Podcast appearances and mentions of jeff hogan

On Episode 57 of the Astonishing Healthcare podcast, host Justin Venneri welcomes Jeff Hogan, President of Upside Health Advisors, back to the show to discuss the major trends he observed in healthcare procurement and plan management in 2024 and areas of focus in 2025. Jeff highlights the evolving role of employer fiduciaries under the Consolidated Appropriations Act of 2021 (CAA), building on Episode 30 and re-emphasizing the necessity of real-time data access and process-driven strategic decision-making. He explains how employers must take greater accountability for healthcare spending, moving beyond reliance on traditional insurance networks (BUCAHs) and considering alternative care delivery models; and adds that provider organizations must adapt to align care delivery with consumer needs or risk obsolescence.The discussion also covers the increasing use of analytics - including platforms like HOMA Health - or outside resources, like Nick Welle explained on Episode 52, to help plan employer plan sponsors manage costs and their vendor contracts, PBM reform, and point solution fatigue. Finally, Jeff outlines key priorities for 2025, including fiduciary compliance, confirming the removal of gag clauses from contracts, and greater transparency in broker compensation to ensure better alignment between healthcare purchasers and providers.Related ContentReplay - Strategic Well-Being: Rethinking Health Benefits to Empower Employees and Drive ImpactAH030 - Plan Sponsors Need a Source of Truth; Get Your Data Now & Find It, with Jeff HoganBest of '24! AH041 - ERISA Litigation Outlook and Meeting CAA Requirements, What Can Plan Fiduciaries Do?Signs it is time to change your PBM vendor, and how to overcome common hesitationsTo learn more about Upside Health Advisors, click here, or you can find Jeff on LinkedIn.Resources MentionedVizient - 2025 Trends Report: Strategy is (finally) back in the driver's seatPeterson Health Tech Institute - Virtual Musculoskeletal Solutions (June 2024)ICER - Peterson Health Tech Institute: Assessment Framework for Digital Health Technologies (Sept. 2023)Peterson Health Tech Institute - Digital Diabetes Management Solutions (March 2024)For more information about Capital Rx and this episode, please visit Capital Rx Insights.

On this final encore episode of the Astonishing Healthcare podcast this year, we're replaying Episode 41, which featured three experts weighing in on rising litigation against employers and pharmacy benefit managers (PBMs) and was one of our most popular. We also want to take the opportunity to say, "Happy Holidays and New Year!" and thank our listeners and guests this year, including current and former colleagues; we couldn't have done it without you!In Episode 41, we discussed what employers sponsoring ERISA-covered health and welfare plans can do to show they are making an effort to establish processes and assess how "reasonable" the fees they pay are. Chris Deacon, Founder of VerSan Consulting; Jonathan Levitt, trial attorney and Co-Founding Partner at Frier Levitt; and Julie Selesnick, Senior Counsel in the employee benefits and ERISA Group at Berger Montague, joined host Justin Venneri for the discussion covering relevant provisions of the Consolidated Appropriations Act of 2021 (CAA), the recent lawsuits against Johnson & Johnson and Wells Fargo, and how plan sponsors can approach things like getting their data to make informed decisions.This episode built on previous conversations, including AH030 - Plan Sponsors Need a Source of Truth; Get Your Data Now & Find It, with Jeff Hogan.Chris, Jon, and Julie share their opinions about the similarities - or lack thereof - of the health plan lawsuits to the 401(k) and pension litigation of the early 2000s, why we will likely see more litigation, the reality and frustration of relying on traditional PBMs and carriers for data (and what to do about it), conflicts of interest in and around PBM procurement and broker/consultant relationships, and why Julie has a "fainting couch!"Related ContentAH004 - Data, Fiduciary Responsibility, and Reversing Trend with Jeff HoganThe Consolidated Appropriations Act & Prescription Drug Data Collection (RxDC): New Rules & Regulations Equal New ResponsibilitiesSelf-funded plans ignore the Consolidated Appropriations Act at their perilFor more information about Capital Rx and this episode, please visit Capital Rx Insights.

On this episode of the Astonishing Healthcare podcast, three experts weigh in on rising litigation against employers and pharmacy benefit managers (PBMs) and what employers sponsoring ERISA-covered health and welfare plans can do to show they are making an effort to establish processes and assess how "reasonable" the fees they pay are. Chris Deacon, Founder of VerSan Consulting; Jonathan Levitt, trial attorney and Co-Founding Partner at Frier Levitt; and Julie Selesnick, Senior Counsel in the employee benefits and ERISA Group at Berger Montague, joined host Justin Venneri for the discussion covering relevant provisions of the Consolidated Appropriations Act of 2021 (CAA), the recent lawsuits against Johnson & Johnson and Wells Fargo, and how plan sponsors can approach things like getting their data to make informed decisions.This episode builds nicely on previous conversations, including AH030 - Plan Sponsors Need a Source of Truth; Get Your Data Now & Find It, with Jeff Hogan.Chris, Jon, and Julie share their opinions about the similarities - or lack thereof - of the health plan lawsuits to the 401(k) and pension litigation of the early 2000s, why we will likely see more litigation, the reality and frustration of relying on traditional PBMs and carriers for data (and what to do about it), conflicts of interest in and around PBM procurement and broker/consultant relationships, and why Julie has a "fainting couch!"Stay tuned for more, and we'll add some new resources (scripts and checklists, for example) to the links as they become available!Related ContentAH004 - Data, Fiduciary Responsibility, and Reversing Trend with Jeff HoganThe Consolidated Appropriations Act & Prescription Drug Data Collection (RxDC): New Rules & Regulations Equal New ResponsibilitiesSelf-funded plans ignore the Consolidated Appropriations Act at their perilFor more information about Capital Rx and this episode, please visit Capital Rx Insights.

If you watch WRAL-TV weekdays in the morning, or at noon, you've seen him. If you play golf in the Pinehurst area, you may have seen him walking our area courses (he's easy to spot as a lefty). Jeff Hogan has called the Raleigh area home for six years and while he's a trusted news source at the Big 5, he's also an avid golfer and loves to tee it up inside the Home of Amercian Golf every chance he gets, especially with our podcast host! In our final Paradise in the Pines broadcast from this year's U.S. Open site at Pinehurst No. 2, Hogan talks about covering a major golf event, the current state of his game and how he'd tame the untamable No. 2... ‪@usga‬ ‪@pinehurstresort‬ ‪@WRAL5‬ #homeofamericangolf #visitnc ‪@visitnc‬

In this episode of the Astonishing Healthcare podcast, Jeffrey Hogan, President of Upside Health Advisors, returns to the show for a timely discussion with Justin Venneri about why the timing is perfect for health plan sponsors and fiduciaries to engage their partners to secure necessary disclosure requirements and access to their data: it's renewal season! The Consolidated Appropriations Act (CAA) placed additional responsibilities on plan fiduciaries, including the need to make attestations. With gag clauses removed from contracts, the door is open. Jeff stresses the importance of analyzing the plan's data to make informed decisions and meet the fiduciary obligations. "The industry is craving trust," and fiduciaries need a trusted source of data and analytics to help them identify areas of waste and make changes that will benefit their plans. Whether it's pharmacy benefits, hospital spend, or the commissions paid to brokers/consultants, there's a unique opportunity to gain the insight needed and avoid the rising risk of liability right now.To learn more about Upside Health Advisors, click here, or you can find Jeff on LinkedIn.Related ContentAH004 - Data, Fiduciary Responsibility, and Reversing Trend with Jeff HoganThe Consolidated Appropriations Act & Prescription Drug Data Collection (RxDC): New Rules & Regulations Equal New ResponsibilitiesSelf-funded plans ignore the Consolidated Appropriations Act at their perilFor more information about Capital Rx and this episode, please visit Capital Rx Insights.

Today on the Buzzcast, we welcome back Jeff Hogan, SRA, AI-RRS, Senior Vice President of Valuations and Chief Appraiser for Valligent. It's been almost two years since Jeff last joined us, and a lot has changed since then.In this episode, we explore how advancements in technology are impacting the appraisal field. Jeff provides insights into how the role of appraisers might evolve, and discusses innovations on the horizon that could further blend human expertise with machine efficiency. We also tackle the big question: Will there always be a need for human involvement in appraisals? Plus, Jeff gives us a sneak peek into his upcoming panel at Valuation Expo, where he'll be part of the highly anticipated Man vs. Machine Debate. You can learn more (or register) here: https://www.valuationexpo.com/At The Appraisal Buzzcast, we host weekly episodes with leaders and experts in the appraisal industry about current events and relevant topics in our field. Subscribe and turn on notifications to catch our episode premieres every Wednesday!

Today is an encore because I am going on vacation next week. It always feels a little bit like a time warp because by the time this show will air, I will be back from vacation. This show with Paul Holmes was one of the most popular episodes of 2023 and definitely is just as relevant now. A lot of the things that Paul talks about are worth repeating or listening to again. For a full transcript of this episode, click here. Before we kick in, though, I'm gonna repeat something that Ge Bai, PhD, CPA, says a lot: There's no angels and there's no devils in the healthcare industry. But we are talking about for-profit entities. And if there's one thing that's generally true about a for-profit entity, especially one that is publicly traded, it's gonna do whatever it can get away with. It becomes up to the customer to set expectations and using the purchasing discipline that they probably use everywhere else in the business because it basically is good business to have purchasing discipline. Before we kick into the episode, just a couple of things. Thing one, if you haven't, do subscribe to the weekly email that goes out describing the show. Here's just one reason to do so. It's really efficient because what is transcribed in that email is the whole beginning half (usually) of the introduction. So, if later on you are trying to remember which episode you heard something in, you can just search your email and find the show. How you subscribe is go to relentlesshealthvalue.com, hang out for probably 15 seconds, and there will be a pop-up. And while you're on the Web site, here's something else you could do. Go to the lower right-hand corner of the Web site. You will notice a little button. It's an orange button. There's a microphone. Click on that; say something like your name, your company name, maybe a word or two about Relentless Health Value; and then encourage others to subscribe to the weekly email that goes out, similarly to what I just did. Then what our team will do is take that recording and potentially use it at the end of some of the shows so we can hear somebody else talk besides myself. So, please do go over to the Web site, click on that little microphone, and record something that you might want to share with the other members of the Relentless Tribe. And with that, here's your encore. If this were a video show, I would stare into the camera with steely eyeballs right now and say that I have a special message for employer CFOs. If you aren't a CFO, pretend that you are so that you get the full effect here. So, now that we're all CFOs, let's pull up the company P&L (Profit and Loss) statement. This is what keeps us all up at night, right? Making sure that the net profit line at the bottom looks good. We could decide to lay off a few people. Reorg something or other. Beat up a vendor. We also could go over and have a strident conversation with sales leadership about what they can do to jack up their sales revenue. Top line begets bottom line and all that. Or, here's another idea: In this healthcare podcast, I am speaking with Paul Holmes, who is an ERISA (Employee Retirement Income Security Act) attorney with a specialty in PBM (pharmacy benefit manager) contracts, especially the PBM contracts from the big PBMs that get jammed in employer plan sponsor faces by whomever and which they are told look fine and that the employer plan sponsor should just go ahead and sign. Now, if we, meaning all of us CFOs, sign that paper, or someone on our benefits team signs the paper … fun fact, our company just spent 30% to 40% over market for our pharmacy benefits. That contract we just signed contains all kinds of expensive little buried treasures—treasures accruing to the PBM and other parties, to be clear, and coming at our expense. There's 17-ish very common treasures in your typical PBM contract, and none of us will ever spot them unless we know what we are looking for. But let's dig into this for a sec, especially for all of us newly minted CFOs because the real ones already did this math. Say our company spends whatever—we're a bigger company, and we spend $100 million a year on our drugs. That's a minimum of $30 million that we got taken for … $30 million a year. Because of the huge dollars at stake (30% to 40% of drug spend), it's certainly the advice of almost anybody that you talk to who's an expert in PBM contracts to have a third party—not your EBC (employee benefit consultant), which we'll get into in a sec, but somebody else (a third party)—review every PBM contract. I mean, what's the worst that can happen for anybody considering having an independent third party review their PBM contract? It costs a couple grand in lawyer fees, and they give it a stamp of approval. Knowledge is power, and now we know. But let's just say this third-party review doesn't happen. We all go with a “devil may care” about this whole PBM overcharging us by 30% to 40% possibility. And let's say the PBM contract is, in fact, a ride on the Hot Mess Express but we don't know it. Here's two pretty bad downsides, especially now, this year, since the passage of the CAA (the Consolidated Appropriations Act). Number one bad thing: Plan sponsors may get sued as per the CAA for ERISA violations. It's not just the company paying that extra $30 million, or 30% to 40%, right? It's also employees. This is risk exposure, bigly. Just like it was on the 401(k) side of the house, which Paul Holmes, my guest today, mentions later on in the interview. He talks about just how much those lawsuits cost and, yeah, exposure. As I mentioned three times already, today I am speaking with Paul Holmes about PBM contracts in all their stealthy glory. The one thing I came to appreciate is that these things are works of art … if you're into those paintings of pretty flowers where, if you look hard enough, you spot a skull tucked in the greenery (memento mori). Paul is a longtime ERISA attorney. He has dedicated his career to helping plan sponsors in their negotiations with PBMs and trying to help them reduce drug spend, especially drug spend that isn't actually paying for drugs. Here's a link to an article we discuss about how a school district in Florida is suing their longtime EBC for taking $2 million a year in alleged secret payments. We also mention an episode with AJ Loiacono (EP379). And along similar lines, Jeff Hogan mentioned on LinkedIn the other day, “It's pretty amazing that just in the course of the [past few] weeks, I'm reading, seeing, and hearing about big new CAA breach of fiduciary duty cases.” So, Paul Holmes says this more eloquently, but if you're a plan sponsor, definitely get your PBM contract reviewed and maybe consider working with an EBC who's happy to sign the disclosure statement that your lawyer has provided without disclaimers. Also mentioned in this episode are Ge Bai, PhD, CPA; AJ Loiacono; and Jeffrey Hogan.   You can learn more by emailing Paul at pbh@williamsbarbermorel.com.   Paul B. Holmes, JD, is a seasoned ERISA lawyer with nearly 40 years of specialization in that field. Paul joined Williams Barber & Morel Ltd. recently, after 31 years with Nixon Peabody LLP and Ungaretti & Harris LLP. Paul is one of the few ERISA lawyers in the United States, concentrating his practice on PBM contracting and oversight. Paul represents large employers, Taft-Hartley welfare funds, and governmental units in their selection, contracting, auditing, and disputes with large pharmacy benefit managers (PBMs). This work includes active oversight of the request for proposal (RFP) process for selecting a PBM, the negotiation and customization of PBM contracts, and legal audits of PBM compliance with their contracts. Paul provides insightful guidance on the prudent selection of independent pharmacy benefit consulting firms (who do not receive indirect compensation from PBMs), which independence is expressly required under Section 202 of the Consolidated Appropriations Act of 2021 (CAA). Recent efforts have focused on reducing wasteful drug spend promulgated by large PBMs in dozens of categories. These include the preference of Humira® biosimilars, reducing off-label utilization of GLP-1s, reducing huge markups on certain specialty generics, and customizing PBM formularies and clinical protocols to better control spend. He was selected, through a peer-review survey, for inclusion in The Best Lawyers in America® (2020 and 2021) in the field of Employee Benefits (ERISA) Law. Paul received his bachelor's degree from Bradley University and his Juris Doctor degree from the University of Illinois College of Law.   07:41 What are Paul's usual observations when a PBM contract crosses his desk? 08:34 “If you just sign … one of their model contracts …, you're probably gonna pay 30% to 40% above market on your drug spend.” 12:11 What is a PBM lawyer? And why is it important to find an ERISA PBM lawyer? 17:12 EP379 with AJ Loiacono. 17:40 Who is on the hook for the cost of the PBM contracts? 21:05 What's the problem with most ERISA lawyers today? 22:56 Lawsuit about PBM contract. 27:43 What's Paul's advice for benefits consultants? 31:40 How much might a plan sponsor be paying their consultant versus what a consultant might be making from a PBM?   You can learn more by emailing Paul at pbh@williamsbarbermorel.com.   Paul Holmes discusses #PBMContracts on our #healthcarepodcast. #healthcare #podcast #financialhealth #primarycare #patientoutcomes #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Ann Kempski, Marshall Allen (tribute), Andreas Mang, Abby Burns and Stacey Richter, David Muhlestein, Luke Slindee, Dr John Lee, Brian Klepper, Elizabeth Mitchell, David Scheinker (Encore! EP363)  

For a full transcript of this episode, click here. On the show today, I am going to use the term TPA (third-party administrator) and ASO (administrative services only) vendor kind of interchangeably here. But these are the entities that a plan sponsor—for example, a self-insured employer is a plan sponsor—but these plan sponsors will use to administer their plan. And one of the things that TPAs and ASOs administer is this so-called weekly claims wire. Every week, self-funded employers get a weekly claims run charge so they can pay expenses related to their plan in weekly increments. The claims run usually comes with a register or an invoice. This invoice might be just kind of a total (“Hey, plan. Pay this amount.”). Or there might be a breakdown like, “Here's your medical claims, and here's your pharmacy claims.” Maybe there's another level down from that of detail if the plan or their advisor is sophisticated enough and/or concerned enough about the fiduciary risk to dig in hard about what the charges are actually for. I was talking about this topic earlier with Dana Erdfarb, who happens to be executive director of HR at a large financial services organization. Dana I'm definitely gonna credit for inspiring this conversation that I'm having today with Justin Leader. Dana was the first one to really bring to my attention just the level of hidden fees that are buried (many times) in these claims wires … because when I say buried in the claims wire, I mean not charged for via an administrative invoice. These hidden fees are also not called out in the ASO finance exhibit in the contract, by the way. So, yeah … hidden. I don't know … if you have to hide your charges, in my mind that's a pretty big tell that your charges are worth hiding. Now the one thing I will point out is that just because the charges are worth hiding doesn't necessarily mean that the services those charges are for are unwarranted. Some of these services are actually pretty worthwhile to do. There's just a really big difference from a plan sponsor knowingly contracting at a known rate with a third party to do something versus paying for a service knowingly or unknowingly via fees hidden in a claims wire wherein the amount paid is not in the control of the one paying the bill. Anyway, I was talking about all of this earlier, as I mentioned, with Dana Erdfarb. That conversation was exactly the framework that I needed to snag Justin Leader, my guest today, to come on the pod and really dig into the detail level of what's going on with this claims wire. So, in this healthcare podcast, we're gonna talk about the five fees that tend to be tucked in to many claims wires. We also talk about one bonus—not sure if it's a fee—one bonus way that plan sponsors give money to vendors in ways the plan sponsor might be unaware of. Here are the five hidden fees that we talk about at length in the show today, and then I'll cover the bonus: 1. Shared Savings Fees. This is where a member of a plan goes out of network, and the TPA/ASO goes and negotiates a discount from the out-of-network provider and then shares the savings. Get it? Shared savings? This category also might include BlueCard Access fees, which we talk about in the show. But there also could be overpayment recoupment fees lumped in here. This is where the TPA messes up, overpays, and then charges the plan sponsor a percentage of the money they just got back when they corrected their own mistake. I'm just gonna pause here while everyone contemplates how we've all gone so wrong in life to not have figured out a way to charge others when we correct our own mistakes. Here's a link to a great LinkedIn post by Chris Deacon and a deep dive article on this topic. 2. Prior Auth Fees. Lots to unpack with this one, which Justin does in the pod. 3. Prepayment Integrity Fees. This is evaluation of the claim before it's being paid. Listen to the show for how this may (or may not) differ from what the TPA/ASO is supposed to be doing (ie, it's the TPA that's supposed to be [yeah, right] adjudicating and paying claims). 4. Pay and Chase Fees. This is where a bill was paid wrong, and it's not immediately the TPA/ASO's mistake. This is where something like a provider double billed or overcharged or something, and the TPA/ASO later figures this out and then chases the pay to get the money back. 5. TPA Claims Review Fees. Sort of self-explanatory but also not. Again, please listen to the show for more. When I'd been talking about all of this with Dana Erdfarb, as I mentioned earlier, just about this whole thing, she said something that Justin Leader echoes today: Many of these fees are structured as a percentage of savings. This is challenging for a plan sponsor because the savings is vendor reported and not validated. But it also means that if the savings increase annually with trend (as they, generally speaking, do), then the fees will increase with that trend as well—and that is something to keep in mind. Okay … so, here's the bonus thing that didn't get a number in the show today, but it is certainly a way that plan sponsors pay money to vendors. And this is medical claims spread pricing. This is buried in the claims wire and inside the dollar amounts the plan sponsor thinks they are paying a provider for a service. It turns out that it can turn out that the amount the plan sponsor is paying is more than the check that's being written to the provider for the service being delivered. Or the amount the plan sponsor is paying the provider for a service is more than for simply that service that has been rendered, right? The plan sponsor is paying the provider for other stuff as well, as is alleged in the DOL v BCBS of Minnesota lawsuit, which Justin brings up in the show today. It drives me nuts, honestly, when there are people who tout their transparency. But then it turns out if the equation is A plus B equals C, only like one of the numbers is transparent. Sorry, functionally, that doesn't count as transparency except in marketing copy. This is all to say—and here's Dana Erdfarb's actionable advice which sums up points Justin also made—when employers review their medical plan vendor contracts, they should make sure to identify, review, and document all fees being paid to their vendors and incorporate this knowledge into their renewal/RFP (request for proposal) discussions and negotiations. Jeff Hogan echoed this advice on LinkedIn the other day when he commented on this show: “Such a great opportunity for employers to have their administrative services agreements and other documents examined to discover these schemes. It's not hard to do. Also, a great advertisement for the value of having retrospective audits performed. It is eye opening to see not only the amount of arbitrage but often how payers don't even pay according to their contracts. Justin Leader is the perfect guest.” As mentioned a myriad of times already, my guest today is Justin Leader, who is president and CEO of BenefitsDNA. Justin works with plan sponsors, both commercial plans as well as Taft-Hartley plans, across the United States. Before we kick into the show today, I just want to thank By the 49ers for the really nice review on iTunes. By the 49ers calls Relentless Health Value a “leading voice in healthcare” and says he or she always leaves “with intrigue, a new idea or a new approach to problem solving.” Really appreciate that. That is certainly one of our goals around here. So, thank you so much. Oh, also, please subscribe to the weekly email that goes out. You can do that by going over to our Web site and signing up. There are a lot of advantages to doing so, which I've talked about before, so I'm not gonna do so again; but it is a great way to make sure that if you're a member of the Relentless Health Value Tribe, you are aware of the current goings-on. Also mentioned in this episode are Dana Erdfarb, Chris Deacon, Jeffrey Hogan, BenefitsDNA, Rik Renard, Cora Opsahl, Al Lewis, Julie Selesnick, Mark Davenport, Karen Handorf, Dawn Cornelis, AJ Loiacono, and Mike Miele. You can learn more at benefitsdna.com or wefixyourhealthcare.com. You can also follow Justin on LinkedIn.     Justin Leader began his career in the pharmaceutical and financial services industries. By 2011, Justin entered into the group benefits field consulting for many notable Fortune 500 clients. In 2014, he established BenefitsDNA, an objective, independent health and welfare benefit plan consulting firm providing compliance oversight, actuarial services, cost mitigation, and traditional broker services to Group Health Plan Sponsors. As a Certified Health Rosetta Chartered Advisor (eighth advisor to join), he's acknowledged for contributing to healthcare solutions in the United States both in policy as well as practice and is an avid supporter of Patient Rights Advocate. Throughout his career, Justin has been instrumental in introducing successful healthcare benefit solutions to the market, which have been pivotal in solving critical issues and saving millions for employers and their employees. As a mission-driven leader, he and his team are passionate about fixing healthcare one client, one member, and one partnership at a time. Having trademarked We Fix Your Healthcare™, their mission is one that his team takes seriously. Justin, a native of Bedford, Pennsylvania, holds a pre-medicine degree and a master's degree in exercise science from California University of Pennsylvania. His dedication extends to servant leadership, volunteering in the local community including serving on the PA State Council of SHRM (Society for Human Resource Management) since 2016. Justin is a public speaker and owner of Leaders Never Quit, where he dedicates his time to inspiring others with a message of hope, humor, and resilience.   07:55 How is the claims wire typically explained to a plan sponsor? 11:18 What is the whole point of self-funding? 11:27 Why is it so vital to understand what you're paying for? 12:38 What are the five “buried” items that wind up in these claims wires? 13:03 What is a shared savings fee? 17:10 “Rates are important, but so are your rights.” 21:01 What's going on with prior auth fees? 23:35 What is prepayment integrity? 28:16 What is pay and chase? 31:54 What is a TPA claim review? 35:47 Is there medical claim spread pricing?   You can learn more at benefitsdna.com or wefixyourhealthcare.com. You can also follow Justin on LinkedIn.   @JustinDLeader discusses #plansponsor #payments on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Scott Conard (Encore! EP391), Jerry Durham (Encore! EP297), Kate Wolin, Dr Kenny Cole, Barbara Wachsman, Luke Slindee, Julie Selesnick, Rik Renard, AJ Loiacono (Encore! EP379), Nina Lathia  

In this episode of the Astonishing Healthcare Podcast, Jeffrey Hogan, President of Upside Health Advisors, shares his insights on the current state of healthcare and the challenges plan sponsors, including employers and other payers, face. He discusses the importance of aligning supply and demand in the healthcare system in the post-COVID era, the significance of the Consolidated Appropriations Act (CAA), and why establishing a process to evaluate plan data is a must. Jeff explains short-term steps plan fiduciaries can take to learn about their new responsibilities, gain access to their data, evaluate cost categories like pharmacy (which has been a primary driver of inflation, often compounding at 10%+ per year), and why advanced primary care models are worth a look, too. Finally, Jeff shares the most astonishing thing he's seen over his 35+ years in the business (hint: it's not exactly how you'd want to get out of a tough presentation to a client)! Related Content: Self-funded plans ignore the Consolidated Appropriations Act at their peril To learn more about Upside Health Advisors, click here, or you can find Jeff on LinkedIn. For more information about Capital Rx and this episode, please visit Capital Rx Insights.

For a full transcript of this episode, click here. This inbetweenisode is me geeking out, so if that's not your thing, you've been warned. There's a term I'd like to encourage anyone interested to look up. It's the narcissism of small differences. It explains a lot. The narcissism of small differences is the idea that those who, maybe in theory, should be friends/BFFs working side by side toward the same major goal are not. We divide ourselves into these micro-camps. Why? It's a thing to get really narcissistic about small differences. Consider vegans and vegetarians who are so often all up in each other's business in really nasty ways. Who knew whether or not someone decides to eat cheese could create such enmity? Or there's subreddits on Reddit dedicated to people fighting about fantasy football. You would think that everyone who plays fantasy football would be friends, except … not. There are apparently major schisms in the fantasy football world. Or consider branches of the same religion who are at war with one another. Consider people in the same political party fracturing over who is the very most whatever … pick something. So, now let's talk about the narcissism of small differences and how it's relevant when we're thinking about helping patients in the United States get better healthcare for an affordable price. We have these gigantic corporate entities right now very industriously vertically integrating to control supply chains and cornering markets buying up physician practices and using every trick in the book to extract maximum profitability from patients and taxpayers and employers. Achieving some kind of tipping point where these incredibly well-orchestrated and well-funded profit machines are driven back will only happen when enough people, individuals, amass behind that tipping point. It will take more than a village. And my ardent request here is to—I don't know—we quit it with the narcissism of small differences. Do not succumb. “When you cling to ‘my way' you preclude your ability to synthesize, cooperate, support, or even—in [some] extreme cases—peacefully co-exist with other members of your tribe. You destroy a fundamental reason for belonging in the first place: community.” That last bit was a quote from a blog post by Frances Cole Jones. I love the community who I interact with most on LinkedIn, and there's also some Listservs and some Slack groups that I love. Even X and Threads, for the most part, are lovely nests of great people trying to understand one another and further a common cause. I guess when you get into the kind of wonky stuff that you and I get into, there's a finite group of us who are even reading these Tweets or posts or whatever they are. It's a “small junior high school,” as one of my clients used to call it a long time ago. But there's also often enough that somebody who swoops down and in the name of ... something … slams a 95% aligned cause. It's like two people agreeing on the restaurant to go to lunch, but one wants to go there and get a rice dish or because it's closer to their house and the other wants to go there because the restaurant serves a great tortilla—and the two of them fight over what's the right reason to go to that restaurant or what the best item is on the menu. This is literally a metaphor that describes some of the sniping that I have seen, that you have seen amongst mostly aligned folks trying to figure out how to put patients over profits. I mean, guys, go to the restaurant. Once you're there, you can place separate orders. Work together to just get to the restaurant. It's certainly easier to say than do, but if we're aware of this and we focus on the points of agreement and maybe just think a little bit about whether the points of difference really even matter—in real life, not theoretical philosophy life—because a lot of times, they don't. And then divided we fall. I think a lot about small difference narcissism-ing when someone comments derisively that a post or an article puts too much emphasis on … I don't know, transparency or employers or mental health or … pick something. But here's the thing: In the village, everybody is gonna have different number one priorities. That's why it takes a village. Maybe I'm wrong, but I'm thinking it's not a zero-sum game. Just because someone is angling hard for patient empowerment or consumerism or whatever doesn't make it harder for anybody else to promote patient health literacy or better quality measures or integrated behavioral health. Probably it will make it easier, since both are trying to figure out how to put patients over profits. Both are pushing in the same direction, albeit one is headed northwest and the other one might be angled really far northeast. Point is, everybody will get momentum as long as we're all roughly headed northbound. Now, caveat and sidebar: There are people emphasizing things because they're actually working on them, and then there are people promoting things because it's good marketing. Jeff Hogan wrote about this at the beginning of January, and I agree with him here. Here's what he had to say, and then I'm gonna connect it back to what I think is a really important point about the narcissism of small differences. Jeff wrote: Over the course of the last month [I have] been asked no fewer than 20 times about exactly which conferences [I am attending] … this year. … All of my conference intentions are focused on one question: What will this conference do to promote a complete change in our healthcare paradigm … focused on superior [patient] access and outcomes as well as payment reform and care transformation? Said a different way, is this conference literally a honey pot for those who have screwed up the existing system and who are merely virtue signalling …? Who is speaking at this conference? Is it representatives of the same health systems and the same payors [and perpetuating] legacy moats and monopolies or is it a conference promoting change makers, risk takers and provider models and systems embracing risk and [healthcare] transformation? … What kind of change and innovation ever came out of an echo chamber? Challenging my friends and healthcare influencers to think carefully about their choices. Conferences create the opportunity to leverage great ideas and movements. We're finally seeing first followers having expanded influence. Are you one of them? So, talking about that conference that happens at the beginning of January, I heard that a CEO of a major PBM (pharmacy benefit manager) stood up in front of that room and used the word transparency or a synonym six times in five minutes. Check out this LinkedIn post/video and this article as to why my eyebrows are sky-high on what transparency actually means for the CEO when you look at what this PBM is actually doing. If you look at quarterly reports again of some of these big entities, the cover of that annual report has lots of wonderful patient-centric words on it—while if you look at how those entities are actually making money, it is in direct conflict with those words. Now, there's always going to be nuances here … always. And that's what makes this very subjective and very personal. Everyone doing well by doing good is going to have a marketing statement, and it wouldn't be a marketing statement if it didn't sound amazing, right? The nuance or the question is: To what degree are they actually achieving that marketing statement? What's the line that separates pure spin from an acceptable level of achievement of the marketing statement? Because we want to support the organizations that are trying here while, at the same time, make sure that we're kind of quarantining those who are just all talk in ways that confuse the marketplace and don't help patients get affordable quality healthcare, just like Jeff just said. I gotta say, sometimes I struggle here myself. This is why I wrote a manifesto (EP399 and EP400). And you might struggle, too. It's probably no coincidence that sometimes the loudest individuals advocating for patients over profits are retired. And, throwing no shade here, I love the whistleblowing and the truth telling. But I think we have to be a little careful because who is actually gonna do the changing and the tipping point reaching are those who are still working for a living on or about the healthcare industry. And when I say “working for a living,” I mean we're taking money and putting it in our pockets. We need to pay the rent and go on vacation every now and then. And we need money to pay for our family's healthcare. If we didn't take money, if we just volunteered, that cash might have funded more patient care or maybe made that care or premiums more affordable. Every one of us is a cost center if we think about it from the standpoint of the patient or plan member. Every one of us. If you did it for free, the money could accrue to patients, right? I also keep in my mind that there are, for sure, individuals within any of these profit-seeking, financially motivated, maybe not patient-motivated organizations; and these individuals have a job to do the good that that organization is doing. These are the ones who are actually working on pilots that actually work or doing work with social determinants of health or behavioral health that are actually (again) working. While I dislike the overall impact potentially of the one who is paying their paycheck, I gotta keep in mind that the more successful this individual is within that corporate entity, the more good that that entity is gonna wind up doing. I think about this because, again, my main concern is doing better by patients, helping the sort of insurgents within some of these entities. These entities should be held accountable, no doubt; but the people who work within them should—I don't know—I still want to encourage them to do better. The goal is to help patients, not catch up some good people in a quest to punish their boss. So, it's always a matter of degrees. It's always nuances. It's always how much value got delivered back for the dollars that we took in compensation for the work that we did. What did the work we do add up to? In my personal case—and I covered this in the manifesto (again, EP399 or EP400)—I worked really hard, by the way. I was sweating bullets when I was creating that manifesto. I was not sure whether I was gonna get skewered. It really was hard, and it took some major soul searching to create (again, EP399 and EP400). What I try to do, I usually shoot for trying to get patients better outcomes in a way that is cost neutral. The work that I do most of the time (ie, my day job) is probably not gonna lower costs. It's not gonna lower costs. It's just not within the parameters of what I do, and it's not within the parameters of my expertise. Others who I count on to do their thing here, they might be working the opposite angle—the care might be the same, but costs are reduced. Again, a fine way to go. Maybe some of you have figured out how to get patients better care at lower costs. That's the holy grail … and big kudos. But not everybody can do it. It's just not possible a lot of times on any number of levels that we don't have time to get into today. Again, all of this is why I wrote my manifesto for how I reconcile my own self and determine what “having personal integrity” means to me and for me and also for my company. And maybe over the years I've made some choices that I wouldn't make again—but those choices ultimately have wound up funding this podcast, so maybe that's my redemption potentially. I don't know. We all live and learn, and we can't start to hate ourselves because we haven't been perfect. A lot of times, you don't realize the ultimate impact of something until after you've done it. And at that point, you just gotta regroup and try again and do better this time. We all just have to contemplate patient impact. On the other hand, there are often conversations with very motivated entrepreneurs that I've had where the words affordability, impact on patient premiums, access, or better actual measurable health … these words don't come up. At all. Or you talk to somebody else who works at one of these behemoth payers or hospital systems or whoever, and those words do not come up. At all. Again, tracking back to the narcissism of small differences here, are we fighting with someone who is basically 95% aligned with what we're trying to do? Or is this somebody on the other side who's really not in the village because they do not have the same overall intent? The point I'm making here in this inbetweenisode is simply that if we're thinking about this from the standpoint of the patient, then every one of us who isn't retired or independently wealthy or volunteering, we all have a great opportunity to do some amazing work. But we're also all living in glass houses, and if somebody really wants to get all small difference narcissistic about it, they probably could very self-righteously take out most of us. This isn't some kind of cartoon where all the good guys all look the same and everything is black-and-white and there's no nuances. I'm belaboring these points because if we want to build a village, we cannot do so without contemplating who we choose to let in it and who we're gonna beat up on LinkedIn or wherever. But we can be a motley bunch and still work together, as long as we accept each other for the imperfect souls that we are and what we can in the aggregate add to the common cause. There's no “one size fits all” for what we want for ourselves and what we want our legacy to be. I wanna just track back for one sec to that earlier comment I made about people who work for a company that's actively working to take as much money out of the system as possible and give it to their shareholders at the corporate level … because here's an actual case study example of that, and maybe it will be helpful. The other day, I was talking to an actuary who worked for a large (again) payer. And this actuary was trying to figure out ways to create win-wins for plan members within the constraints of his job. This actuary, if he can figure out the math, given the scale of members that he'll reach, he could have a really large positive impact even if he only changes the trajectory of his math by a fraction of a percentage point. I want this guy on my team and in my tribe. He is trying to help, and he has the power to incrementally fix some stuff that is gonna matter to potentially millions of people. I'm not gonna kick him out of my village anyway because of who pays his paycheck. Conversely, I'm gonna try to encourage him to spread his way of thinking to the other actuaries that he works with. Or I get emails all the time (all the time) from people, especially at the beginning of their careers; and they're looking to find a job where they can make an impact. These are smart, ambitious young job searchers, and I hear from them so often I actually have a very long template response that I've been poking away at for years. And I always tell them some variation of many of the things that I have said on this podcast. Often enough, though, I'll get a response back that's something like, “Wow! Thanks so much. This was all so helpful. After much thought, I've decided I'll go work in private equity (PE). I'm gonna go work for a private equity firm so I can fund start-ups who are gonna make a difference for patients.” They may go on, and they mention how they were reading the Slack channel of one of these many groups where they don't talk about the stuff that we talk about on Relentless Health Value. They talk about the thrilling world of start-ups and health information technology and scaling and AI and repeatable whatever. Hold your judgment. I am managing to keep mine in check. I consider that Iora Health (now One Medical) and ChenMed really help a lot of patients. There are some great new companies out there. People also have made lots of money at some of them. Nuances. Choices. Also, who's their leadership? Now, it's inarguable that anyone that's working for a profit-seeking missile of a publicly traded company or a PE-funded company is going to have to contend with a moral framework that is more of a money framework than a moral framework. Same thing goes for anyone working at a huge, consolidated hospital system like the ones that get written up in the New York Times for all kinds of egregious stuff. This money focus may be irrevocably misaligned with the values of someone who works there, and the person may ultimately quit because it becomes too much cognitive dissonance. And if and when they quit, great. They're at a different place in their journey. Maybe they listened to Relentless Health Value long enough and began to realize some of their employer's Kool-Aid might not taste quite right. For them to get to the next stage of their journey and have the impact that they may ultimately want to have, they kinda had to start out in the belly of the beast—and I won't hold that against them, especially if they were able to alter the trajectory of the organization or help patients along the way while they were there. Here's another example to think about as we think about the narcissism of small differences and who gets to be in the village and who we're gonna tell to talk to the hand. I was talking to a friend of my dad's who literally was going to die from a neuroendocrine cancer. He had weeks to live, maybe not even plural. He was given a new immunologic cancer drug. And it's now two years later, and he's still here and in remission. According to the package insert of this drug, he'll probably have 47 months, almost four years, of extra life. Yeah, that drug was expensive. I opened my mouth to say something, and my dad's friend … he kinda shushed me. He said, “Do not say anything bad about the pharma company or my doctors at the big, consolidated health system where I got my care. I am alive, and I should be dead.” This is why I started Relentless Health Value and why I continue to do this thing. It's because almost everything in the healthcare industry along the good-for-patients curve is a matter of degrees. Tip too far in one direction, and we start to cost more than the value we put out in exchange. Tip too far in the other direction, we go out of business. Everything I talk about on Relentless Health Value is in the service of helping myself and you and anybody else I can reach. It's in the service of us figuring out how all of these nuances work in the real world—to help figure out who gets what when and how that might impact patients caught in the crossfire. It's to help figure out my own path forward that I can be proud of, and maybe I can help others trying to do the same. But at the end of the day, we're all gonna make slightly different choices and evaluations. Please don't let the narcissism of small differences prevent us from creating a village large enough to fix healthcare for patients. Also, it's just a nicer way to exist. Also mentioned in this episode are Frances Cole Jones; Jeffrey Hogan; Eric Bricker, MD; Iora Health; and ChenMed. For more information, go to aventriahealth.com.   Each week on Relentless Health Value, Stacey uses her voice and thought leadership to provide insights for healthcare industry decision makers trying to do the right thing. Each show features expert guests who break down the twists and tricks in the medical field to help improve outcomes and lower costs across the care continuum. Relentless Health Value is a top 100 podcast on iTunes in the medicine category and reaches tens of thousands of engaged listeners across the healthcare industry. In addition to hosting Relentless Health Value, Stacey is co-president of QC-Health, a benefit corporation finding cost-effective ways to improve the health of Americans. She is also co-president of Aventria Health Group, a consultancy working with clients who endeavor to form collaborations with payers, providers, Pharma, employer organizations, or patient advocacy groups.   00:42 What “the narcissism of small differences” means. 02:18 How does this narcissism of small differences show up in the effort to fix the healthcare industry? 05:26 Quote from Jeff Hogan. 10:12 “What did the work we do add up to?” 16:31 Why we shouldn't judge someone for working within the “belly of the beast.”   For more information, go to aventriahealth.com.   Stacey Richter discusses small differences and #healthcaresystem fixes on our #healthcarepodcast. #healthcare #podcast #pharma #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Peter Hayes, Joey Dizenhouse, Benjamin Jolley, Emily Kagan Trenchard (Encore! EP392), Cora Opsahl (Encore! EP372), Jodilyn Owen, Ge Bai, Andreas Mang, Karen Root (Encore! EP381), Mark Cuban and Ferrin Williams  

For a full transcript of this episode, click here. Here's a quote from Ann M. Richardson, MBA. She wrote it on LinkedIn, and I love it: Quiet the noise that doesn't add value. Surround yourself with intelligent and respectful people who can deliver endless opportunities. Celebrate brilliance and new beginnings. Together, we've got this. Thanks for this beautifully stated call to action (I wish I would have written it myself) because it is also precisely the goal of Relentless Health Value and my hope for the Relentless Health Value Tribe—those of you who have connected with each other by way of this podcast vis-à-vis LinkedIn, or maybe you've met each other at an online or live event. For sure, subscribe to the weekly email to get notified of such goings-on. Now, this aspirational vision doesn't mean putting the onus on just any given individual to fix the systemic failings that get talked about on the podcast, but we can start somewhere. We can sit with ourselves; we can ask ourselves some big questions. We can decide the legacies we want to leave and what we want our life's work to add up to. That is what this show should, I hope, help you accomplish. And, yeah … together, we've got this. In this healthcare podcast, I am speaking with Peter Hayes; and we talk about five realities of 2024 for hospital chains, integrated delivery networks, health systems. Now, to make one thing very clear, as I have said many times on many Relentless Health Value shows: Not all hospital chains or hospitals are the same. There are large, consolidated, extremely rich, extremely politically and economically powerful organizations who are called health systems. And then there are rural or urban institutions that are barely scraping by and serving huge vulnerable patient populations. And despite the many aforementioned names for hospital chains and their associated outpatient facilities and owned physician groups and urgent care centers, all these names for these big care delivery entities are flabbergastingly meaningless because they do not separate the consolidated rich ones from the very desperately not rich ones. Today on the show, we're talking about the first kind of health systems: the big rich consolidated ones which are taking over every geography where there's money to be made. These are the ones where you read about their bad behavior in the New York Times or hear about them in YouTube videos like this one. Peter Hayes talks about the five things that these behemoth entities may really need to start thinking hard about, even in the face of their fierce and often-unrelenting market power and the political hold that they have over many local communities and all the regulatory capture that goes along with that. So, here's Peter's list in a nutshell—the five things to get real about: 1. Health systems need to get real about the CAA (Consolidated Appropriations Act) and its implications that plan sponsors only pay “fair and reasonable” prices for medical services. Now, before I dig in on this, jargon alert: When we say plan sponsors, that means entities such as self-insured employers—sponsors of health plans, if you will (the purchasers, the ones who are actually paying the bills). Peter explains the quick version of what the Consolidated Appropriations Act is in the show that follows, so do listen. But for more info on this really, really meaningful bit of legislation that is the law as of 2021, go back and listen to the episodes with Chris Deacon (EP342 and EP408) or check out the myriad of LinkedIn posts from Jeff Hogan. Also, others like Darren Fogarty, Justin Leader, Jamie Greenleaf, and others have some great words of wisdom that you will be able to find that really explain what the point is of the CAA, the Consolidated Appropriations Act, and its sprawling implications. 2. To survive on reduced commercial reimbursements, health systems need to get real about becoming ruthlessly aggressive in driving administrative and technology efficiencies. 3. They need to get real about pivoting from fee-for-service reimbursement to episode-based care based on taking real downside risks for good clinical outcomes. They need to pivot from a mindset of maximizing patient revenue to maximizing patient health. They need to move from a sick care reimbursement model to a healthcare reimbursement model based on health. 4. They need to get real about being completely transparent and accountable in reporting how they are using the value of their tax-exempt status. Similarly, they need to account for and report how they're using the estimated $55 billion in net margins that they're realizing off the 340B drug program. 5. They need to get real about quality and patient safety. We still have about 46% of our hospitals that have a C or lower Leapfrog rating. And, by the way, the chance of having a fatality on an avoidable error is 90% higher at a C or lower-rated Leapfrog entity versus a Leapfrog entity that has an A or a B. Now, some of you—and by some of you, I mean practically everybody listening—are thinking of reasons why any one of these “get real about” things is arguable or how one of the above is not holding up in some market. I think Peter would tell you the same thing that I would: You're not wrong. But trying to predict a zeitgeist or the next pet rock never works well because it's always a confluence of right time/right place where the whole is way more than the sum of its parts. Think about Malcolm Gladwell's The Tipping Point. It's about how small changes can have enormous effects if the context is right. So, now contemplate these five things that Peter brings up. All these forces are pushing in the same direction. Put it all into a stew where 48% of Americans have delayed or forgone care due to cost. Listen to the show with Wayne Jenkins, MD (EP358) for more on that. Or, you have the article John Tozzi just wrote in Bloomberg. Here's a quote: “In one California community, teachers have to pay an extra $10,000 a year to upgrade to insurance that covers the local hospitals. Teachers who can't afford it … give birth outside the county.” Meanwhile, insurers are making record profits, along with hospital CEOs and C-suites. At the same time, you know who I think is the third-biggest group with medical debt in this country? Yeah, it's people who work in hospitals—nurses, others. There's this frothing lack of trust for hospitals and what goes on there: 30% of physicians do not trust the leadership of their health system. And no wonder. There are examples of healthcare executives sitting up there in their palatial offices acting more like mobsters than the nuns they took over the hospital from. So, to orient your context, you are here. Peter Hayes is the newly retired former president and CEO at the Healthcare Purchaser Alliance of Maine. He is a national presence in healthcare strategy, innovation, and a keynote speaker. For more on the wild-ass problems with hospital pricing, check out this list of shows. But, spoiler alert, some of these are hair-raising. Encore! EP249: The War on Financial Toxicity in North Carolina as a Case Study Everybody Should Be Keeping Their Eye On, With Dale Folwell, North Carolina State Treasurer EP395: Consolidated Hospital Systems and Cunning Anticompetitive Contracts, With Brennan Bilberry EP390: What Legislators Need to Know About Hospital Prices, With Gloria Sachdev, PharmD, and Chris Skisak, PhD EP389: The Clapback When Hospitals Cannot Constrain Their Own Prices, With Mike Thompson EP346: How Did Health Systems Get Addicted to the Inflated Prices They Charge Employers and Some Patients? 2021 Update, With Peter Hayes, President and CEO of the Healthcare Purchaser Alliance of Maine EP394: Spoiler Alert: It Is Counterintuitive Which Hospitals Offer the Most Charity Care, With Vikas Saini, MD, and Judith Garber, MPP Also mentioned in this episode are Ann M. Richardson, MBA; Chris Deacon; Jeffrey Hogan; Darren Fogarty; Justin Leader; Jamie Greenleaf, AIF, CBFA, C(k)P; Wayne Jenkins, MD; John Tozzi; NASHP (National Academy for State Health Policy); Gloria Sachdev, PharmD; Chris Skisak, PhD; Leon Wisniewski; Cora Opsahl; Rik Renard; John Rodis, MD; Rob Andrews; Al Lewis; Eric Bricker, MD; Vikas Saini, MD; Judith Garber, MPP; Lown Institute; RAND Corporation; Dale Folwell; Brennan Bilberry; and Mike Thompson. You can learn more by following Peter on LinkedIn.   Peter Hayes recently retired as the president and CEO of the Healthcare Purchaser Alliance of Maine and formerly a principal of Healthcare Solutions and director of associate health and wellness at Hannaford Supermarkets. He has been recognized as a thought leader in innovative, strategic benefit design for the past 25+ years. He has received numerous national awards in recognition of his commitment to working collaboratively with healthcare providers and vendors in delivering health benefits that are focused on value (high-quality efficient care). He has been successful in this arena by focusing on innovative solutions for patient advocacy, chronic disease management, and health promotion programs. Peter has also been involved in healthcare reform leadership roles on both the national and regional levels with organizations like Center for Health Innovation, Care Focused Purchasing, and Leapfrog. He's also co-founder of the Maine Health Management Coalition and has been appointed by two different Maine Governors to serve on Health Care Reform Commissions to recommend public policies to improve the access and affordability of healthcare for Maine citizens.   08:04 Why do hospitals need to get real about the implications of the Consolidated Appropriations Act? 10:09 What is considered fair pricing for hospitals? 13:00 EP390 with Gloria Sachdev, PharmD, and Chris Skisak, PhD. 15:59 The medical transparency tool, Billy. 16:34 How does lowering prices become more challenging with consolidated hospital systems? 18:07 What is one of the solutions available to combatting this now? 19:31 Why do hospital systems need to get real about administrative and technology efficiencies? 22:27 EP373 with Cora Opsahl. 26:51 Why do hospitals need to get real about pivoting from fee-for-service reimbursement to episode-based care? 30:16 EP415 with Rob Andrews. 30:53 Why do hospitals need to get real about the 340B program and their tax-exempt status? 35:38 EP394 with Vikas Saini, MD, and Judith Garber, MPP. 38:19 What are the ethical and moral issues that are coming to a head with healthcare costs? 39:03 Why do hospitals need to reexamine their care quality and patient safety? 40:05 “We just need to make sure that the health industry is as accountable as some of our other industries.” 42:53 Why does Peter think it's going to take regulation to move the dial?   You can learn more by following Peter on LinkedIn.   @pefhayes discusses #hospitalsystems and what their executives need to do on our #healthcarepodcast. #healthcare #podcast #pharma #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Joey Dizenhouse, Benjamin Jolley, Emily Kagan Trenchard (Encore! EP392), Cora Opsahl (Encore! EP372), Jodilyn Owen, Ge Bai, Andreas Mang, Karen Root (Encore! EP381), Mark Cuban and Ferrin Williams, Dan Mendelson (Encore! EP385)

For a full transcript of this episode, click here. Why did I decide to encore this episode where Cora Opsahl from 32BJ spends 29 minutes talking about the importance of getting your data if you are an employer or a union health fund? Let me quote Jeff Hogan with some light edits here. Jeff wrote about the “outsized role” that employer data and intentional analytics can and will play. This is emerging and a must-have. The show with Andreas Mang (EP419) from three weeks ago, the show with Dan Mendelson (EP385), the one with Mark Cuban and Ferrin Williams (EP418) … everything that has been talked about in all of these shows and more is gonna be hard to do without having the data so you know what's going on. But I will let Cora Opsahl explain far more succinctly than I can here. One more note before we dive in here: After you listen to this show, you might want to go back and listen to episode 373 with Cora—and that one is entitled “How to Kick a Big Hospital Out of Your Network”—because this is one of the things that 32BJ did when it got its data. 32BJ realized that if it kicked out the really expensive hospital from their network, it would (and did!) save $35 million. Kicking this one hospital out of its network enabled the union to get its biggest wage hike in however many years, and also the employers employing union members got a premium holiday and did not have to pay into the health fund for a few months. Imagine if they didn't have this data and realized the millions and millions of dollars being siphoned out of the plan by this one hospital charging way too much. It's just crazy how many employers or unions wind up becoming imprudent fiduciaries because they just don't have the data to know better. But I'll tell you who is realizing it: class action attorneys. In this healthcare podcast, I am speaking with Cora Opsahl, who directs the 32BJ Health Fund. Important to know about Cora's background is this: In previous roles, she's worked deep in the inner workings of the healthcare industry. So, she came to 32BJ armed with a BS meter that is finely tuned, which is, unfortunately, an essential skill for anyone trying to help the patients and members relying on them to successfully navigate the healthcare industry. This conversation gets into everything that the 32BJ Health Fund does with their data. They have lots of data. They demand it. So, besides kicking out overly expensive health systems from their network, here's other things that 32BJ is currently doing with their data and which other employers and unions may get a few ideas from. If you have the data, you (like 32BJ) can use it to: Make smart benefit decisions that are validated, not just guesses. Before you decide to do something (add a wellness program etc), be able to model it accurately for how much it will actually cost you—which, spoiler alert, is most of the time not what the vendor will estimate. You have way more data than the vendor does, so you can certainly use it to great effect in this way. Make sure that the right members are being communicated with so that benefit designs are successful. As Ashleigh Gunter said in episode 368, success when changing benefit designs has a lot more to do with communication than many realize. Create dashboards for leadership that may show trend lines, for example, which could be very helpful to ensure that the fund doesn't run out of money etc … little things like that. Figure out how much the fund is spending on various procedures and where. There's all this talk right now about the crazy variability of prices for the same exact service in the same local market. At one hospital, a colonoscopy could literally cost $10,000; and in another hospital—same quality, same basically everything—that same colonoscopy will be $2000 or $3000. I mean, there's a 500% delta or something in some of these cases. Ensure that if a vendor said they were going to do something, that they are actually doing it. This is especially meaningful for point solutions because of the whole squeezing the balloon thing. I can save money in a silo, and you won't realize that those dollars are getting transferred elsewhere unless you are doing your own math. This is a big deal if you start thinking about how pharmacy benefits are typically siloed from medical benefits. So, if I'm a pharmacy benefit manager, I can talk about how much I'm saving by denying patients drugs without consideration of the medical downstream implications of that. Ensure you're not paying a bill and writing a check for more than the bill was for, which is weirdly common. There's a whole show with Dawn Cornelis (EP285) about this. 32BJ has an engineering team that is creating an app to help members navigate to great doctors with fair prices. All of these things roll into basically three categories: 1.    Cutting wasteful spending and finding fraud 2.    Making smart benefit decisions 3.    Being able to see trends and forecast the future, which is really helpful for financial solvency etc As Cora Opsahl says, “I think we [all can] recognize [that] you [cannot] make smart … decisions and be a fiduciary of [a] fund without having [data].” This whole conversation has been really a big bright spot for me and will provide hope, I think, for any employer/union who is seeking ways to protect their members and patients, the ones on their plans and therefore under their aegis and whom they have a fiduciary responsibility to look out for. 32BJ represents about 200,000 members. They are mostly in residential and commercial real estate—so, for example, your doormen, your maintenance workers, your security, your cleaners, amongst others. Members are in about 11 states, but a lot of them are in the New York City metro area. These union members who are in the fund work for over 5000 different employers. The 32BJ Health Fund has zero-dollar premiums. Wowza on that point—that's a huge benefit. Also mentioned in this episode are Jeff Hogan; Andreas Mang; Dan Mendelson; Mark Cuban; Ferrin Williams, PharmD, MBA; Ashleigh Gunter; Dawn Cornelis; and Wayne Jenkins, MD. You can learn more at 32bjhealthfundinsights.org.   Cora Opsahl is the director of the 32BJ Health Fund, a self-funded plan that provides affordable, comprehensive, and innovative health coverage to 200,000 union members and their families. As director of the Health Fund, Cora has implemented multiple benefit changes that saved more than $35 million: removing NewYork-Presbyterian Hospital System and physicians from the network, transitioning to a new pharmacy vendor and pharmacy group purchasing coalition, and establishing an expanded Centers of Excellence program administered by Mount Sinai Solutions. Currently, she is leading a comprehensive medical RFP. Prior to joining the 32BJ Health Fund, Cora spent 12 years at Express Scripts, a pharmacy benefit manager, where she held a variety of roles, including with Medicare Part D, strategy and acquisitions, operations, and account management. She holds an MBA from Saint Louis University.   06:53 How much data does 32BJ Health Fund have, where do they get it, and how do they use it? 08:52 How did 32BJ Health Fund successfully demand their data from 100% of their vendors? 09:42 “We feel it's really important that we own this information ourselves.” 10:05 “It always concerns me—if a vendor doesn't want to give you the information, what are they hiding?” 10:32 “It's not just getting the data; it's then using the data.” 13:41 “Without data, you're really just taking a guess; and guesses are never gonna get you where you need to go.” 15:19 EP285 with Dawn Cornelis. 15:40 Is the cost of creating a data analytics team worth the cost savings of those data discoveries? 19:03 “The use of data has really built our knowledge.” 20:52 “It's really important to us that as we make benefit decisions, we're doing it smartly.” 25:27 EP358 with Wayne Jenkins, MD. 25:38 How is 32BJ Health Fund making their data knowledge actionable? 28:11 “If we can figure out how to make telehealth accessible … there may be an opportunity for telehealth … to upset some of these … monopoly systems or low-choice options.” 30:22 “It's really easy to think that we can solve this problem through benefit design … but in the end … it's the price.”   You can learn more at 32bjhealthfundinsights.org. Cora Opsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #healthcareleadership #healthcaretransformation #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Jodilyn Owen, Ge Bai, Andreas Mang, Karen Root (Encore! EP381), Mark Cuban and Ferrin Williams, Dan Mendelson (Encore! EP385), Josh Berlin, Dr Adam Brown, Rob Andrews, Justina Lehman

This is one of those podcast conversations that's still a little baffling to me because I'm shocked it actually happened. Let me explain. When I was a student in college, way back in the dark ages—I mean, the early 1990s—I was introduced to the music of Christian recording artist Wes King. My good friend Jeff Hogan was a guitar player and worship leader, and one day I was in his apartment on campus. He said, “You've gotta listen to this guy Wes King. He's an incredible musician.” The first song he played for me was Wes's song “Life on the Vine,” from his album “Sticks and Stones.” I was immediately hooked. From then on, I was a huge Wes King fan. In the 1990s and early 2000s, Wes released a number of incredible albums, including “The Ultimate Underlying No-Denying Motivation,” the aforementioned “Sticks and Stones,” “The Robe,” “Common Creed,” “A Room Full of Stories,” “What Matters Most,” and “Invention,” a collaboration with fellow guitar virtuosos Scott Dente and Phil Keaggy. Wes has also written songs with, and collaborated with, many other Christian artists over the years, such as Michael W. Smith, Amy Grant, Kim Hill, Gordon Kennedy… the list goes on. He's known as an insightful, lyrical, and theologically-minded songwriter… not to mention a world-class guitarist. I couldn't tell you how many hours I've devoted over the years to figuring out how to play some of his songs and the crazy tunings they're in. So, you can imagine my surprise when, a few weeks ago, I had the opportunity to visit Wes in his home in Franklin, TN, to meet him in person and record this interview. This conversation drifted to a range of issues, including his music career, songwriting, the creative life, theology, and much more. A quick note: we were not in a studio for this conversation. I used a small digital recorder, so it has a different sound than my typical Zoom interviews. But I hope you enjoy it, and much more important, I hope you check out Wes's music if you're not already familiar with it. You can also connect with him on Facebook. * * * Today's episode is sponsored by Vellum, the go-to book formatting software for indie authors who care about creating beautiful ebooks and print books. Use the link to download Vellum for FREE.

This is one of those podcast conversations that's still a little baffling to me because I'm shocked it actually happened. Let me explain. When I was a student in college, way back in the dark ages—I mean, the early 1990s—I was introduced to the music of Christian recording artist Wes King. My good friend Jeff Hogan was a guitar player and worship leader, and one day I was in his apartment on campus. He said, “You've gotta listen to this guy Wes King. He's an incredible musician.” The first song he played for me was Wes's song “Life on the Vine,” from his album “Sticks and Stones.” I was immediately hooked. From then on, I was a huge Wes King fan. In the 1990s and early 2000s, Wes released a number of incredible albums, including “The Ultimate Underlying No-Denying Motivation,” the aforementioned “Sticks and Stones,” “The Robe,” “Common Creed,” “A Room Full of Stories,” “What Matters Most,” and “Invention,” a collaboration with fellow guitar virtuosos Scott Dente and Phil Keaggy. Wes has also written songs with, and collaborated with, many other Christian artists over the years, such as Michael W. Smith, Amy Grant, Kim Hill, Gordon Kennedy… the list goes on. He's known as an insightful, lyrical, and theologically-minded songwriter… not to mention a world-class guitarist. I couldn't tell you how many hours I've devoted over the years to figuring out how to play some of his songs and the crazy tunings they're in. So, you can imagine my surprise when, a few weeks ago, I had the opportunity to visit Wes in his home in Franklin, TN, to meet him in person and record this interview. This conversation drifted to a range of issues, including his music career, songwriting, the creative life, theology, and much more. A quick note: we were not in a studio for this conversation. I used a small digital recorder, so it has a different sound than my typical Zoom interviews. But I hope you enjoy it, and much more important, I hope you check out Wes's music if you're not already familiar with it. You can also connect with him on Facebook. * * * Today's episode is sponsored by Vellum, the go-to book formatting software for indie authors who care about creating beautiful ebooks and print books. Use the link to download Vellum for FREE.

I couldn't resist the “who's suing who” because, yeah, you can't go wrong with Aretha Franklin references. Back on the pod we have Chris Deacon, who is going to give us a rundown of the legal goings-on going on right now that impact self-insured employers, carriers, hospitals, and taxing authorities like cities. Chris breaks down the legal activity into three main categories, and then we discuss some examples of lawsuits in each category. So, here's the outline of our upcoming conversation: 1. Breach of Fiduciary Line of Cases Against Carriers a.    Bricklayers vs Anthem Class Action b.    Mass Laborers vs Blue Cross Blue Shield c.     Member vs Cigna 2. Carrier vs Hospital (upcoding) and Hospital vs Carrier (underpayment) a.    United vs TeamHealth b.    TeamHealth vs United 3. Taxing Authority vs Nonprofit Hospitals a.    Tower Health line of cases in Pennsylvania b.    Pittsburgh vs UPMC This episode itself is a little on the longer side—and I didn't want to edit too many of Chris's words of wisdom—so I'm gonna make this a little bit shorter, this intro. But just one point that I'll make, and this is about the first category of legal activity wherein self-insured employers mostly try to pass the “who is actually the fiduciary” hot potato to carriers, ASOs (administrative services only), and TPAs (third-party administrators). And the carriers, ASOs, and TPAs are like, “It ain't us.” Moving forward here, I'm just gonna say carriers as a catchall for carriers, ASOs, and TPAs to save myself a mouthful. But bottom line on this topic, I just want to underscore something that Chris makes clear later on in the show: Plan sponsors (ie, self-insured employers) are the fiduciary, the sole fiduciary, at least according to the carriers who are getting sued right now. This is the position that you can see them taking in every lawsuit that I have seen. What the carriers say also, as a follow-on, is that if there is any contractual language between the carrier and the employer that violates the CAA (Consolidated Appropriations Act) or any other regulations, it is or was the employer's responsibility to not sign the contract. It's not the carrier's responsibility to point out that there's stuff in their own contract that's in violation for the employer to sign. And this includes contracts that don't give self-insured employers the right to their own data, which is pretty much a rate critical for any and all CAA compliance. As Justin Leader wrote the other day in reference to the bricklayer case, “To get to the point of filing the suit, there was a solid 2 years of failed negotiations [for the bricklayers to get their own claims] data.” Two years trying to get claims data that is necessary for a fiduciary to have from a carrier who is saying essentially, “Good luck with that. You're the ones that signed our contract.” Here's one of Chris Deacon's latest LinkedIn posts about this topic. And here's another one from Jeff Hogan that was interesting. Also, here's the link to the earlier episode with Chris (EP342), where we dive into the deep end on the topic of the CAA, which was signed into law at the beginning of 2022 and states that self-insured employers have certain rights and responsibilities based on their role as the fiduciary of their health plan. For more on the Member vs Cigna case, check out the encore episode with Dawn Cornelis (Encore! EP285). The show with Vikas Saini, MD, and Judith Garber, MPP (EP394) comes up where we talked about hospitals and their charitable giving. And lastly, I mention the show with Suhas Gondi, MD, MBA (EP404) about who is on the board of directors of hospitals, big nonprofit hospitals in particular. My guest in this healthcare podcast, Chris Deacon, is a lawyer by training. She ran the state health plan for the state of New Jersey, which covered about 820,000 public-sector lives. She now has an independent consulting firm, VerSan Consulting.   You can learn more at versanconsulting.com and connect with Chris on LinkedIn. You can also email her at cdeacon@versanconsulting.com.   Chris Deacon has a deep understanding of the fiduciary role health plan administrators hold and should be leveraging in order to drive value for their plan sponsors and members. An attorney by training, Deacon formed VerSan Consulting, LLC, in order to educate and engage employers to be more prudent purchasers of healthcare. From creative procurement methodologies and demanding contracts to population health initiatives and primary care investment, Deacon believes that large employer-sponsored health plans have not only an opportunity but an obligation to drive healthcare transformation that delivers value for the market. Prior to founding VerSan Consulting, Deacon ran one of the largest health plans in the country for the New Jersey Department of Treasury, which covered over 820,000 public-sector lives, including state employees, teachers, and uniformed professionals. During her tenure, Deacon was credited with helping the state save over $3 billion through a number of initiatives, including enhanced oversight, payment integrity programs, procurement strategy, and strict accountability for the vendors with which the state engaged. Deacon has also served as a deputy attorney general and then special counsel to Governor Christie where she oversaw the Department of Banking and Insurance, Economic Development Authority, and Treasury. She holds a JD from Rutgers Law School and bachelor's degree in international affairs from The George Washington University.   04:47 What does the current legal landscape look like, and how does it bode for the future? 07:24 “We need to catch the legal framework up with the current reality.” 19:53 How is this first circuit decision affecting who might be found liable in future cases? 21:38 What happened in the Member vs Cigna case? 24:49 Are we heading in the direction of the employer having fiduciary responsibility? 25:47 What's happening in the Carrier vs Hospital cases? 28:49 Who's really paying the price for the current business practices being examined in court? 30:00 What's happened in the Tower cases?   You can learn more at versanconsulting.com and connect with Chris on LinkedIn. You can also email her at cdeacon@versanconsulting.com.   @VerSan_cdeacon discusses current legal affairs in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #hcmkg #healthcarepricing #pricetransparency #healthcarefinance   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Vivek Garg, Lauren Vela, Dale Folwell (Encore! EP249), Eric Gallagher, Dr Suhas Gondi, Dr Rachel Reid, Dr Amy Scanlan, Peter J. Neumann, Stacey Richter (EP400), Dawn Cornelis (Encore! EP285)  

Well, this episode became extremely relevant again after that Cigna case bubbled up in the news. Here's the “too long, didn't read” version: Attorneys filed a class action lawsuit against Cigna, alleging that the carrier is overcharging for lab services or did overcharge for lab services. The plaintiff is an individual member of a Cigna plan. The complaint tells a pretty wild story. On the Explanation of Benefits (EOB) that this member received for lab services, the amount billed was over $17,000. My understanding is, this member went to Labcorp to get those lab services. Cigna claimed it had negotiated a discount of over $14,000 for those lab services, meaning the remaining balance was something like $2700. OK … good news, I guess. Instead of the lab services costing $17,000, they cost $2700 to the plan and member. Except Cigna said to this member that they were only gonna pay $471 on the member's behalf. This left the member with the responsibility to fork out over $2000 in deductible and coinsurance payments. I'm rounding the numbers here for brevity. So, in sum, member's told she owes $2000+ out of pocket for charges that were allegedly originally over $17,000. Now, a couple things: The cash price for an uninsured customer at Labcorp for the same services was $449, according to the complaint. Also, weirdly, on the Explanation of Benefits, Cigna allegedly said that the lab services provider was not Labcorp. It was “Health Diagnostic Lab” (or everything I just said in all caps with some letters missing) instead of the actual provider Labcorp. Then the plot thickens … The lawsuit alleges that this “HLTH DIAG LAB” is a pseudonym for Cigna Healthcare of Arizona and that this Cigna affiliate used their pseudonym to create a fake invoice. This is also a quote from the complaint. Bottom line, and this is the real point I wanna make here, the actual out of pocket to the payer was something less than $500, $600, you would think. But it appears that the plan was hoping to get almost 5x that out of the plan member. And had this plan member met her deductible that year, I would speculate that this 5x would have come out of the pocket of the plan sponsor. Either way, 5x margin? That's some pretty sweet returns. Look, the point I'm making here isn't about this particular case. It's about the totality of the thing. This case just got a whole bunch of attention because, as Julie Selesnick put it on LinkedIn recently, “This case … hits all the high notes—overcharging, keeping the spread, fraudulent billing.” But think about this for a second. You think this was an isolated incident? That someone in Arizona had a brainstorm to juice their quarterly earnings and set up a whole company to jack up one person's lab payments? I don't know. What do you think? As Lee Lewis mentioned on LinkedIn, while this case has a lot going on, a member getting charged $2500 for what should cost $450 or whatever … he wrote, “I've seen worse.” I say all this to say: Plan sponsors? Hi there. Are you getting your claims data, and are you having it audited for stuff like this? And by whom are you having your claims data audited for stuff like this? And that's not a rhetorical question. I mean, here we have a well-respected payer opening up (allegedly) a reseller of lab services sending allegedly fake invoices. That's one way to vertically integrate, I guess. Here's another way you can vertically integrate that maybe we all should be aware of: companies that provide audit services that many plan sponsors use to check if claims have been paid properly. Those same auditing companies, these same companies oftentimes have another book of business besides their auditing claims for plan sponsors work. They also work with provider organizations doing revenue optimization. Right. They help providers maximize their revenue, revenue that is coming from … claims they send plan sponsors. Sometimes when I talk about this stuff, I feel like I'm in a cartoon—like that meme with all the Spider-Men pointing at each other and nobody knows who is actually Spider-Man because everybody is dressed up in the same costume pointing and saying the other guy is the one causing the problems here. As Dawn Cornelis says in this episode today, approximately 30% of healthcare spending (ie, healthcare payments) are some combination of fraud, waste, and/or abuse. It's a $1-billion-a-day problem. In this episode, we dig into the three main issues that Dawn tends to find when looking at the claims that were going to hit the checkbook of a plan sponsor as per their payer or TPA (third-party administrator): 1. Claims that were not paid correctly: Turns out, 5% to 10% of claims just aren't paid right. There's a whole motley crew of errors that can transpire, but bottom line, the bill was for $10 and somehow the plan sponsor was gonna pay $15. Or they double paid. 2. Things that, if we knew about them, we could do better in the interest of the member: Jeff Hogan put this really well on LinkedIn the other day. He wrote, “Today's purchaser fiduciary needs great analytics to prioritize the needs of their members … including wasteful and abusive vendors, site of care, cost/quality variation in health systems.” Do labs that the plan is being charged $2500 instead of $450 go here or in the next problematic category? I'm not sure. 3. Claims that are just wrong: They should never have been sent in the first place. We also talk about kind of a different issue entirely: the hidden fees that are buried in some of these payer contracts, which felt like a reprise, frankly, of the conversation I had with Paul Holmes a few weeks ago in episode 397 talking about PBM (pharmacy benefit manager) contracts and all the hidden fees and, ultimately, probably costly provisions buried in them that plan sponsors are on the hook for—a lot of times very unknowingly.   You can learn more at claiminformatics.com or by emailing Dawn at d.cornelis@claiminformatics.com.     Dawn Cornelis is a professional in healthcare cost containment with 30+ years of dedication to combatting improper payments, fraud, waste, and abuse. She has led the industry in developing healthcare transparency technology platforms and services. As a result of her efforts, hundreds of millions of dollars of improper payments were delivered through pre- and post-payment technology programs. She is an expert in the field of healthcare claims data, with an emphasis in audit and recovery, and has navigated the payment systems of all of the national healthcare carriers. Furthermore, she approaches each project with integrity and attention to detail while cultivating long-term client relationships. In 1993, Dawn cofounded the first audit and recovery firm and served for 17 years as the chief operating officer of Claim Recovery Services while representing some of the best Fortune 100 companies. In 2017, Dawn cofounded ClaimInformatics, a healthcare technology company that offers a SaaS-based solution product to support health plans in the marketplace that addresses the new transparency regulations. She developed and trademarked multiple technologies and has a United States Patent Pending named CONTINUITY OF CARE (Publication #20150127370). Dawn currently serves as a member of the Self-Insurance Institute of America's price transparency committee, which focuses on legislation and education for self-funded entities. Over the course of her career, Dawn's efforts have supported national and local organizations spanning financial, healthcare, union, and government sectors. With her years of healthcare knowledge, Dawn is a proven expert, consistently delivering excellence.   06:57 The story in the data. 07:33 Who's submitting these claims? 08:04 The three problems with the data. 10:54 The varying factor between carrier systems to stop fraud, waste, and abuse. 11:32 Why carriers don't push for better systems to stop inappropriate dollars. 13:28 The difference between fraud, waste, and abuse. 14:46 “When it becomes the norm, that's what's very bothering.” 15:10 The barriers or hurdles in the marketplace. 17:38 What we don't know about but could do better at when looking at the data. 19:10 “It's not so much the health system and what they are charging. It's about … what the contracted rate is agreed to. That's what drives our costs.” 20:04 “Data's fixed for itself.” 22:49 Identifying and eliminating fraud. 22:54 The lack of enforcement behind preventing illegal billing. 26:01 How providers ensure they aren't inadvertently harming employers and patients through billing.   You can learn more at claiminformatics.com or by emailing Dawn at d.cornelis@claiminformatics.com.   Check out our encore #healthcarepodcast with Dawn Cornelis of @claiminformati1 as she discusses saving billions through healthcare billing. #healthcare #podcast #digitalhealth #healthtech #healthcarebilling   Recent past interviews: Click a guest's name for their latest RHV episode! Stacey Richter (EP399), Dr Jacob Asher, Paul Holmes, Anna Hyde, Dea Belazi (Encore! EP293), Brennan Bilberry, Dr Vikas Saini and Judith Garber, David Muhlestein, Nikhil Krishnan (Encore! EP355), Emily Kagan Trenchard

If this were a video show, I would stare into the camera with steely eyeballs right now and say that I have a special message for employer CFOs. If you aren't a CFO, pretend that you are so that you get the full effect here. So, now that we're all CFOs, let's pull up the company P&L (Profit and Loss) statement. This is what keeps us all up at night, right? Making sure that the net profit line at the bottom looks good. We could decide to lay off a few people. Reorg something or other. Beat up a vendor. Stop buying the gold paper clips. We also could go over and have a strident conversation with sales leadership about what they can do to jack up their sales revenue. Top line begets bottom line, after all. Or, here's another idea: In this healthcare podcast, I am speaking with Paul Holmes, who is an ERISA (Employee Retirement Income Security Act) attorney with a specialty in PBM (pharmacy benefit manager) contracts, especially the PBM contracts from the big PBMs that get jammed in employer plan sponsor faces by whomever and which they are told look fine and that the employer plan sponsor should just go ahead and sign. Now, if we, meaning all of us CFOs, sign that paper, or someone on our benefits team signs the paper … fun fact, our company just spent 30% to 40% over market for our pharmacy benefits. That contract we just signed contains all kinds of expensive little buried treasures—treasures accruing to the PBM and other parties, to be clear, and coming at our expense. There's 17-ish very common treasures in your typical PBM contract, and none of us will ever spot them unless we know what we are looking for. But let's dig into this for a sec, especially for all of us newly minted CFOs because the real ones already did this math. Say our company spends whatever—we're a bigger company, and we spend $100 million a year on our drugs. That's a minimum of $30 million that we got taken for … $30 million a year. That's a metric load of our cold hard cash that got dumped out back and burned. Because of the huge dollars at stake (30% to 40% of drug spend), it's certainly the advice of almost anybody that you talk to who's an expert in PBM contracts to have a third party—not your EBC (employee benefit consultant), which we'll get into in a sec, but somebody else (a third party)—review every PBM contract. I mean, what's the worst that can happen for anybody considering having an independent third party review their PBM contract? It costs a couple grand in lawyer fees, and they give it a stamp of approval. Knowledge is power, and now we know. But let's just say this third-party review doesn't happen. We all go with a “devil may care” about this whole PBM overcharging us by 30% to 40% possibility. And let's say the PBM contract is, in fact, a ride on the Hot Mess Express, but we don't know it. Here's two pretty bad downsides, especially now, this year, since the passage of the CAA (the Consolidated Appropriations Act) at the beginning of 2022. Number one bad thing: Plan sponsors may get sued as per the CAA for ERISA violations. It's not just the company paying that extra $30 million, or 30% to 40%, right? It's also employees. This is risk exposure, bigly. Just like it was on the 401(k) side of the house, which Paul Holmes, my guest today, mentions later on in the interview. He talks about just how much those lawsuits cost and, yeah, exposure. As I mentioned three times already, today I am speaking with Paul Holmes about PBM contracts in all their stealthy glory. The one thing I came to appreciate is that these things are works of art … if you're into those paintings of pretty flowers where, if you look hard enough, you spot a skull tucked in the greenery (memento mori). Paul is a longtime ERISA attorney. He has dedicated his career to helping plan sponsors in their negotiations with PBMs and trying to help them reduce drug spend, especially drug spend that isn't actually paying for drugs. Here's a link to an article we discuss about how a school district in Florida is suing their longtime EBC for taking $2 million a year in alleged secret payments. We also mention an episode with AJ Loiacono (EP379). And along similar lines, Jeff Hogan mentioned on LinkedIn the other day, “It's pretty amazing that just in the course of the [past few] weeks, I'm reading, seeing, and hearing about big new CAA breach of fiduciary duty cases.” So, Paul Holmes says this more eloquently, but if you're a plan sponsor, definitely get your PBM contract reviewed and maybe consider working with an EBC who's happy to sign the disclosure statement that your lawyer has provided without disclaimers. Oh, hey … one last thing and new topic. Here's a cool goings-on: Right now, the March Healthcare Classic is in full swing. Each spring, Josh Berlin's rule of three team collaborates with other experts to predict which major trend will find itself at the top of the healthcare agenda over the next 12 months. This year, their selection committee includes Anisha Sood; Danny Brywczynski; David Carmouche, MD; Shaheed Koury, MD; and Stephanie Mercado. Check it out and weigh in yourself should you choose to do so.   You can learn more by emailing Paul at pbh@williamsbarbermorel.com.   Paul B. Holmes, JD, is a seasoned ERISA lawyer with nearly 40 years of specialization in that field. Paul joined Williams Barber Morel recently, after 31 years with Nixon Peabody LLP and Ungaretti & Harris LLP. Paul has extensive and unique experience in representing large employers and Taft-Hartley welfare funds in their selection, contracting, auditing, and litigation with large pharmacy benefit managers (PBMs). Paul has logged over 8000 hours during the past four to five years, advising large employers and Taft-Hartley welfare funds managing their prescription drug benefit plans. This work includes active oversight of the request for proposal (RFP) process for selecting a PBM, the negotiation of final PBM contracts (including pricing, rebates, and audit rights), and regular audits of PBM compliance with their contracts. He was selected, through a peer-review survey, for inclusion in The Best Lawyers in America (2020 and 2021) in the field of Employee Benefits (ERISA) Law. Paul received his bachelor's degree from Bradley University and his Juris Doctor degree from the University of Illinois College of Law.   06:06 What are Paul's usual observations when a PBM contract crosses his desk? 06:57 “If you just sign … one of their model contracts …, you're probably gonna pay 30% to 40% above market on your drug spend.” 10:35 What is a PBM lawyer? And why is it important to find an ERISA PBM lawyer? 15:37 EP379 with AJ Loiacono. 16:05 Who is on the hook for the cost of the PBM contracts? 20:36 What's the problem with most ERISA lawyers today? 22:28 Lawsuit about PBM contract. 27:15 What's Paul's advice for benefits consultants? 31:11 How much might a plan sponsor be paying their consultant versus what a consultant might be making from a PBM?   You can learn more by emailing Paul at pbh@williamsbarbermorel.com.   Paul Holmes discusses #PBMContracts on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Anna Hyde, Dea Belazi (Encore! EP293), Brennan Bilberry, Dr Vikas Saini and Judith Garber, David Muhlestein, Nikhil Krishnan (Encore! EP355), Emily Kagan Trenchard, Dr Scott Conard, Gloria Sachdev and Chris Skisak, Mike Thompson  

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  

Today's Buzzcast interview is with Jeff Hogan, Vice President of Valuations for Veros. We sat down with Jeff and Joan Trice, Founder of Allterra Group, LLC, to discuss his MBA panel on policy and tech perspectives on appraisals and what's happening in the industry today.   What are the influential policies that are impacting appraisers today? How does tech play a role when it comes to appraising? How are these changing perspectives the key to a flourishing appraisal industry? These questions and much more will be answered between Jeff and Joan as they dive into this subject.   Have any comments or would you like to submit content of your own? Email comments@appraisalbuzz.com.

In the latest episode of Yankee Institute's podcast Y CT Matters, Jeff Hogan, president of Upside Health Advisors, returns to discuss innovations in healthcare, as well as potential reforms to improve transparency and accountability within the system. 

In our season two premiere, health editor and host Alander Rocha sits down with Jeff Hogan, professor of infectious diseases at UGA's Animal Health Research Center, to discuss everything you need to know about the monkeypox virus. Hogan shares his expertise on the monkeypox virus, the vaccine, and whether we can call it an STD or not.

In the latest episode of Yankee Institute's podcast Y CT Matters, Jeff Hogan, president of Upside Health Advisors, discusses the complexities of the current healthcare system, how it was impacted by the COVID-19 pandemic, and the potential solutions to restoring the doctor-patient relationship.

Creating a value-based healthcare ecosystem with the highest quality outcomes at a reasonable cost for employers and their healthcare consumers requires collaboration. In the state of Connecticut, a grassroots community has formed with the mission to create a value-based healthcare ecosystem.  The Moving to Value Alliance is a multi-stakeholder community composed of individuals, practices, and organizations deeply rooted in Connecticut's healthcare environment.  They believe that collaboration is the key to solving complex problems and are leading the way to transform healthcare delivery in their state. Joining us this week are two leaders involved in this important movement to employer-based healthcare transformation in Connecticut. With more than 35 years in the health care sector, Jeff Hogan is a consultant to payers and large provider groups for product development and launch and a resource to employers desirous of implementing strategies to manage their health spend. Lisa Trumble is the President and CEO of the Southern New England Healthcare Organization (SoNE HEALTH), a clinically integrated network comprised of six hospitals and 1,700 physicians, which is a for-profit entity owned jointly by Trinity Health Of New England and its employed and independent physicians.  In this episode, we talk about healthcare transformation in the state of Connecticut, vertical and horizontal consolidation in the industry, the dysfunctional health benefits market, the need for employer alliances, leading innovators in the marketplace, value-based insurance design, prescription drug costs, healthcare consumerism, and bundled payment innovation. The time to move to value is now!  We can create a transformed healthcare ecosystem through industry collaboration.  Thank you, Lisa and Jeff, for showing us the way. Episode Bookmarks: 01:30 “Collaboration is the key to solving complex problems.” 01:45 The Moving to Value Alliance - a multi-stakeholder grassroots community creating a value-based healthcare ecosystem for employers in Connecticut 02:00 Introduction to Jeffrey Hogan and Lisa Trumble 03:45 Eric reflects on his recent experience attending the MTVA 2022 Symposium 05:00 The leadership of Dr. Stephen Shutzer and other leaders 06:00 Referencing Michael Leavitt's book, “Finding Allies, Building Alliances” where he talks about the power of collaboration networks 06:20 “Connecticut is known for being ground zero for most of the BUCA health plans and has also been the land of frozen molasses in value-based care.” 07:00 “Healthcare is opaque and balkanized, and COVID has inspired the opportunity to think about things differently.” 07:30 Transparency, Collaboration, Innovation, Consumer Expectations, and the “Great Resignation” 08:30 Lisa shares her background in value-based care transformation in Massachusetts and how that differs from Connecticut 09:30 “We must break away from the traditional structures of fee-for-service, and pursue clinical integration, innovation, alliances, and partnerships.” 10:00 A new wave of horizontal and vertical consolidation between hospitals and physician practices 12:00 The inevitability of consolidation after the pandemic and how consolidations have not resulted in cost and quality improvements. 12:30 The lack of value-based transformation strategy in health systems and why that is short-sighted 13:00 “The pandemic opened up the doors to innovation in a way that none of us anticipated in every sector of healthcare.” 13:40 Concerns about vertical integration of providers in consolidated payer-led structures 14:20 Lisa shares background on SoNE HEALTH (Southern New England Healthcare Organization) and how they partner with physicians. 15:20 Jeff describes how he has never seen so much change in healthcare in such a short period of time. 16:00 The movement to health equity as a result of consumer pressures, innovation, and market trends. 17:00 The hybridization of health systems,

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

Recently I was talking to someone, a civilian not in health care, and I mentioned something about how patients don't always get a treatment plan (a care plan) based on the best evidence or sometimes even any evidence. Here's how I explained it to him—what this looks like in the real world: Let's say two patients, patient 1 and patient 2, with the exact same clinical needs and zip code … both these two patients see the exact same doctor. The only difference between these two patients is that they're two different colors. And let's add a third patient into this mix: say, ME. Let's say I have the exact same profile and zip code as those first two patients. I see a different clinician in the same exact practice, though. In all these circumstances, evidence is evidence, right? There should be one care plan that all three of us get when we show up at that same care setting. Until the evidence changes, that is, right? But the reality is that it's just as likely that those other two patients and I, we all get various shades of different care plans. The civilian I was having the original conversation with about evidence-based medicine and this care planning? He literally recoiled in surprise. He was shocked. He said he thought medicine was more science than that. I'm going to take that anecdote as a data point to suggest that there is a disconnect between what patients think is going on and what is actually going on relative to how care plans tend to happen in health care. Alex Akers from Health Catalyst in episode 176 and Clint Phillips from Medici in episode 201 get into this in detail. You can listen to full episodes and learn more about this week's guests at relentlesshealthvalue.com.  Jeffrey Hogan is the northeast regional manager for Rogers Benefit Group, a national benefits marketing and consulting firm. Jeff has been with Rogers Benefit Group for 30 years. Additionally, Jeff operates a consulting firm, Upside Health Advisors, where he provides expert witness services on health care–related litigation, is a consultant to payers and large provider groups for product development and launch, and is a resource to employers desirous of implementing strategies to manage their health spend. Jeff is focused on health care payment reform, health policy, care coordination, value-based health care, health care quality, and precision medicine. Jeff regularly appears on national forums focused on moving to value-based health care and is actively working to promote health care–related transparency measures in the market. He serves as the group's liaison to the National Alliance of Healthcare Purchaser Coalitions. Jeff is the regional leader for The Leapfrog Group. He is also one of the coordinators of Connecticut's Moving to Value Alliance. Darrell Moon founded Orriant in 1996 to change the dynamics of health care and give employers some control over the ever-increasing costs of the health care benefits they offer their employees. Darrell believed that engaging individuals in the management of their own health was a key that had to be inserted back into the economic equation of health care. Darrell received both his bachelor's degree in finance and his master's degree in healthcare administration from Brigham Young University. As the CEO, COO, or CFO, Darrell managed medical and psychiatric hospitals throughout the country for over 10 years prior to creating Orriant. He also has more than a decade of experience managing insurance and managed care products. Darrell is a Forbes leadership contributor. Grace E. Terrell, MD, MMM, is CEO of Eventus WholeHealth, a company focused on integrated value-based behavioral medicine and primary care in the long-term care space. She is a national thought leader in health care innovation and delivery system reform and a serial entrepreneur in population health outcomes driven through patient care model design, clinical and information integration, and value-based payment models. She is the former CEO of Cornerstone Health Care, one of the first medical groups to make the “move to value” by lowering the cost of care and improving its quality for the sickest, most vulnerable patients; the founding CEO of CHESS, a population health management company; and the former CEO of Envision Genomics, a company focused on the integration of precision medicine technology into population health frameworks for patients with rare and undiagnosed diseases. Dr. Terrell currently serves on the US Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee and the board of the AMGA (American Medical Group Association), is a founding member of the Oliver Wyman Health Innovation Center, and is the coauthor of Value-Based Healthcare and Payment Models. Rich Klasco, MD, FACEP, has focused throughout his career on rendering evidence-based medicine operational—that is, making the right thing the easy thing to do. He has pursued this goal in academia, in industry, in policy, and in the press. In addition to publishing extensively in both peer-reviewed journals such as JAMA and lay publications such as The New York Times, Dr. Klasco has taught at leading academic medical centers, including Harvard, Stanford, Mayo, and the University of California, San Francisco; served on the executive committee of Brigham and Women's Hospital Center for Patient Safety Research and Practice; testified before the United States Congress on evidence-based practices; and won CMS (Centers for Medicare & Medicaid Services) approval for an officially designated compendium of evidence-based oncologic drug information. Dr. Klasco previously served as chief medical officer and editor-in-chief for the Thomson Reuters group of health care companies, where he had editorial responsibility for companies including Micromedex, the Physicians' Desk Reference (PDR), and the United States Pharmacopoeia (USP) Drug Information. For the past 15 years, Dr. Klasco has served as chief medical officer for Motive Medical Intelligence, where he provides clinical leadership for the development and deployment of solutions that quantitative assess physician performance for payers, providers, and patients, and integrate scientific knowledge into workflow systems where it can be accessed and applied in real-time. Dr. Klasco received his medical degree from Harvard Medical School. He completed his internship and residency in internal medicine at Brigham and Women's Hospital, and he completed his residency in emergency medicine at the Denver Health Residency in Emergency Medicine, where he served as chief resident. Nicole Bradberry is the founder and chief of growth and innovation officer for MIND 24-7. MIND 24-7 runs mental health crisis centers with a focus on immediate access, quality care, and the understanding that mental health and substance abuse drive significant health cost. She is also the founder of ValueH Network, which aggregates high-performing value-based care network providers in order to enable the best performance in new innovate contracts. In addition, she is currently the chief executive officer and chairman of the board of the Florida Association of ACOs (FLAACOs). FLAACOs is the premier professional organization for accountable care organizations (ACOs) throughout Florida which provides education and collaboration in the fee for value health care space. Nicole spent 16 years leading operations and information technology programs for UnitedHealth Group and Cigna HealthCare. While there, she served as business lead for the technology transformation of the country's largest dental and vision services company, led the national deployment of health care quality and affordability programs, and was responsible for the successful integration of many major health plans. Nicole holds a bachelor's degree in statistics from the University of Florida. She has been recognized for her personal and professional achievements many times, recently as the nation's Outstanding Midmarket IT Leader of the Year and one of the Business Journal's “Women of Influence.” She is often found on the speaker faculty for health care conferences focused on ACOs, population health, and value-based care. She is passionate about changing health care and enabling physicians to provide high-quality, cost-effective, and consumer-focused care. Kelly A. Conroy is director of Pinnacle Healthcare Consulting and brings more than 30 years of health care finance, management, and leadership experience with significant experience in value-based care. As a leader in the field, she'd contributed through multiple start-up health care companies with a leading-edge focus on advancements in care delivery and alignment. Kelly started the first Medicare ACO in the country, which delivered nearly $40 million in savings in its first year and has gone on to manage some of the most profitable ACOs in the country. She is now sought after as a senior advisor and consultant, having developed a reputation as one of the most experienced and effective ACO professionals in the country. As a true catalyst driving the shift in health care culture toward physician leadership, her understanding and strategic vision are unmatched, along with her comprehension of the latest government-proposed valued-based agreements. From starting health care organizations to serving in multiple senior executive leadership roles, Kelly is a seasoned executive with a career record of negotiating and increasing revenues through new product offerings while optimizing efficiency and productivity in the medical field. 02:10 Jeff Hogan (EP309) talks about the consequences of when there's a disconnect between what the patient thinks is happening and what is actually happening in a care plan.03:48 EP315 with Bob Matthews. 03:58 Merrill Goozner's perspective on successful population health.04:55 Why did Darrell Moon (EP305) give up being a hospital administrator because of care plans? 08:02 “It's a myth that population medicine … and precision medicine are incompatible or opposites.”—Dr. Grace Terrell (EP319) 11:28 Dr. Rich Klasco (EP321) explains “noncognitive” medicine and why it bogs physicians down.14:45 What is at the core of appropriateness for care? 16:33 “You start to bring that data to the physician, and it really does open their eyes.”—Nicole Bradberry (EP324) 16:51 Nicole Bradberry and Kelly Conroy (EP324) discuss how to really change the way physicians work. You can listen to full episodes and learn more about this week's guests at relentlesshealthvalue.com.  Jeff Hogan, Darrell Moon, @gracet22, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy discuss #careplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth What are the consequences when there's a disconnect between what the patient thinks is happening, and what is actually happening in a care plan? Jeff Hogan, Darrell Moon, @gracet22, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy discuss #careplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth Why did Darrell Moon give up being a hospital administrator because of care plans? Jeff Hogan, Darrell Moon, @gracet22, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy discuss #careplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth “It's a myth that population medicine … and precision medicine are incompatible or opposites.” Jeff Hogan, Darrell Moon, @gracet22, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy discuss #careplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth What is “noncognitive” medicine, and why does it bog physicians down? Jeff Hogan, Darrell Moon, @gracet22, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy discuss #careplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth What is at the core of appropriateness for care? Jeff Hogan, Darrell Moon, @gracet22, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy discuss #careplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth “You start to bring that data to the physician, and it really does open their eyes.” Jeff Hogan, Darrell Moon, @gracet22, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy discuss #careplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth How do you really change the way physicians work? Jeff Hogan, Darrell Moon, @gracet22, Dr. Rich Klasco, Nicole Bradberry, and Kelly Conroy discuss #careplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard, Josh LaRosa, Dr David Carmouche (EP316), Bob Matthews, Dr Douglas Eby (AEE14), Dr Sheldon Weiss, Dan Strause and Drew Leatherberry, Dr Douglas Eby (EP312), Ge Bai, Sumit Nagpal, Dr Vikas Saini and Shannon Brownlee

Jeff discusses filming in Yellowstone, working with Sir David Attenborough & Chris Morgan, and utilizing custom made camera traps to film mountain lions.

One way to spot a flash point is to notice when people are using different words to describe the same concept. Throughput is one example of this. On one side of the table, you have those who grasp that if a provider organization is concerned about patient outcomes, with few exceptions, building relationships with said patients is essential. It’s not entirely clear to anyone anywhere how you manage to build relationships and trust without spending a certain amount of time with patients. These “we need time with patients” people will bring up the Quadruple Aim issues that arise from rigid 7-minute appointments or even 50-minute appointments really. On the other side of the table, you have those who have built practice fiscal models on the backbone of however-many-minute appointments. They use different terminology for this whole concept, however. They call it throughput. How many patients can a physician manage to squeeze into a day? Some of these folks will tell you that throughput success is “more is more.” In other words, throughput is one of those things that you can never have too much of. Let me back up for a sec and mention the mission of this show. It is to connect health care leaders together by helping everyone understand each other well enough to communicate effectively, which is rate critical numero uno for any collaboration. You can’t collaborate if parties don’t really grasp what anyone else is actually saying when they communicate their WIIFMs (their “what’s in it for me?”) or their organizational imperatives. If we consider that the health care industry can only transform when multiple stakeholders collaborate, these little “language discrepancies” actually can have macro implications. In this respect, this throughput example—not in all cases but at a minimum—it’s an exemplar illustration and certainly something to contemplate. Consider people arguing against 7-minute appointments without mentioning the word throughput. They’re probably not going to even reach the headspace of those who just spent the past two decades in meetings to increase throughput. It’s like two ships passing in the night. You could be sitting there right now pooh-poohing what I’m saying, but I’ve sat in enough meetings where people talk around each other using different terminology, think they’ve agreed on some collaboration or compromise or solution, except nothing happens because everyone got to walk out without addressing the elephant in the room. It sounds something like this: DOCTOR OR NURSE: We need you to enable patients to have quality time with their doctors and the rest of the care team. SOMEBODY ELSE: We need to get rid of inefficiencies, which means driving maximum throughput. ANOTHER PERSON: OK, let’s compromise. Doctors should have quality time while maximizing throughput. Don’t laugh. I’ve heard “action items” like this often enough, and so have you if you think about it. That’s why I originally started this podcast—because I can also guarantee you if this is the action item, no action will actually take place. The only way this conversation is going to net any change is if people around that table head-on confront that quality time with patients means less throughput. And how much less are we going to agree on and/or how are we going to creatively change the practice model so throughput is an archaic term (ie, asynchronous stuff, etc)? I say all this to say that this throughput business also leaks into the technology space in ways that we should probably think about. Increasing throughput, after all, is one of the key ways to increase FFS (fee-for-service) revenue. FFS is all about the need for speed. The faster you can smack a billing code on a patient visit, the more patient visits you can pack into a day, the more billing revenue you can rack up. To some extent, throughput is code word for an addiction to FFS. You can always tell a tech vendor who is used to selling in an FFS environment because the second slide of their pitch deck is always one of two things: either how much faster the tool will get patients in and out of a doctor’s line of sight or what the billing code is for the tool (but that’s a whole different topic). I just described the second slide in an FFS-centric technology vendor deck. The first slide in those “use our AI thingamajig to revolutionize your throughput” decks is always some mission statement about improving patient care. And this is where not everybody using the same language creates immense wiggle room for profit over patients under cover of mismatched terminology. To add one point of context, when I say throughput here or increasing throughput, nobody is talking about making the front desk more efficient, minimizing faxing things around, or streamlining prior auths or duplications in the workflow (ie, fixing things that are in desperate need of a fix). What we’re talking about in this health care podcast are tools like the one I saw the other day. This biz dev person of this company was up and about early promoting some AI diagnostic tool. With this tool, so their slide deck promised, a physician could see 50 patients a day. Even for this particular vendor, I guess a full-throated “Hey, let’s burn out all your doctors and make patients wonder if they imagined their doctor visit would happen so fast”—a blunt message like that—presumed a little too much avariciousness on the part of the practice. So, they tempered their message by stating the inarguable fact that there is a physician shortage in rural America and that this tool will help resolve that. OK … that’s a worthy thing to fix. But, seriously, is the goal to get rural patients an automagical visit with a doctor that, in hindsight, they wonder if they hallucinated it was so fleeting? Or is it to actually help patients get better health? Also inarguably, health care that leads to better health requires less than pedal-to-the-metal throughput. If you think differently and want to change my mind, feel free but show me the study. I say all this to say that I called up Arshad Rahim, MD, MBA, FACP, a little bit ago to see what he thought of my aforementioned burning premises (aka rants) about throughput; and he kindly agreed to come on the show again. Dr. Rahim is senior medical director of population health at Mount Sinai. He was last on Relentless Health Value on EP219 talking about population health for reals in the real world. Go back and listen to that show after this one if you want to hear more of Dr. Rahim’s sage advice.  One more recommendation: For more insights into the impact of maximum throughput, read the awesome op-ed in MedPage Today by Brian Klepper, PhD, and Jeff Hogan.  You can connect with Dr. Rahim on LinkedIn.  Arshad Rahim, MD, MBA, FACP, is a practicing physician and a health economist at his core. He enjoys a track record of building innovative health care businesses, including Mount Sinai Population Health, Healthgrades, and Sg2. As the vice president, clinical integration and population health, at Mount Sinai Health System, Dr. Rahim is responsible for the 4500-provider Mount Sinai Clinically Integrated Network (CIN) and has built a team-driven practice focusing on key value-based care metrics of utilization, cost, access, and quality. He is also leading a team driving ambulatory care standardization for six key chronic conditions across Mount Sinai Health System. Dr. Rahim has a bachelor’s degree in economics from Duke University, an MD from the University of North Carolina, and an MBA from Emory University. He completed his internal medicine residency at Yale University and Northwestern University and is an actively practicing hospitalist at the Mount Sinai Hospital. 07:37 When does throughput negatively affect patient care? 08:55 Why does diagnostic inaccuracy become a problem with throughput? 09:27 Do population health outcomes decline with less throughput? 10:20 “The way you can also be most financially successful is by taking care of sicker patients.” 10:53 What do patients actually want and need? 11:55 “The emotionality in a health care interaction is always there … [when] you’re focused on throughput, you can definitely lose the healing and calming presence.” 14:18 What do doctors need from their organizations to sustain a high level of care? 15:59 “The actions vary across the spectrum from very supportive to not very supportive at all.” 17:02 “There definitely is a challenge of competitive pay.” You can connect with Dr. Rahim on LinkedIn.  Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools and #throughput on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools When does throughput negatively affect patient care? Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools Why does diagnostic inaccuracy become a problem with throughput? Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools Do population health outcomes decline with less throughput? Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools “The way you can also be most financially successful is by taking care of sicker patients.” Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools What do patients actually want and need? Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools “The emotionality in a health care interaction is always there … [when] you’re focused on throughput, you can definitely lose the healing and calming presence.” Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools What do doctors need from their organizations to sustain a high level of care? Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools “The actions vary across the spectrum from very supportive to not very supportive at all.” Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools “There definitely is a challenge of competitive pay.” Arshad Rahim, MD, MBA, FACP, of @MountSinaiNYC discusses #digitaltools on our #healthcarepodcast. #healthcare #podcast #digitalhealth #digitalhealthtools

In episode 20 of Headway, Jeff Hogan joins the podcast. Jeff is the founder of Hogan Fine Jewelry, a retail jewelry store that specializes in high-quality certified diamonds and jewelry.Jeff has been working directly with customers for years and has learned a lot about offering value, connecting with clientele, and identifying the core competencies of his company.In my conversation with Jeff, we discussed his journey that led him into business, what the non-negotiables are in his company, and how to clearly and effectively define the core competencies of your company.Discussed Resources: Fortitude: https://amzn.to/3xKY838No Pain No Gains: https://amzn.to/3ehO2ixImpact Theory Podcast: https://impacttheory.com/episodes/Connect with Jeff:Email: jeff@hoganfinejewelry.comPhone: (863) 860-3500Website: hoganfinejewelry.com

On tonight's episode of Pickens Local we have with us Jeff Hogan and Roy Costner Jr. of the Azalea Festival

  Meg was once on Disney's Dream Squad, and while that usually meant making dreams come true - one time it almost meant her job! Plus, Jay Sherer faces off with Josh Taylor in a game of Goldblumian and Nic Cagean proportions on Theme Park Pulse: The Game!-To support our work for as little as $1 a month on Patreon - click here!-AUTOMATED TRANSCRIPTION (will contain many, many, many errors) Kory: [00:00:00] welcome to  pulse, the game, the game show for theme park fans. I'm your host Kory in San Francisco, California. And I'll introduce you to the rest of the panel in just a second. Theme Park Pulse: The Game is a fan supported podcast. Meaning this ultimately costs us more money than we make. It's truly a labor of love for everyone you hear on the show and we can really use your support on our Patriot for as little as a dollar a month. You'll get some awesome benefits and you'll help us offset the costs associated with making this show. There's a link down in the show notes. If money is tight and we totally get that, help us out by telling a friend about the show and showing them how to subscribe. Hmm, thanks in advance. In the next half hour, you'll meet a former cast member and part of the Walt Disney world dream squad laid off during the pandemic and our buddy Jay Sherer from the story geek stops by for an unconventional showdown on rollercoaster. Rapid-fire up first. It's the Park's pop culture pop quiz. if you'd like to play theme park pulse the game. Call (213) 935-0513. That's (213) 935-0513. And leave a message. Let's welcome. Our listener contestant on theme park pulse the game from Orlando, Florida. It's Meg Patton. Hey meg. Great to be here. Thank you for joining us! In just a minute. I'm going to test your Park's knowledge with the Park's pop culture pop quiz. But first I'd like to introduce you to our legacy panel,  Albie: [00:01:54] Oh, that's not funny.  Kory: [00:01:56] Up first. Check again from the deck of a star ship that is randomly docked in Sacramento, California, for some reason, it's our scorekeeper Albie up high.  Adam: [00:02:05] Yeah.  Albie: [00:02:05] So I needed fuel some like, Hey, this place looks cool and it's not covered in snow. Let's stop here.  Kory: [00:02:11] And the gas prices are cheaper there than, you know, a lot of nearby cities.  Sean: [00:02:15] Yeah. I  Albie:[00:02:15] don't have to steal it from a. Pirates some space.  Kory: [00:02:19] It's just practical, just a few miles away from Alby there in California's capital city sits the host of Adam's theme park time machine on this channel, and very much in competition for the best beard on this show. It's Adam Vargas. Well, and see we're  Adam: [00:02:32] on zoom, so I'm not wearing a mask so you can see it. And it's newly trimmed. It's good  Kory: [00:02:37] for this next panelist known for her haikus. A poem roses are red. Violets are blue. Nikki loves kitties and podcasting. Oh,  Nikki: [00:02:48] that  Kory: [00:02:48] was wonderful. Co-host of Jack and Nicky weekday mornings on WVA Q in Morgantown, West Virginia. Hey man. Oh,  Nikki: [00:02:56] what's up? Y'all  Kory: [00:02:57] South South West of West Virginia in the suburbs of Greenville. South Carolina is where we find our friend Jack. Calls him Shawny. Shawn, Shawn, Shawn, or daddy. Goth Santa's is used regularly, but his friends just call him Sean.  Sean: [00:03:12] I'm also not wearing a mask, but when I do, you can still see my beard. They just become one after a while.  Kory: [00:03:20] It's true. And finally, he is the host of modern mouse on YouTube and in your podcast feeds. And he's the trivia. God. He wrote that on Tuesday nights for Disney trivia, Tuesday on the theme park pulse, Twitch and Facebook live. It's Josh Taylor in Denver, Colorado. Hey, John Corey, I wrote you a potent too. Adam: [00:03:37] Did you? Yeah. Uh, it  Unknown: [00:03:38] goes like this, uh, roses are red. You just introduced me. I'm here for some games and probably some hazing. Yeah. I.  Sean: [00:03:50] And a genius Kory: [00:03:55] continuing our series. He's on former cast members of the Walt Disney company. Maggie worked on the dream squad, which by the way, sounds super rad. Just get to make people's dreams come true. It's amazing. And you had a bit of a swash buckling interaction. You might say with a guest at up cuts, mouse gear, can you share that story? Meg: [00:04:15] I would say the, you know, the dreams, God was amazing, you know, given out dreams, nicest Cinderella, castle, suite, and Disney vacation club memberships. But when you were not doing all those high profile things, you were just literally wandering the park and. Looking for ways to amuse yourself and others. So I came out from our office and I look over and there's this older grandfather type gentlemen coming out of mouse gear, wearing a child's pirate hat is kind of standing there, you know, arms crossed. I was like, Oh, I have to go talk to this guy. So immediately, very chatty we're talking it up, I'm calling them a pirate, R B from Mayday and you know, he's going back and forth. I was like, Oh, this is great. What fun? I was like, wait, I have, I have a pirate button. I can like officially make this guy a pirate. So I take out the button, I make it this big thing. He's like all excited. And he goes, would you mind pinning it on me? And I was like, Oh, you know, okay. I don't, you know, any, I will never forget this. He like slow motion pulls his arm that had kind of been hidden, which I didn't. Well, he noticed out and on his hand is an honest to goodness, real life hook. So all of a sudden my brain goes, I just called a man to the hook. It  Unknown: [00:05:31] five times  Meg: [00:05:34] I. If going to get fired. I like look at the fellow dream squad member that is with me who thank goodness is the sweetest person on the planet. So I was like, they will believe Jackie that I will not  thank goodness. I have a witness and he like taps the button with his hook. So that like day, sir, I was like, Oh my God. Oh my God. So I immediately go upstairs, write a whole email to my leader like this. I was really trying to make magic. It really blew up in my face. So fast forward the end of the night, if you've ever been at the parks, sometimes we wave and so dreams called. We would do that. And I saw this man coming in a sea of like 30,000 people. I see my pirate. I was like, Oh my gosh, this is it. This is where he's going to call me out from everyone. And about these were this big family and they all yell my name. Everybody literally bought it.  Unknown: [00:06:26] So excited. They're like, he's been  Meg: [00:06:27] jogging about you all night. I'm so glad he got to meet you. He's so proud to be a pirate. So I was like, Oh,  Kory: [00:06:34] ultimately really happy with what you had done.  Adam: [00:06:37] But I was  Meg: [00:06:37] like, this is, I can't believe I called a man with a hook, a pirate.  Kory: [00:06:43] Maggie, you haven't let leaving the Disney company slow you down. You have a next page with mag where you put together a children's literature with related activities for kids. You've also created this thing that I'm fascinated by story hunts. What is story  Meg: [00:06:55] hunts? So I personally have always been a fan of. Trivia, you know, it's just something I naturally liked and there's this great Facebook group called for each other that allows cast members and folks that want to support the impact of cast members, ways to connect. And what are people looking for? And someone said, Hey, we're going to the parks. We know not everything's open. We're looking for like a scavenger hunt type of thing. And I was like, shh. I can't do that. You know, no one tells a story like Disney and there are so many details, teeny tiny ones, a big ones, you know, of course you can walk into agency expedition, Everest, and you know, you're in Asia, but do you also ever look at the prayer flags that are hanging and the dinged up pots and pans that are from the village? So it's, it's that type of stuff that I send people all over the park.  Kory: [00:07:39] I'm looking for. Where can people find your scavenger hunts? Cause that sounds really fun.  Meg: [00:07:42] Yes. People are like, which one's your favorite? I'm like, well, I really try not to make a lame one. I mean, they're all on both Facebook and Instagram as well as Gmail next page with Meg. All right,  Kory: [00:07:56] man. We're going to play the parks, pop culture, pop quiz. I'm going to ask you three questions about some recent news from Park's pop culture. If you get too correct, we'll send you a glow in the dark theme park pulse wristband. You're ready to play. Oh, yeah, let's do it. Here we go. Question one. It was once the rainforest cafe. Now it's Disneyland's first store outside the park dedicated to what space centric franchise,  Meg: [00:08:23] a desktop. Kory: [00:08:27] Oh, you can no longer get a burger under a drippy elephant. You can take home a grow goo of your very own. In my mind, I'm like. Can we do both room for all. How about a drippy Grogan? Can we get that? Sean: [00:08:43] Eat the crumbs  Unknown: [00:08:44] out of that little baby's mouth. Kory: [00:08:50] Okay. Mag question two. It was announced recently that Disneyland is considering a dedicated entrance gate for what,  Meg: [00:08:58] uh, annual pass  Unknown: [00:08:59] holders.  Kory: [00:09:01] That's right. An idea. And it's one that has already been implemented widely at Walt Disney world in Florida. But it makes me wonder before you give pass holders, their own entrance. Wouldn't you want to consider actually like having pass holders?  Unknown: [00:09:17] I don't know for us legacies.  Kory: [00:09:19] You have your own line to go buy a one day one park ticket. All right, Meg, last question. As part of the upcoming 18 month celebration of Walt Disney world's 50th anniversary, which spherical park icon is getting some lighting upgrades. Unknown: [00:09:34] I believe it is  Meg: [00:09:34] spaceship earth.  Kory: [00:09:37] That's right. It was also announced that those lighting upgrades will be permanent Disney. It's calling the 50th, the world's most magical celebration. It's rumored that Imagineers are already working on plans for the 60th anniversary of the resort, which they plan to call the world's more, most magical or celebration Topia. Adam: [00:09:56] They really need you on  Kory: [00:09:57] payroll. They do. I'll be headed back, do on the Park's pop culture, pop quiz. As the legendary  Adam: [00:10:02] RuPaul says,  Unknown: [00:10:03] you're a winner, baby. Kory: [00:10:08] I wondered if lb could make this show a little bit Geyer and he did. Thank you, Alby. Congratulations, Maggie. Will you stick around and play some more games later in the show? Up next. We meet our guest Jay Scherer and put him to the test against a member of our panel and a game of gold blue Meehan and Nick KGN proportions. See what I mean? Next on theme park pulse, the game. Welcome back to theme park, post the game. Our guests this week is a long time friend of the no midnight media family of podcasts. He's an author and is a part of the story geeks podcast and YouTube channel in Southern California. It's our pal, Jay Shearer. Welcome Jay. Hey,  Jay Sherer: [00:10:55] it is a pleasure to be here. It's like in pandemic days. I'm just  Kory: [00:10:58] glad I get to hang out with you guys. It does feel like hangs, not quite the same as the hangs we're used to, but almost how are you and your wife passing the time they're in. So Cal without Disneyland to run off.  Jay Sherer: [00:11:10] Oh, it is such a bummer. I will tell you, we do get down to downtown Disney when it, when it's open and we'll have, you know, a meal and try to get some ice cream and salt and straw, which is amazing. But yeah, a lot of times, I mean, we're just like watching TV, doing podcasts, working remotely, staying at home.  Kory: [00:11:27] You do what you can, in addition to being a super talented podcaster, definitely checkout story geeks. You're also an author and that you co-wrote an audio book called death of a bounty Hunter. That's getting a lot of attention. Tell us about that. What's death.  Jay Sherer: [00:11:42] Death of a bunny owner is my favorite thing that I have actually ever written. And one of the things that made it, my favorite thing is it exists as a novel. But we wrote it to be a full cast audio book. So we know we didn't have the budget to film a movie. And so what we did was we said, look, we can actually write this as a full cast audio book use all of our friends who are in the acting community and do this. And so we have three different narrators who were recording from the first person, but we have a total of 11 voice actors voicing 14 different characters. It's like a supernatural steam punk Western. So if you're into that kind of thing, it's a genre mashup, and it's a story about a Korean bounty Hunter who kind of, has to come face to face with the widow. Of a guy that he killed. And so it's a very intense, but very fun story. And you guys can check it out death of  Adam: [00:12:33] a bunny, hunter.com. Can I just say quickly as an avid audio book listener, I wish more audio books would do that. I get so sick of hearing the same white dude doing voices. Bravo, man. Good job,  Kory: [00:12:47] Jay. What is the story? Geeks podcast.  Jay Sherer: [00:12:50] We're all about storytelling. And so the art of storytelling is really important to us. So Kayla Monroe, who is a screenwriter, he wrote the Mongolian connection. And I, uh, and sometimes occasional guests will talk about the philosophy of storytelling and what goes on, um, when you're writing our story or telling a story. And then we also have a whole team of people who just like to geek out about geek stories, science fiction, fantasy comic book stories. And so that's kind of a big mashup of all the things that we do together. And I think almost everybody here has been on that  Adam: [00:13:22] show. Right?  Jay Sherer: [00:13:23] Almost everybody here has been on that show at one point in time or  Kory: [00:13:25] another analyst, Josh Taylor have hosted a podcast dedicated to the personalities and work of two great American actors. You've got one. You've already done one that's coming up. The first one was on Jeff Goldbloom. And the upcoming one is about Nick cage. Why those two actors and later why work with Josh Taylor? I'm just kidding.  Adam: [00:13:49] It's fair. Actually. I want to do  Jay Sherer: [00:13:51] those podcasts because I get to work with Josh Taylor, who I think is super fun to work with. He's the best. Basically Josh came to me and it was like, I love Jeff Goldbloom and I think you're going to fall in love with Jeff Goldblum. I was like, all right, let's see. And then of course you do because he's Jeff Goldbloom. We had a blast on that podcast. That was a fun one. That was good. I think we just said to ourselves, like we chose one huge nineties celebrity. Who else was big in the nineties. Oh, Hey, that guy, Nick cage big. Let's go after  Kory: [00:14:17] him. Scope living still out there somewhere. Josh  Sean: [00:14:20] Taylor. Yeah. You can still listen to global blooming currently  Unknown: [00:14:24] at the. Network 1901 or modern mouse website.  Kory: [00:14:27] After all that work, you should be an expert on both of those men by now, but so HSA Josh Taylor. So this time on theme park, post the game, we are pitting you against each other. It's rollercoaster. Rapid-fire the Goldbloom cage Taylor Scherer showdown, Adam.  Adam: [00:14:46] All right. I'll admit, I don't think Nicholas cage and Jeff Goldbloom have that much to do with theme parks, but you know what? You guys love those guys. And we like to have fun. It's  Kory: [00:14:55] technicality. They like parks and they like these guys. Adam: [00:14:58] It's two degrees of separation. I guys, we played rollercoaster. Rapid-fire, uh, quite a few times here on theme park, host the game, but just a quick refresher on how this works. I am going to ask you five questions with a number. That is incorrect. All you have to do is tell me, is the correct number higher or lower for no other reason than the fact that Josh is before Jay on my screen, Josh is going to go first. And Jeff Goldbloom is going to be the first set of questions. No roller coaster rep fire, the marvelous Jeff Goldblum. Here we get the number of Portlandia episodes that Jeff Goldbloom stars in six.  Sean: [00:15:41] Oh, uh, uh, lower  Adam: [00:15:48] eight. My favorite roles include the doily salesman and the karaoke coach. Everybody needs to watch Jeff Goldbloom on Portlandia. Kory: [00:15:55] I think he's great. As the pullout King,  Adam: [00:15:57] he is very good as a pullout thing as well. Appearances in best picture, Oscar nominees, three lower. For Annie hall, the big chill, the right stuff. And the grand Budapest hotel. I don't know anything  Sean: [00:16:16] about Adam: [00:16:19] the number of times. Ian Malcolm says the word chaos or chaotic in Jurassic park nine. I'm  Sean: [00:16:28] going to go lower,  Adam: [00:16:30] correct. Six times. The word is said seven times in the movie once by Dr. Sattler and the other six by Dr. Malcolm Jeff gold blooms, Instagram followers, 1.5 million. Let me go higher 1 million, which honestly, that, that is criminally underrated. Yeah, man  Sean: [00:16:54] fashion icon that is still too low for our Lord and savior  Adam: [00:16:59] fifth and final question. The year he appeared on Saturday night live as Dr. Kent Waller opposite will Farrell as Harry Carey, 1999. Slower. 1997. And I only have one question for you. Hey, eat the moon. If it was made of ribs,  Kory: [00:17:22] I'll be, how many did he get?  Unknown: [00:17:24] He got three, right? So I guess he kind of does know  Adam: [00:17:26] Jeff Goldbloom ish. He recovered. Nice. All right. J three is the number to beat. And I'm nervous about this guys. Nicolas cage. Joshua  Jay Sherer: [00:17:35] was the one that did all the history stuff for this. Kory: [00:17:39] I'm trying  Adam: [00:17:40] to be interesting.  Kory: [00:17:41] Oh, is this big trouble? I guess  Jay Sherer: [00:17:42] let's see what I can do.  Adam: [00:17:45] Number of IMD B after credits 90. Oh,  Unknown: [00:17:50] higher.  Adam: [00:17:53] 102. I don't have a joke for that. That's a lot of movies, the rotten tomatoes approval rating for the Wicker man, 20% lower 15%. They're probably just all people who really, really liked. B's  Kory: [00:18:14] Josh, how are you feeling right now? I'm  Adam: [00:18:16] just really  Sean: [00:18:17] excited that we're talking  Unknown: [00:18:18] about  Jay Sherer: [00:18:19] Nick cage and  Adam: [00:18:19] Jeff Hogan movies in which he's credited by his birth name, Nicolas Coppola for if  Jay Sherer: [00:18:28] you would've asked me what his birth name was, I would not have known  Kory: [00:18:31] it. I'm going to say lower. Adam: [00:18:36] Yeah. Nicolas Coppola is for folks who don't know is the nephew of Francis Ford Coppola. He was credited by his birth name and two movies, a TV movie in the early eighties and fast times at Ridgemont high, where he's the pizza delivery guy amount of time that he was married to Lisa Marie Presley 100 days  Jay Sherer: [00:18:56] a minute, say higher, Adam: [00:19:01] just barely 107 days, which means of course he has something in common with Michael Jackson. One of the only people weirder than Nicholas cage. Ah, we got to do that. Jackson podcast, Jay Sherry, you're going for the clean sweep on Nicholas cage, the amount of money he spent on a T-Rex skull, $250,000.  Kory: [00:19:25] I don't even care what the answer is. Oh,  Jay Sherer: [00:19:28] I'm going to say that it's  Adam: [00:19:29] higher than that. Unknown: [00:19:34] Perfect  Adam: [00:19:35] score in rollercoaster, rapid fire. $270,000. He returned it when he found out it was stolen. Now maybe I'm a cynical guy, but if somebody said you'll want to buy this T-Rex skull, I would just assume that he didn't get it legitimately. What's the legitimate  Sean: [00:19:52] way to  Adam: [00:19:52] get it. See Rex  Sean: [00:19:53] skull, then  Kory: [00:19:55] Jeff Goldbloom would have, uh, found a way one roller coaster, rapid fire this  Adam: [00:20:01] time. I mean, see, I'm obsessed  Unknown: [00:20:03] with Cardi B and obviously. BJ's obsessed with Nick cage. So Jay won. Congratulations.  Kory: [00:20:09] I don't know what  Jay Sherer: [00:20:09] it says about me,  Kory: [00:20:12] Jay, will you hang out on the panel for a bit and play the eighth to work with us at the end of the show? Sure. Up next on the podcast, you see, Nikki will read haiku's exactly. Three. If Meg can guests two out of three, she might just be the champion of our next game by Nikki. I know. Oh my God. Thankfully, Nikki is a way more effective poet than I am happy. Hi, cruise is next on theme park pulse. welcome back to theme park, post the game. If you'd like to be a contestant call (213) 935-0513 and leave a message or you can email Nikki in IKK I at noon, midnight media.com. Let's welcome back to the show from Orlando, Florida. It's Meg Patton. Welcome back. Thank you, Meg, we've invited you back to play a game of silly lines and crispy rhymes. Yes. I made that up. It's a game Nikki invented. It's called happy haikus. Nikki  Nikki: [00:21:17] Meg, you create scavenger hunts for families at Walt Disney world and the resorts and beyond. So I thought I would create a little puzzle for you to solve, but we're going with Disney land rides.  Kory: [00:21:32] Just out of sheer cruelty. Really? I'm sorry. Tricky. Tricky.  Unknown: [00:21:38] I  Nikki: [00:21:38] have created three haikus for you. You need to guess two out of three, correct? Two wins. So keep those Disneyland rides in mind. All right. Haikus number one, who even are you eat? Drink grow shrink heads will roll a tumbling down. We go.  Meg: [00:21:58] I feel like that. I forget what it's called. Alice in Wonderland.  Nikki: [00:22:04] There you go. All right. This one might be a little bit tougher. Hey, number two. What a waste of pies? I hope you have insurance look out for that  Unknown: [00:22:17] train.  Meg: [00:22:20] Mr. Toad's wild ride  Nikki: [00:22:24] pass. He needs one  Meg: [00:22:25] insurance.  Adam: [00:22:27] Didn't that watch out for that train thing. Was that like a, what were you like doing a little Georgia? The jungle tie-in thing. That's what my mind went  Sean: [00:22:33] to.  Nikki: [00:22:34] Oh yeah. I didn't even think  Kory: [00:22:36] of that. I'm actually just surprised you didn't find a way to Ryman goes to hell in there somewhere because I mean, that's a real, real thing. You've got to give the devil his due. It's an important plot point,  Unknown: [00:22:47] right?  Sean: [00:22:48] Crispy rhymes,  Meg: [00:22:50] haiku, number three,  Nikki: [00:22:52] a code adventure, stop and play some basketball. Harold waits for  Kory: [00:22:57] you. Oh, this one's tricky. Matter what?  Unknown: [00:23:00] Yeah,  Kory: [00:23:04] that was very insightful. Basketball, I guess she would say I'll be, how did Meg do on happy haikus, our special  Unknown: [00:23:12] guest three questions. You're a winner. Kory: [00:23:20] close enough. We'll wrap up the show with park guests behaving badly. The eighth dwarf is next on the game. Hey, it's Corey real quick while I have you at the park post, the game is a completely fan supported podcast. And well, last year we almost broke even, but because of the pandemic and the economic downturn, we've seen a lot of our financial support dry up. If you've been thinking about supporting our work now would be a really great time to join us on Patrion. Just search for a patrion.com/no midnight. And join for as little as a dollar a month. You'll pick up multiple cool bonus episodes every week and get early access to all of our shows with no ads like this one. There's a link down in the description of this podcast. Take a look at that. Join us on Patrion. If you can, either way. Thank you so much for listening now back to the show. before we wrap up the show this week, we're going to play another round of the eighth dwarf play along at home or on social media using the hashtag eighth dwarf, Sean, take it away.  Sean: [00:24:35] All right. So we all know the seven doors they're designed to represent specific behaviors, personality traits. And at some point during any Disney trip, we're likely to see or be sleepy, dopey, happy, or. While 2020 keeps casting its shadow over 2021 grumpy, but every now and then we witnessed people in the parks. So we just can't categorize as one of the seven dwarfs. Their behavior is so outrageous that we fit these people into their own category that we call. The eighth dwarf. All right. We're all avid Disney fans park goers. Or we were back in the house the on days of 2019, you know, back in the before times. And we're all guilty, a little bit. Some of us made more than others of being that friend. You know, the one that, the note, all that is more than happy to offer tons of unsolicited advice. The minute you hear someone say the word Disney, most of us. Meanwhile, but then there are folks like Alex, no matter what Alex, who is single with no kids mind, you knows what's best for you on your trip with your family. It doesn't matter that your family five who is bringing along grandma and grandpa, which was not an uncommon occurrence before 2020, Alex has yet. Do it counter a trip that he can't micromanage all the help. He will gladly make all of your decisions for you. Context, be damned. He has a foolproof, one size fits all plan that you need to know. And clearly, if you don't listen to Alex, you are the stubborn one. Corey, what do we call Alex?  Kory: [00:26:08] Daddy  Sean: [00:26:11] buffoon. He,  Nikki: [00:26:14] you said he's single, right? Yeah, Unknown: [00:26:21] this is Len Testa from touringplans.com ah,  Adam: [00:26:28] E type a,  Kory: [00:26:33] I  Jay Sherer: [00:26:33] literally do not have a better answer than  Kory: [00:26:37] shots. Also. We have two Lin testers. That's the first  Sean: [00:26:44] and Meg.  Kory: [00:26:47] I see,  Sean: [00:26:49] I think Papa's he takes it. That's got a good flow. Good. All right. Next up, we have Danny with an eye. Let me start this whole thing by saying I'm old ish and I'm aware of this, but I don't reflectively hate all young people. For example, I think I do a wonderful job of tolerating, Jackie, Jack, Jack, and all of his shenanigans jokes aside. I do try to do my best to remember that I was in my twenties once and well, it's kind of a Rite of passage. You dumb manned or short-sighted things in your twenties. Oh, but Danny, she goes just a little bit too far, or at least Danny goes too far when she's on trips, surrounded by five of her friends, flash photography on pirates, reciting the script in the haunted mansion, singing loudly and poorly on carousel of progress, saving quote unquote spots in line for all of their new friends in the space, mountain queue, perhaps the most egregious. Practically stampeding over a young girl, dressed like bell so they can record themselves with guest on for their followers. Quote, unquote, I'll admit to being too old to get tick tock, but I sort of feel like it's not old fashioned to suggest that people not run over children. Unless, of course you are guest on, and then it's pretty much on brand. But come on, Danny. Corey, what is Danny's eighth dwarf name? This  Kory: [00:28:15] is why we can't have nice things. He  Sean: [00:28:19] Al be exasperated.  Unknown: [00:28:23] Look at me. Sean: [00:28:29] I feel like that he would just go on.  Unknown: [00:28:32] Josh, this would be entitled influencers, David Dilbert in his blog squad, Sean: [00:28:41] Adam  Adam: [00:28:42] hashtag the worst.  Jay Sherer: [00:28:46] Mine's kind of similar to Nikki's, but it's selfie E Sean: [00:28:53] and Meg  Meg: [00:28:54] non influencing  Kory: [00:28:58] non-influenza  Meg: [00:29:00] fluid.  Sean: [00:29:02] I think we're going to go with selfie, Jay. Well done. The extended E's really sell that one. I  Kory: [00:29:07] think Jay and Meg, thank you so much for joining us this week on theme park,  Jay Sherer: [00:29:11] post the game. It was great to be here and I'm a little bit ashamed of how well I did it in the cage Adam: [00:29:19] theme park pulse, the game was created, written and produced by the panelists you heard on the show today, Corey, Allie, Nicki,  Kory: [00:29:25] Adam, Sean. And, uh, we'd like to thank our special guests, Jay shear of the story geeks and our contestant former cast member, Meg Patton in  Nikki: [00:29:33] Orlando. An all new episode of the doom. Scroll drops tomorrow on our Patrion. That show is weekly and at all tiers plus  Sean: [00:29:40] assemble each Tuesday where right now we're doing a deep dive into one division. Check out the link in the description and support our work for as little as $1 a month. And you'll get that as well as other cool bonuses. We'd also love to see you for a trivia Tuesdays  Unknown: [00:29:53] on the theme park, pulse Twitch and Facebook live that's 5:00 PM. Uh, West 8:00 PM Eastern every Tuesday night. The single most important thing that you can do to help us out is share the part, cost the game with all your lovely  Kory: [00:30:08] friends. This is a fact from our family to yours, wear a mask, or is it three now, wash your hands. Keep your eyes on the road. Call your mother and join us next time for an all new theme park pulse the game

This episode might be about local providers getting disintermediated not by virtual front doors like I discussed with Jeff Hogan in EP309 but by entities providing virtual continuous care at home. Predictivae and proactive, the idea is to help reduce acute events requiring on-premises care. But if someone does wind up needing ramped-up care, they can get it hospital at home or SNF (skilled nursing facility) at home instead of them going anywhere. So, there’s a baseline level of home monitoring followed by periods where care is stepped up. The point is, everything is going down at home with the care coming to the person at the care level that they need, so it ramps up or down depending on what they’re going through or need at the time.  I’m talking in this health care podcast with Sumit Nagpal, CEO and founder over at Cherish Health. We talk about the goings-on in the whole aging in place or, as he calls it, living in place vertical. A couple of takeaways from our conversation I think are notable: First of all, who is going to drive first change here isn’t going to be, for example, hospital systems at scale suddenly deciding to work against their own perverse incentives to keep heads out of beds. Our first movers here—the ones who will push assisted living at home or SNF at home or CCRC at home or whatever you want to call it at home—is going to be consumers and their families who either can’t afford to or don’t want to send Grandma to an assisted living institution. So, this is how it’s gonna go down: Families across the country install technology to keep Grandma safe at home. A natural ally here, if you think about it, is Big Retail, by the way. Why wouldn’t Big Retail and Big Tech sell these solutions to grandmas’ families like they sell televisions today? But the second that grandmas everywhere have monitoring software in their homes is the second that FFS-dependent hospitals and other providers have a problem on their hands—a business problem, that is. And assisted living facilities and SNFs working a similar model are in the same boat. Here’s why. Actionable population heath data is now available, and once that data is available and looked at predictively and proactively, grandmas are not going to go to the ER like they once were for two reasons: (1) Proactive and predictive technology in the home will reduce acute events and (2) because if and when Grandma does have an acute event, she’s not calling an ambulance. The technology is notifying someone. Maybe it’s notifying the Medicare Advantage plan that Grandma’s on, who has realized the power of all this at-home stuff. And the Medicare Advantage plan maybe just hooked up with a forward-thinking hospital that built an ER at home service or a hospital at home service. Or maybe there’s some national technology player who is providing similar services. Sumit Nagpal and I talk through how this might look and also the essential factors for the health care industry to eventually adopt an at-home model. You can learn more at cherishhealth.com. Sumit Kumar Nagpal is the CEO and founder of Cherish Health, a consumer electronics company that develops advanced sensors and artificial intelligence combined with medical evidence and human touch. Cherish Health solutions improve the lives and enable the supported self-care of people aging or living with health challenges—our grandparents, parents, children, many of us. Sumit is a serial entrepreneur and has cofounded and grown five digital health companies over the past two and a half decades that have tackled progressively bolder challenges facing our health care economies. He serves on important industry boards, including HIMSS and Health eVillages. Prior to founding Cherish Health, Sumit was global lead for digital health strategy at Accenture. He is sought after for his expertise and unstoppable energy as an entrepreneur, change agent, strategist, and technology architect. 03:55 What does “health care is coming home” truly mean? 07:35 “It’s not like we’re cheese and we’re aging in place. We’re living. We’re living our lives.” 07:51 “Give us the ability to live where we want for as long as we want as safely as possible.” 10:31 “The challenge with wearables beyond the initial cost is … you have to remember to wear them.” 10:53 “The tech itself is not unreliable, but we as human beings are unreliable.” 13:34 “The conversation typically begins with privacy and goes into other kinds of risks.” 15:50 “Our health care economy is fundamentally misaligned.” 17:57 “The incentives … today don’t really enable this kind of proactive, preventive engagement.” 23:30 How do we solve this cost problem at scale? 23:44 How do you align incentives for those that will care to solve these problems? 26:47 “I don’t think that we’re going to have mass, large-scale change in health care moving home until people are starting to adopt … these kinds of services in their homes.” You can learn more at cherishhealth.com. @sumitknagpal of @WeCherishHealth discusses #aginginplace and #ffs on our #healthcarepodcast. #healthcare #podcast #digitalhealth What does “health care is coming home” truly mean? @sumitknagpal of @WeCherishHealth discusses #aginginplace and #ffs on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It’s not like we’re cheese and we’re aging in place. We’re living. We’re living our lives.” @sumitknagpal of @WeCherishHealth discusses #aginginplace and #ffs on our #healthcarepodcast. #healthcare #podcast #digitalhealth “Give us the ability to live where we want for as long as we want as safely as possible.” @sumitknagpal of @WeCherishHealth discusses #aginginplace and #ffs on our #healthcarepodcast. #healthcare #podcast #digitalhealth “The challenge with wearables beyond the initial cost is … you have to remember to wear them.” @sumitknagpal of @WeCherishHealth discusses #aginginplace and #ffs on our #healthcarepodcast. #healthcare #podcast #digitalhealth “The tech itself is not unreliable, but we as human beings are unreliable.” @sumitknagpal of @WeCherishHealth discusses #aginginplace and #ffs on our #healthcarepodcast. #healthcare #podcast #digitalhealth “The conversation typically begins with privacy and goes into other kinds of risks.” @sumitknagpal of @WeCherishHealth discusses #aginginplace and #ffs on our #healthcarepodcast. #healthcare #podcast #digitalhealth “Our health care economy is fundamentally misaligned.” @sumitknagpal of @WeCherishHealth discusses #aginginplace and #ffs on our #healthcarepodcast. #healthcare #podcast #digitalhealth “The incentives … today don’t really enable this kind of proactive, preventive engagement.” @sumitknagpal of @WeCherishHealth discusses #aginginplace and #ffs on our #healthcarepodcast. #healthcare #podcast #digitalhealth How do we solve this cost problem at scale? @sumitknagpal of @WeCherishHealth discusses #aginginplace and #ffs on our #healthcarepodcast. #healthcare #podcast #digitalhealth How do you align incentives for those that will care to solve these problems? @sumitknagpal of @WeCherishHealth discusses #aginginplace and #ffs on our #healthcarepodcast. #healthcare #podcast #digitalhealt

This episode is a tale of what happens when some employers decide to open up a few virtual front doors and when these virtual front doors lead only to referrals to providers who are willing to be accountable and offer financial predictability. That’s what these employers want, after all. They want accountability and financial predictability. Many employers now have access to all claims databases and other data like the RAND 3.0 report. Therefore, employers can and are using this information in a big way to steer their plan member populations. Given these goings-on, some slower-moving providers could easily find themselves on the outside looking in. So, who are those providers who are or will be getting shut out of referral flows? They’re definitely FFS-centric, but they could be a large health system, an urgent care center, or a hospital-owned PCP. In this health care podcast, I speak with Jeff Hogan, the northeast regional manager for Rogers Benefit Group and also president of Upside Health Advisors. We talk in this episode not about what might be theoretically possible but about what is happening right now. You can learn more at jhogan@rogersbenefit.com and connect with Jeff on LinkedIn. Jeffrey Hogan is the northeast regional manager for Rogers Benefit Group, a national benefits marketing and consulting firm. Jeff has been with Rogers Benefit Group for 30 years. Additionally, Jeff operates a consulting firm, Upside Health Advisors, where he provides expert witness services on health care–related litigation, is a consultant to payers and large provider groups for product development and launch, and is a resource to employers desirous of implementing strategies to manage their health spend. Jeff is focused on health care payment reform, health policy, care coordination, value-based health care, health care quality, and precision medicine. Jeff regularly appears on national forums focused on moving to value-based health care and is actively working to promote health care–related transparency measures in the market. He serves as the group’s liaison to the National Alliance of Healthcare Purchaser Coalitions. Jeff is the regional leader for The Leapfrog Group. He is also one of the coordinators of Connecticut’s Moving to Value Alliance. 01:43 What are self-insured employers doing right now to impact referral flows? 03:29 Are any virtual tech companies moving in on the local provider space? 07:46 “What we’re trying to do … is to help the member have the best outcome.” 10:32 “It’s a continuum, if you will.” 10:44 “There is a fairly significant gulf between providers … and, say, a COE [Center of Excellence].” 11:13 “What is value for employers coming out of COVID? Accountability and predictability.” 13:40 What are second-order effects? 14:29 “People like and want better access.” 14:46 “Fee-for-service providers fear the informed health care consumer.” 22:19 “Many of the brick-and-mortar providers are realizing that they have to up their game.” 24:52 “Things will change.” 25:07 “People not only want convenience, but they want safety, they want data.” 26:11 “We are at an inflection point … After 35 years in the business, I really finally feel like we’ve broken through.” 27:31 “This requires people to really think; it requires employers to actually know what their biggest problems are.” 29:53 “We can’t go back to the fragmentation of fee for service.” 30:25 “Data is critical.” You can learn more at jhogan@rogersbenefit.com and connect with Jeff on LinkedIn. Jeff Hogan of #UpsideHealthAdvisors and #RogersBenefitGroup discusses #FFS providers in our #healthcarepodcast. #healthcare #podcast #digitalhealth What are self-insured employers doing right now to impact referral flows? Jeff Hogan of #UpsideHealthAdvisors and #RogersBenefitGroup discusses #FFS providers in our #healthcarepodcast. #healthcare #podcast #digitalhealth Are any virtual tech companies moving in on the local provider space? Jeff Hogan of #UpsideHealthAdvisors and #RogersBenefitGroup discusses #FFS providers in our #healthcarepodcast. #healthcare #podcast #digitalhealth “What we’re trying to do … is to help the member have the best outcome.” Jeff Hogan of #UpsideHealthAdvisors and #RogersBenefitGroup discusses #FFS providers in our #healthcarepodcast. #healthcare #podcast #digitalhealth “There is a fairly significant gulf between providers … and, say, a COE [Center of Excellence]” Jeff Hogan of #UpsideHealthAdvisors and #RogersBenefitGroup discusses #FFS providers in our #healthcarepodcast. #healthcare #podcast #digitalhealth “What is value for employers coming out of COVID? Accountability and predictability.” Jeff Hogan of #UpsideHealthAdvisors and #RogersBenefitGroup discusses #FFS providers in our #healthcarepodcast. #healthcare #podcast #digitalhealth “People like and want better access.” Jeff Hogan of #UpsideHealthAdvisors and #RogersBenefitGroup discusses #FFS providers in our #healthcarepodcast. #healthcare #podcast #digitalhealth “Fee-for-service providers fear the informed health care consumer.” Jeff Hogan of #UpsideHealthAdvisors and #RogersBenefitGroup discusses #FFS providers in our #healthcarepodcast. #healthcare #podcast #digitalhealth “People not only want convenience, but they want safety, they want data.” Jeff Hogan of #UpsideHealthAdvisors and #RogersBenefitGroup discusses #FFS providers in our #healthcarepodcast. #healthcare #podcast #digitalhealth “We are at an inflection point … After 35 years in the business, I really finally feel like we’ve broken through.” Jeff Hogan of #UpsideHealthAdvisors and #RogersBenefitGroup discusses #FFS providers in our #healthcarepodcast. #healthcare #podcast #digitalhealth “This requires people to really think; it requires employers to actually know what their biggest problems are.” Jeff Hogan of #UpsideHealthAdvisors and #RogersBenefitGroup discusses #FFS providers in our #healthcarepodcast. #healthcare #podcast #digitalhealth “We can’t go back to the fragmentation of fee for service.” Jeff Hogan of #UpsideHealthAdvisors and #RogersBenefitGroup discusses #FFS providers in our #healthcarepodcast. #healthcare #podcast #digitalhealth “Data is critical.” Jeff Hogan of #UpsideHealthAdvisors and #RogersBenefitGroup discusses #FFS providers in our #healthcarepodcast. #healthcare #podcast #digitalhealth

What does Move to Value mean and why is it important for employers to understand? In Part 1 of this conversation, Jeff Hogan, over at Rogers Benefit Group, jumps on the podcast to discuss the shift that is happening in healthcare as we move from fee-based care towards value-based care.

Jeff Hogan, WRAL morning anchor, is hoping to complete his 30th marathon soon. The Runologie crew caught up with the veteran news anchor to discuss how running helps reset the day filled with interesting work hours and how one marathon lead to ultramarathons.

WRAL anchor Jeff Hogan has been with the station for nearly two years, but shortly after joining the station he was in a horrific accident that nearly took his life. He talks about that accident and what lingering affects it still has on his life. We also talk about what lead him to North Carolina and what he likes to do in his spare time! Hogan and anchor Renee Chou are hosting WRAL's coverage of the Raleigh Christmas Parade on Nov. 23, starting at 9 a.m. Learn more about your ad choices. Visit megaphone.fm/adchoices

WRAL anchor Jeff Hogan has been with the station for nearly two years, but shortly after joining the station he was in a horrific accident that nearly took his life. He talks about that accident and what lingering affects it still has on his life. We also talk about what lead him to North Carolina and what he likes to do in his spare time! Hogan and anchor Renee Chou are hosting WRAL's coverage of the Raleigh Christmas Parade on Nov. 23, starting at 9 a.m.

Dr. Susan Eirich of Earthfire Institute and wildlife filmmaker Jeff Hogan discuss how even those of us with the best intentions don't always realize the impact human activity has on the ability of wildlife to make a living. Cinematographer Jeff Hogan has been filming and photographing wildlife around the world for over 30 years, earning numerous awards for his work, including several Emmy nominations for cinematography. Being a naturalist at heart, Jeff's passion is to witness wildlife behavior and to provide us a privileged view in to the secret lives of wildlife, capturing intimate imaging that illustrates just what it takes for our wildlife to make a living and highlighting the unique stories that abound throughout the natural world. Jeff resides in the heart of the Yellowstone ecosystem with his wife Karen and son Finn, with homes in Jackson Hole, WY, and Silver Gate, MT. Living at the doorstep of both Yellowstone and Grand Teton National Parks, Jeff often captures behavioral sequences rarely witnessed in the wild. Bringing these images and stories to the screen is Jeff's goal, with the understanding and hope that society will respond with a desire to conserve and protect all life and treasure our incredible natural world. Jeff can be reached at hoganfilms.com. After our conversation, Jeff generously shared footage of F16, a female cougar he has been following for many years. To see this footage, visit earthfireinstitute.org/jeffhogan.

Jeff Hogan is the Founder of Killer Whale Tales, a program that visits schools to teach kids about the plight of killer whales and what we can do to help them. Hogan hopes the kids will not only change their own behavior to be better stewards of the environment, but also change the behavior of their parents.

On this episode of ShiftShapers, Jeff Hogan shares the innovative approach his company has used to deliver an engaging, modern, and consultative approach to employee benefits. At the core of this approach lies a focus on building strong partnerships with brokers to provide better options for employers and employees alike.    Jeff and his team encourage employers to view their benefits offerings like any other corporate asset. Once they've established this mindset, Jeff works closely with his brokers to bring them quarterly data and analytics about everything from core benefits to wellness and other benefit initiatives. You can find show notes and more information by clicking here: http://bit.ly/2q0mToz  

In addition to creating a presence for his company, Rogers Benefit Group, in a new, carrier rich environment, Jeff Hogan has created unique partnerships with his brokers that help them to deliver an engaging, modern and consultative approach to employee benefits. Listen to this episode to learn about Rogers Benefit Group's innovative and successful approach. See how you can adapt their model to your practice to bring greater value and differentiate your agency.