Podcasts about coordinated care

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In this two-part episode, Jonathan Fish, MD, with Cohen Children's Medical Center and Joanna Pierro, DO, with Staten Island University Hospital discuss the transformative impact of a streamlined referral process to simplify setting up consultations for HCT and cell therapy. In Part I: Overcoming Barriers through Coordinated Care, guests explore how this simple system created using RedCap software can help overcome logistical barriers and enhance coordinated care through a single point of entry for referrals. To read bios on the panelists and to access additional resources related to this episode, visit Our Site. 

In this episode of Inside Health Care, we present two interviews that each ask really basic, yet complex, questions about health care.The first question: Why is it so hard to develop a health care coordinator service for patients at the local level? It's something most of us could use: a helper to walk with us through a health journey, advise us in a crisis and make sure we get all the tests and records we should have.Taylor Justice is a U.S. Army veteran and co-founder of Unite Us. Unite Us provides end-to-end solutions that establish a new standard of care that identifies and predicts social care needs in communities, helps enroll people in services and leverages meaningful outcomes data to drive community investment. With services extending to at least 44 U.S. states, Unite Us creates accountable coordinated-care networks, interconnecting providers of social services to reduce the cost of care by integrating ALL social determinants of health.The other question: Why are patient alcohol and substance use issues so often overlooked in primary care? This interview will not only answer that question: it will point patients and providers in the right direction: toward adoption of universal alcohol screening and follow-up. Three experts remind us that there is help to implement evidence-based alcohol health care—free resources from NCQA and the National Institute on Alcohol Abuse and Alcoholism [NIAAA].At NCQA's second annual Health Innovation Summit, we interviewed Dr. Thekla Brumder-Ross, Dr. Katharine Bradley and Dr. Laura Kwako.Dr. Thekla Brumder-Ross is a clinical psychologist and national leader of addiction medicine. In her 14 years at Kaiser Permanente, Thekla led and implemented large-scale practices and policies in addiction medicine, treatment protocols and primary care behavioral health integration. Notably, she led the addiction medicine leaders of operations and research across the Kaiser Permanente Enterprise, facilitated the spread of the “screening, intervention and referral to treatment” methodology known as “Alcohol as a Vital Sign” across eight Kaiser markets, and developed a national “harm reduction” strategy. Thekla currently provides strategic consultation to the NIAAA.Dr. Laura Kwako is chief of the Treatment, Health Services, & Recovery Branch in the Division of Treatment and Recovery at the NIAAA. Her office supports research in broad categories, including behavioral health treatments, translational research and innovative methods and technologies across the continuum of care.Her work also focuses on under-served populations, including NIH-designated health disparity populations, individuals with co-occurring disorders and fetal alcohol spectrum disorders. During her time at NIAAA, Laura has been involved in development of the Healthcare Professional's Core Resource on Alcohol and the Addictions Neuro-clinical Assessment. She received her PhD in Clinical Psychology from Catholic University in Washington, DC.Dr. Katharine Bradley is a primary care general internist, and her research on unhealthy alcohol use and opioid use disorder has included developing trials of implementation of alcohol screening, brief interventions and shared decision making for alcohol use disorder across primary care clinics. She recently received NIAAA funding for the SIP trial, the full title of which is Systematic Implementation of Patient-Centered Care for Alcohol Use Trial: Beyond Referral to Treatment.Drs. Brumder-Ross, Kwako and Bradley collectively strive to link substance use disorders and treatment to behavioral health, which they see as just one part of a “whole health” approach to clinical medicine. We discussed some amazing tools now available to incorporate screenings for alcohol or drug use into mainstream primary care assessments. And those tools, by the way, take advantage of NCQA HEDIS measures. But let's hear it from them.Some resources discussed in this interview:The NIAAA Alcohol Healthcare Roadmap: A simple workflow that plans and providers can adaptHealth plans can adopt the NCQA HEDIS measure on Alcohol Screening and Follow Up – now publicly reportable, bringing potential financial incentives to health plansImplementation guides available in Core Additional LinksNCQA resources for patient screeningFree training from NIH: NIAAA's Healthcare Professional's Core Resource on Alcohol

Here's why I think this interview with Justina Lehman is different. We get into the actual whys and how-tos of trying to be specialists, like an OB/GYN or an orthopedic practice that offers coordinated care … AND gets paid to do so. There's so many conversations that transpire at the 50,000-foot level. This one is far closer to the ground. And if you want an even deeper dive on this topic, go back and listen to the episode with Steve Schutzer, MD (EP294). There are so many who put financial growth and doing “value-based” coordinating care kinds of things at a counterpoint. Like, “Oh, boy … we need to make some money this quarter, so let's put all the VBC [value-based care] stuff on the back burner.” The point that Justina Lehman makes, both implicitly and also explicitly, is that doing the right things for patients, things we know are going to improve patient outcomes … doing these right things can also be a growth strategy. And I don't just mean offering access and convenience. I mean also doing things that defragment care and coordinating it—things that will truly drive better chronic disease outcomes. This is what we talk about exactly and specifically in this healthcare podcast: How do practices work alone or band together into a kind of “value alliance,” I'll call it, to both improve patient care AND make money? Alright, so here's the absolute simplest possible business upside that taking really good care of patients can achieve: higher patient volumes at the practice. Patients, who I guess could be called consumers in this example, want to go to such a practice. The practice is differentiated. Your marketing has to be good for that to happen, but yeah … turns out patients really like nonfragmented care with a physician, a nurse navigator, and the rest of their clinical team who patients know, like, and trust. Also, turns out clinicians, ones who are purpose driven, like to work at places where they can be part of a team providing great care. So, you wind up with growth—you got your demand from patients who want to come to your practice; you got supply of clinicians who want to work there. Who would have thought? So, as long as practice leadership is also purpose driven, this can all be very opportunistic. But there's also some risk exposure for those who don't consider models like this. Will Shrank, MD, said on the pod last week (EP413) that any specialists who aren't figuring out how to work with capitated primary care docs are gonna have some referral problems coming up here. And how do you work with capitated, advanced primary care docs? You demonstrate you have better patient outcomes. You cannot do that unless you do all the things that Justina Lehman talks about in this healthcare podcast. So, there's risk in not doing some of this stuff. I'm gonna summarize the process that Justina uses to level up care and also get paid for it. 1. Assemble a committee of purpose-driven, committed physicians who want to improve care. Committee should self-select. No one should be there who doesn't want to be there. 2. Define the situation analysis. What is care as usual? And then, what's ideal care? And then, determine what the delta is between where we are now and where we want to go. 3. Design ideal care and the plan for how you're gonna get from where you are now to where you want to be. What does ideal care look like? I actually gave the keynote at the PBGH (Pittsburgh Business Group on Health) symposium a few weeks ago, and I showed a slide that Justina Lehman had put together showing the ideal care pathway for a patient with gestational diabetes. If you weren't there, here's the aha: Ideal care includes multiple physicians. It includes working with payers and PBMs (pharmacy benefit managers) and how you're gonna do that. There's also gonna be a nurse navigator involved. It includes standardizing certain care flows and choices and making sure that patients have the right information so that they can get to the right care settings at the right time. The exam room, as Justina Lehman says, is but the start of the patient journey; it's not the beginning, middle, and end of it. 4. Align the model to possible financials. First of all, consider two potential payers: self-insured employers … you could offer a bundle if you see a lot of any self-insured employer's members. You also could go to a regular payer kind of payer. There's gonna be two kinds of payers: engaged payers and not engaged payers. If there's an engaged payer who is actually trying to figure out how to work with providers in their network, then there's four potential opportunities with such an engaged payer: (1) You could start talking about prospective bundle payments. (2) Less attractive, you could start talking about retrospective payments based on savings. (3) There could be quality incentives that are a percentage of FFS (fee-for-service) withhold, or a quality incentive that is in addition to FFS payments. (4) There could be specialty quality programs that are PMPM (per member per month). If you're dealing with a not engaged payer, then one potential move is to gang up with others in the area, create some sort of value alliance, and see if you can inspire the payer to become more engaged. You also could try to align your care pathway to what is possible to get paid for within an FFS model. Scott Conard, MD, in an earlier episode (EP391), talks a little bit about that. He's talking from a PCP standpoint, though. 5. Measure results. 6. Prepare the story/value prop for payers. 7. Get more docs on board. Create the meaningful stories that inspire additional doctors to want to become a part of this beyond your initial gang. 8. Manage and maintain success; continue to evolve. Big takeaways for me: It's really important to engage payers and get them at the table early. Will Shrank, MD, in another point of alignment from last week's show to this week's, Dr. Shrank also was talking about this same thing. He said, historically payers and providers have had a pretty adversarial relationship … but it can be really hard for a provider to migrate to a value-based arrangement without the payer to provide data and, to some degree, shelter for providers who are along the transition to value journey. Besides the show with Dr. Steve Schutzer and Dr. Scott Conard that I mentioned earlier, I'm gonna leave you with two other interesting “for further reading or listening” references. One is a LinkedIn post from Benjamin Schwartz, MD, MBA, that also includes some pretty great comments and back and forth. In sum, Dr. Schwartz wrote, “We need to uncouple value from the payment model and focus on outcomes tied to diagnoses.” I also thought a Radio Advisory show was thought provoking. This was with Rae Woods, Erik Johnson, and Daniel Kuzmanovich. The gist of it is, at one point, Rae Woods says, “If I think about the very fragile financial state that a lot of these leaders are in, they're telling me, ‘I've got to pull back on my value-based care objective for 2024, maybe even 2025, because I just have to focus on my margin right now.' But what I'm hearing you say is that's actually not the right mindset to have.”   You can learn more by connecting with Justina on LinkedIn.   Justina Lehman, CNP, DNP, founder and president of Revolution Health, is a proven visionary leader at the forefront of transforming healthcare and fueling people's passion for high-value care. With over a decade of leadership experience, she has devoted herself to urging forward a revolution in healthcare. She stands as a staunch advocate for physicians and clinicians eager to join the movement toward high-value care. In an evolving healthcare landscape, Justina serves as a guiding force, reigniting the passion of physicians and clinicians and accelerating them toward a future of high-value care that is transparent, accessible, and transformative for all.   07:35 What has Justina been up to, and why is it relevant to this conversation? 08:23 What is high-value care, and how do we figure out what it is in reality? 08:59 EP412 with Robert Pearl, MD, on the art and science of medicine. 10:08 “What is the clinical design of … high-value care?” 10:21 Care as usual vs ideal care. 11:11 Summer Shorts 8 with Larry Bauer. 12:23 How does Justina figure out what the benchmark is for high-value care? 12:36 Meeting patients where they are at, not where we want them to be. 17:42 EP402 with Amy Scanlan, MD. 18:28 “What is the story as a group to the payer? What is the story as a group to the self-funded employer?” 19:19 How do you align business operations and the financials? 20:16 What are the four avenues for getting paid for high-value care? 21:58 What are highly engaged payers most intrigued by in high-value care? 24:11 What are the different ways a practice can get compensated? 28:52 Are there programs that have advanced without payers leading the way? 29:37 What's the “hook” for payers? 31:12 What's a winning message to payers and employers? 33:04 Summer Shorts 4 with Eric Gallagher. 34:13 “Not everyone needs to participate.” 38:24 Can a program be successful even if a physician is a passive participant in the program?   You can learn more by connecting with Justina on LinkedIn. Justina Lehman discusses delivering better care and getting paid for it on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Will Shrank, Dr Carly Eckert (Encore! EP361), Dr Robert Pearl, Larry Bauer (Summer Shorts 8), Secretary Dr David Shulkin and Erin Mistry, Keith Passwater and JR Clark (Summer Shorts 7), Lauren Vela (Summer Shorts 6), Dr Jacob Asher (Summer Shorts 5), Eric Gallagher (Summer Shorts 4), Dan Serrano  

Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief of JAMA, the Journal of the American Medical Association, for the April 18, 2023, issue. Related Content: Audio Highlights

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  

When Hennepin Medical Center saw that some of their patients were frequently visiting the emergency department for all their health care needs, they recognized how vital it was to find a better way to care for them. Our guest this week is Christene Jolowsky, senior director of pharmacy at Hennepin Healthcare. Christene shares how Hennepin has used 340B savings to operate a coordinated care clinic that meets the health and social needs of their patients. Prior to the interview, we provide news updates on the restoration of full Medicare payment rates for 340B drugs and details about another drug company that is attempting to block the federal government from requiring 340B discounts on drugs dispensed at contract pharmacies.A One-Stop Shop for CareChris shares how the coordinated care clinic determines which patients are eligible for its services. She then describes a typical patient experience at the clinic and how this experience meets the clinic's mission to provide comprehensive care. This includes addressing social determinants of health such as transportation and food insecurity. Keys to the Clinic's Success Many patients come into the clinic with distrust of the medical system and providers. Chris explains how Hennepin's providers build trust with patients and provide personalized care. The Role of 340B340B savings have supported every aspect of the coordinated care clinic. Chris discusses how the clinic's presence has reduced emergency department visits and shares a story of how the clinic significantly reduced the number of prescribed medications for one of its patients.  Check out all of our episodes on the 340B Insight podcast website. You also can stay updated on all 340B Health news and information by visiting our homepage. If you have any questions you'd like us to cover in this podcast, email us at podcast@340bhealth.org.Resources  Medicare 340B Payment Cut Ending for the Remainder of 2022 UCB Sues HHS Over 340B Contract Pharmacy Violation Letter  Report on Hennepin Healthcare's Coordinated Clinic: 340B Hospitals Are Directing Savings Toward Their Communities' Unique Needs

Briana Stonelake is a Belief Strategist and Licensed Clinical Social Worker who helps people find greater success in their marriages, relationships, business, and within themselves through identifying limiting beliefs. She has worked in the mental health field for 11 years focusing on trauma, anxiety, depression, and relationship disconnects in various cultures and helps people see the lies and negative mindsets that hold them back from greatness.  For more please visit: https://www.stonelakelife.com/Like our podcast?  Please rate & subscribe at mikeyopp.com Get full access to The Casual Casuist at mikeyopp.substack.com/subscribe

What does it take for an entire network of safety net health centers to transition to a new electronic health record (EHR) system — one that enhances coordinated care and is better equipped to serve their communities? For Community Health Center Network (CHCN), it was a multiyear journey involving many readiness assessments, drumming up excitement to encourage staff buy-in, and lots of collaboration across all levels of the organization. In this episode, we discuss lessons learned  and the bright spots of this enormous project. Here's where you can learn more about the people, places, and ideas in this episode: Molly Hart, director of clinical optimization, Community Health Center Network (CHCN)Amit Pabla, chief quality and transformation officer, Axis Community Health (Note:  He has since moved on from this role.)Oregon Community Health Information Network (OCHIN)OCHIN EpicTechnology Hub, a CCI program that helps organizations vet, pilot, evaluate, and spread innovative digital health solutions targeting Medicaid markets and historically underinvested communities.© 2022 Center for Care Innovations. All Rights Reserved.

A patient portal is a great innovation, but busy clinic staff don't have time to help every patient get set up on them and answer all their questions about it. In addition, patients often need ongoing support on how to communicate with their provider on the website, get updates, and access their health records.Enter the Health Tech Navigators — people serving in a role that is for the community, by the community.  These Navigators, hired directly from the community, work closely with patients to support not only enrollment, but to increase portal use and to bridge gaps in healthcare accessibility that have long existed with language, culture, trust, and tech literacy. Listen to how the Los Angeles Department of Health Services (LADHS) created and supports its Health Tech Navigator program to surface a growing practice of cultural humility and competency in patient engagement.Here's where you can learn more about the people, places, and ideas in this episode: Anshu Abhat MD, MPH, Director of Patient Engagement in the Office of Patient Access at LADHSMayra Ramirez, MSW, ASW, Staff Analyst, Program Manager with the Patient Engagement Program at LADHSLA Health Portal AppTechnology Hub, a CCI program that helps organizations vet, pilot, evaluate, and spread innovative digital health solutions targeting Medicaid markets and historically underinvested communities.© 2022 Center for Care Innovations. All Rights Reserved.

This three-part episode follows a discussion of the current state of HCT by exploring its evolution over time. Fred Appelbaum, MD, of Fred Hutchinson Cancer Center, and Courtney Bellomo, MD, of New York Oncology Hematology lead the discussion. In Part 3: Persistent Misconceptions, Coordinated Care and the Future of HCT, they discuss the challenge and importance of understanding when, who, and how to refer for a transplant consultation, promoting coordinated care and open communication across the care team. They also discuss emerging advances and the future of HCT, including CAR-T and treatments for sickle cell and thalassemia. For more information, resources from the episode, or full bios of our guests, visit our site. 

Welcome to Eyepod Bayer! Today we are presenting another Viewpoint from the Vision academy. The title of the Viewpoint is: Coordinated Care in Diabetic Eye Disease Management We would be happy to hear your feedback. eyepod@bayer.com MA-M_AFL-DK-0177-1    

Lucy is joined by Helena Baker who was born with a congenital limb defect, worked as a nurse and is the outgoing CEO of Rare Disease Nurse Network.Helena was born with fibular hemimelia - a disorder of limb budding results in a congenital limb malformation characterized by complete or partial absence of the fibula bone combined with dysplasia and hypoplasia of the tibia and dysplasia, hypoplasia or aplasia of parts of the foot (Orphanet).Despite having 100s of operations and having a fairly classical presentation of this condition Helena did not know her diagnosis until aged 49.5 years. Despite the name of the condition not changing her management it meant a lot to her family to be able to understand that nobody was to blame for what Helena had endured her whole life. And not long after Helena had to come to terms with the requirement to amputate her "little foot".In this episode Lucy and Helena talk openly about how an assumption of knowledge left her in the dark about her diagnosis, what it's like to say goodbye to your own limb and how coordination of care and better communication could make all the difference to people like Helena. Which is why she is passionate that RDNN become the Macmillan equivalent for rare disease. Sponsorship NoticeThis podcast is brought to you by Medics4RareDiseases. M4RD receives sponsorship from commercial companies. In 2022 this includes: Alexion Therapeutics, Amicus Therapeutics UK Ltd, BioMarin, Bionical Emas, Healx, Kyowa Kirin and SOBI. These companies have no editorial control over this or any other M4RD content. Sponsorship does not equate to endorsement of companies or products. Views expressed during this podcast are personal and don't reflect those of M4RD sponsors. Go here to find out more about how M4RD works with sponsors. Companies have no editorial control over any of M4RD's activities or content of this podcast.

Reimaging child welfare starts with looking inward. On this bonus episode, get to know more about host Matt Anderson as he provides candid responses to listener questions about reimaging child welfare, the power of listening, and his source of hope. Call in with your questions and reactions at (512) 815-3956. 00:01:45  | Adrian McLemore, Program Officer, Annie E. Casey Foundation, and Host, FosterStrong Podcast: What keeps you hopeful while doing this work, given how the premise of foster care is centered around traumatic experiences? 00:03:56  | Lyndsey Wilson, CEO, FirstStar: I'd love to hear you talk about why, as a service providing organization, is it important to prioritize hearing and telling stories? 00:07:04  | Maureen Sorenson, Senior Director of Foster Care Operations at Coordinated Care of Washington and Part-time Lecturer in the School of Social Work at the University of Washington: How can we encourage more [prospective] adoptive parents to be focused on reunification?  Maureen alludes to Seen Out Loud S1, E1: WHAT IF WE DIDN'T HAVE TO WAIT UNTIL BAD ENOUGH Matt references Seen Out Loud S1, E6: THE WALLS STARTED TO COME DOWN 00:10:12  | Kathleen Creamer, Managing Attorney of the Family Advocacy Unit, Community Legal Services of Philadelphia: What does it say about us that we've designed a system where expressions of care and compassion for parents are experienced and described by parents as miraculous exceptions?  Matt references Seen Out Loud S1, E2: LOOKING FOR THAT WARM HUG ALL MY LIFE 00:13:34  | Gina, Kinship Parent and Family Partner: When you're talking about amends, what does it mean [for child welfare] and how can we all work towards reestablishing trust with the [child welfare] systems.   Gina references Seen Out Loud S1, E1: WHAT IF WE DIDN'T HAVE TO WAIT UNTIL BAD ENOUGH  “Amends” are also discussed in Seen Out Loud S1, E7: TITLE THE MOMENTUM IS BUILDING 00:16:31  | Austin, Program Coordinator, Psychological Department of Social Services: How can we become better listeners? Can you offer any practical suggestions for how all of us can become better listeners?  00:19:17  | Matt shares final thoughts on Season 1 of Seen Out Loud. Call in at (512) 815-3956 to leave a message with your questions. Resources Submit your questions to our host by emailing our team at podcasts@instituteforfamily.org. Join our LinkedIn group to ask Matt Anderson and other professionals your questions about reimagining child welfare Book: “The Whole Language: The Power of Extravagant Tenderness” by Father Greg Boyle 

At the Wenatchee Enrollment Center, Suzie and Matt have a special guest.  CEO of Coordinated Care, Beth Johnson and us talk about the impact that the American Rescue Plan is having and there are some sneak peeks of things to come in Washington State Healthcare.  If you have bought a plan off the Washington Healthplanfinder or might in the near future then this is an episode to listen to. 

Image credit: Maricopa.gov Susan Kochevar, owner of the Historic 88 Drive-In Theatre, joins Kim to converse about the greatness of America and the continued assault on its foundation of liberty and freedom.  Email your dissent on potential changes to HIPAA rules that will loosen patient’s privacy  at:   Proposed Modifications to the HIPAA Privacy Rule To Support, and Remove Barriers to, Coordinated Care and Individual Engagement.  Establishment consultants continue to negotiate against conservatives such as political and media consultant Frank Luntz.  Terms limits needed for bureaucrats; for elected officials it takes place at the ballot box. Chris Cantwell, Senior Business Advisor with Transworld Business Advisors, discusses the need for businesses to have an exit plan regardless of how far in the future it may happen.  There is significant growth of those wanting to be entrepreneurs.  In reality the two are connected, and that is where Chris can help.  He has vast experience in helping owners sell and people wanting to be their own boss.  Give Chris a call at 844-SELL-BIZ. Kim and Sue dissect SB21-246 Electric Utility Promote Beneficial Electrification.  This bill is filled with multiple force words and includes demand-side management (DSM) policies, which was exactly the problem in Texas during the recent winter storm.  To top it off, it is very misleading as it states that fossil fuels are inefficient.  Kim and Sue then reviewed a recent CPR article on police reforms in Colorado.  Crime has increased across the board in Colorado.  If we do not have safe communities, we will not thrive and prosper. Jason McBride, Senior Vice President with Presidential Wealth Management, talks about risk tolerance for investors.  As some people relate today's market to the internet bubble in the 1990s, people are assessing their risk tolerance.  Jason will help you evaluate risk in your financial holdings and review any possible changes that you may be thinking about.  Give Jason a call at 303-694-1600. Jen Hulan, entrepreneur and owner of Waters Edge Winery, highlights specials for Mother's Day.  Jen has also ordered “Free Breather” pins.  They should be available within the next two weeks.  Check out her website wewdenver.com Frequent guest Josh Phillip, Senior Investigative reporter with The Epoch Times and host of Crossroads, begins by addressing the Arizona audit on the 2020 Presidential Election.  The current audit of 2.1 million ballots from Maricopa County has been challenged by the Democrat Party in court and in the mainstream media.  The Democrat Party is losing on all fronts as the audit continues.   Audit security has been questioned.  Election laws were changed across the nation at the last moment which has led to va

Kim begins the week informing listeners  that comments on HIPPA proposed policy changes regarding patient medical data is due by May 6th.  The link is: Federal Register :: Proposed Modifications to the HIPAA Privacy Rule To Support, and Remove Barriers to, Coordinated Care and Individual Engagement.  We are seeing common paths to the Democrat radical left bills in Colorado that are pushing Marxist ideas.  Don't be discouraged as there is an awakening.  The Divine Provider had his hand on the founding of America and continues to this day. Colorado Representative Tonya Van Beber is co-sponsor of HB21-1191-Prohibit Discrimination COVID-19 Vaccine Status.  University and colleges, as well as employers, are mandating the COVID-19 vaccination, which is an experimental gene therapy drug not approved by the FDA.  The Colorado government is allowing employers and educational institutions to be the “long arm of the law.”  We cannot be complicit and allow medical tyranny.  The bill is scheduled to be heard on Wednesday, May 12th, in committee. Jason McBride, Senior Vice President with Presidential Wealth Management, comments on the markets maintaining an upward trend.  Many companies are reporting earnings and may show fluctuation in stock prices.  Risk tolerance is personal and that is where Jason can help you.  He will examine your specific needs, desires, responsibilities and goals when strategizing for your financial portfolio.  Call Jason at 303-694-1600. Guest Orson Swindle, Marine pilot, North Vietnamese Prisoner of War, former Commissioner of the Federal Trade Commission and former Assistant Secretary of Commerce during the Reagan administration, has a conversation with Kim on 2021 America.  Orson talks about his experience as a POW and how he got to know California Gov. Reagan, a firm supporter of  Vietnam Veterans.  As a POW all he had was his heart and his head.  When he came back after six years and four months, he saw vividly how progressives had taken over our society and the destructive path the country was on, and continues to be.  Education has failed us miserably.  Massive government build up will destroy our economy.  Socialism has never worked.  There is an assault on our intellect; we must think critically.  The radicals are using “Swarm Theory”—overwhelm your opponent from every possible direction.  We can overcome this.  Read history and be inspired by the people who have fought for our country.  Change the education system by being involved with our children/grandchildren.  Support Congress and state legislatures to say “no” to socialism and Marxism.

Course DescriptionWhen we practitioners approach complex medical problems (whether pain, depression, or even GERD) that have psychological and lifestyle components and we do so with minimally monitored drug-only therapies, we may bounce from one “wonder drug” to another and end up bewildered or worse. These problems need complex approaches that address the component parts and we can’t just rely on finding the next wonder drug. Perhaps it’s part of the American mindset: wanting a pill to fix problems. Part of it is from the perverse incentives in a healthcare system that wants to find solutions to complex issues and then implement them on the cheap, running them through primary care on a conveyor belt. In pain we see history repeating itself around the medical cannabis issue. All the same mistakes are being made again and with poor care coordination, risk management, and assessment it will end up doing harm.

It's Turnquist Friday!  Rick Turnquist, blogger and author, joins Kim in studio to discuss the intentional misleading narrative regarding forced minimum wages and his featured op-ed, Minimum Wage Fail (kimmonson.com/featured_articles/minimum-wage-fail/).  Minimum wage jobs are a means to learn skills and gain experience for future, better paying jobs.  HB21-175 Prescription Drug Affordability Review Board is all about price controls. Hal Van Hercke, founder and owner of Castlegate Knife and Tool (castelgate.com), addresses minimum wage.  It is appalling that politicians continue their assault on small business while having no business experience themselves when pursuing more draconian policies.  Minimum wage can easily wipe out the average profit of 7% for many small businesses.  If entry level job salaries are increased, everyone above them will be looking for an increase as well.  Employers will look to job reductions, automated jobs and delayed hiring to preserve their businesses if forced minimum wages are implemented. Dr. Jill Vecchio, radiologist saving lives and informing listeners weekly on important medical issues, discusses new proposed HIPAA rules.  Dr. Vecchio summarizes the new proposed changes and the results of the changes including phone vendors will not be restricted by HIPAA and the patient's medical records will no longer have restricted access.  Visit this link to read the proposed changes:  https://www.hhs.gov/sites/default/files/hhs-ocr-hipaa-nprm.pdf.  Dr. Vecchio encourages people to make comments.  Comments are due by May 6, 2021.  On page 2 of the document the following information is given: You may submit comments to this proposed rule, identified by RIN 0945-AA00 by any of the following methods: Federal eRulemaking Portal You may submit comments to this proposed rule, identified by RIN 0945-AA00 by any of the following methods: You may submit electronic comments at Federal Register: Proposed Modifications to the HIPAA Privacy Rule To Support, and Remove Barriers to, Coordinated Care and Individual Engagement Regular, Express, or Overnight Mail: You may mail comments to U.S. Department of Health and Human Services, Office for Civil Rights, Attention: Proposed Modifications to the HIPAA Privacy Rule to Support, and Remove Barriers to, Coordinated Care and Individual Engagement NPRM, RIN 0945- AA00, Hubert H. Humphrey Building, Room 509F, 200 Independence Avenue, SW, Washington, DC 20201. Jason McBride, Senior Vice President with Presidential Wealth Management, comments on annuities.  Jason can sift through the verbal complexity so you can have a complete understanding of annuities and the benefits that can be advantageous to your financial portfolio.  Give Jason a call at 303-694-1600 to set up an appoin

Ross Acker, Advanced Health CCO Director of Coordinated Care & a Licensed Professional Counselor; Megan Ridle, Coos Health and Wellness Brief Treatment Crisis Services Manager & a Licensed Professional Counselor; and Kelley Andrews, Retired Coos County Sheriff Office Captain discuss: Building relationships with partners from the ground up; The evolution of partnerships and programs within Coos County;  The importance of CIT being about relationships and not just a training;  Coos County's work on starting a sobering center; and Discussion of cases that highlight the importance of behavioral health and law enforcement working together.  For more information about the intersection between criminal justice and behavioral health in Oregon, please reach out to us through our website at http://www.ocbhji.org/podcast and Facebook page at https://www.facebook.com/OCBHJI/. We'd love to hear from you. For more information about CIT in Oregon, visit OCBHJI's CIT webpage http://www.ocbhji.org/cit/. For more information about the partnership between OCBHJI and DPSST via the Crisis Intervention Teams Center of Excellence (CITCOE), visit http://www.ocbhji.org/cit/citcoe/. 

What does the future of healthcare look like under the Biden Administration? In this episode, APG President & CEO Don Crane interviews John Kitzhaber, MD, former Governor of Oregon and the chief architect of Oregon's coordinated care organization initiative. Dr. Kitzhaber discusses the COVID-19 crisis, Affordable Care Act subsidies, Medicaid expansion, and increasing Medicare costs, as well as how Oregon saved a billion dollars by moving away from fee-for-service to value-based care.

Episode 4 of the DiepCJourney podcast speaks to an educator, microsurgeon, and Director for MedStar Plastic & Reconstructive Surgery and Academic Chair for the Department of Plastic Surgery at Georgetown University Medical Center, Dr. David H. Song.  Dr. Song holds the BC3 Conference (Breast Cancer Coordinated Care) in Washington, D. C. every other year. We discuss the medical professionals that can comprise the team and why each is an integral factor for those diagnosed with breast cancer or at high risk of getting breast cancer.  Access and disparities in care can limit the ability to fully coordinate care so Dr. Song and I tackle this topic in our conversation with breast cancer and reconstructive resourcesfor breast cancer patients.

Post By: Adam Turteltaub As healthcare moves increasingly from fee for service model to one focused on outcomes and value-based payments, the traditional fraud and abuse laws, such as the Anti-Kickback Statute and the Stark Law, pose obstacles to this transition. As a result, the Department of Health and Human Services (HHS) issued a proposed rule to make changes to these statutes’ regulations as part of its Regulatory Sprint to Coordinated Care. These changes both address facilitating the transition to value-based payments and also reduce regulatory burden by proposing new or amending safe harbors and exceptions. The Stark Law proposed rule also includes new or revised definitions of key terms, such as fair market value, the “volume or value of referrals,” and commercial reasonableness. In this podcast, Katherine Bowles, a registered nurse and healthcare attorney at Nelson Hardiman and Tony Maida a partner at McDermott Will & Emery explain these proposed changes and how to consider preparing for a final rule. This preparation could include exploring potential partnerships to create a value-based enterprise. Even if the proposed rules are finalized, compliance with the Anti-Kickback Statute and Stark Law will remain an important part of an organization’s compliance program. The panelists discuss ways for compliance programs to address these issues, such as having a sound approval process and monitoring contract performance. Finally, our panelists also discuss how the COVID-19 pandemic has impacted compliance with these laws, including the rise of telemedicine and the Stark waivers and Anti-Kickback policy statements. Listen in to learn more.

This episode, McDermottPlus VPs Mara McDermott and Sheila Madhani discuss the Regulatory Sprint to Coordinated Care, price transparency, and consumer privacy, three areas of focus for the Administration this year. For our full 2020 Policy Forecast, click here mcdermottconsulting2020forecast.splashthat.com/

CF 097: w/ Dr. James Lehman (Pt. 2) – National Scope, Chronic Pain vs. High Impact Chronic Pain , Coordinated Care/Medicaid, DACO to DIANM Today we're going to be talking with Dr. James Lehman. This is Part Two of the interview. If you are just now joining us and did not get to hear Part... The post w/ Dr. James Lehman (Pt. 2) – National Scope, Chronic vs. High Impact Chronic Pain, Coordinated Care/Medicaid, DACO to DIANM appeared first on Chiropractic Forward.

Today we're going to be talking with Dr. James Lehman. Yes, THE Dr. James Lehman and we are fortunate to have him with us. The experience and the common sense Dr. Lehman brings to the table is immense and I can't wait to dive into it today. We're going to talk about national scope But... The post w/ Dr. James Lehman (Pt. 1) – National Scope, Chronic vs. High Impact Chronic, Coordinated Care/Medicaid, DACO to DIANM appeared first on Chiropractic Forward.

  NCQA President Peggy O’Kane discusses her appointment to the U.S. Department of Health and Human Services’ Quality Summit group. Peggy is serving among some of the nation’s top health care policy leaders to advise the government on the challenges ahead and the proposed solutions to address them.  NCQA Public Policy Vice President Frank Micciche  […]

The end of 2018 and the first months of 2019 brought a number of regulatory developments impacting care coordination and the adoption and reimbursement of digital health services. From the Centers for Medicare & Medicaid Services' (CMS) Regulatory Sprint to Coordinated Care and Pathways to Success initiatives to the updated Physician Fee Schedule, speakers Dale Van Demark and Lisa Schmitz Mazur discuss the rules and regulations that have the potential to enhance or hinder access to digital health solutions and how digital health companies can position themselves for success in this evolving regulatory landscape.

CCOs and ACOs - What are they and what's the difference? --- Support this podcast: https://anchor.fm/healthcare-minute/support

Dr. Erik Hess, Dr. W. Franklin Peacock, and Dr. Simon Mahler discuss complex issues involving chest pain protocols in "ruling-out" low risk chest pain patients. They tackle the issues of: 1. Troponin-Only Pathway: The Era of High Sensitivity Troponins (Hess) 2. Importance of Incorporating Accelerated Diagnostic Protocols (Peacock) 3. How to Get Buy-In and Implement ADPs in the Emergency Department (Mahler) Dr. Hess is the Vice Chair in the Department of Emergency Medicine at the University of Alabama. Dr. Peacock is the Vice Chair in the Department of Emergency Medicine at Baylor University. Dr. Mahler if the Director of Clinical Research in the Department of Emergency Medicine at Wake Forest University. Hosted by Dr. Jason Woods

Improving healthcare through a coordinated care model that govern all other elements that impact an individual’s health that isn’t medical in nature

Look who stopped by to talk about the value of the Patient-Centered Medical Home model of care. Susanne Madden is founder and CEO of The Verden Group, a consulting firm founded to help practices navigate through the increasingly complex business of healthcare. Her career has spanned several sections of the healthcare industry. Prior to founding Verden, […]

What does it mean to create a healthy population?  It means not just treating patients for their specific illnesses but taking into account their whole health – the other factors that might contribute to their particular illness – then applying that kind of care to a group of people with similar health needs.  It’s that whole-person […]

Dr. Jim Rickards joins Dr. Britt Berrett for this episode, in which they discuss Rickards' recently published book, Our Health Plan: Community Governed Healthcare That Works (New York: Morgan James Publishing: 2017). Rickards, a radiologist who earned his medical degree from Indiana University School of Medicine, also holds an MBA from Oregon Health and Science University. He is the senior medical director at Moda Health in Portland, Oregon. He was a pioneer in developing the Coordinated Care Model for the state of Oregon as a new way to deliver healthcare services to its nearly 1.1 million Medicaid members.

In our first Inside Health Care episode, we preview the Quality Talk of Dr. Martin Makary. We encourage you to register now at www.qualitytalks.org.  Hope you enjoy the preview. Martin A. Makary, MD, MPH | Professor of Surgery, Johns Hopkins University School of Medicine; Professor of Health Policy & Management, Johns Hopkins Bloomberg School of Public […]

Date: May 7, 2015 Featuring: Chris DeMars, MPH, Director, Systems Innovation, Oregon Health Authority- Transformation Center Ronald Stock, MD, MA, Director of Clinical Innovation, Oregon Health Authority-Transformation Center Trissa Torres, MD, MSPH, FACPM, Senior Vice President, IHI Far from the epicenter of Washington, DC, and the federal government’s efforts to expand health insurance coverage and usher in health care delivery and payment reform, states are moving ahead with amazing innovations of their own these days. Medicaid waivers, which offer states running room to experiment with public dollars, are one big reason. And one big example of what’s possible is unfolding in Oregon. No stranger to trail-blazing with transformative ideas and initiatives, Oregon’s latest efforts to provide better care and value to nearly one million Medicaid recipients the focus of this WIHI. The groundwork and the enabling policies and legislation for Coordinated Care Organizations (CCOs) have been several years in the making, and the careful shaping of the program is leading to some impressive results. You'll hear about the money, the care, the innovative use of community health workers, and just how 16 CCOs across Oregon function as one system on this great episode of WIHI.  

Starting Strong Illinois invites you to the sixth in a series of webinars on the Affordable Care Act (ACA). This webinar will provide information about upcoming changes in how patients and providers interact with Illinois’ Medicaid system and how the ACA supports improved patient outcomes that are expected to result from the implementation of these changes. Learning Objectives: - Learn how Medicaid services are currently delivered and the reforms expected to occur in the next several years; - Understand the difference between Managed Care Organizations (MCOs), Coordinated Care Entities (CCEs), Integrated Care Pilots (ICPs), and Managed Care Community Networks (MCCNs); - Find out about pending Illinois policy decisions related to implementation and what you can do to ensure that populations you care about benefit from these reforms.

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