Podcast appearances and mentions of Mark Miller

On the latest episode of Chesterfield Behind the Mic, we talk to Dr. Mark Miller of the Chesterfield County Board of Supervisors to talk about his background with mental health support, his view of the economic development announcements in the last year, how he sees the role the county plays in supporting schools, and the latest updates on a slew of projects and topics within the Midlothian District.   Credits: Director: Martin Stith Executive Producer: Teresa Bonifas Producer/Writer/Host: Brad Franklin Director of Photography/Editor: Matt Boyce Producer/Camera Operator: Martin Stith and Matt Neese Graphics: Debbie Wrenn Promotions and Media: J. Elias O'Neal, Elizabeth Hart, and Jackie Wilkens   Music: Hip Hop This by Seven Pounds Inspiring Electronic Rock by Alex Grohl   Guest: Dr. Mark Miller, Chesterfield County Board of Supervisors (Midlothian District)   Recorded on location by Constituent and Media Services   Chesterfield.gov/podcast     Follow us on social media! On Facebook, like our page: Chesterfield Behind the Mic. On Twitter, you can find us at @ChesterfieldVa and on Instagram it's @ChesterfieldVirginia. And you can also watch the podcast on WCCT TV Thursday through Sunday at 7 p.m. as well as on weekends at noon on Comcast Channel 98 and Verizon Channel 28.

Description: In this episode, I am speaking with the Eanes, who has been on the podcast pre-pandemic. Russ has pivoted from religious publishing to being an author, walker, bicyclist, guide, travel educator and a few other things that I cannot remember right now. The point is Russ continues to adapt and takes advantage of opportunities as they arise. Russ is a writer, walker and cyclist from Harrisonburg, Va., a freelance publishing consultant and a travel coach and guide. His goal in living is to inspire others to more meaningful, peaceful and less consumptive lives. He is also an avid traveler, with a love of culture, cuisine and history, especially of Europe and Latin America. Russ is a former member and successful graduate of the Career Pivot community. I first interviewed Russ in episode 143 after he published his first book The Walk of a Lifetime: 500 Miles on the Camino de Santiago. I later published an updated episode in February 2021 about how Russ was adapting to the pandemic. Russ continued to make adaptions throughout the next couple of years including spending one year working full time for GetSetup as a travel instructor. Russ recently published his latest book, Pilgrim Paths to Assisi: 300 Miles on the Way of St. Francis. We discuss in this episode how he got to where he is today and that he is not done yet. Russ's story was highlighted in an article in the New York Times by my friend and colleague Mark Miller, no we are not related, called How a Solo Gig Can Give You a Stronger Retirement. I recommended Russ to Mark for this article. This episode is sponsored by Career Pivot. Check out the Career Pivot Community, and pick up my latest book, Repurpose Your Career: A Practical Guide for the 2nd Half of Life Third Edition. For the full show notes and resources mentioned in the episode click here.

In 2021, editor Alex Neason's grandfather passed away. On his funeral program, she learned the name of his father for the first time: Wilson Howard. Not Neason. Howard. And when she asked her family why his last name was different from everybody else's, nobody had an answer. In this episode, we tag along as Alex searches for answers through swampy cemeteries, libraries, and archives in the heart of south Louisiana: who was her great grandfather, really? Is she supposed to be a Neason? Where did the name Neason come from, anyways? And is a name something whose weight you have to shed, or is it the only path forward into the future?Special thanks to, Cheryl Neason-Isidore, Karen Neason Dykes, Johari Neason, Keaun Neason, Kevin Neason, Anthony Neason, the late Clarence Neason Sr. and Anthony Neason, Clarence Neason Jr., Olivia Neason, Tori Neason, Orelia Amelia Jackson, Russell Gragg, Victor Yvellez, Asher Griffith, Devan Schwartz, Myrriah Gossett, Sabrina Thomas, Nancy Richard, Katie Neason, Amanda Hayden, Gabriel Lee, Paul Brandenburg, Justin Flynn, Mark Miller, Kenny Bentley, Jason Issacs, Irene Trudel, Bill Hyland, the staff members at the Orleans Parish, East Feliciana Parish, and Plaquemines Parish Clerk of Court offices. Episode Credits:Reported by - Alex Neasonwith help from - Nicka Sewell-SmithProduced by - Annie McEwenwith help from - Andrew ViñalesMusic performed by - Jason Isaacs, Paul Brandenburg, Justin Fynn, Mark Miller, and Kenny Bentleywith engineering and mixing help from - Arianne Wack and Irene TrudelFact-checking by - Emily KriegerEpisode Citations:Audio - You can listen to the episode of La Brega (https://zpr.io/p5EcBJyU2dfJ), in English and in Spanish.Our newsletter comes out every Wednesday. It includes short essays, recommendations, and details about other ways to interact with the show. Sign up (https://radiolab.org/newsletter)! Radiolab is supported by listeners like you. Support Radiolab by becoming a member of The Lab (https://members.radiolab.org/) today. Follow our show on Instagram, Twitter and Facebook @radiolab, and share your thoughts with us by emailing radiolab@wnyc.org.   Leadership support for Radiolab's science programming is provided by the Gordon and Betty Moore Foundation, Science Sandbox, a Simons Foundation Initiative, and the John Templeton Foundation. Foundational support for Radiolab was provided by the Alfred P. Sloan Foundation.

Mark Miller is a seasoned business leader, international best-selling author, leadership growth pioneer, and thought leader.   leadeveryday.com markmillerleadership.com

Text Hawk to 66866 to become part of "Mindful Monday." Join 10's of thousands of your fellow learning leaders and receive a carefully curated email from me each Monday morning to help you start your week off right... Full show notes at www.LearningLeader.com Twitter/IG: @RyanHawk12   https://twitter.com/RyanHawk12 Mark Miller started his Chick-fil-A career working as an hourly team member in 1977. Mark's cell phone number is 678-612-8441. He asked that you text him your thoughts on this episode. In 1978, he joined the corporate staff working in the warehouse and mailroom. Since that time, he has provided leadership for Corporate Communications, Field Operations, Quality and Customer Satisfaction, Training and Development, and Leadership Development. During his tenure with Chick-fil-A, the company has grown from 75 restaurants to over 2,300 locations with annual sales approaching $10 billion. Mark began writing almost twenty years ago when he teamed up with Ken Blanchard, co-author of The One Minute Manager, to write The Secret: What Great Leaders Know and Do. He's now written 11 books that have sold over 1 million copies. His latest is called Culture Rules.  Notes:  “Your capacity to grow determines your capacity to lead.” You must make the choice to be a learner... Let's start with a story told by the late philosopher, David Foster Wallace. He said, “There are these two young fish swimming along, and they happen to meet an older fish swimming the other way who nods at them and says, “Morning boys. How's the water?” And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, “What the hell is water?” Mark Miller conducted research with more than 6,000 individuals from ten countries that revealed that 71% of U.S. leaders believe culture is their most powerful tool to drive performance. However, the study revealed that enhancing workplace culture ranked eleventh on the leader's priority list. “If your heart is not right, no one cares about your skills.” Your character, integrity, and care for others must be there to earn any type of followership. If your heart is not right, no one cares about your skills. The 3 culture rules are aspire, amplify, and adapt: Aspire - Share your hopes and dreams for the culture (Andrew Cathy, new CEO, said “Rooted in purpose, known for our care.”) Amplify - Always be looking for ways to reinforce and amplify the aspiration for your culture. Adapt - Always look for ways to enhance your culture and be innovative. The Magic Circle: It dates back to 1938 when Dutch Historian Johan Huizinga wrote about the impact of play on culture… The "Must-Have" leadership qualities Character Competence Chemistry Mark has spent a lot of time with Navy SEALs to learn about culture... Key takeaways: Shoot Move Communicate Is focusing on culture a soft skill? The data suggests it is the #1 driver of performance. Storytelling - People remember the stories more than the stats. Don't just tell... Take people there.

Fr. Mark Miller, CSsR

Somebody wrote on Twitter the other day that he was gonna give a talk on the use of evidence in drug policy, and Barrett Montgomery replied, “That'll be a short talk then!” So, let's talk about the IRA (Inflation Reduction Act) for a moment, specifically the “CMS can negotiate for drugs for Medicare patients” part of the IRA. There's one topic I don't hear discussed what I would consider maybe often enough. Will these negotiations result in pricing that is evidence based? Will good drugs that companies developed using less taxpayer money for R&D, drugs that positively impact the patient lives or have spillover benefits for society or save downstream medical costs, drugs that have solid comparative evidence data, drugs that are a meaningful therapeutic advancement over competitors ... will these drugs be priced in line with that value? Everything I just mentioned, by the way, are things that CMS is supposed to take into account during its negotiations. So, that's what this show is all about. To have this conversation, I invited Dr. Peter Neumann on the podcast because Dr. Neumann (along with his two coauthors, Joshua Cohen and Daniel Ollendorf) just wrote a book about pharmaceutical pricing entitled The Right Price. I convinced Dr. Neumann to come on the show and talk about what the likely impact the IRA will have on these right drug prices. And short version, Dr. Neumann told me that “presumably drugs that offer more therapeutic advances will do better under these negotiations.” Here's a really, really top-line summary of the negotiation provisions that are in the IRA: CMS will negotiate prices on the highest gross spend top 10 Part D drugs in 2026, 15 Part D drugs in 2027, and 15 drugs from Medicare Part B and D for 2028. Small molecule drugs become negotiation contenders after 9 years, and biologics after 13 years. Once a generic or biosimilar comes out (ie, the patent is well and truly expired), then this negotiation provision is no longer in play. Now, CMS is given some discretion over how it's going to do things, and they will issue guidance and figure out how to implement the law over the next couple of years. As with so many things (and Chris Deacon talked about this recently on LinkedIn), it's how that law is operationalized that actually determines if it achieves this “right price” goal and/or—and Dr. Neumann, my guest in this healthcare podcast, makes this point really clearly, too—maybe the point of the law is as much about cost containment, frankly, as it is about achieving value-based “right” prices. And cost containment and value-based pricing are not the same thing. I'm gonna do a show on this coming up. So, what are the likely effects of the IRA pharma price negotiation provisions? And not talking about the whole IRA here and the cadre of other stuff like patient out-of-pocket caps and inflation caps. This show is complicated enough just talking about the negotiation portion and just talking about its potential to achieve pricing based on “value.” Here's a summary of likely impact of Medicare drugs being negotiated, some of which we talk about in this episode. There's “seven-ish” main implications: 1. “Some Medicare patients will benefit substantially from negotiations …, as a reduction in the drug's price will result in lower coinsurance and liability during the deductible phase.” Okay … this makes sense. 2. “Overall, negotiations are projected by the CBO [Congressional Budget Office] to reduce premiums, resulting in lower costs for all Medicare beneficiaries.” References: CBO estimates drug savings for reconciliation. Committee for a responsible federal budget. Accessed April 11, 2023. https://www.crfb.org/blogs/cbo-estimates-drug-savings-reconciliation  Congressional Budget Office. Estimated budgetary effects of Public Law 117-169, to provide for reconciliation pursuant to Title II of S. Con. Res. 14. Published 2022. Accessed April 11, 2023. https://www.cbo.gov/system/files/2022-09/PL117-169_9-7-22.pdf Okay … so, this #2 here is kind of thought provoking, especially when it's unclear at this time whether the negotiated price will refer to the list price, the AWP (average wholesale price), or the rebated price (ie, the price after rebates are applied). There are many, many implications if the negotiated price is before or after rebates, just given how “addicted” plans are to rebates and use the rebates, and cost shifting to patients, in a convoluted and super-inefficient way to try to keep premiums down. Listen to the show with Chris Sloan (EP216) for more on this. 3. There's more incentive to go after biologics than small molecule drugs—obvious, due to the 9-year versus 13-year thing. There's additionally some incentive for rare-disease and orphan drugs, most of which are biologics, in other parts of the IRA. 4. More interest in drugs for non-Medicare markets (ie, drugs for diseases of younger populations, perhaps) 5. Possibly less pharma innovation, fewer drug launches Oh, boy, with this one. Listen to the show with Mark Miller, PhD (EP380), for many, many nuances here. But let me give you a few things to think through, and I'd start with four words: We are chasing Goldilocks. There are two ends of the spectrum, and neither are good. On one end, Pharma charges way too much and the system gets bankrupted while pharma shareholders get rich. On the other side of the spectrum, there's not enough returns for any investors to invest in new drug development. It's all about moderation—finding the sweet spot in the middle—something the healthcare industry has a super hard time with. Bottom line, we want to incent meaningful innovation, drugs that actually work. If we pay a ton of money for drugs that don't work particularly well, then what's the incentive to find good drugs? As per my earlier point, if this legislation does as was intended, then good drugs should get rewarded and less comparatively effective drugs should be less rewarded. Let's cross our fingers, shall we? 6. Will Pharma raise its launch prices because the negotiations center on discounts? A higher price times the discount means a higher discounted price, after all. This one could be exacerbated by the part of the IRA that mandates inflation caps. There is some evidence that higher launch prices are already happening. 7. Manufacturers wait to launch until they have all their indications ready to go. If you didn't understand this, we explain in more detail during the interview. 8. There are incentives for Pharma to jack up commercial prices. Because they're making less money in Medicare, they try to make more money in the commercial market. But as Dr. Neumann says, you'd think that if Pharma could do that, they already would have done it. Or let me say that a different way: You'd think that if Pharma could have raised their commercial prices more than they already have been raising their commercial prices, they would have already done it. So, I think whether cost shifting actually increases here is a sizable question mark. 9. There's also less incentive for Pharma to innovate me-too kinds of drugs. If a drug in the same class for the same disease is being negotiated, then a new drug coming out in that same category might sort of have to charge a price similar to the negotiated price of the other drug. Dr. Peter Neumann, my guest in this episode, has a background in health economics and currently directs a research center that's focused on health economic issues. His group does a lot of work trying to understand the cost effectiveness of drugs and other health interventions. Other shows you should, for sure, listen to here are the ones with Mark Miller, PhD (EP380); Anna Kaltenboeck (EP303); Bruce Rector, MD (EP300); Scott Haas (EP365); and Chris Sloan (EP216). These shows offer context and adjacencies that are extremely relevant right now if you're gonna understand the potential impact of the IRA. Here's a quote from the book The Right Price (written by Dr. Peter Neumann and his coauthors, Joshua Cohen and Daniel Ollendorf) that I thought summed up some of the issues here very nicely: If there existed a Rorschach test for drug prices, it might conjure one of two images. Some people might perceive prices as a compass directing companies to invest in products that people value most. Aligning prices with value is akin to a “true north” orientation of the compass's arrow. Failure to link prices with value sends misleading signals to drug producers. Others might regard drug prices as a wall preventing patients from accessing the drugs they need. For them, the barrier should be as low as possible. But aligning prices with value might have little effect in lowering the wall. How then to accomplish that goal?   You can learn more at cevr.tuftsmedicalcenter.org or by reading The Right Price.   Peter J. Neumann, ScD, is director of the Center for the Evaluation of Value and Risk in Health (CEVR) at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center and professor of medicine at Tufts University School of Medicine. He is the founder and director of the Cost-Effectiveness Analysis Registry, a comprehensive database of cost-effectiveness analyses in healthcare. Dr. Neumann has written widely on the role of clinical and economic evidence in pharmaceutical decision-making and on regulatory and reimbursement issues in healthcare. He served as co-chair of the 2nd Panel on Cost-Effectiveness in Health and Medicine. He is the author or coauthor of over 300 papers in the medical literature and the author or coauthor of three books: Using Cost-Effectiveness Analysis to Improve Health Care (Oxford University Press, 2005); Cost-Effectiveness in Health and Medicine, 2nd edition (Oxford University Press, 2017); and The Right Price: A Value-Based Prescription for Drug Costs (Oxford University Press, 2021). Dr. Neumann has served as president of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). He is a member of the editorial advisory board of Health Affairs and the panel of health advisors at the Congressional Budget Office. He has also held several policy positions in Washington, DC, including special assistant to the administrator at the Health Care Financing Administration. He received his doctorate in health policy and management from Harvard University.   09:33 Is it imperative that drugs whose patents are expiring have their prices negotiated? 10:50 “We need innovation; we want to encourage innovation.” 11:01 Does this new law strike a balance between innovation and price regulation? 11:21 How are we assessing cost effectiveness and innovation in the drug space? 12:29 What's the problem with the current drug markets? 13:14 Why can't you rely on the drug market for the cost effectiveness of a drug? 14:13 Why very expensive drugs do not equate to poor value. 15:06 What are the likely outcomes of the IRA? 18:33 How does pharmacy budget factor into high-value drugs? 19:26 “Value-based pricing doesn't mean necessarily lower spending overall.” 22:59 What are the types of drugs that will be excluded from the IRA? 23:22 Who will the law create problems for? 24:44 What have pharmacy benefit managers (PBMs) been doing to move forward with the new law? 26:04 What are plan sponsors doing right now? 28:32 What are the most important value metrics according to Dr. Neumann?   You can learn more at cevr.tuftsmedicalcenter.org or by reading The Right Price.   @PeterNeumann11 discusses #drugprice #negotiations on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Stacey Richter (EP400), Dawn Cornelis (Encore! EP285), Stacey Richter (EP399), Dr Jacob Asher, Paul Holmes, Anna Hyde, Dea Belazi (Encore! EP293), Brennan Bilberry, Dr Vikas Saini and Judith Garber, David Muhlestein  

Guest this hour: Mark Miller, attorney, and host of "Talk to the Lawyers" Mark Miller lawyer and host of “Talk To The Lawyers” on KCBQ “The Answer” NEWS YOU CAN USE - SCOTUS news - Student Loan forgiveness. / abandoning the legislativeprocess.  PLUS, ” NEWS YOU CAN USE - bankruptcy, debt, individual and business.  Caller about bankruptcy, and debt/loan forgiveness. / AND Shaq: Jill Biden inviting Iowa women's team to the White House was about race CLIP and RESPONSE from A.K. !  AND, Trump releases a video ripping the 'weaponization' of the U.S. Justice System.  http://www.AndreaKayeShow.com See omnystudio.com/listener for privacy information.

Strengthen Your Stewardship and Multiply Your Leadership Potential How can I serve you? I host two forms of content on this podcast. One is high-capacity leaders like today's conversation with Mark and two is supporting ambitious leaders who want to accelerate their growth in one coaching conversation. When you are ready to unleash your God-given potential reach out and let's connect to see if you are a good fit to share a real-time coaching conversation with the world. www.lantzhoward.com - Mark Miller has published over 25 books, has served with Chick-fil-A for over 44 years, and is getting ready to reach his next level of impact. Here are a few noteworthy questions: Tell us about the culture of your marriage and how that reflects your leadership. Why living adventure matters. What would you want Truett Cathy to say to you today as you make your final lap at Chick-fil-A? What is God's heart with the things that he has entrusted to your care? Why does reaching and impacting 100,000,000 million leaders matter? and much more. Grab Mark's latest book Culture Rules: The Leaders Guide to Creating the Ultimate Competitive Advantage at www.leadeveryday.com - Support this content by sharing it with a friend and leaving a review. Thank You!

“When I walk into a room, I'm trying to figure out how I can add value. Sometimes it means being in charge and sometimes it means taking out the trash.” Mark Miller, VP of High Performance Leadership at Chick-fil-A and best-selling author of the book Smart Leadership, knows calling yourself a servant leader is one thing, but acting on those words is another. In this episode, we're revisiting our conversation with Mark, where he shares the benefits of being a leader who is others-focused and leads with generosity. Listen in to learn how you can adopt an “adding value” mentality and hear about what Mark calls “the leadership fountain of youth.”

Host Chaz Wolfe welcomes Sheldon Stewart! With over 3 decades of experience in the painting industry, and a successful 7+ figure painting business, Sheldon is a king in the construction industry and shares from his wealth of real insight and wisdom he's picked up along the way.In this episode, Chaz and Sheldon discuss how to set yourself apart from your competitors, the importance of constantly getting better, and how to build systems and processes to facilitate growth. Tune in now and start growing your business!During this episode, you will learn about;[01:21] Intro to Sheldon and his business[01:57] After his success, why Sheldon continues to push[03:59] How Sheldon got started in the painting industry[06:21] Sheldon's transition into a serious business[08:16] How Sheldon knew it was time to scale his business[10:31] A good business decision Sheldown made along the way[13:39] A joker vs. a real business owner[15:54] A ‘bad' decision Sheldon made in his business[16:39] Sheldon's thoughts on culture change [18:00] Hiring a consulting firm[20:41] Disciplines Sheldon has around decision making[23:59] If Sheldon could only track one metric, what would it be?[25:41] Does Sheldon intentionally network or mastermind?[26:56] If he only had one hour to work on his business, what would Sheldon do within that one hour?[32:01] If he lost it all, what would Sheldon do?[35:08] How to connect with Sheldon[35:48] Information on Gathering The Kings MastermindNotable Quotes“I wanted to do or be something more than someone that had five or six or 10 houses in front of me.” - Sheldon Stewart“I realized in our industry, there's so many people that have a ladder and have a truck and they have a name on the side of it and THAT'S their company.” - Sheldon Stewart“I was just always trying to find a way to stand out.” - Sheldon Stewart“People always say, ‘Debt is bad. You don't want a lot of debt.' For me, if I looked back, that debt created me, it made me WORK.” - Sheldon Stewart“You're probably not gonna make money unless you build your brand in that industry to be at the highest point that you can get it to.” - Sheldon Stewart“If you're only doing it for the money, then I always say the money will never come.” - Sheldon Stewart“The right thing for me doesn't mean it's the right thing for you, but you've gotta be true to yourself.” - Sheldon Stewart“No one likes change. They like the results to change, they wanna lose the 20 pounds. They just don't want that thing in the middle called the diet.” - Sheldon Stewart“I never stick my head in the sand and say, I can't learn anything today.” - Sheldon Stewart“If I'm the smartest guy in the room I'm worried.” - Sheldon Stewart“ But I think the reality is that there's a lot of guys, they just they have a side hustle, they have a little thing that they just dabble with.” - Chaz Wolfe (Host)“The differentiator is that the guys who took it seriously probably had a uniform. They probably carried themselves in a specific way. They had clean vehicles or whatever the thing was down the line. It wasn't just, ‘Hey, I've got a paintbrush, a ladder and a truck'.” - Chaz Wolfe (Host)Books and Resources Recommended:“The Secret:What Great Leaders Know And Do,” by Ken Blanchard & Mark Miller

In this week's episode of the SIMPLE brand podcast, I talk with Mark Miller, author of Culture Rules: The Leader's Guide to Creating the Ultimate Competitive Advantage.Mark's the Vice President of High Performance Leadership with Chick-fil-A. And Mark's the author of 11 best-selling books including his latest Wall Street Journal bestseller - Culture Rules: The Leader's Guide to Creating the Ultimate Competitive Advantage.Some of the topics we discuss include:The three rules that go into creating a high-performance cultureWhy leaders shouldn't worry too much about how they define their vision, mission, and purposeThe simple test to know if you have defined your team's aspiration wellThe value of recognizing reality and comparing that to your culture aspirationHow to ensure your people can clearly articulate your culture valuesWhat Alexander the Great teaches us about modeling values to your peopleThe right way to use storytelling with your peopleHow to discern and remove toxins from your organizationBe grateful that there's no finish line to developing and adapting your cultureRESOURCES FROM THIS EPISODE:Mark's site - leadeveryday.comMark's book - Culture Rules: The Leader's Guide to Creating the Ultimate Competitive AdvantageMark's book - Smart Leadership: Four Simple Choices to Scale Your ImpactMark's book - Win the Heart: How to Create a Culture of Full Engagement

Reporting live from SXSW! Join Dmitri Vietze and Tristra Newyear Yeager as they catch up with music industry movers and shakers including Colin Ramsay, Dave Godowsky, Mansoor Rahimat Khan, Mihai Manescu, and Cliff Fluet. Tune in to an in depth interview with Mark Miller, Founder and CEO of Labelcoin, the stock exchange for songs. Discover how Labelcoin allows fans to financially engage and support their favorite artists as songholders. Find out how Labelcoin is empowering artists with the knowledge and tools they need to support their careers. Look to the future of A&R in the age of TikTok. What's next for the music industry? Find out on this week's episode.  The Music Tectonics podcast goes beneath the surface of the music industry to explore how technology is changing the way business gets done. Visit MusicTectonics.com to learn more, and find us on Twitter, Facebook, and Instagram. Let us know what you think!

Charlie and Mark Miller take a trip to the past and the start of smart contracts. Charlie kicks off the show sharing an abstract that Mark wrote in 1988 that envisioned a future of smart contracts. Mark shares what was missing from that abstract when it comes to blockchain, diving into solving the problems of ignorance and malice brought on by centralization. Mark explains Polycentrism and how it relates to consensus mechanisms. Charlie shares his thoughts on Bitcoin and its lack of need to make decisions. Mark talks about the road to immutability and the DAO bug on Ethereum. Mark shares info on Agoric and how it's building a blockchain on utilizing familiar technology. Mark dives into finality, proof-of-stake, and differences between Bitcoin and Ethereum. Charlie and Mark hypothesize consensus scenarios with Ethereum. Mark shares Agoric's capabilities and its governance mechanism.

In this episode, we're bringing you a conversation from The Authority Podcast, part of the Be Podcast Network.  Today's guest is international best-selling author and business leader Mark Miller, Vice President of High Performance Leadership for Chick-Fil-A.  Culture Rules: The Leader's Guide to Creating the Ultimate Competitive Advantage is Mark's 11th book. He currently has over one million books in print in more than twenty-five languages. Ross and Mark discuss: 71% of U.S. leaders believe culture is their #1 most powerful tool to drive performance, but enhancing culture ranks low on their priority list — why the gap? First move: decide and declare what you're trying to create. Culture needs to be explicit.  The 3 Culture Rules: Aspire, Amplify, Adapt What does culture mean to your customers? Microsoft CEO Satya Nadella wanted to shift the company from being “know-it-alls” to “learn-it-alls” — what did Mark learn while working on the book? The “magic circle” of game design and how it explains culture.  What Mark learned about innovation and purpose.  Measuring culture Culture Rules is now available for purchase, with a number of bonuses available for individual and bulk orders. Learn about them here: https://www.leadeveryday.com  The Authority is a weekly podcast featuring interviews with leading authors from the education world and beyond. Host Ross Romano, a leadership coach, storytelling strategist and edtech advisor, draws out their invaluable insights on leadership, culture-building, transformation, and student & educator success. Subscribe to The Authority: Apple: https://apple.co/3ePnTea  Spotify: https://spoti.fi/3JxkyeX  RSS: https://feeds.libsyn.com/425789/rss  Connect on social media: Mark Miller is a business leader, best-selling author, and communicator. He began writing almost twenty years ago, and with over one million books in print in more than twenty-five languages, Mark's global impact continues to grow. Connect with him: https://www.linkedin.com/in/highperformanceleaders/  https://twitter.com/MarkMillerLeads  Ross Romano is a co-founder of the Be Podcast Network and CEO of September Strategies, a consulting firm that helps organizations and high-performing leaders in the K-12 education

The WisSports.net Podcast for March 28th, 2023. WSN General Manager Travis Wilson is joined by WSN girls basketball writer Norbert Durst to recap the girls hoops state tournament, plus Mark Miller and Colton Wilson join in to talk about low state tournament attendance, possible opportunities to address attendance, sectional and state tournament plans and options, and the upcoming vote on the Competitive Equity proposal. Join the Buckle Up Phone Down movement! WisDOT challenges Wisconsin to put safety first by taking the two most important actions to prevent or survive a crash. Accept the Buckle Up Phone Down challenge. Use your seat belt every trip and put down the phone when driving.

Are annuities the best product since sliced bread … or a house of mirrors? Or could they be both? We'll talk about it today with Mike Miller on Faith and Finance. Mike Miller is a Partner and Senior Private Wealth Advisor at the South Carolina office of Ronald Blue Trust. He's also a certified financial planner and a Certified Kingdom Advisor.  Mark Miller is a Certified Kingdom Advisor. If you want to learn even more about annuities, you can listen to his two-part podcast on the topic at TalkingMoneyRadio.com.At Faith and Finance, we're generally not fans of annuities. But let's take a closer look. First, what is the main problem with any investment that guarantees returns, such as annuities?Miller says they're always a tradeoff. Guarantees come with a cost. Typically, the lower the risk, the lower the return. WHAT DOES THE BIBLE SAY?You won't find the word “annuities'' in the Bible, but there is a biblical principle to guide us on this topic. Miller talks about the Parable of the Talents found in Matthew 25. One of the servants buried his talent in the ground. The master asked why he did that. The servant said he was afraid, and the master was displeased.Miller says all too often, annuities are marketed and purchased based on fear. WHAT TO LOOK OUT FORIf a salesperson is ONLY selling annuities, rather than a full suite of investment options, that's a potential problem. If he or she only has a square peg to sell, they'll always try to sell a square peg, regardless of whether the hole is a square, a circle, or a triangle. Also, if an annuity salesperson is trying to get you to put a large percentage of your money into an annuity? If so, watch out! It's always a good idea to diversify. And do you feel like someone is trying to sell it because it's in your best interest? … or because they're trying to win a contest? Listen to those spirit checks if you feel like they're not acting in your best interest. There are three different types of annuities: Fixed, indexed, and variable. Fixed annuities do have some advantages in an era of elevated interest rates. You usually get a higher guarantee than in other types of annuities, at least for a period of time. Variable annuities have a higher potential upside, but a higher potential downside as well. Whatever the annuity, it always makes your money less liquid and available. And if you're going to leave that money alone for a long period of time, why not invest in the things the insurance companies are investing in (the market)? Just take a long-term approach and diversify properly. There are some limited situations in which an annuity makes sense. That could be a situation in which you've exhausted other investment options. Seek out a kingdom adviser if you want to evaluate annuities for your needs. On this program, Rob also answers listener questions: What is the best option to consolidate debt? How can a married couple get out of a living paycheck-to-paycheck situation? RESOURCES MENTIONED:Bankrate.comRemember, you can call in to ask your questions most days at (800) 525-7000. Also, visit our website at FaithFi.com where you can join the FaithFi Community, and give as we expand our outreach.  

The WisSports.net Podcast for March 23rd, 2023. WSN General Manager Travis Wilson is joined by WSN boys basketball writer Mark Miller to recap and review the boys basketball state tournament, talk about best games, performances, and more, plus take a sneak peak ahead to next season. Join the Buckle Up Phone Down movement! WisDOT challenges Wisconsin to put safety first by taking the two most important actions to prevent or survive a crash. Accept the Buckle Up Phone Down challenge. Use your seat belt every trip and put down the phone when driving.

Author and Chick-fil-A VP of High Performance Leadership Mark Miller Interviews with Matthew Kelly @chickfila @markmillerleadership8683 New York Times bestselling author Matthew Kelly interviews Mark Miller, VP of High Performance Leadership at Chick-fil-A and author of the new book, Culture Rules.Get Mark's new book CULTURE RULES: https://amzn.to/3JjucD2Get Matthew's 60 Second Wisdom delivered to your inbox: https://www.matthewkelly.com/subscribeIf you have not read HOLY MOMENTS, get your copy today! - https://holymomentsbook.comSubscribe to Matthew's YouTube Channel today! https://www.youtube.com/c/MatthewKell...https://www.matthewkelly.comGet Matthew's 60 Second Wisdom delivered to your inbox: https://www.matthewkelly.com/subscribe The Best Version of Yourself and 60 Second Wisdom are registered trademarks.#MatthewKelly #chickfila #leadership #culture #ProfoundlyHuman #BestVersionOfYourself

I Don't Wanna Hear It Podcast215 – Disc Dives For Dummies: Change Is A Sound by Strike AnywhereThis week we dive into Strike Anywhere's debut LP, Change Is A Sound - an unadulterated masterpiece, that is just as incredible today as it was the day it was released, twenty-two years ago. And the guys in the band are so NICE.Check out more of our stuff at I Don't Wanna Hear It and join the Patreon, jabroni. I mean, if you want. Don't be weird about it. Oh, and we publish books now at WND Press because we want to be bankrupted by a dying medium.We now have a Big Cartel where you can buy shirts, pins, mugs, and coffee.Also, you should listen to our 2021 Christmas special: A Black Metal Christmas Carol, our 2022 Halloween special: Ghoulie Ghoulie Ghoul, Where Are You?, our 2022 Christmas Special: How the Stench Stole Christmas, as well as Mikey's true crime podcast, Wasteland and Shane's psychology podcast, Why We Do What We Do.Aaannnddd... our good buddy and frequent third host Matt Moment is in a great hardcore band called Contact. Check 'em out! You can preorder their upcoming record, Before and Through and Beyond All Time right here from Patient Zero Records.Episode Links:Change Is A Sound by Strike AnywhereSome of our old bands are on Spotify:Absent FriendsWe're Not DeadYears From NowMusical Attribution:Licensed through NEOSounds. License information available upon request.“5 O'Clock Shadow,” “America On the Move,” “Baby You Miss Me,” “Big Fat Gypsy,” “Bubble Up,” “C'est Chaud,” “East River Blues,” “The Gold Rush,” “Gypsy Fiddle Jazz,” “Here Comes That Jazz,” “I Wish I Could Charleston,” “I Told You,” “It Feels Like Love To Me,” “Little Tramp,” “Mornington Crescent,” “No Takeaways.”

The WisSports.net Podcast for March 15th, 2023. WSN General Manager Travis Wilson is joined by WSN boys basketball writer Mark Miller to preview the boys basketball state tournament with a look at the top games, the best semi-final matchup, D1 prospects to watch, predictions, and much more. Join the Buckle Up Phone Down movement! WisDOT challenges Wisconsin to put safety first by taking the two most important actions to prevent or survive a crash. Accept the Buckle Up Phone Down challenge. Use your seat belt every trip and put down the phone when driving.

The WisSports.net Podcast for March 9th, 2023. WSN General Manager Travis Wilson is joined by WSN boys basketball writer Mark Miller to take a look back at boys hoops regionals plus preview sectional play, including a look at each of tonight's sectional semi-final matchups. Join the Buckle Up Phone Down movement! WisDOT challenges Wisconsin to put safety first by taking the two most important actions to prevent or survive a crash. Accept the Buckle Up Phone Down challenge. Use your seat belt every trip and put down the phone when driving.

How do you avoid getting bogged down in the quicksand of competing demands? According to Mark Miller, Vice President of High-Performance Leadership at Chick-fil-A, it all boils down to your choices. In this episode, Mark shares insights from over 20 years of leadership coaching and team development. With over one million books in print in more than 25 languages, you will see how Mark's insights into leadership are sought by organizations across the globe.Guest Links:Mark's LinkedInLead Every Day WebsiteChick-fil-A HomepageCulture Rules: The Leader's Guide to Creating the Ultimate Competitive Advantage by Mark MillerSmart Leadership: Four Simple Choices to Scale Your Impact by Mark MillerCredits: Lisa Nichols, Host; Scott Crosby, Executive Producer; Jenny Heal, Guest Coordinator; Kendall Brewer, Leadership Programs; Joe Szynkowski, Marketing Support

Our guest, Mark Miller, writes about financial matters for publications like the New York Times, Reuters, and Wealth Management. And Mark is widely recognized as an expert on retirement and aging. His latest book -- Retirement Reboot: Commonsense Financial Strategies for Getting Back on Track – is a terrific guide to planning for a secure and rewarding lifestyle in the years after your primary career. Today we discuss why it's never too early to lay groundwork for your later life. And Mark explains keys to planning, like considering your timing, becoming familiar with Social Security options, smart ways to save money, and strategies for turning home equity into cash. For more see: https://retirementrevised.com

"This'll be cinchy! [cut to: sobbing]" We thought we'd have a more straightforward time of our quarterfinal rankings, but alas, no. We did have a Whitney-koan reader mail, a visit from Katharine Hepburn, the aural equivalent of a sped-up Bob Ross episode, and music-minister shout-outs before Julio got the stretch and carted off four more beloved songs. Grab a fine-tooth comb and join us for Episode 8 of the Record Of The Year Showdown. Our intro is by David Gregory Byrne with an assist by Whitney Houston, and our outro is by the Sundays. For more information/to become a patron of OUR show, visit patreon.com/mastas. SHOW NOTES Not sure what's going on? ROTYS Episode 1 Rev. Mark Miller leaving it all on the field at Barbara Bunting's memorial (jump to 7:44) Bob Ross at 8x speed "Sugar, We're Goin' Down," '80s-style Episode 111: Bruce Willis and Don Johnson Episode 106: Turnerdome!

The WisSports.net Podcast for February 27th, 2023. WSN General Manager Travis Wilson is joined by WSN boys basketball writer Mark Miller to preview the upcoming boys basketball playoffs. The guys look at the top teams in each sectional for each division, the other contenders, how seeding played out, and much more. Join the Buckle Up Phone Down movement! WisDOT challenges Wisconsin to put safety first by taking the two most important actions to prevent or survive a crash. Accept the Buckle Up Phone Down challenge. Use your seat belt every trip and put down the phone when driving.

Fr. Mark Miller, CSsR

Mark Miller, Vice President of High-Performance Leadership at Chick-fil-A, sits down with XINNIX CEO and Founder Casey Cunningham for this In Excellent Company Interview. Join Casey and Mark as they discuss the high-performance culture of Chick-fil-a, how it has contributed to Chick-fil-A's success, plus some extra tips for you to use if you want to develop a high-performing team.

Thanks, shurx, for this review on iTunes entitled “Prepare to Learn.” Shurx wrote: “[RHV] provides key insight from experts that you won't find anywhere else. It paints the picture of how our healthcare is tangled, and who benefits because of it. Whether it's drug pricing, PBM shenanigans, hospital billing, or market trends that are challenging the status quo, this podcast is worth your time. I've shared many of the episodes with my pharmacy colleagues who have replied, ‘I didn't know that's how it worked.' Now they do thanks to Stacey and her team.” I wanted to kick off this particular show with this review because today we are again digging into the business of hospital care in this country. That's actually how Sanat Dixit, MD, MBA, FACS, put it on LinkedIn recently. He said some of the hospitals these days aren't in the healthcare business; they're in the hospital care business. And when I say some hospitals, I mean some people in decision-making roles at some hospitals. There was an opinion piece in the New York Times the other day by Eric Reinhart, and here's my highlight from his essay. He writes, “But the burnout rhetoric misses the larger issue in this case: What's burning out health care workers is less the grueling conditions we practice under, and more our dwindling faith in the systems for which we work.” Relentless Health Value is here so that our Relentless Tribe has the information that you need to influence what goes on in some of the boardrooms where some of these decisions are being made. With that, let's move on. You know why my guest, Brennan Bilberry, got into his current line of work battling hospital chain anticompetitive practices? He got into it because this behavior, which is normalized in healthcare, would never be tolerated in any other sector of the economy. No one would get away with it because these anticompetitive practices are, hey, anticompetitive. They spell the death of functioning markets. We kick off our conversation, Brennan and I, going through the typical hospital system consolidation playbook and how anticompetitive practices are kinda part of the typical gig here. It's quite clever, by the way, for hospital system executives to think this way. I mean, it's illicit and, some would say, unethical but clever if your main metric is revenue maximization. Anticompetitive contract terms are, after all, a flywheel. You consolidate to get enough market power to effectively force everyone to sign your anticompetitive contracts. And then step two: After that, you break out your anticompetitive contract terms spatula and you scrape out any remaining competition from your area. Which leads you to step three: Rub your hands together and raise prices and donate to politicians so legislation becomes even less likely. And then step four: Continue to raise your prices. Don't you love it when a plan comes together? In this healthcare podcast with Brennan Bilberry, we talk about four contract terms that any self-respecting anticompetitive hospital contract should include and how each of them restricts competition unfairly and causes higher prices for communities, taxpayers, patients, employers … basically everybody, including people who work at the health system, who wind up needing medical care. In a nutshell, here's the four anticompetitive contract terms that we dig into in this episode: All-or-nothing contracting, wherein a hospital system says if you want us in your network, you must include every single facility that we have in your network and at the monopoly-level prices we demand, even in areas that might be competitive. There is a reason why a hospital system might be all hachi machi to buy a rando not super profitable hospital in a rural area. The payer must include that hospital in their network then because of network adequacy or whatever. And then from then on, all of their care settings are now in network—even the lower-quality ones—and all of them at the highest prices. And there's no price negotiation that's possible after that. Anti-steering and anti-tiering clauses: This means that a payer/ASO (administrative services organization)/TPA (third-party administrator)/plan sponsor cannot steer members to lower-cost or higher-quality hospitals, nor can it offer benefit designs that have tiers (ie, lower co-pays if a member goes to specified high-value hospitals). So, any chance of using consumerism or navigation as a way to get members to better places is just eviscerated by this little move. Pricing gag clauses: It's when contract terms prohibit an ASO/TPA from telling its plan sponsor customers or members what the price of services are before (or sometimes even after) the service is rendered, claiming it's important to not let employers or patients know these costs because revealing actual prices will [checks notes] cause hospital prices to go up. I'm speechlessly mystified by this logic, but OK … I only have a bachelor's in economics. Contract terms that restrict other providers in the market: So, a dominant hospital uses admitting privileges or referrals or other leverage to effectively control other providers in the market, including providers who are ostensibly independent. So, while the market may look dynamic, it is really not. Some links to interesting articles and posts and other episodes related to this topic: Definitely listen to the shows with Mike Thompson (EP389) and also the one with Chris Skisak and Gloria Sachdev (EP390). We talk about market dynamics and hospital legislation in these two shows, which are, frankly, the best ways to get rid of hospital systems' ability to hold their communities and other local providers hostage with some of this strong arming. Here's a link to an article I was thinking about while recording this show about Daran Gaus's hypothesis for how mergers will impact hospital prices. And here's a link to an article about how commercial prices for outpatient visits were 26% higher for patients receiving care at a health system than those visiting non-system physicians and hospitals. Another episode I mentioned when Brennan and I discussed the consequences of some of these anticompetitive contract terms is the one with Cora Opsahl (EP373). I also reference the episode with Dale Folwell, treasurer in North Carolina (EP249). One last link is to the conversation I had with Dr. Scott Conard (EP391), where the local hospital bought a local ACO (accountable care organization) physician organization and the community paid an additional $100 million to the hospital the following year. My guest in this healthcare podcast as aforementioned is Brennan Bilberry, who is a founding partner over at Fairmark Partners, which is a law firm litigating some of these antitrust lawsuits against some of these hospital chains. You can learn more at fairmarklaw.com.  Brennan Bilberry is a founding partner of Fairmark Partners, LLP, a law firm focused on fair competition issues, especially in the healthcare industry. Fairmark has filed numerous antitrust cases against dominant hospital systems, seeking to tackle anticompetitive practices that lead to higher prices for businesses, consumers, and unions. Prior to founding Fairmark, Brennan worked as a policy consultant and political operative whose work included overseeing environmental public policy campaigns in numerous countries, providing international political intelligence for US investors, advising political campaigns around the world, and designing consumer and legal advertising. Brennan also worked on numerous US political campaigns, including serving as communications director for Terry McAuliffe's 2013 successful campaign for Virginia governor, serving as deputy executive director of the 2012 pro-Obama Super PAC Priorities USA, and developing research and policy communications for the House Democrats. Brennan is a native of Montana and South Dakota and has lived in Washington, DC, for the past 15 years.   06:16 What happens after a hospital consolidates? 07:23 What does an anticompetitive system look like when a hospital consolidates? 10:13 Tricia Schildhouse on LinkedIn. 10:35 What are some anticompetitive “tricks” that hospitals employ? 12:37 The Sutter case in northern California. 14:50 What can you do if you're forced to engage in an all-or-nothing contract with a hospital system? 18:31 The Atrium case in North Carolina. 19:36 EP373 with Cora Opsahl. 21:33 What are price gag clauses? 23:08 How are legacy gag clauses designed to prevent scrutiny in litigation? 24:04 EP249 with Dale Folwell. 26:08 How do hospital restrictions on other providers create an anticompetitive environment? 27:23 EP391 with Scott Conard, MD. 29:48 EP389 with Mike Thompson or EP390 with Gloria Sachdev and Chris Skisak.   You can learn more at fairmarklaw.com.   @brbilberry discusses #hospital #anticompetitive practices on our #healthcarepodcast. #healthcare #podcast #hospitals #hospitalsystems #anticompetitivepractices Recent past interviews: Click a guest's name for their latest RHV episode! 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, Dr Rishi Wadhera (Encore! EP326), Ge Bai (Encore! EP356), Dave Dierk and Stacey Richter (INBW37), Merrill Goozner, Betsy Seals (EP387), Stacey Richter (INBW36), Dr Eric Bricker (Encore! EP351), Al Lewis, Dan Mendelson, Wendell Potter, Nick Stefanizzi, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki  

The WisSports.net Podcast for February 23rd, 2023. WSN General Manager Travis Wilson is joined by WSN boys basketball writer Mark Miller to talk about conference title races still in the balance, surprising conference champions, and the continued impact of the move a few years ago to 24 games. Join the Buckle Up Phone Down movement! WisDOT challenges Wisconsin to put safety first by taking the two most important actions to prevent or survive a crash. Accept the Buckle Up Phone Down challenge. Use your seat belt every trip and put down the phone when driving.

Today we're excited to have Mark Miller back on the podcast. Mark serves as the VP of High-Performance Leadership at Chick-fil-A.  Mark has authored over 10 leadership books and helps grow leaders both at Chick-fil-A and around the world.  We discuss his latest book called Culture Rules and the 3 things every leaders must do to develop the culture they wish to have in their company. Pre-Order Culture Rules Here: https://www.markmillerleadership.com/ GET YOUR FREE COST OF FUNDING ANALYSIS HERE The views, information, or opinions expressed during this show are solely those of the participants involved and do not necessarily represent those of SouthState Bank and its employees.  SouthState Bank, N.A. - Member FDIC

On this episode of the American Shoreline Podcast, co-hosts Peter Ravella and Tyler Buckingham are joined by G. Mark Miller, retired NOAA Corps Officer and founder of Greenwater Marine Sciences Offshore. GMSO is a company that offers a scalable fleet of oceanographic small research vessels to meet the overwhelming demand for research vessel time. Mark shares his vision of revolutionizing the field of oceanographic research by providing affordable, optimally sized, and cost-effective vessels to scientists and explorers whose projects could not otherwise afford time on the water. The study that Commander Miller commissioned during his tenure at NOAA revealed the need for small research vessels and the potential to fulfill 3,000-7,000 days at sea per year. Listen to this episode to learn more about Mark's career at NOAA, GMSO's mission, and approach Don't miss it, only on ASPN!

Pete, Paul and Dave return with episode 36 of Old-Time Radio Essentials! Season 3 is almost over, and Dave brings us an episode of "Let George Do It" to discuss. Stay tuned after the regular discussion for an interview with the novelist Mark Miller, regarding his new novel, "The Two-Headed Lady at the End of the World." Learn more about your ad choices. Visit megaphone.fm/adchoices

Old-time Radio Essentials continues its 3rd season with an episode of Let George Do It – "There Ain't No Justice"! This one's Dave's pick, and it sparks quite an animated discussion. Who will like it? Will anybody hate it? Why wonder? Tune in and find out! And since we're on the subject of finding things out, while you listen you'll learn if we feel this entry meets the following criteria: 1. Is it truly representative of that series? (Can anyone point to it and say, "Yes, that is what [NAME OF SERIES] was all about.") 2. Is it an episode worthy of inclusion in any and every OTR aficionado's private collection? So with this in mind, we three bring you, as our thirty-sixth number (but 11th -- and penultimate -- official episode of S3), this episode of Let George Do It, from syndication, likely 1954 or '55. We'll introduce the show, play it in its entirety, then discuss it at length. Thanks for joining us, and we hope you enjoy it!  NOTE: Please stay with us after the regular show for a very special interview with novelist Mark Miller, discussing his new novel, The Two-Headed Lady at the End of the World! Please show your support of the podcast by doing any of the following... To comment on how we might improve OTR-E, or give suggestions for future discussions, please write to us at f6point3@gmail.com . Put the word "Essentials" in the subject line. Your feedback means a lot to us! A review at iTunes or at your usual podcatcher would be appreciated. Next Time: Paul brings us, for our season finale, an episode of David Harding: Counterspy!

Old-time Radio Essentials continues its 3rd season with an episode of Let George Do It – "There Ain't No Justice"! This one's Dave's pick, and it sparks quite an animated discussion. Who will like it? Will anybody hate it? Why wonder? Tune in and find out! And since we're on the subject of finding things out, while you listen you'll learn if we feel this entry meets the following criteria: 1. Is it truly representative of that series? (Can anyone point to it and say, "Yes, that is what [NAME OF SERIES] was all about.") 2. Is it an episode worthy of inclusion in any and every OTR aficionado's private collection? So with this in mind, we three bring you, as our thirty-sixth number (but 11th -- and penultimate -- official episode of S3), this episode of Let George Do It, from syndication, likely 1954 or '55. We'll introduce the show, play it in its entirety, then discuss it at length. Thanks for joining us, and we hope you enjoy it!  NOTE: Please stay with us after the regular show for a very special interview with novelist Mark Miller, discussing his new novel, The Two-Headed Lady at the End of the World! Please show your support of the podcast by doing any of the following... To comment on how we might improve OTR-E, or give suggestions for future discussions, please write to us at f6point3@gmail.com . Put the word "Essentials" in the subject line. Your feedback means a lot to us! A review at iTunes or at your usual podcatcher would be appreciated. Next Time: Paul brings us, for our season finale, an episode of David Harding: Counterspy!

Even before the pandemic, a large share of Americans over age 50 faced the threat that their living standards would decline sharply in retirement. In the wake of COVID-19, these numbers will surely worsen. In Retirement Reboot: Commonsense Financial Strategies for Getting Back on Track, finance writer and regular New York Times retirement contributor Mark Miller offers practical strategies for Americans to improve their retirement prospects. He joins us this weekend to discuss. Have a money question? Email us, ask jill [at] jill on money dot com. Please leave us a rating or review in Apple Podcasts. "Jill on Money" theme music is by Joel Goodman, www.joelgoodman.com. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

Even before the pandemic, a large share of Americans over age 50 faced the threat that their living standards would decline sharply in retirement. In the wake of COVID-19, these numbers will surely worsen. In Retirement Reboot: Commonsense Financial Strategies for Getting Back on Track, finance writer and regular New York Times retirement contributor Mark Miller offers practical strategies for Americans to improve their retirement prospects. He joins us this weekend to discuss. Have a money question? Email us, ask jill [at] jill on money dot com. Please leave us a rating or review in Apple Podcasts. "Jill on Money" theme music is by Joel Goodman, www.joelgoodman.com. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

Mark Miller, the executive vice president of health care at Arnold Ventures joins Dr. Josh Sharfstein to talk about the impact of the Inflation Reduction Act for Medicare patients this year, as well as two areas of future work to bring down the cost of prescription drugs. They discuss patent reform and opportunities to increase transparency for pharmaceutical benefit managers.

The WisSports.net Podcast for February 16th, 2023. WSN General Manager Travis Wilson is joined by WSN boys basketball writer Mark Miller to talk about some of the big games last week, conference races up for grabs in the final couple weeks, and what to expect in the seeding process as playoff brackets are released this weekend. Join the Buckle Up Phone Down movement! WisDOT challenges Wisconsin to put safety first by taking the two most important actions to prevent or survive a crash. Accept the Buckle Up Phone Down challenge. Use your seat belt every trip and put down the phone when driving.

You would think that hospitals with the most money would offer the most charity care—trickle down and all of that. If my health system is big and I have lots of money and profitable commercial patients, I can stuff more dollar bills into the charitable donation balance sheet bucket, right? Except, in general, it's a fairly solid no on that. Let's talk about some of my takeaways from the conversation that I had with Vikas Saini, MD, and Judith Garber from the Lown Institute. During the conversation, there's also mention of a powerhouse of a New York Times article. So, let's circle up on but a few of the more interesting (according to me) reasons why some rich hospitals fail to offer the level of charity care that you might think they could or should: #1: Chasing commercial contracts because they are very profitable means building in areas where there are frankly not a whole lot of poor people. You see hospital chains doing this all of the time and saying at the 2023 JPM (J.P. Morgan) conference that they intend to do more of it, opening up in a fancy suburb with no affordable housing. When this happens, there is just less opportunity to offer charity care. The need for financial aid in that ZIP code is just less. #2: The Ambulatory Surgical Center (ASC) movement, which is weird to say because, in other respects, I'm a big fan. There are a lot of services and surgeries moving out of the hospital into ambulatory surgical centers or just the outpatient setting, and this is going on for a bunch of reasons, including Medicare and employers being very on board with this to save facility fees. But here's a consequence: Surgeons and other docs are now not in the hospital. So, indigent patient shows up in the emergency room and needs an emergency surgery or some intervention. But wait … those physicians and their teams are no longer in the hospital. And now the hospital doesn't have the “capability or the capacity” to serve that patient. I heard from a surgeon the other day, and when he's on call at his hospital, he's getting patients shipped to him on the regular from hospitals in other states. Now, about this “oh, so sorry … we can't possibly help you so we're gonna stick you in an ambulance and take you to another state” plan of action. I called up emergency room expert Al Lewis. He told me that if this “ship 'em out” is being done routinely as a pattern by hospitals who have an ER, you could call it evidence of an EMTALA (Emergency Medical Treatment and Labor Act) violation on several levels. You can't have an emergency room and then routinely not be able to handle emergencies, especially when the emergencies you can't handle always seem to be of a certain kind and for a certain kind of patient. Speaking of violations, one more that reduces the need and level of charity care is canoodling with ambulance companies to take the poor people to some other hospital and the rich people to your hospital, which was allegedly transpiring in New Jersey, based on a recent lawsuit. #3: [play some foreboding music here] This last one is the big kahuna underlying reason why some very rich hospitals may not offer the level of charity care which you'd think they would. This was superbly summed up by Tricia Schildhouse on LinkedIn the other day. She knew a physician leader who would go around saying, “Non-profit and for-profit is a tax position, not a philosophy.” Bottom line, this whole thing boils down to what has been normalized as OK behavior at some of these rich hospitals. You have people in decision-making roles taking full advantage of their so-called tax position to jack up their revenues—revenues which they have no interest in frittering away on charitable causes. Why would they do that when they can use the money to, I don't know, stand up a venture fund or make Wall Street investments? Don Berwick's latest article in JAMA is entitled “The Existential Threat of Greed in US Health Care.” And, yeah … exactly. Back to that New York Times article that we talk about in this healthcare podcast, here's what it says about a hospital in Washington State. It says: “The executives, led by [the hospital's CFO] at the time, devised … a program called Rev-Up. “Rev-Up provided [the hospital's] employees with a detailed playbook for wringing money out of patients—even those who were supposed to receive free care because of their low incomes.” All of this being said, there are hospitals out there who are, in fact, living up to their social contract and serving their communities well with very constrained resources. You also have hospitals just in general working within some really whack payment models that we have in this country, which easily could be a root cause precipitating this suboptimal-ness. Dr. Saini and Judith Garber mention three direct solves for hospital charity shortfalls and also the larger context of the issue. So, there's, of course, better reporting and better auditing, which is pretty nonexistent in any kind of standardized way right now. I also really liked one of the solutions that Dr. Saini mentions on the show: Maybe instead of all the hospitals doing their own charity care thing, they all should pool their money regionally and then put a community board in charge of distributing it. That way, if there is a hospital in an area where the charity care is really needed, even if the rich hospital nearby doesn't have a facility there, they can help fund this care that their larger community really needs—including, by the way, public health needs, which is currently a big underfunded problem. As mentioned earlier, I am speaking with Vikas Saini, MD, and Judith Garber. Dr. Saini is president of the Lown Institute. Judith Garber is a senior policy analyst there. They've studied hospitals from a number of dimensions, not just charity care.   You can learn more at lowninstitute.org and lownhospitalsindex.org.    Vikas Saini, MD, is president of the Lown Institute. He is a clinical cardiologist trained by Dr. Bernard Lown at Harvard, where he has taught and done research. Dr. Saini leads the Institute's signature project, the Lown Institute Hospitals Index, the first ranking to measure hospital social responsibility. The Index, first launched in July 2020, evaluates hospitals on equity, value, and outcomes and includes never-before-used metrics such as avoiding overuse, pay equity, and racial inclusivity. In his role at the Lown Institute since 2012, Dr. Saini led the development of the Right Care series of papers published by The Lancet in 2017, convened six national conferences featuring world-renowned leaders in healthcare, and guided other Lown Institute projects such as the “Shkreli Awards.” Dr. Saini also serves as co-chair of the Right Care Alliance, a grassroots network of clinicians, patient activists, and community leaders organizing to put patients, not profits, at the heart of healthcare. Prior to the Lown Institute, Dr. Saini was in private practice in cardiology for over 15 years on Cape Cod, where he also founded a primary care physician network participating in global payment contracts. He also co-founded Aspect Medical Systems, the pioneer in noninvasive consciousness monitoring in the operating room with the BIS device. Dr. Saini is an expert on the optimal medical management of cardiologic conditions, medical overuse, hospital performance and evaluation, and health equity. He has spoken and presented research at professional meetings around the world and has been quoted in numerous print media, on radio, and on television.  Judith Garber is a senior policy analyst at the Lown Institute. She joined the Lown team in 2016, after receiving her Master of Public Policy degree from the Heller School of Social Policy. Her research interests include hospital community benefit policy, overuse and value-based care, and racial health disparities. She has authored several white papers, journal articles, op-eds, and other publications on these topics. Judith previously worked at the Aspen Institute Financial Security Program, the Midas Collaborative, and Pearson Education. She has a bachelor's degree in American studies and political science from Rutgers University.   06:50 Why does America need socially responsible hospitals? 08:23 What standards are hospitals beholden to with their charitable spending? 08:47 “It's the honor system, essentially.”—Dr. Saini 11:38 What is fair share spending? 13:43 Which hospitals are paying their fair share? 15:05 Why do hospitals that are financially more strapped tend to give back to their communities more? 17:25 Why is it hard for hospitals with the most privately insured patients to do the most for their community? 18:56 “These outcomes … are the outcomes of the [current system].”—Dr. Saini 21:23 “A key problem here is [that] systems have gotten so big.”—Dr. Saini 22:30 What's the solution to fixing the problem with hospital charity care? 23:52 EP374 with Dave Chase. 29:21 What would be the level of acceptance with changing the system as it stands with hospitals?   You can learn more at lowninstitute.org and lownhospitalsindex.org.   @DrVikasSaini and @JudiTheGarber of @lowninstitute discuss #hospitalcharitycare on our #healthcarepodcast. #healthcare #podcast #hospitals Recent past interviews: Click a guest's name for their latest RHV episode! David Muhlestein, Nikhil Krishnan (Encore! EP355), Emily Kagan Trenchard, Dr Scott Conard, Gloria Sachdev and Chris Skisak, Mike Thompson, Dr Rishi Wadhera (Encore! EP326), Ge Bai (Encore! EP356), Dave Dierk and Stacey Richter (INBW37), Merrill Goozner, Betsy Seals (EP387), Stacey Richter (INBW36), Dr Eric Bricker (Encore! EP351), Al Lewis, Dan Mendelson, Wendell Potter, Nick Stefanizzi, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari  

Fr. Mark Miller, CSsR

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

Time Travelin' Top 40 E111 Brandon Vogt sits down with Mark Miller of Sawyer Brown to talk about their current tour and the huge hits "Some Girls Do" and "The Walk"See omnystudio.com/listener for privacy information.

This week, I am with my Aventria team on-site at one of our clients. We are holding a full-day workshop to help our client figure out who all across the healthcare industry they will need to get aligned with to achieve greater success in the market and how to handle all of these inevitably conflicting interests strategically and also potentially from a messaging standpoint. I'm one of the subject matter experts who gets to pipe up during the part where we talk about all of these market dynamics, what everybody is up to, and who is going to want what so the client team can do their thing and get paid for it. Anyway, I say all this to say that this week, I am pretty darn busy but also thrilled to encore this episode with Nikhil Krishnan, founder of Out-Of-Pocket, and one of our most popular episodes in the past 12 months. My guest in this healthcare podcast is Nikhil Krishnan, who is the founder of the Out-Of-Pocket newsletter. I was talking with Nikhil, and we identified—or, more accurately, he identified—five business models of digital health. What makes each model distinct is a few factors. If you weren't in the healthcare industry, you'd probably expect that I'm going to say that the biggest factor a business model must hinge on must have something to do with patient outcomes or care or something that has something to do with the hopes and lives of patients. Except no. Mostly, our models do not define themselves by attributes of their patients, except on one dimension: who is paying their bills. Who is paying has enormous downstream consequences that I don't think people outside of healthcare, or even people inside of healthcare sometimes, really appreciate. It's because of all of the perverse incentives. It's a tangled web we weave. For example, let's just say you're a start-up founder trying to cook up your unique selling proposition. You can't just decide you're gonna lower costs and improve patient care as general constructs. Because let's just say you do that—that's your USP (lower costs and improve patient care)—and then you try to sell your thing to Medicare Advantage plans or large provider organizations. Oh, right … Medicare Advantage plans or even commercial ones—they don't care about the total cost of care. Neither do provider organizations unless they take on sufficient risk to care, and many do not. In fact, as came out in that JAMA article the other day, it could be construed that entities such as these carrier health plans have a perverse incentive to see total costs of care go up. So right, you naively (you're the start-up founder again in this case study, don't forget) trot into some administrator's office with a great something or other to reduce total costs of care—and you'll get cast out upon your petard on the quick. Every single day of the year in my world, I see people make this same mistake over and over again: not tailoring their product market fit to any particular market, with the recognition that some in this healthcare industry have a vested interest to see costs going up and some have a vested interest in costs going down. Either way, if we're talking about large organizations here and even some small ones, the money wins over patient care. So sad to have to say that, but listen to EP351 with Dr. Eric Bricker and you'll get all the context you need on that point. Here's the thing, though. I don't know about you, but I can't tell you how many digital health start-ups I run across where I look at their decks or have a conversation with a founder, and I ask who their customer is. Is it employers or health plans or … ? And they don't know. They're gonna figure this out later. I don't get how to successfully do that. I'm indubitably wrong here given all of the pivots I hear about that seem to go OK, but the prospect of completely redefining my operational goals and operations and market positioning at some point in the future seems like a daunting and avoidable prospect. I would be remiss not to mention, however, the number of really good mission-driven healthcare companies out there really trying hard to figure out how to create a sustainable business, a fair profit, while at the same time serving patients really well. There are companies adding value commensurate with the dollars that they come by, and I certainly applaud everything that they are doing. At the same time, given all this, here's a message for all of you VCs and private equity etc—people with money—out there. Let me quote Dr. Vivek Garg here (@vgargMD on Twitter): “If you're financing care delivery without board-level focus on clinical outcomes, you're part of the problem.” So, let's talk about these five business models that health and healthcare start-ups eventually settle themselves into after they figure out who their customer is. Nikhil Krishnan, my guest today, and I discuss how they can be financially viable and if we think they'll actually be able to provide superior patient outcomes. [Trumpets play here] In no particular order, this is what we've got for our five business models: Completely avoiding incumbents, creating a cash-pay ecosystem Better middleware (being the pipes, as I've heard so many times these past couple of weeks) Companies serving incumbents either by being a virtual front door for them or disrupting the competitive landscape somehow Joint ventures Old-school digital health who are now incumbents in their own space My guest in this episode, Nikhil Krishnan, has a bunch of things going on. He might be best known for his newsletter, Out-Of-Pocket Health, which you should certainly subscribe to. He's also working on a healthcare 101 crash course to teach newcomers about the Wild West we call American healthcare. Besides all of this, Nikhil does some early-stage investing. You can learn more at outofpocket.health and with Nikhil's upcoming course.   Nikhil Krishnan is the founder/thinkboi at Out-Of-Pocket, where he's trying to make the business of healthcare more easily understandable and (hopefully) entertaining. He runs a newsletter (yes, yet another one) and an online healthcare community and does some digital health investing on the side. He's “extremely online,” and you can find him firing off obscure healthcare memes plus the occasional insight on Twitter at @nikillinit.   06:20 What are the different models of digital health? 08:05 What are the different motives for cash-pay digital health models? 13:54 “One of healthcare's original sins is that every solution deployed has been a custom solution for the end user.” 14:19 How willing will these companies be to share their data with third parties? 18:07 “I don't think selling tech to large incumbents is going to move the needle.” 21:14 “These companies, most of them are actually getting extra money for the more expensive stuff.” 22:58 How did joint-venture digital health business models come about? 26:37 Why do you see partnerships more on the payer/provider side? 27:29 Who are the old-school digital health companies that could be considered incumbents? 29:36 Why do so many digital health start-ups have a hard time pinpointing who will pay for their services? 32:10 “The ability to go through the idea maze is way faster now.” 34:55 “The field is wide open to help teach people how healthcare works.”   You can learn more at outofpocket.health and with Nikhil's upcoming course.   @nikillinit discusses #digitalhealth on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Emily Kagan Trenchard, Dr Scott Conard, Gloria Sachdev and Chris Skisak, Mike Thompson, Dr Rishi Wadhera (Encore! EP326), Ge Bai (Encore! EP356), Dave Dierk and Stacey Richter (INBW37), Merrill Goozner, Betsy Seals (EP387), Stacey Richter (INBW36), Dr Eric Bricker (Encore! EP351), Al Lewis, Dan Mendelson, Wendell Potter, Nick Stefanizzi, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase  

So, a few things to remind everybody. First of all, don't forget EHRs (electronic health records) were purpose built originally for billing. This is no secret. People quite openly have called EHR systems glorified cash registers. If I want to be generous, maybe I would restate this to say that EHRs were designed to document patient interactions. This is what their core architecture was built to achieve. But today, there's a lot that goes on that isn't a traditional patient interaction. First of all, me even calling it, frankly, a patient interaction should give longtime listeners a clue where this is headed. I mean, say you're sitting at home on your couch. I don't know. You're probably not considering yourself a patient. You're considering yourself a person sitting on your couch. However, say you're sitting on your couch and you haven't taken your COPD maintenance therapy. Potentially that is something of clinical significance that maybe should get figured out and noted somewhere—potentially prior to the acute event going down. Or, still talking about things that are relevant to patient health but which don't naturally tuck into an EHR system's native architecture, maybe we have social workers and nutritionists and all kinds of people who are not doctors or nurses or PAs (physician assistants) in this mix. Most of the time, these people don't even have access to the EHR. I mean, what percentage of things that are going to impact a person's health outcomes can be classified as traditional patient encounters that EHRs were designed to document? I mean, you've got your scheduler who wants to tell the transportation company something about a patient. Anything RPM. Where's the caregiver or the family in that garden-variety patient interaction? In sum, what is happening between codes getting written in patient health records? Where's all that information going? I mean, what order set are you gonna use to get all that in and out of the system? Am I saying anything revolutionary that many of you don't already know extremely well? No, I am not. But I am shining the spotlight on it to challenge what might have become a sort of default position at provider organizations today, which is to make the EHR the one ring to rule them all, which might be something to consider revising strategically. My guest in this healthcare podcast, Emily Kagan Trenchard, makes a super point about all of this that I haven't heard made so succinctly or so eloquently. Emily puts it this way: She says just integrating into the EHR as a reflex without contemplation is kind of the olden days. She talks about identifying the core functionalities, the centers of gravity that are needed to bring together providers and patients and everybody else in the mix. Then you find the best systems—call them platforms if you want. But if, at a fundamental level, you have a technology designed for one thing and you're trying to shoehorn it to do something else and this something else is a critical business function, maybe this is something to think about at the highest levels. Of course, it goes without saying that these platforms have to work together (obviously); but you kind of gotta get the right platform for the right job. Now, to make one point clear as glass, what we are not talking about here is cobbling together a bunch of point solutions. What we are talking about is getting the fundamentals, the core architecture here, solidified. Pam Arora talks about this at length in episode 246. She's the CIO at Texas Children's. Pam Arora says that if a health system doesn't get its technology infrastructure rock solid, if that infrastructure is janky in any way, then everything built on top of it will require duct tape and workarounds and probably not go as well as planned. On the show today, Emily Kagan Trenchard continues that theme. She talks about the four platforms that she feels are very necessary to underpin or be the chassis to best support helping providers and others help patients and people in and out of the clinic. She calls each platform a tentpole. These four platforms are: The EHR A CRM (customer relationship manager). And, by the way, when Emily says CRM, she's talking about more than software. It's more like a philosophy or a whole approach around relationship building with patients/people/customers. A cloud platform for data and analytics A data exchange One last takeaway, for me at least. Emily has talked about two basic facts that inform her thinking: (1) Providers and patients alike are increasingly not tolerant of friction. (2) What is easiest is the most likely to happen. Something that we don't get into in this show but certainly bears considering is the larger context here. Yeah, we got Amazon, we got Google—not only what they are doing alone but also what they are investing in. They have platforms that are purpose built to remove friction and to be really, really easy … one-click easy. So, let's talk about the WIIFM (the “what's in it for me?”) here for health systems to get a move on. When Merrill Goozner was on the show a few weeks ago (EP388), he says that when patients and employers and taxpayers start crying uncle on both healthcare prices as well as just bad friction-filled experiences and also when, at the same time, technology and new competitors move in on the supply side, he says what's gonna happen then is older incumbents like hospitals could find themselves getting their lunches eaten. So, probably intuitively as well as intellectually, health systems really getting their technology clearly optimized to support their communities, their patients, and their providers might seem to be mission critical, especially as we contemplate the stuff that Mike Thompson was talking about in episode 389 about how there is increasingly data out there which identifies hospitals who are very inefficiently run. And so, if at a very basic level a hospital has misaligned tech that's requiring a lot of workarounds and stuff, which is another way to say wasting a lot of staff time, having the right technology deployed in the right way will certainly ground efforts to be effective and also help compete with some of these lurking entities who are looking to take a piece of the $3 or $4 trillion healthcare industry in this country—of which hospitals account for something like $1 trillion. And as Eric Bricker, MD, says in episode 351, this is why hospitals have a big red target on their back. Also, I would be remiss not to mention that non–purpose-built, dare I say bad, technology causes bad clinician burnout, which causes bad turnover, which is really expensive. Arshad Rahim, MD, MBA, FACP, talks about this in episode 323. By the way, I interviewed Emily Kagan Trenchard at NODE.Health's Annual Digital Medicine Conference in New York City this past December—always a great conference. Emily is SVP and chief of consumer digital solutions over at Northwell Health. Northwell, in case you haven't heard of this health system, is very large: 21 hospitals, 850 outpatient clinics, 300,000 patients a year. Yeah, it's big. You can learn more at northwell.edu and connect with Emily on LinkedIn. Emily Kagan Trenchard offers a unique perspective from within the American medical system: A spoken-word-poet-turned-healthcare-executive, she is on a mission to remix the human in healthcare, challenging entrenched assumptions about what it means to give and receive care in the digital age. As senior vice president, chief of consumer digital solutions, for New York State's largest health system, Northwell Health, Emily leads teams that push the limits of how we use technology to make healthcare seamless and steeped in humanity while keeping the company competitive at a time of radical change. She is a big believer that innovation is an ongoing process, not just a box to check, and launched Northwell's first UX department to ensure that patient perspectives and needs drove the design of digital tools and systems. Prior to joining Northwell, Emily led Web systems for New York City's Lenox Hill Hospital, where she drove the development of many early consumer health tools, including the first-ever implementation of the Zocdoc scheduling platform for a hospital. Emily holds a master's degree in science writing from Massachusetts Institute of Technology and a bachelor's degree from the University of California at Berkeley.   07:55 How does customer digital solutions fit into the larger technology infrastructure in healthcare? 09:54 “Where else do you have centers of gravity that you should respect in the architecture?” 10:11 “There is a constellation of need here.” 11:51 “We interact with way more than just patients.” 14:28 “We have to be able to understand the network of relationships in a population.” 15:11 How do EHRs and CRMs interact as two tentpoles in healthcare? 17:32 “The question is, where does a human being work?” 19:54 How are patients staying on a nonfragmented care journey in a proactive way? 23:46 “Anybody who's a consumer of our digital offerings has a relationship with us.” 29:33 “The medicine is being practiced not only on our physical bodies but on our digital bodies.” You can learn more at northwell.edu and connect with Emily on LinkedIn.   @ektrenchard of @NorthwellHealth discusses #EHRs and #CRMs on our #healthcarepodcast. #healthcare #podcast #EHR #CRM   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Scott Conard, Gloria Sachdev and Chris Skisak, Mike Thompson, Dr Rishi Wadhera (Encore! EP326), Ge Bai (Encore! EP356), Dave Dierk and Stacey Richter (INBW37), Merrill Goozner, Betsy Seals (EP387), Stacey Richter (INBW36), Dr Eric Bricker (Encore! EP351), Al Lewis, Dan Mendelson, Wendell Potter, Nick Stefanizzi, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373)  

On Relentless Health Value, I don't often get into our guests' personal histories. There are a bunch of reasons for this, which, if you buy me beer, we can talk podcast philosophy and I will tell you all about my personal, very arguable opinion here. Nevertheless, in this healthcare podcast, we are going rogue; and I am talking with Scott Conard, MD, who shares his personal story. You may ask why I decided to go this route for this particular episode, and I will tell you point blank that Dr. Conard's experience, his narrative, is like the perfect analogue (Is analogue the right word [allegory, composite example]?). His story just sums up in a nutshell what happens when a PCP (primary care provider) does the right thing, manages to improve patient care for real, and then at some point gets sucked into the intrigue and gambits and maneuvering that is, sadly, the business of healthcare in the United States today. Before we kick in, I just want to highlight a statement that Scott Conard makes toward the end of the show. He says: So, this isn't about punishing or blaming aspects of care that are being overrewarded today. It's really about what's the path forward for corporations, for middle-class Americans, and for primary care doctors who don't choose to be part of a big system. We have to figure out how to solve this problem. I hope people don't hear this and think that there are horrible people at some not-for-profit hospital systems, for example. There are some great people at not-for-profit health systems, but they have some really screwed-up incentives. A few notable notes from Dr. Scott Conard's journey and words of wisdom that I will just highlight up front here: He says that as a PCP, you actually can produce high-value care in a fee-for-service model … if you think differently and you change practice patterns. I have heard this from others as well, including most recently David Muhlestein, PhD, JD, who says this in an upcoming episode. Now here's a surefire way to fail at that, though: Be a physician who is getting asked to basically do everything a patient needs done alone and by themselves with little or no help and being told to do all of this within a seven-minute visit. This surefire way to not do well also could mean working on a team that's a team in name only because it's more of a marketing thing than an actual thing. As Dr. Scott Conard says later in this episode, healthcare organizations must embrace the art of medical leadership. So, I guess that's a spoiler alert there. Another point that Dr. Conard makes very crisply toward the end of the show is that doctors can kinda get pushed and pulled around in this mix. You have docs just trying to provide good care, and they work for one entity that gets bought and now it's some other entity … and what's happening upstairs and the prices being charged or somebody somewhere deciding not to make prices transparent, or deciding to sue low-income patients for unpaid medical bills or what charity care to offer or not to offer. These are not doctors in clinics making these calls, and we need to be careful here not to homogenize what some of these health systems are choosing to do like some kind of democratic vote was taken by everybody who works there. Health systems, hospitals, are many-celled complex entities. And a third takeaway—there are a bunch of takeaways in this show, but a third one I'll highlight here from Dr. Conard's story—is the old fiduciary responsibility code word being used by health system administrators as a euphemism for strategies that might need a euphemistic code word because the strategy has questionable community benefit. In the case study that we talk about today, the local health system managed to raise healthcare spend in North Texas by $100 million year over year. Employers and employees in North Texas, communities, wound up paying $100 million more year over year in healthcare one particular year. This was prices going up. It also was removing a big systemic initiative to keep heads out of hospital beds. Reiterating here, we are not talking about doctors here particularly because, of course, the vast majority of doctors are trying to prevent avoidable hospitalizations. But suddenly in North Texas, physicians did not have the population health efforts and the team really standing behind them helping to prevent avoidable hospitalizations. That sucks for everybody trying to do the right thing, and, as has been said, burnout is moral injury in a cheap Halloween costume. Moral injury happens when you have good people, clinicians, doctors, and others who realize that what is going on, at best, is not helping the patient. You can learn more by emailing Dr. Conard at scott@scottconard.com. Scott Conard, MD, DABFP, FAAFM, is board certified in family and integrative medicine and has been seeing patients for more than 35 years. He was an associate clinical professor at the University of Texas Health Science Center at Dallas for 21 years. He has been the principal investigator in more than 60 clinical trials, written many articles, and published five books on health, well-being, leadership, and empowerment. Starting as a solo practitioner, he grew his medical practice to more than 510 clinicians over the next 20 years. In its final form, the practice was a value-based integrated delivery network that reduced the cost of care dramatically through prevention and proactive engagement. When this was acquired by a hospital system, he became the chief medical officer for a brokerage/consulting firm and an innovation lab for effective health risk–reducing interventions. Today, he is co-founder of Converging Health, LLC, a technology-empowered consulting and services company working with at-risk entities like self-insured corporations, medical groups and accountable care organizations taking financial risk, and insurance captives to improve well-being, reduce costs, and improve the members' experience. Through Dr. Conard's work with a variety of organizations and companies, he understands that every organization has a unique culture and needs. It is his ability to find opportunities and customize solutions that delivers success through improved health and lower costs for his clients. 05:26 What triggered Scott's career journey? 06:02 What caused Scott to rethink what is good primary care? 06:42 Why did Scott realize that he is actually a risk-management expert as a primary care doctor rather than someone who treats symptoms? 07:56 Encore! EP335 with Brian Klepper, PhD. 08:24 How did Scott's practice change after this realization? 08:35 What is a “Whole-Person Risk Score”? 09:39 Scott's book, The Seven Numbers (That Will Save Your Life). 11:37 “You start to move from a transactional model to a relationship model.” 14:02 Did Scott have any risk-based contracts? 14:39 Why is it so important to look at total cost of care and not just primary care cost? 19:39 Scott's book, The Art of Medical Leadership. 20:44 EP381 with Karen Root. 29:14 Why did Scott move over to help corporations? 31:42 EP364 with David Muhlestein, PhD, JD. 32:22 “Everybody thought they were honoring their fiduciary responsibility, and the incentives are completely misaligned.” 33:02 EP384 with Wendell Potter. 33:15 “It's the system that's broken; it's not bad people.” You can learn more by emailing Dr. Conard at scott@scottconard.com. @ScottConardMD discusses #privateequity on our #healthcarepodcast. #healthcare #podcast #PCP #patients Recent past interviews: Click a guest's name for their latest RHV episode! Gloria Sachdev and Chris Skisak, Mike Thompson, Dr Rishi Wadhera (Encore! EP326), Ge Bai (Encore! EP356), Dave Dierk and Stacey Richter (INBW37), Merrill Goozner, Betsy Seals (EP387), Stacey Richter (INBW36), Dr Eric Bricker (Encore! EP351), Al Lewis, Dan Mendelson, Wendell Potter, Nick Stefanizzi, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372)    

Today on the podcast we welcome back Mark Miller, who is an author, columnist, and a nationally recognized expert on trends in retirement and aging. His latest book is called Retirement Reboot: Commonsense Financial Strategies for Getting Back on Track. Miller's work considers retirement holistically, including healthcare and Medicare, Social Security, retirement investing, midlife careers, and housing. He is a regular contributor to Morningstar.com, and he also writes about retirement matters for Reuters, The New York Times, and WealthManagement.com. In addition to Retirement Reboot, Miller has written several other books, including The Hard Times Guide to Retirement Security and Jolt: Stories of Trauma and Transformation. Additionally, Miller has his own podcast and newsletter, both of which are called Retirement Revised.BackgroundBioRetirement Reboot: Commonsense Financial Strategies for Getting Back on Track, by Mark MillerThe Hard Times Guide to Retirement Security: Practical Strategies for Money, Work, and Living, by Mark MillerJolt: Stories of Trauma and Transformation, by Mark MillerThe State of Retirement“Toward a New Social Insurance Era,” by Mark Miller, WealthManagement.com, Dec. 23, 2022.“Retirement Planning Amidst Inflation,” by Mark Miller, WealthManagement.com, Oct. 13, 2021.“The Inflation Reduction Act's Impact on Retirees,” by Mark Miller, Morningstar, Aug. 16, 2022.“How to Cope With Medicare's Rising Costs,” by Mark Miller, The New York Times, Dec. 21, 2021.“Social Security Benefits' 2023 COLA: Is It Enough?” by Mark Miller, Morningstar, Nov. 9, 2022.Delaying Retirement“Kerry Hannon: Remote Work Trend Benefits Older Workers,” The Long View podcast, Morningstar, Oct. 21, 2020.“For Disabled Workers, a Tight Labor Market Opens New Doors,” by Ben Casselman, The New York Times, Oct. 25, 2022.“Returning to Work but Close to Retirement? Adjust Your Plan,” by Mark Miller, Reuters, April 21, 2022.“Why Working Till Whenever Is a Risky Retirement Strategy,” by Mark Miller, The New York Times, May 16, 2019.“How Have Older Workers Fared in the Pandemic-Induced Downturn?” by Mark Miller, Morningstar, June 2, 2021,CoGenerateMedicare, Healthcare, and Long-Term Care“Optimizing Social Security for Clients,” by Mark Miller, WealthManagement.com, Sept. 29, 2022.“Social Security's Cost-of-Living Increase Largest in Four Decades, Estimate Says,” by Mark Miller, The Seattle Times, Sept. 14, 2022.“Social Security Doomsayers Are Wrong Again, but Reform Choices Loom,” by Mark Miller, Reuters, Sept. 16, 2021.“A Quiet Experiment Is Testing Broader Privatization of U.S. Medicare,” by Mark Miller, Reuters, Jan. 14, 2022.“Big Changes May Be Coming to Traditional Medicare,” by Mark Miller, Morningstar, April 22, 2022.“Medicare's Private Option Is Gaining Popularity, and Critics,” by Mark Miller, The New York Times, Dec. 3, 2022.State Health Insurance Assistance Program“Medicare vs. Medicare Advantage,” by Mark Miller, WealthManagement.com, March 24, 2020.“How to Evaluate Medigap Plans,” by Mark Miller, Morningstar, March 2, 2022.“The Financial Health of Medicare and Social Security: A Closer Look,” by Mark Miller, Morningstar, June 29, 2022.“Long-Term-Care Coverage Is Trending in the Wrong Direction,” by Mark Miller, WealthManagement.com, June 13, 2022.Housing and Other Debt“Should You Pay Off Your Mortgage?” by Mark Miller, Morningstar, Oct. 8, 2021.“Waiting for the Reverse Mortgage Surge,” by Mark Miller, WealthMangement.com, Feb. 8, 2022.Retirement Complexity“‘The Cash Monster Was Insatiable': How Insurers Exploited Medicare Advantage for Billions,” by Reed Abelson and Margot Sanger-Katz, The New York Times, Oct. 8, 2022.“U.S. Health Officials Seek New Curbs on Private Medicare Advantage Plans,” by Reed Abelson and Margot Sanger-Katz, The New York Times, Dec. 17, 2022.