And then, from there, figuring out, you know, both where the kind of the high priority areas where change or investment is needed. But then also figuring out, yeah, kind of based on all that, what's the right way to go about that with the different groups? Because yeah, it's definitely isn't a one size fits all solution. But for me, it's always kind of starting from a place of listening and understanding and using that to develop, I guess, empathy for the people involved and understanding their perspectives and then figuring it out from there. I imagine–I don't know, but I imagine thoughtbot's a pretty distributed company. How do you all kind of think about some of those challenges of just navigating people coming from very different contexts? WILL: Yeah, I was going to ask Victoria that because Victoria is one of the leaders of our team here at thoughtbot. So, Victoria, what are your thoughts on it? VICTORIA: I have also one of the most distributed teams at thoughtbot because we do offer 24/7 support to some clients. And we cover time zones from the Pacific through West Africa. So, we just try to create a lot of opportunities for people to engage, whether it's remotely, especially offering a lot of virtual engagement and social engagement remotely. But then also, offering some in-person, whether it's a company in-person event, or encouraging people to engage with their local community and trying to find conferences, meetups, events that are relevant to us as a business, and a great opportunity for them to go and get some in-person interaction. So, I think then encouraging them to bring those ideas back. And, of course, thoughtbot is known for having just incredible remote async communication happening all the time. It's actually almost a little oppressive to keep up with, to be honest, [laughs] but I love it. There's just a lot of...there's GitHub issues. There's Slack communications. There's, like, open messages. And people are really encouraged to contribute to the conversation and bring up any idea and any problem they're having, and actively add to and modify our company policies and procedures so that we can do the best work with each other and know how to work with each other, and to put out the best products. I think that's key to having that conversation, especially for a company that's as big as Datadog and has so many clients, and has become such a leader in this metrics area. Being able to listen within your company and to your clients is probably going to set you up for success for any, like, tech leadership role [laughs]. I'm curious, what are you most excited about now that you've been in the role for a little while? You've heard from a lot of people within the company. Can you share anything in your direction in the next six months or a year that you're super excited about? SEAN: So, there's usually kind of probably two sides to that question of kind of, like, from a product and business standpoint and from an internal infrastructure standpoint, given that's where my day-to-day focus is. You know, on the product side, one thing that's been definitely interesting to watch in my time at Datadog is we really made the transition from kind of, like, a point solution type product to much more of a platform. For context, when I joined Datadog, I think logs had just gone GA, and APM was in beta, I think. So, we were just starting to figure out, like, how we expand beyond the initial infrastructure metrics product. And, obviously, at this point, now we have a whole, you know, suite of offerings. And so, kind of the opportunities that come with that, as far as both different spaces that we can jump into, and kind of the value that we can provide by having all those different capabilities play together really nicely, is exciting and is cool. Like, you know, one of the things that definitely lit an interesting light bulb for me was talking to some of the folks working on our newer security offerings and them talking about how, obviously, you want to meet, you know, your normal requirements in that space, so being able to provide the visibility that, you know, security teams are looking for there. But also, figuring out how we integrate that information into your developers' everyday experience so that they can have more ownership over that aspect of the systems that they're building and make everybody's job easier and more efficient, right? Instead of having, you know, the nightmare spreadsheet whenever a CVE comes out and having some poor TPM chase half the company to get their libraries updated, you know, being able to make that visible in the product where people are doing their work every day, you know, things like that are always kind of exciting opportunities. On the internal side, we're starting to think about, like, what the next major evolution of our kind of Kubernetes and kind of internal build and release tooling looks like. Today, a lot of kind of how teams interact with our Kubernetes infrastructure is still pretty raw. Like, they're working directly with specific Kubernetes clusters, and they are exposed to all the individual Kubernetes primitives, which is very powerful, but it's also a pretty steep learning curve. [laughs] And for a lot of teams, it ends up meaning that there's lots of, you know, knobs that they have to know what they do. But at the end of the day, like, they're not getting a lot of benefit from that, right? There's more just opportunity for them to accidentally put themselves in a bad place. So, we're starting to figure out, like, higher level abstractions and offerings to simplify how all that for teams look like. So, we're still a bit early days in working through that, but it's exciting to figure out, like, how we can still give teams kind of the flexibility and the power that they need but make those experiences much easier and not have to have them become Kubernetes experts just to deploy a simple process. And, yes, so there's some lots of fun challenges in there. [laughs] Mid-Roll Ad: When starting a new project, we understand that you want to make the right choices in technology, features, and investment but that you don't have all year to do extended research. In just a few weeks, thoughtbot's Discovery Sprints deliver a user-centered product journey, a clickable prototype or Proof of Concept, and key market insights from focused user research. We'll help you to identify the primary user flow, decide which framework should be used to bring it to life, and set a firm estimate on future development efforts. Maximize impact and minimize risk with a validated roadmap for your new product. Get started at: tbot.io/sprint. WILL: I have a question around your experience. So, you've been a developer around 20 years. What has been your experience over that 20 years or about of the growth in this market? Because I can only imagine what the market was, you know, in the early 2000s versus right now because I still remember...I still have nightmares of dial-up, dial tone tu-tu-tu. No one could call you, stuff like that. So, what has been your experience, just seeing the market grow from where you started? SEAN: Sure, yeah. I think probably a lot of the biggest pieces of it are just seeing the extent to which...I want to say it was Cory Doctorow, but I'm not sure who actually originally coined the idea, but the idea that, you know, software is eating the world, right? Like, eventually, to some degree, every company becomes a software company because software ends up becoming involved in pretty much everything that we as a society do. So, definitely seeing the progression of that, I think, over that time period has been striking, you know, especially when I was working in more consulting contexts and working more in companies and industries where like, you know, the tech isn't really the focus but just how much that, you know, from an engineering standpoint, relatively basic software can fundamentally transform those businesses and those industries has definitely been striking. And then, you know, I think from a more individual perspective, seeing as, you know, our tools become more sophisticated and easier to access, just seeing how much of a mixed bag that has become [laughs]. And just kind of the flavor of, like, you know, as more people have more powerful tools, that can be very enabling and gives voice to many people. But it also means that the ability of an individual or a small group to abuse those tools in ways that we're maybe not fully ready to deal with as a society has been interesting to see how that's played out. VICTORIA: Yeah. I think you bring up some really great points there. And it reminds me of one of my favorite quotes is that, like, the future is here—it's just not evenly distributed. [laughs] And so, in some communities that I go to, everyone knows what Kubernetes is; everyone knows what DevOps is. It's kind of, like, old news. [laughs] And then, some people are still just like, "What?" [laughs]. It's interesting to think about that and think about the implications on your last point about just how dangerous the supply chain is in building software and how some of these abstractions and some of these things that just make it so easy to build applications can also introduce a good amount of risk into your product and into your business, right? So, I wonder if you can tell me a little bit more about your perspective on security and DevSecOps and what founders might be thinking about to protect their IP and their client's data in their product. SEAN: That one is interesting and tricky in that, like, we're in a little bit of, like, things are better and worse than they ever have been before [laughs], right? Like, there is a certain level of, I think, baseline knowledge and competency that I think company leaders really just have to have now, part of, like, kind of table stakes, which can definitely be challenging, and that, like, that probably was much less, if even the case, you know, 10-20 years ago in a lot of businesses. As an example, right? Like, obviously, like if it's a tech-focused company, like, that can be a thing. But, like, if you're running a plumbing business with a dozen trucks, let's say, like, 20 years ago, you probably didn't have to think that much about data privacy and data security. But, like, now you're almost certainly using some kind of electronic system to kind of manage all your customer records, and your job scheduling, and all that kind of stuff. So, like, now, that is something that's a primary concern for your business. On the flip side of that, I think there is much better resources, and tools, and practices available out there. I forget the name of the tool now. But I remember recently, I was working with a company on the ISO long string of numbers certifications that you tend to want to do when you're handling certain types of data. There was a tool they were able to work with that basically made it super easy for them to, like, gather all the evidence for that and whatnot, in a way where, like, you know, in the past, you probably just had to hire a compliance person to know what you had to do and how to present that. But now, you could just sign up for a SaaS product. And, like, obviously, it can't just do it for you. Like, it's about making your policies. But it still gave you enough support where if you're, like, bootstrapping a company, like, yeah, you probably don't need to hire a specialist to [inaudible 25:08], which is a huge deal. You know, similarly, a lot of things come much safer by default. When you think about, like, the security on something like an iPhone, or an iPad, or an Android device, like, just out of the box, that's light-years ahead of whatever Windows PC you were going to buy ten years ago. [laughs] And so, that kind of gives you a much better starting place. But some interesting challenges that come with that, right? And that we do now, literally, every person on the planet is walking around with microphones and cameras and all kinds of sensors on them. It's an interesting balance, I think. Similarly, I'm curious how you all think about kind of talking with your clients and your customers about this because I'm sure you all have a non-trivial amount of education to do there. [laughs] VICTORIA: Yeah, definitely. And I think a lot of it comes in when we have clients who are very early founders, and they don't have a CTO or a technical side of their business, and advising them on exactly what you laid out. Like, here's the baseline. Like, here's where you want to start from. We generally use the CIS controls, this internet for internet security. It puts out a really great tool set, too, for some things you were mentioning earlier. Let's figure out how to report and how to identify all of the things that we're supposed to be doing. It could be overwhelming. It's a lot. Like, in my past role as VP of Operations at Pluribus Digital, I was responsible for helping our team continue to meet our...we had three different ISO long number certifications [laughs]. We did a CMMI as well, which has come up a few times in my career. And they give you about a couple of hundreds of controls that you're supposed to meet. It's in very kind of, like, legalese that you have to understand. And that's a pretty big gap to solve for someone who doesn't have the technical experience to start. Like, what you were saying, too, that it's more dangerous and more safer than it has been before. So, if we make choices for those types of clients in very safe, trusted platforms, then they're going to be set up for success and not have to worry about those details as much. And we kind of go forward with confidence that if they are going to have to come up against compliance requirements or local state regulations, which are also...there's more of those every day, and a lot of liability you can face as a founder, especially if you're dealing with, like, health or financial data, in the state of California, for example. [laughs] It puts you at a really big amount of liability that I don't think we've really seen the impact of how bad it can be and will be coming out in the next couple of years now that that law has passed. But that's kind of the approach that we like to think. It's like, you know, there's a minimum we can do that will mitigate a lot of this risk [laughs], so let's do that. Let's do the basics and start off on the right foot here. SEAN: Yeah, no, that makes sense. Yeah, it's definitely something I've come to appreciate, especially doing work in regulated spaces is, when you do reach the point where you do need to have some kind of subject matter expert involved, whether it's somebody in-house or a consultant or an advisor, I've definitely learned that usually, like, the better ones are going to talk to you in terms of, like, what are the risk trade-offs you're making here? And what are the principles that all these detailed controls or guidelines are looking to get at? As opposed to just, like, walking you through the box-checking exercise. In my experience, a really good lawyer or somebody who will talk to you about risk versus just saying whether or not you can do something. [laughs] It has a very similar feeling in my experience. VICTORIA: Yeah, it's a lot about risk. And someone's got to be able to make those trade-off decisions, and it can be really tough, but it's doable. And I think it shouldn't scare people away. And there's lots of people, lots of ways to do it also, which is exciting. So, I think it's a good space to be in and to see it growing and pay attention to. [laughs] It's fun for me to be in a different place where we're given the opportunity to kind of educate or bring people along in a security journey versus having it be a top-down executive-level decision that we need to meet this particular security standard, and that's the way it's going to be. [laughs] Yeah, so that I appreciate. Is there anything that really surprised you in your conversations with Datadog or with other companies around these types of services for, like, platform engineering and observability? Is there anything that surprised you in the discovery process with potential clients for your products? SEAN: I think one of the biggest surprises, or maybe not a surprise but an interesting thing is, to what extent, you know, for us, I don't know if this is still the case, but I think in many places, like, we're probably more often competing against nothing than a competing product. And by that, I mean, especially as you look at some of our more sophisticated products like APM, or profiling, it's not so much that somebody has an existing tool that we're looking to replace; it's much more than this is just not a thing they do today. [laughs] And so, that leads to a very interestingly different conversation that I think, you know, relates to some of what we were saying with security where, you know, I think a non-trivial part of what our sales and technical enablement folks do is effectively education for our customers and potential customers of why they might want to use tools like this, and what kind of value they could get from them. The other one that's been interesting is to see how different customers' attitudes around tools like this have evolved as they've gone through their own migration to the cloud journeys, right? We definitely have a lot of customers that, I think, you know, 5, 10 years ago, when they were running entirely on-prem, using a SaaS product would have been a complete non-starter. But as they move into the cloud, both as they kind of generally get more comfortable with the idea of delegating some of these responsibilities, as well as they start to understand kind of, like, the complexity of the tooling required as their environment gets more complex, the value of a dedicated product like something like Datadog as opposed to, you know, what you kind of get out of the box with the cloud providers or what you might kind of build on your own has definitely been interesting. [laughs] VICTORIA: Is there a common point that you find companies get to where they're like, all right, now, I really need something? Can you say a little bit more about, like, what might be going on in the organization at that time? SEAN: You know, I think there could be a few different paths that companies take to it. Some of it, I think, can come from a place of...I think, especially for kind of larger enterprise customers making a transition like that, they tend to be taking a more holistic look at kind of their distinct practices and seeing what they want to change as they move into the cloud. And often, kind of finding an observability vendor is just kind of, like, part of the checklist there. [laughs] Not to dismiss it, but just, like, that seems to be certainly one path into it. I think for smaller customers, or maybe customers that are more, say, cloud-native, I think it can generally be a mix of either hitting a point where they're kind of done with the overhead of trying to maintain their own infrastructure of, like, trying to run their own ELK stack and, like, build all the tooling on top of that, and keeping that up and running, and the costs associated with that. Or, it's potentially seeing the sophistication of tooling that, like, a dedicated provider can afford to invest that realistically, you're never going to invest in on your own, right? Like, stuff like live profiling is deeply non-trivial to implement. [laughs] I think especially once people get some experience with a product like Datadog, they start thinking about, like, okay, how much value are we actually getting out of doing this on our own versus using a more off-the-shelf product? I don't know if we've been doing it post-COVID. But I remember pre-COVID...so Datadog has a huge presence at re:Invent and the other similar major cloud provider things. And I remember for a few years at re:Invent, you know, we obviously had, like, the giant 60x60 booth in the main expo floor, where we were giving demos and whatnot. But they also would have...AWS would do this, like, I think they call it the interactive hall where companies could have, like, more hands-on booths, and you had, like, a whole spectrum of stuff. And there were, like, some companies just had, like, random, like, RC car setups or Lego tables, just stuff like that. But we actually did a setup where there was a booth of, I think, like, six stations. People would step up, and they would race each other to solve a kind of faux incident using Datadog. The person who would solve it first would win a switch. I think we gave away a huge number of switches as part of that, which at first I was like, wow, that seems expensive. [laughs] But then later, you know, I was mostly working the main booth at that re:Invent. So by the, like, Wednesday and Thursday of re:Invent, I'd have people walking up to the main booth being like, "Hey, so I did the thing over at the Aria. And now I installed Datadog in prod last night, and I have questions." I was like, oh, okay. [laughs] So, I think just, like, the power of, like, getting that hands-on time, and using some of the tools, and understanding the difference there is what kind of gets a lot of people to kind of change their mind there. [laughs] VICTORIA: You'd get me with a switch right now. I kind of want one, but I don't want to buy one. SEAN: [laughs] WILL: Same. [laughs] VICTORIA: Because I know it'll take up all my time. SEAN: Uh-huh. That's fair. [laughs] VICTORIA: But I will try to win one at a conference for sure. I think that's true. And it makes sense that because your product is often going with clients that don't have these practices yet, that as soon as you give them exposure to it, you see what you can do with it, that becomes a very powerful selling tool. Like, this is the value of the product, right? [laughs] SEAN: Yeah, there is also something we see, and I think most of our kind of peers in the industry see is, very often, people come in initially looking for and using a single product, like, you know, infrastructure, metrics, or logs. And then, as they see that and see where that touches other parts of the product, their usage kind of grows and expands over time. I would obviously defer to our earnings calls for exact numbers. But generally speaking, more or less kind of half of our new business is usually expanded usage from existing customers as opposed to new customers coming in. So, I think there's also a lot of just kind of organic discovery and building of trust over time that happens there, which is interesting. VICTORIA: One of my favorite points to make, which is that SRE sounds very technical and, like, this really extreme thing. But to make it sound a little more easier, is that it is how you validate that the user experience is what you expect it to be. [laughs] I wonder if you have any other thoughts you want to add to that, just about, like, SRE and user experience and how that all connects for real business value. SEAN: I think a lot of places where, you know, we've both seen internally ourselves and with customers is, you know; obviously, different companies operate in different models and whatnot. Where people have seen success is where, you know, people with formal SRE titles or team names can kind of be coming in as just kind of another perspective on the various kind of things that teams are trying to drive towards. The places reliability is successfully integrated is when they can kind of make that connection that you were talking about. It's, like, obviously, everybody should go take their vitamins, but, like, what actual value is coming from this, right? Nobody wants to have outages, but, like, to do the work to invest in reliability, often, like, it can be hard to say, like, okay, what's the actual difference between before and after? Having people who can help draw those connections and help weigh those trade-offs, I think, can definitely be super helpful. But it is generally much more effective, I think, in my experience, when it does come from that perspective of, like, what value are we providing? What are we trading off as part of this? As opposed to just, well, you should do this because it's the right thing to do, kind of a moralistic perspective. [laughs] But, I don't know, how do you all kind of end up having that conversation with your customers and clients? VICTORIA: That's exactly it. That's the same. It's starting that conversation about, like, well, what happens when this experience fails, which designers don't necessarily think about? What's, like, the most important paths that you want a user to take through your application that we want to make sure works? And when you tie it all back there, I think then when the developers are understanding how to create those metrics and how to understand user behavior, that's when it becomes really powerful so that they're getting the feedback they need to do the right code, and to make the right changes. Versus just going purely on interviews [laughs] and not necessarily, like, understanding behavior within the app. I think that starts to make it clear. SEAN: Part of that, I think that's been an interesting experience for us is also just some of the conversation there around, like, almost the flip side of, when are you investing potentially too much in that, right? Because, like, especially after a certain point, the cost of additional gains grows exponentially, right? Each one of those nines gets more and more expensive. [laughs] And so, having the conversation of, like, do you actually need that level of reliability, or, like, is that...just like what you're saying. Like, you know, kind of giving some of that context and that pressure of, like, yeah, we can do that, but, like, this is what it's going to cost. Is that what you want to be spending your money on? Kind of things can also be an interesting part of that conversation. VICTORIA: That's a really good point that, you know, you can set goals that are too high [laughs] and not necessary. So, it does take a lot of just understanding about your data and your users to know what are acceptable levels of error. I think the other thing that you can think about, too, like, what could happen, and we've seen it happen with some startups, is that, like, something within the app is deeply broken, but you don't know. And you just think that you're not having user engagement, or that users are signing off, or, like, you know, not opening the app after the first day. So, if you don't have any way to really actively monitor it and you're not spending money on an active development team, you can have some method to just be confident that the app is working and to make your life less miserable [laughs] when you have a smaller team supporting, especially if you're trying to really minimize your overhead for running an application. SEAN: Yep. It's surprisingly hard to know when things are broken sometimes. [laughs] VICTORIA: Yes, and then extremely painful when you find out later [laughs] because that's when it's become a real problem, yeah. I wonder, are there any other questions you have for me or for Will? SEAN: How big of an organization is thoughtbot at this time? VICTORIA: Close to 75 people? We're, yeah, between the Americas and the [inaudible 38:31] region. So, that's where we're at right now, yeah. SEAN: Nice. At that size, like, and I guess it sounds like you're pretty heavily distributed, so maybe some of this doesn't happen as much, but, like, one of the things I definitely remember...so, when I joined Datadog, it was probably about 500 people. And I think we're just under 5,000 now. There are definitely some points where there were surprisingly, like, physical aspects to where it became a problem of just, like, where certain teams didn't fit into a room anymore. [laughs] Like, I had surprise in the changes in that, like, dynamic. I'm curious if you've all kind of run into any kind of, I don't know, similar interesting thresholds or changes as you've kind of grown and evolved. WILL: I will say this, we're about 100, I think, Victoria. VICTORIA: Oh, okay, we're 100 people. I think, you know, I've only been at thoughtbot for just over a year now. And my understanding of the history is that when we were growing before COVID, there's always been a very intentionality about growth. And there was never a goal to get to a huge size or to really grow beyond just, like, a steady, profitable growth. [laughs] So, when we were growing in person, there were new offices being stood up. So, we, you know, maybe started out of New York and Boston and grew to London. And then, there was Texas, and I think a few other ones that started. Then with COVID, the decision was made to go fully remote, and I think that's opened up a lot of opportunities for us. And from my understanding in the previous and the past, is that there's a big shift to be fully remote. It's been challenging, where I think a lot of people miss some of the in-person days, and I'm sure it's definitely lonely working remote all day by yourself. So, you have to really proactively find opportunities to see other people and to engage remotely. But I think also, we hire people from so many different places and so much different talent, and then, also, you know, better informs our products and creates a different, you know, energy within the company that I think is really fun and really exciting for us now. WILL: Yeah, I would agree with that because I think the team that I'm on has about 26 people on the Lift Off team. And we're constantly thinking of new ways to get everyone involved. But as a developer, me myself being remote, I love talking to people. So, I try to be proactive and, like, connect with the people I'm working with and say, "Hey, how can I help you with this?" Let's jump in this room and just work together, chat together, and stuff like that, so... And it has opened the door because the current project that I'm on, I would never have had an opportunity to be on. I think it's based in Utah, and I'm in South Florida. So, there's just no way if we weren't remote that I'd been a part of it. So... SEAN: Nice. And I can definitely appreciate that. I remember when we first started COVID lockdown; I think, at that point, Datadog was probably about...Datadog engineering was probably about 30% remote, so certainly a significant remote contingent but mixed. But my teams were pretty remote-heavy. So, in some ways, not a lot changed, right? Like, I think more people on my team were, like, who are all these other people in my house now instead of [laughs], I mean, just transition from being in an office to working from home. But I do remember maybe, like, about six months in, starting to feel, yeah, some of the loneliness and the separation of just, like, not being able to do, like, quarterly team meetups or stuff like that. So, it's definitely been an interesting transition. For context, at this point, we kind of have a hybrid setup. So, we still have a significant kind of full-time remote contingent, and then four people who are in office locations, people joining for about three days a week in office. So, it's definitely an interesting transition and an interesting new world. [laughs] VICTORIA: Yeah. And I'm curious how you find the tech scene in Denver versus New York or if you're engaging in the community in the same way since you moved. SEAN: There definitely is some weirdness since COVID started [laughs] broadly [inaudible 42:21]. So, I moved here in 2020. But I'd been coming out here a lot before that. I helped to build an office here with Bitly. So, I was probably coming out once a quarter for a bunch of years. So, one parallel that is finally similar is, like, in both places, it is a small world. It doesn't take that long for you to be in that community, in either of those communities and start running into the same people in different places. So, that's always been [inaudible 42:42] and especially in New York. New York is a city of what? 8, 9 million people? But once you're working in New York tech for a few years and you go into some meetups, you start running into the same people, and you have one or two degrees [inaudible 42:52] to a lot of people, surprisingly quickly. [laughs] So, that's similar. But Denver probably is interesting in that it's definitely transplant-heavy. I think Denver tends to check the box for, like, it was part of why Bitly opened an office here and, to a degree, Datadog as well. I think of like, you know, if you're trying to recruit people and you previously were mostly recruiting in, like, New York or Silicon Valley; if you're based in New York, and you're trying to recruit somebody from Silicon Valley, and part of why they're looking for a new gig is they're burned out on Silicon Valley, asking them to move to New York probably isn't all that attractive. [laughs] But Denver is different enough in that in terms of kind of being a smaller city, easier access to nature, a bunch of that kind of stuff, that a lot of times we were able to attract talent that was a much more appealing prospect. [laughs] You'll see an interesting mix of industries here. One of the bigger things here is there's a very large government and DOD presence here. I remember I went to DevOps Days Rockies, I think, a few years ago. There was a Birds of a Feather session on trying to apply DevOps principles in air-gapped networks. That was a very interesting conversation. [laughs] VICTORIA: That's interesting. I would not have thought Colorado would be a big hub for federal technology. But there you go, it's everywhere. WILL: Yeah. SEAN: Denver metro, I think, is actually the largest presence of federal offices outside of the D.C. metro. VICTORIA: That's interesting. Yeah, I'm used to trying to recruit people into D.C., and so, it's definitely not the good weather, [laughs], not a good argument in my favor. So, I just wanted to give you a final chance. Anything else you'd like to promote, Sean? SEAN: Generally, not super active on social things these days, but you can find whatever I have done at seanoc.com, S-E–A-N-O-C.com for the spelling. And otherwise, if you're interested in some engineering content and hearing about some of those kind of bleeding edge challenges that I was mentioning before, I would definitely check out the Datadog engineering blog. There's lots of kind of really interesting content there on both, you know, things we've learned from incidents and interesting projects that we're working on. There's all kinds of fun stuff there. VICTORIA: That makes me think I should have asked you more questions, Sean. [laughs] No, I think it was great. Thank you so much for joining us today. I'll definitely check all that stuff out. You can subscribe to the show and find notes along with a complete transcript for this episode at giantrobots.fm. If you have questions or comments, email us at hosts@giantrobots.fm. You can find me on Twitter @victori_ousg. WILL: And you can find me on Twitter @will23larry. This podcast is brought to you by thoughtbot and produced and edited by Mandy Moore. Thanks for listening. See you next time. ANNOUNCER: This podcast is brought to you by thoughtbot, your expert strategy, design, development, and product management partner. We bring digital products from idea to success and teach you how because we care. Learn more at thoughtbot.com. Special Guest: Sean O'Connor.
CMS has notified around 612,000 Medicare beneficiaries whose information may have been affected in a data breach this spring. CMMI will pilot a care model for people with dementia and their caregivers. And, Amazon expands its direct-to-consumer telehealth clinic to all 50 states. That's coming up on today's episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.
In this episode Chess Vice President of value-based operations, Josh Vire, has a conversation with JP Sharp, one of the original architects of the Next Gen ACO model at CMMI and current Chief Growth Officer at Rippl Care, about what it was like at the infancy of the value movement. JP Sharp welcome to the move to value podcastThanks! pleasure to be here! I want to start you have had an interesting path in getting into the healthcare you are a lawyer by training, and you earned your JD from the University of Michigan also received your Master of Public Health from there as well was there a particular moment or experience that got you interested in in healthcare and moving away from the law? Yeah, excellent question. I won't pretend to give universal career advice on how to go about this, so I could tell a little bit about how I got started, which is I went into law school kind of with healthcare in mind. I have a healthcare family from different angles, a veterinarian, oral surgeon, and a pathologist all kind of in the in the family. And I was a little bit of the black sheep and didn't go in directly into the clinical side of things but was still fascinated by it and also just the complexity of it. So, as I was thinking about you know grad school that's when the ACA passed and lots of effort and attention on that unique window of opportunity there. So, I went in thinking I hey let's be a lawyer for a little bit and focus on healthcare and then see what happens. And the see what happens happened most sooner while I was in school and just realizing that great experience, but I wanted to start doing things and being part of this transformation sooner rather than later. So that's kind of where I took that turn to say alright how do I get on the front lines and really start being an actor in this space.That's great. Interesting to sort of hear your thought process there and glad you moved over to healthcare. You've had an expensive career been in a number of places including CMMI, Blue Cross Blue Shield, Optum, recently you've moved over to the provider side of the house. But I'd like to start with your time at CMS. You were there in the in the early days of CMMI and payment transformation and redesign, tell us a little bit what was that experience like being there in those early days?Yeah, it was a lot of fun it was pretty unique. Some people described CMMI as the little innovation group inside you know the government bureaucracy, and a little start up inside the government and it's actually like that both with the people, the mission, and mostly like how we worked physically. It was set in a separate building which, one of those like nondescript you don't know it's a government building from the outside, but you know inside they'd like colored it you know bright colors and had treadmill desks and stuff and so it was like they set it up to actually be a little bit more exciting. And they brought in people who otherwise probably weren't going to be super attracted to government jobs like that you stereotypically think of, you know the bureaucratic of regular day-to-day stuff, but they're able to because of the mission here and the attention that this is getting is just a major off opportunity and moments in healthcare transformation. They brought in people of all walks of life and different backgrounds. So, we had people with Health Sciences, health services researchers with pH D's and MD's and MBAs and MPHs and a few folks with like me with random other degrees just all like get around the table and figure things out from end to end. And so, it was really just like a very mission...
In June, the Centers for Medicare & Medicaid Services (CMS) announced a new primary care model – the Making Care Primary (MCP) Model – that will be tested under the Center for Medicare and Medicaid Innovation in eight states. We welcome CMS Deputy Administrator and Center for Medicare and Medicaid Innovation Director Dr. Liz Fowler to discuss the Making Care Primary Model, the process in developing the model, and it's connections with health equity.
In this episode, I sat down with Dawn Alley, President of Decision Support at Carebridge, a company that works with health plans and states to care for individuals receiving long-term support services. Prior to joining Carebridge, Dawn spent about a decade working in the federal government as Chief Strategy Officer at the Centers for Medicare and Medicaid Innovation (CMMI), and before that as Deputy Senior Advisor for Value-based Transformation at HHS. Dawn and I discuss: The main initiatives she worked on at CMMI including the Accountable Health Communities Model and Medicare Diabetes Prevention Program Lessons learned during her tenure about implementing and delivering healthcare models at scale Why Dawn is excited about the future of long-term care services and why she believes in Carebridge's model
Value-based care has emerged as an alternative and potential replacement for traditional fee-for-service reimbursement, centering quality and outcomes rather than quantity. That is the theory. In practice, value-based care has been shown to exacerbate some disparities in the healthcare system by making it harder for those patients with complex conditions, or being impacted by social determinants of health, to access care. Put simply, if some categories of patient are more financially risky than others to treat, providers may find ways to exclude them – unless checks and balances are put in place to help manage risks associated with SDOH and comorbid conditions. Health policy expert Matt Reiter hosts a discussion featuring Bill Finerfrock from Capitol Associates, and Tom Dorney from The Root Cause Coaltion. Together they discuss the very real danger of widening health disparities resulting from the expansion of value-based care, and the legislative solution proposed by the John Lewis EMMT Act (Equality in Medicare and Medicaid Treatment) which has been reintroduced in 2023 by Rep. Teri Sewell and Sen. Cory Booker. All organizations advocating for health equity are encouraged to help advance the legislation by writing letters of support (template below) to Matt Reiter reiterm@capitolassociates.com who will coordinate their forwarding to Representative Sewell and Senator Booker. ------------------------------ LETTER OF SUPPORT TEMPLATE Dear Representative Sewell & Senator Booker, I am writing in support of S.1296/H.R.3069, the John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act of 2023. The EMMT Act would require the Center for Medicare and Medicaid Innovation (CMMI) to include experts in health disparities and social determinants of health as part of the evaluation and review process for new payment models. If enacted, this bill would also require fairness of these new payment methods for women, high-risk patients, patients from racial or ethnic minorities, or patients from rural communities. Lastly, it directs CMMI to develop and test a payment model that is tailored to addressing social determinants of health. While quality and cost are important considerations, equal consideration should be given to the impact a proposed model may have on access to care for women, minorities and beneficiaries residing in rural areas. CMMI is under no statutory obligation to account for social determinants of health when considering new payment models. Indeed, the only factors CMMI must consider when determining whether to approve a new payment model are quality and cost. Because Medicare is the single largest health care payer in the country, and many commercial insurance plans will adopt policies based on Medicare, Congress must ensure that the models approved by CMMI incentivize reductions in minority and rural health disparities and not create barriers to care. We appreciate all that this CMS Administration has done to advance health equity. Passing the EMMT Act will ensure that all new models account for social determinants of health and how the models impact minority and rural populations. Your leadership on eliminating health disparities for women, minorities and beneficiaries residing in rural areas is deeply appreciated. I applaud your leadership on this important bill. The EMMT Act will go a long way towards improving access to quality healthcare for Medicare and Medicaid beneficiaries. On behalf or our organization: Sincerely, ------------------------------ Health Disparities Podcast Episode 143 (c) Movement is Life 2023
In this episode, Josh and Brian hand over the mic to Aledade's Chief Policy Officer, Sean Cavanaugh, a former Director of Medicare and senior leader at the Center for Medicare and Medicaid Innovation (CMMI) as he talks with the two current leaders of his former offices. Sean is joined by Meena Seshamani, M.D., Ph.D., Deputy Administrator and Director for the Center for Medicare, and Elizabeth Fowler, Ph.D., J.D., Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation (CMMI). Directors Seshamani and Fowler discuss how they view their centers and how they're united by one common strategic vision.
In this episode, I sat down with Dr. Bassem Mikhael, SVP, of the Clinical Enterprise at Somatus. Started in 2016 by Dr. Ikenna Okezie, Somatus partners with clinicians, health plans, health systems, and multi-disciplinary community-based care teams to improve health, quality of life, and cost of care for patients with kidney disease. Somatus employs over 1,450 team members and serves more than 150,000 patients across 36 states. Dr. Mikhael and I discuss: 1) The vital role that kidneys play in maintaining health, the issues that arise from diseased kidneys, and how these challenges translate into per patient costs that are 10x higher, on average, than those for patients without kidney disease, 2) The traditional model for treating patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) and how Somatus' model realigns incentives to focus on integrated, preventative, and patient-centered care, 3) Why the federal government, CMS, and CMMI have prioritized investments in kidney care and what we've learned from their initiatives and care model tests, and 4) Clinical innovations that make Dr. Mikhael optimistic about the future for patients living with kidney disease.
For all of you leaders out there on a value-based care journey, it is not lost on any of you that health value has become synonymous with health equity. We are at an inflection point in our society in the recognition that everyone needs a fair and just opportunity to attain their highest level of health. Achieving this will require ongoing societal efforts to address injustice, overcoming socioeconomic barriers to health, and eliminating preventable health disparities. But we cannot do that as a healthcare industry without the proliferation and scale of payment models that align incentives so we can realize true change for the better. On the Race to Value this week, you will hear from one of the foremost leaders on the national scene who is shaping the landscape for accountable care delivery that can advances health equity. Dr. Dora Hughes is someone who has taken this charge to lead in service to the underserved so that we may realize the dream of a more equitable and healthy society. She is the chief medical officer at the CMS Innovation Center at the Centers for Medicare & Medicaid Services (otherwise known as CMMI). She leads the Center's work on health equity, provides clinical leadership and input on models, serves as the Innovation Center's primary liaison with medical and clinical stakeholders, and provides leadership to the Innovation Center's clinician community. In addition, Dr. Hughes is part of the CMS Innovation Center's Senior Leadership Team, helping to provide enterprise-level leadership and strategic direction to the Center. In this interview, we discuss the elevated national consciousness to advance health equity, how ACOs and other risk bearing entities can succeed with a health equity strategy, and the work being done by the Innovation Center to redesign alternative payment models for equity. We spend considerable time discussing ACO REACH and value-based Medicaid transformation as well. This is certainly a conversation you should listen to as you plan for success in your Race to Value! Episode Bookmarks: 01:30 Health Value has become synonymous with Health Equity -- everyone needs a fair and just opportunity to attain their highest level of health. 02:30 Introduction to Dora Hughes, M.D., M.P.H., the chief medical officer at the CMS Innovation Center (CMMI) 04:30 If you control for all variables that may contribute to health disparities, African Americans still get the worst quality of healthcare of any demographic in the country. 05:30 The first pillar of CMS' Strategy Plan is Health Equity 06:30 Cara James, Ph.D., president and CEO of Grantmakers in Health: "I'm someone who's working on equity before it became cool to work on equity." 07:00 Referencing the seminal findings of the Heckler Report in the 1980s that investigated racial and ethnic disparities in the United States. 08:00 Momentum has been building towards addressing health inequities, despite the historical lack of national prioritization. 08:30 “It really took the pandemic and police brutality to blast the issues of health inequities into the national consciousness.” 09:00 Disparities go beyond COVID (e.g. black disparities in maternal health, colorectal cancer, kidney disease) 09:45 “Executive pay is now being tied to reduction in disparities. You wouldn't have heard that 10 years ago or even perhaps five years ago.” 10:00 Referencing CCSQ Deputy Jean Moody-Williams: "For those of us engaged in health equity, this is our moment, but it is only a moment." 10:30 Actions Needed: collecting and analyzing demographic and health data, knowing patients individually and at the population level, identifying disparities, implementing evidence-based interventions. 11:45 “It takes vibrancy, resiliency, and an indomitable spirit to tackle disparities and scale progress at a national level.” 13:00 CMMI's work to address Social Determinants of Health (SDOH), e.g. ACOs, Accountable Health Communities (AHC) Model
We got two new reviews this week on the podcast, which I was thrilled to see. The first was from, it turns out, Dave Chase from Health Rosetta, who wrote that “with so many people in healthcare practicing ‘innovation theater' and bloviating versus driving real change, it's a breath of fresh air to listen to Relentless Health Value.” Thank you so much for saying that, Dave. We try really hard to get guests who are actually doing great things such as yourself. And then there's another review from mattiw2002, who says, “For anyone trying to stay abreast of developments in the healthcare space, there's none better than … Relentless Health Value.” Thank you so much to the two of you who took the time to write a review—could not appreciate it more. There have been two inbetweenisodes this year where I get deep into the why behind the “why collaborate.” And when I say collaborate, what I mean is anybody in the healthcare industry working together with and for the patients that we're supposed to be serving here. It's creating alignment amongst stakeholders around what's best for the patient. Here is the nutshell version of the two previous shows. First point: Patients fall into one care gap after another. You hear this from any PCP you talk to who's working in a care setting when there's little, if any, collaboration effort on the front end to ensure a non-fragmented patient journey. So then, all these care gaps wind up getting surfaced, which, by the way—let's not forget this—these care gaps were there all along negatively affecting patient outcomes. It's just, in the past, we didn't know about them. But now that we know about them, it becomes the fee-for-service PCPs' job to mop up all the care gaps while the faucet is still running. So, that's the situation analysis, and if we're going to put an end to this, it means that payers have to align with providers and give enough incentive for those providers to create a non-fragmented patient journey (ie, making sure that the care gaps don't happen to begin with). This also means providers need to talk amongst themselves and collaborate. Keep in mind that a multi-morbid Medicare patient sees something like 5 to 13 doctors, on average, depending on what study you look at … 13! If anybody thinks that a patient can see 13 doctors not collaborating with each other and coordinating care and not wind up with some polypharmacy adverse event or materially conflicting advice … I don't know. Call me. I just do not understand how consistent excellence in patient outcomes or patient care even could be achieved. That whole cliché the left hand doesn't know what the right hand is doing? That's a cliché for a reason, and I seriously suspect the entire field of medicine isn't weirdly excluded from it. So, first point: Collaboration/alignment is required amongst healthcare stakeholders for patients to get decent outcomes, especially patients with multiple chronic conditions. Payers gotta pay for the right stuff, and providers have to coordinate care. Otherwise, you wind up with all of the care gaps that PCPs currently working in systems with fragmented patient journeys are seeing. Here's the second point from earlier episodes: Financial toxicity is clinical toxicity. Patients are forgoing care they need and not taking drugs they need because they cannot afford them. This is not speculation. Trilliant Health just released a report that showed this. Healthcare utilization, if you subtract COVID care and behavioral health, might be permanently down. Other reports speculated that by 2030, a leading cause of death might be nonadherence due to cost concerns. Wayne Jenkins, MD, in episode 358, talks about a whole constellation of negative effects when patients can't afford care; and yeah … here we are. Patients cannot afford their care. They cannot afford premiums, deductibles, out-of-pockets. These are insured patients a lot of times we're talking about here. Also, this is not a “Medicaid” problem, as Dan Mendelson put in episode 385. So, go back and listen to the earlier shows for the who and the what and the why of the above and much more context; but nothing I've just said is stuff that I personally would regard as my personal opinion. There is one study after another that bears all this out. There is just one anecdote after another. Fragmented patient care and care that is way more expensive than a patient can afford is going to result in outcomes that are not, let's just say, super. Alright, all of this being said, does then aligning payers and providers, and providers collaborating with each other and coordinating care … if these things are done, do patient outcomes improve? Do care gaps reduce? Are patients more satisfied with their care? Said another way, when physician practices get paid to deliver health and not paid for sick care, does patient health actually improve? Why, yes. Yes, it does. Why do I say this? First of all, this very much seems to be the conclusion of CMS. Here's from the Center for Medicare & Medicaid Innovation (CMMI). They released a report updating their strategic vision for implementing value-based care. One of the key new strategies focuses on creating greater care coordination between primary care doctors and specialists. What might be some of the success stories that precipitated the CMMI focusing their strategy on exactly what I've been running around squawking about for one to three years now? The ChenMed Case Study: ChenMed focuses on the most vulnerable patients and dramatically improves access for those patients, which has led to a 30% to 50% reduction in hospitalizations. They published there's been a 20% to 30% reduction of stroke. They've doubled six-month cancer survival rates and, in some cases, reduced heart failure readmissions by 50%, 70%, up to 90%. They see evidence that they are extending lives five or more years. How? By the providers being aligned with the payers and then also making sure that there is very coordinated care going on there. Johns Hopkins has a paper in JAMA that concluded that a care coordination model can be associated with improved outcomes, including substantial cost reduction. I was talking to Larry Bauer from FMEC, the Family Medicine Education Consortium; and he sent me probably a 40-page PDF of really great patient results when care is coordinated and payers are aligned to pay for health. As just one example, Dr. Daniel Hoefer from Sharp HealthCare, they have created what they call their Transitions program. And the idea is by moving aggressive care upstream via community-based palliative medicine, they have proven that the vast majority of people never need to see the inside of a hospital during the last year-ish of their life. The revolving door of hospitalization should be considered an archaic residual of a bygone era, as they put it. Again, this is very well-coordinated care with payer alignment. Do patients actually want this stuff? Before I get into our evidence here, just let me remind you that Kaiser is a payvider with a narrow network and also that Centivo is an innovative TPA (third-party administrator) pulling together narrow networks. On the podcast the other week, Dan Mendelson (EP385) from Morgan Health said that 40% of new employees are choosing lower-premium plans with either Kaiser or Centivo benefit designs. They are choosing lower-cost plans just as much for the lower premiums as for the care coordination and the “I don't want anybody between me and my doctor” messages. This is what happens when payers and providers are aligned. Nobody gets in the middle there. Heard a similar story from Nick Stefanizzi (EP383) from Northwell Direct. They're doing direct contracting with customers like Whole Foods. Everybody I talk to here is surprised how many employees are electing these kinds of plans. So, yeah … The Nuka System of Care in Alaska (EP312), where I get into this with Doug Eby, MD, MPH, CPE, in great detail. But wow, just wow there. With the Nuka ecosystem, they went from basically a failing mess into the health system that many consider to be the best or one of the best in the country at something like half the price per patient than in mainland US. They have this whole thing where they integrate specialty care into primary care. They have established an agreed-upon referral patterns and also an agreed-upon way to work with specialists that very much involves PCPs talking to specialists so that the whole person, the whole patient can be considered. They structure their whole program around paying for health and getting paid for health. Also, Nuka has a 96% patient satisfaction rate. So again, patients are certainly on board with this. If I was gonna sum up these five examples, I would certainly say that any physician practices looking to take better care of patients, rediscover clinical excellence and focus … get aligned with payers (CMS or otherwise). That's step one and certainly easier said than done. After that, work to collaborate with fellow providers. All of these entities that we just talked about who can brag about their patient outcomes and care quality are doing both of the stuff that we just talked about: aligning and collaborating with payers and other providers. They are also, at the same time, folding three other things into their strategy. And this other stuff is required because you kinda can't align with payers and you can't collaborate unless you're doing these three things at the same time: standardizing best-practice care, getting and using data, and using good technology in conjunction with that data. All of this in the service of this last thing, which is turning transactions into relationships. Human relationships. Relationships with patients. As Rebecca Etz, PhD, and her team at The Larry A. Green Center have shown quite crisply (discussed in episode 295), no relationship with a patient means worse outcomes for patients. End of sentence. But then there's also having relationships with colleagues and relationships with other docs who have patients in common. It is really tough to coordinate care without relationships, and it's also not very fulfilling. Alright, moving on to another question: Are doctors happy in these models where payers are paying for health and where it's a must-have to coordinate across the continuum of care? Well, I can tell you a couple of things. ChenMed has been named to Newsweek's “Most Loved Workplaces” list. Nuka System has a 93% employee satisfaction rating. Considering that elsewhere one out of two family practice docs are burned out, this is pretty striking in contrast. Also, here's another quote from a physician leader about good accountable care where health is being paid for. He said, “This has changed our physicians' lives … the idea that we can get paid to actually take care of people. To actually have data to send people to the best for follow-up care, who we know will continue and contribute to the patients' well-being in the same way. Burnout reduces here because burnout is moral injury in a cheap Halloween costume.” I'm really sorry I can't remember who said that because it's a great quote and so true. Larry Bauer from FMEC also told me the other day that DPC (Direct Primary Care) conferences have never had a session on burnout. Larry says he tells people if they want to see what 350 happy primary care docs look like, they need to come to a DPC summit. They're happy as clams. Now, while DPC isn't the “be entirely responsible for downstream costs” kind of accountable care, what is going on in DPC is, these docs are accountable to their patients and for the care that they are providing. Here's another anecdote which I think, in sum, adds up to a “yes” if the question is “Do docs really like this stuff?” I had a long conversation with Scott Conard, MD, the other day about his work with clinics in Queens. What I learned was, these clinics, they used to have waiting rooms overflowing with patients who had been waiting the entire day to be seen and just ... it wasn't good for anybody. Fast-forward a few years—high-risk patients get seen fast, and there's time for care coordination. Patients are happy; outcomes are better. But here is why I inferred that the docs are happy in this model: There was a new office manager. New office manager starts trying to go back to the old way, the “normal” way that practices are run. And it was mutiny on the bounty. No way no how were those docs going back. I took that as a pretty solid testimonial if I ever heard one. So, I don't know if anybody has done any sort of global physician satisfaction studies to determine if physicians who are in pay-for-health models where they're collaborating with one another are happier and less burned out than doctors in the current fee-for-service (FFS) environment. But I can tell you that if somebody did do this, there's gonna be one really big confounding factor … and this is what it is: There's a world of difference between a well-functioning accountable care model and a very terrible one. I have had a series of (as I said earlier) pretty heartbreaking, honestly, conversations with PCPs around the country who think value-based care pretty much sucks. For the big why on this, listen to the show with Dan O'Neill (EP359). But in short, in “not quite there yet” value-based care models, one's still in the two canoes messy middle (ie, they've got one foot in the value-based care world and one foot firmly in the FFS world). Life can get really hard for PCPs especially because they get the worst of both. They get to be care gap cowboys and cowgirls while, at the same time, having to do all of the FFS coding; and they still have seven-minute visits and RVU targets. There's not really great population health. Nobody's figured out how to defragment the care journey. And then there's the whole measurement industrial complex that gets piled on top of their day. I cannot stress this enough. Alright, so let's just check off our last big question here for the money motivated. This especially comes up when talking with especially specialists, who are doing very well, thank you very much—financially, I mean—in the current FFS status quo. So, let's not avoid the elephant in the room. Is taking on risk, getting paid for value, being accountable to deliver great results, deliver health … is it worth it from a financial standpoint? Alright, let's take a look at this. Here's from show 343 with David Carmouche, MD, when he was at Ochsner. He said, “Anything that we can do to convert the effective reimbursement in the Medicare space to something greater than Medicare fee-for-service rates, we think that this is in our best interest. So, we have gone very heavy into moving as much of our Medicare business into risk as we can. And we will take full capitation under a couple of Medicare advantage contracts.” So, that includes primary care as well as specialist care. Let's talk about One Medical for a moment. Five percent of One Medical members account for 51% of the company's revenue. You know which 5% account for that 51% of revenue? Right, the at-risk ones that are part of the Iora value-based medical group with a capitated model. That is a pretty strong financial endorsement there. There's a whole show with Brian Klepper, PhD (EP335), about why private equity is willing to pay $55,000 per patient in a capitated model. So, some actuaries somewhere think this is a very financially sound way to go. I am not sure if I would die on this hill, but I'd also say there's likely a downside to making zero effort on the accountable care front and banking on FFS being a forever cash cow. Everything I've just said, not a secret. Not at all. You see CMS moving in the “making providers accountable” direction. I already mentioned this and what CMMI is up to. But this is very much an overall strategy. Currently, 44% of traditional Medicare beneficiaries with parts A and B are in a care relationship with some accountability for quality and total cost of care. CMS aims to boost that number to 60% by 2024 and 100% by 2030. In sum across the industry, it looks like 19.6% of healthcare payments were risk-based in APMs (Alternative Payment Models) that include upside and downside. This is a couple points higher than in 2020, but it's not like it's skyrocketing. So, that might be a curb to our enthusiasm. However, in 2022 here, looking forward to 2023, you know who besides CMS is going heavy on trying to pay for health and not sick care? I have never seen my entire career more CEOs of Fortune 500 companies—CEOs!—who are actively taking a role in their employee health benefits. I think it's because they can't afford not to at this point. Again, financial toxicity is very, very real for employed individuals. Here's something that Jeff Hogan called out from a McKinsey report: “VBC [value-based care] models that show promise in the employer context include high-performance provider networks with cost- and quality-based metrics, episode-based payments for standardized patient-care journeys … , and risk-based contracts for end-to-end management of high-cost conditions.” You know what all those things have in common that I just rattled off? Only high-performing docs are in network—and this includes specialists. I say all this to say, I don't know, if I were a practitioner of healthcare and I knew that all this data was floating around about my practice patterns and given that doctors that don't perform well as per that data are being excluded from networks … I don't know, just given all of the signs that are pointing in a risk-based direction, learning to take on risk just seems like—I was never a Boy Scout, but the whole “Be prepared” seems pretty sound advice right now, especially given how long it takes to get good at this. For more information, go to aventriahealth.com. To listen to the playlist of the mentioned episodes, click here. 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. 05:03 When physician practices get paid to deliver health and not paid for sick care, does patient health actually improve? 05:46 What is the ChenMed Case Study? 06:26 Can a care coordination model be associated with improved outcomes, including substantial cost reduction? 06:38 Are there examples of really great patient results when care is coordinated and payers are aligned to pay for health? 07:29 Do patients actually want this stuff? 07:46 Are employees choosing lower-cost plans just as much for the lower premiums as for the care coordination and the “I don't want anybody between me and my doctor” messages? 08:29 What is the Nuka System of Care in Alaska? 09:25 “I would certainly say that any physician practices looking to take better care of patients, rediscover clinical excellence and focus … get aligned with payers (CMS or otherwise). That's step one and certainly easier said than done.” 10:45 Are doctors happy in these models where payers are paying for health and where it's a must-have to coordinate across the continuum of care? 11:16 “This has changed our physicians' lives … the idea that we can get paid to actually take care of people. To actually have data to send people to the best for follow-up care, who we know will continue and contribute to the patients' well-being in the same way. Burnout reduces here because burnout is moral injury in a cheap Halloween costume.” —Physician leader 13:25 “There's a world of difference between a well-functioning accountable care model and a very terrible one.” 13:59 “Life can get really hard for PCPs especially because they get the worst of both. They get to be care gap cowboys and cowgirls while, at the same time, having to do all of the FFS coding; and they still have seven-minute visits and RVU targets.” 14:43 Is taking on risk worth it from a financial standpoint? 16:05 “There's likely a downside to making zero effort on the accountable care front and banking on FFS being a forever cash cow.” 17:11 “I have never seen my entire career more CEOs of Fortune 500 companies—CEOs!—who are actively taking a role in their employee health benefits. I think it's because they can't afford not to at this point. Again, financial toxicity is very, very real for employed individuals.” 17:54 “Only high-performing docs are in network—and this includes specialists.” For more information, go to aventriahealth.com. To listen to the playlist of the mentioned episodes, click here. Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast When physician practices get paid to deliver health and not paid for sick care, does patient health actually improve? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast What is the ChenMed Case Study? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Can a care coordination model be associated with improved outcomes, including substantial cost reduction? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Are there examples of really great patient results when care is coordinated and payers are aligned to pay for health? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Do patients actually want this stuff? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Are employees choosing lower-cost plans just as much for the lower premiums as for the care coordination and the “I don't want anybody between me and my doctor” messages? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast What is the Nuka System of Care in Alaska? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast “Are doctors happy in these models where payers are paying for health and where it's a must-have to coordinate across the continuum of care?” Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast “There's a world of difference between a well-functioning accountable care model and a very terrible one.” Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Is taking on risk worth it from a financial standpoint? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast “There's likely a downside to making zero effort on the accountable care front and banking on FFS being a forever cash cow.” Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast “Only high-performing docs are in network—and this includes specialists.” Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Recent past interviews: Click a guest's name for their latest RHV episode! Dr Eric Bricker (Encore! EP351), Al Lewis, Dan Mendelson, 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
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