Podcasts about medicaid innovation

In this episode, Erfan Karim, Chief Clinical Operations Officer at NYC Health + Hospitals/Bellevue, discusses the critical role of Medicaid in public health, the impact of recent policy shifts, and how innovation in care delivery can help safeguard vulnerable communities. He also shares how personal experience drives his commitment to equitable access for all.

In this episode, Erfan Karim, Chief Clinical Operations Officer at NYC Health + Hospitals/Bellevue, discusses the critical role of Medicaid in public health, the impact of recent policy shifts, and how innovation in care delivery can help safeguard vulnerable communities. He also shares how personal experience drives his commitment to equitable access for all.

The new iteration of the Center for Medicare and Medicaid Innovation promises to focus on health, not healthcare. Will its plans come to fruition? David W. Johnson and Julie Murchinson graded CMMI's new strategic direction on, “CMMI Pursues an Ounce of Prevention,” the new episode of the 4sight Health Roundup podcast, moderated by David Burda

5/22 Update: The House early Thursday narrowly passed the One Big Beautiful Bill Act, a budget bill that includes a number of healthcare provisions that could have a significant impact on Medicaid, Medicare, and the Affordable Care Act. It has been over 100 days since President Donald Trump began his second term. During that time, Radio Advisory has received a steady stream of questions from leaders seeking guidance in an uncertain policy and business environment. With looming funding cuts, the restructure of HHS, the arrival of DOGE and MAHA, and more, leaders are grappling with what to focus on, how to respond, and how to engage productively with the federal government. To help answer these questions, Radio Advisory turned to policy experts from both parties to address your questions, acknowledge your anxieties, and highlight shared opportunities. This week, host Rachel (Rae) Woods welcomes Liz Fowler, former director of the Center for Medicare and Medicaid Innovation under the Biden Administration, and Eric Hargan, former Deputy Secretary of the Department of Health and Human Services during the first Trump term. Together, they discuss how to navigate the shifting policies and priorities of the Trump administration's second term. Plus, stay tuned to the end of the episode, where co-host Abby Burns discusses the bill proposed by the House Energy and Commerce Committee that would reduce federal Medicaid spending by more than $600 billion over the next ten years. Links: Tracking the Medicaid Provisions in the 2025 Reconciliation Bill | KFF Ep. 244: What's happened in Washington (so far) and what policy changes we're bracing for Ep. 230: Elections results are in: What healthcare leaders need to know Thousands laid off at HHS: What you need to know Healthcare policy updates Listen to Radio Advisory's Health Policy playlist Subscribe to Advisory Board's Daily Briefing newsletter and get the most important industry news in your inbox – every day. A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.

It has been over 100 days since President Donald Trump began his second term. During that time, Radio Advisory has received a steady stream of questions from leaders seeking guidance in an uncertain policy and business environment. With looming funding cuts, the restructure of HHS, the arrival of DOGE and MAHA, and more, leaders are grappling with what to focus on, how to respond, and how to engage productively with the federal government. To help answer these questions, Radio Advisory turned to policy experts from both parties to address your questions, acknowledge your anxieties, and highlight shared opportunities. This week, host Rachel (Rae) Woods welcomes Liz Fowler, former director of the Center for Medicare and Medicaid Innovation under the Biden Administration, and Eric Hargan, former Deputy Secretary of the Department of Health and Human Services during the first Trump term. Together, they discuss how to navigate the shifting policies and priorities of the Trump administration's second term. Plus, stay tuned to the end of the episode, where co-host Abby Burns discusses the bill proposed by the House Energy and Commerce Committee that would reduce federal Medicaid spending by more than $600 billion over the next ten years. Links: Tracking the Medicaid Provisions in the 2025 Reconciliation Bill | KFF Ep. 244: What's happened in Washington (so far) and what policy changes we're bracing for Ep. 230: Elections results are in: What healthcare leaders need to know Thousands laid off at HHS: What you need to know Healthcare policy updates Listen to Radio Advisory's Health Policy playlist Subscribe to Advisory Board's Daily Briefing newsletter and get the most important industry news in your inbox – every day. A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.

Over 160 million Americans are served by Optum, yet many still don't fully understand what it actually does—or why it matters.Dr. Patrick Conway, newly appointed CEO of Optum and former head of CMS Innovation Center and Blue Cross NC, joins Steve for a wide-ranging discussion on the state of healthcare delivery, affordability, and the potential of value-based care at a national scale. With experience spanning the frontlines of medicine to top government and corporate leadership, Conway breaks down how Optum aims to improve care while controlling costs—and why he continues to practice as a pediatric hospitalist on weekends.We cover:

Rajaie Batniji, MD, PhD, Afia Asamoah, JD, and Sanjay Basu, MD, PhD, cofounders of Waymark, join Vineeta Agarwala, MD, PhD, a16z Bio + Health general partner, to discuss their transformative approach to Medicaid care delivery. This episode dives into their rising risk signal prediction framework, where cutting-edge machine learning predicts patient needs and enables community-based care teams to reduce preventable ER visits and improve health outcomes at scale. The team recently published their real-world results—including a 23% reduction in unnecessary acute care—in the New England Journal of Medicine Catalyst.Additional resources:Supporting Rising-Risk Medicaid Patients Through Early Intervention, NEJM CatalystThe Body Economic: Why Austerity Kills, by David Stuckler and Sanjay Basu

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In EPISODE 177 OF GROWING OLDER LIVING YOUNGER, Dr. Gillian Lockitch talks with Dr. Brad Stuart about his book "Facing Death: Spirituality, Science, and Surrender at the End of Life." Dr. Stuart discusses his transition from emergency medicine to hospice care, emphasizing how he came to realize the importance of healing over simply curing. He shares personal experiences and scientific insights into near-death experiences and the role of the default mode network in the brain. He highlights the spiritual and emotional aspects of end-of-life care, advocating for a holistic approach that includes mental, emotional, and spiritual well-being. He also touches on the potential of psychedelic therapy in addressing death anxiety and depression. Brad Stuart, MD is a physician specializing in end-of-life care, a healthcare innovator, and an author and international speaker. He has devoted his career to helping make the end of life a vital part of life itself. After graduating from Stanford Medical School and practicing internal medicine in the ER and ICU, he switched over to hospice practice to care for the dying. As Senior Medical Director for the largest healthcare system in Northern California, he created the first large-scale Advanced Illness Management (AIM) program in the US, funded by a $13 million award from the Center for Medicare and Medicaid Innovation. He was featured in the HBO special, Letting Go: A Hospice Journey. Brad has been recognized as Physician of the Year by the California Association of Health Services at Home, named a Top 20 national difference-maker by HealthLeaders' Media, and designated as a Visionary by the American Academy of Hospice and Palliative Medicine. Episode Timeline 0:01 Introduction to Dr. Stuart's journey from ER/ICU doctor into end-of-life care 12:48 The evolution of Dr. Stuart's approach to medicine 17:49 Personal experiences with death and recalled experiences   36:42 Neuroscience and Near-Death Experiences   43:16 Conclusion and Final Thoughts   Book : Facing Death: Spirituality, Science, and Surrender at the End of Life. https://www.bradstuartmd.com Schedule a free Discovery Call with Dr. Gillian And if you have not already done so, follow, rate and review this Growing Older Living Younger podcast.

Caprice Knapp, a seasoned health economist with over 20 years of experience in Medicaid and healthcare policy, shares her journey through various roles in government, academia, and private insurance. In this episode, Caprice offers a unique perspective on the challenges of measuring quality in healthcare, the importance of data-driven decision-making, and how global healthcare models can inspire innovation in Medicaid. From pediatric palliative care to cost-effective policy solutions, Caprice sheds light on how improving quality of care can transform healthcare outcomes for vulnerable populations.

Imagine a world where health care is as personalized and easy to use as your favorite streaming service. That's the vision of CJ Stimson, MD, urological surgeon, Executive Vice President of Population Health and Chief Medical Officer for the Employee Health Plan at Vanderbilt University Medical Center. In this episode, he hops in the miniVHAN to share how his personal experience and time as senior advisor at the Center for Medicare and Medicaid Innovation have fueled his passion for value-based care – an approach he believes can revolutionize patient outcomes and increase provider satisfaction.     With an aging population and too few doctors, traditional ways of providing care aren't working. Dr. Stimson will explore how a team-oriented approach, focused on patient needs, can empower providers, reduce clinician burnout and improve patient care. We'll learn how better communication and cooperation between patients, employers and providers can overcome the challenges of the value-based care shift and drive this transformation forward. 

My conversation today is with Will Shrank, MD. Dr. Shrank led the evaluation group at CMMI (Center for Medicare and Medicaid Innovation). He has spent time in the private sector, first at CVS Health and UPMC (University of Pittsburgh Medical Center) as chief medical officer of the health plan in Pittsburgh, and then as the chief medical officer for Humana. Now he is a venture partner at Andreessen Horowitz and doing some consulting for CMMI. To read the full article and show notes which include mentioned links, visit the episode page.  If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. We start out this conversation talking about waste in healthcare. In fact, Dr. Shrank was on a team who did a study about waste in the US healthcare system. (The article is, unfortunately, paywalled.) In that study, it says estimates suggest we have upwards of a trillion dollars of waste a year. This waste can be categorized into administrative and clinical failures. Dr. Shrank emphasizes the need for aligning incentives with higher quality care, paying for patient outcomes, and highlights the potential rising power of PCPs. The discussion covers the progress made towards value-based care, the challenges faced by the current fee-for-service model, and the future landscape of primary care and healthcare delivery. In sum, we have a waste problem in this country. Aligning incentives might be one way to curb that waste. 06:54 Can we cut healthcare waste while improving patient care? 07:33 What does “healthcare waste” consist of? 07:46 What are the six categories of “healthcare waste”? 10:23 EP363 with David Scheinker, PhD. 10:37 How much money does Dr. Shrank estimate is wasted each year in healthcare? 13:09 Where is that healthcare waste going, and why does it happen? 20:07 Uncaring by Robert Pearl, MD. 21:18 “We've built a backbone of extraordinary waste on a fee-for-service chassis.” 22:16 EP409 with Larry Bauer, MSW, MEd. 24:24 EP359 with Dan O'Neill. 26:02 Dr. Shrank's warning to providers out there. 30:03 Summer Shorts 2 with Scott Conard, MD. 31:41 Why there might be a generational shift among younger providers looking to work with different models.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs Editor-in-Chief Alan Weil welcomes Liz Fowler, Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services, to A Health Podyssey to discuss the future of health care payments, CMMI's specialty care strategy, mandatory models versus voluntary alternative payment models, CMS' newly-proposed Medicare Physician Fee Schedule for 2025, and more!Related Articles from Liz Fowler on Health Affairs:The CMS Innovation Center's Strategy To Support Person-Centered, Value-Based Specialty Care: 2024 UpdateAdvancing Health Equity Through Value-Based Care: CMS Innovation Center UpdateUpdate On The Medicare Value-Based Care Strategy: Alignment, Growth, EquityOrder the July 2024 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone. Subscribe to UnitedHealthcare's Community & State newsletter.

We're discussing Breaking Barriers in Primary Care through Innovative Models! Faisel and Dan are joined by Liz Fowler, PhD, JD – Director of the Centers for Medicare and Medicaid Innovation.Our conversation revolves around incentives to expand access and increase equity, multi-organization collaboration for healthcare policy, and public perception of Primary Care.This conversation was recorded as a live interview at Primary Care for America's annual event PrimaryCare24.

Hosts Tod Ibrahim and David White discuss the Center for Medicare and Medicaid Innovation's recently announced Increasing Organ Transplant Access (IOTA) Model proposed rule.

Hosts Tod Ibrahim and David White discuss the Center for Medicare and Medicaid Innovation's recently announced Increasing Organ Transplant Access (IOTA) Model proposed rule.

Marinah identifies as an indigiqueer chicana daughter of a spiritual, artistic mother from Chihuahua, Mexico who taught her traditional medicine, a Chicano musician and Engineer father from the borderlands, and mother to indigenous mixed-race children and grandchildren.Marinah is the owner of Phoenix Midwife and the founder of Indigenous Birth, an umbrella organization for diverse advocacy and health justice projects which affirms the importance of traditional and indigenous midwives and assembles initiatives and coalitions nationally and internationally. She is also a sometime podcaster, public speaker and writer.Marinah has served as consultant, facilitator, board member, Executive Director, and midwife for health justice projects in the U.S, North America, Central America, and Uganda, facilitating policy initiatives on public health responses, indigenous/immigrant reproductive and primary healthcare access, education programs, birth center development, and workforce development.Marinah is a founding member of Phoenix Allies for Community Health, a free clinic primarily serving immigrant families, a direct result of her active street medic work. Marinah is the past president of the Midwives Alliance of North America, and worked in a dedicated coalition with national midwifery groups for United States Midwifery, Education, Regulation, and Association (USMERA).Marinah is a Culture of Health Leader, advisory board member for Birth Detroit, Team Leader for an all POC midwifery learning collaborative in Arizona through a project initiated by the Institute of Medicaid Innovation, working alongside native and indigenous immigrant communities on reclamation of birth sovereignty, and planning essential convenings for midwives and healers.Marinah is a practitioner in Somatic Experiencing, with advancing certification in the prenatal and perinatal period, as part of her dedication to traditional medicine and healing.Marinah is the past Director of Organizational Wellness with Birth Center Equity, and is currently under Fellowship.Marinah's current roles, besides the multiple projects of Indigenous Birth, focus primarily in facilitation with Breath of My Heart Birthplace, the only Native-led nonprofit free standing birth center in the United States, Center for Indigenous Midwifery, learning indigenous data collection in partnership with The Firelight Group, and working with her traditional teachers in Mexico learning traditional medicine, and creating artistic and medicinal resources.Website: https://www.indigenousbirth.org/Contact: info@indigenousbirth.org

This episode is part of a continued series that will provide insights into the experiences of GSA Policy Interns from various cohorts. Join former policy intern Bailee Brekke ('23) as she speaks with the 2021 interns, Lei Chen and Kaleigh Ligus, about their internship experience and how it has impacted their current work.   Guest Bios: Lei Chen, PhD, is a postdoctoral scholar at the University of California, San Francisco (UCSF) Philip R. Lee Institute for Health Policy Studies. She is a transdisciplinary and cross-cultural researcher whose work focuses on long-term services and supports, immigrants' access to health care, migrant workforce, aging and health policy, aging and technology, and cross-cultural study. Dr. Chen is working on a National Institutes of Health–funded project that aims to advance research on the health care workforce that serves people living with dementia. She applies quantitative and qualitative methodologies to her research. Before joining UCSF, she worked on several research projects at the University of California, Los Angeles (UCLA) Center for Health Policy Research and collaborated with the UCLA Human-Centered Computing and Intelligent Sensing Lab. Dr. Chen also engages in policy-related work such as assisting in developing and implementing the Master Plan for Aging in California. Kaleigh Ligus, PhD, is a social science research analyst at the Center for Medicare and Medicaid Innovation. Her work includes developing, implementing, and evaluating new CMS patient care models aimed at improving Medicare beneficiaries' health care experiences and health outcomes. Dr. Ligus currently works on the team for the Guiding an Improved Dementia Experience Model. She has been dedicated to serving older adults living with chronic disease since 2015 during her experience at the University of Connecticut (UConn) Health Center on Aging. She earned her doctoral degree in human development and family sciences, with a specialization in adulthood, aging and gerontology, from UConn in 2023. During graduate school, she served as the Greg O'Neill Policy Intern for the Gerontological Society of America (summer 2021) and Health Policy Fellow at AcademyHealth (summer of 2022), working with like-minded community collaborators and political leaders to advocate for health policy change.

Two decades of collaborative innovation have reshaped policies, showcasing the transformative power of interdisciplinary collaboration. In this episode, Malaz Boustani, an agile and innovative implementation neuroscientist, author, and entrepreneur, discusses the groundbreaking advancements and policy changes related to brain health, particularly dementia care. He shares the challenges and successes of creating a comprehensive care model for dementia patients and their caregivers. Malaz delves into the model's positive outcomes, the hurdles faced within the fee-for-service healthcare system, and the Center for Medicare and Medicaid Innovation's announcement to test an alternative payment model for evidence-based dementia care services. He explains how this new payment model includes per-member-per-month payments to healthcare organizations and additional funds for patient respite care, aiming to enhance accessibility and sustainability. Get ready to be inspired and informed about the challenges and triumphs in crafting a transformative care model for dementia patients and their caregivers. Resources:  Connect and follow Malaz on LinkedIn here. Visit Malaz's website. Check out Malaz's previous Outcomes Rocket episode!

Jacob and Nikhil sit down with Toyin Ajayi, Co-Founder and CEO of Cityblock Health, an SDoH-focused provider of primary care, behavioral health, and chronic disease management for Medicaid and dual eligible patients. They discuss innovating in Medicaid, engaging patients with digital solutions, building sustainable companies, and more. (0:00) intro(0:50) the state of Medicaid innovation today(2:33) Toyin's time at Commonwealth(7:33) incubators in the current climate(11:02) biggest risks starting Cityblock(14:46) surprises in building Cityblock(23:06) how Cityblock chooses which services to offer and which to outsource(29:22) lower acuity patients(33:23) state-by-state differences(37:59) policy changes to improve Medicaid(42:15) a shift towards profitability(45:01) generative AI Out-Of-Pocket: https://www.outofpocket.health/

The Congressional Budget Office says the CMS Center for Medicare and Medicaid Innovation's experiments in value-based reimbursement have cost Medicare and taxpayers money. David Johnson and Julie Murchinson debate the right way to measure the return on investment in Medicare value-based care models on the new episode of the 4sight Health Roundup podcast, “Calculating the ROI of VBC,” moderated by David Burda.

My conversation today is with Will Shrank, MD. Dr. Shrank led the evaluation group at CMMI (Center for Medicare and Medicaid Innovation). He has spent time in the private sector, first at CVS Health and UPMC (University of Pittsburgh Medical Center) as chief medical officer of the health plan in Pittsburgh, and then as the chief medical officer for Humana. Now he is a venture partner at Andreessen Horowitz and doing some consulting for CMMI. We start out this conversation talking about waste in healthcare. In fact, Dr. Shrank was on a team who did a study about waste in the US healthcare system. (The article is, unfortunately, firewalled.) In that study, it says estimates suggest we have upwards of a trillion dollars of waste a year. There's two main groupings of said waste, turns out. The first is in administrative failures. There's three subcategories here: fraud, waste, and abuse; administrative complexity; and pricing failures. Then there's the clinical failures side of the waste house. There's three subcategories here as well, and they are failures in care coordination, failure in care delivery, and then low-value care. Dr. Shrank digs in a bit on each of these in the interview that follows, but I have to say, I go in fast for the now what. Great that we know where the waste is coming from, because gotta know the problems to solve for them. But really, what's the best way to solve for this waste? You know me by now, so I, of course, point out immediately that someone's waste is someone else's profit. So, that's a wrinkle. And it's a really rough wrinkle, because now you have groups lobbying to basically protect the waste. As just one example, what are pricing failures, after all, if not someone else's margin? Major spoiler alert here, but Dr. Shrank says one sort of broad-stroke solution is aligning incentives with higher-quality care, paying for the longitudinal patient journey, and paying for outcomes. If you do this, then at least the clinical failures side of the equation could improve. The implication here is that if the incentive is to be accountable for value—which is, you know, numerator quality denominator cost—then the supply chain has an incentive to reduce its own waste because effectively, at that point, it's coming out of their pocket as opposed to somebody else's. Will this resetting of the financial model happen overnight? That was a rhetorical question that we all know the answer to. Commercial payers are slow to change, and all but the best employers have been (historically, at least) busy making extremely lateral moves and going nowhere fast. Few seem super inclined to reward and pay for what they care about rather than just negotiating a price. I sort of say this to Dr. Shrank, and he says, yeah, true enough. I'm paraphrasing with a lot of creative license right now, but he says, let's reset our expectations with reality. We've actually come a pretty long way, baby, in not a particularly long time if you consider the whole value-based thing really only started not that long ago, relatively speaking. So, there will be problems to overcome and bumps in the road. We should expect that, and we haven't had the time to work them all out yet. I think a couple of other interesting insights for me, one was a little sidebar we go off on about the power that PCPs might find themselves wielding if they can gang up and harness it. And this is kind of starting. We'll see if it goes anywhere. I recently heard a story about a bunch of employed PCPs who went to their health system bosses and asked to stand up an APCP (advanced primary care practice) able to coordinate care, etc, do all the things that at this juncture we know are the right things to do for patients. Now they got shot down—bam!—with the backhands from above. I hope those engaged and activated PCPs quit and start up their own thing. Maybe they will. PCPs getting together here could be a way to solve for waste if they can gang up and harness it. And that's actionable if you happen to be a PCP or are looking to continue to employ them moving forward. The potential rising power of PCPs might cause some health systems to rethink some of the choices they are making (ie, the choice to employ PCPs as RVU [relative value unit] referral machines). PCPs, better than anyone, can see the harm inflicted by the business model that forces a drive-by PCP level of care. Moral injury is at an all-time high, and in addition, I just saw that study recently that showed to do all the administrative work of a PCP these days, it would take longer than 24 hours in a day. If you're a self-insured employer, I'd also kind of take note of this because it also could be actionable for you. Someone who would know told me recently that if enough employers demanded some value-based accountability, some advanced primary care going on, even a dominant consolidated health system would listen. So there seems to be some alignment here between employers and PCPs if these groups can come together and collaborate. In sum, we have a waste problem in this country. Aligning incentives might be one way to curb that waste. Can I just share with you some of the reviews that we got on iTunes recently? They make my heart so warm. I just want to acknowledge these individuals who took the time to write reviews. Here's the first one. It's from Jspeaks1987. He wrote, “[RHV is] my weekly go-to for smart takes on VBC [value-based care]. I have recommended this podcast to literally hundreds of people (including onstage at our recent customer success summit). Anyone who cares about the sustainability of our healthcare system owes it to themselves to give [Relentless Health Value] a permanent spot on their playlist. Always smart, often provocative, scrupulously fair [I like that … scrupulously fair], it's well worth the listen.” Thank you so much, Jspeaks1987. Here's another one. And this is from happygilmore80. I know who you are, happygilmore. “RHV is an amazing podcast and sorely needed in the healthcare community. I tell everyone about it. … I'm a recent listener and have learned so much from [episode] 399 and 400 [which are the manifestos]. Episode 410 was packed with knowledge, 407 was great, etc. Let's start a hundred RHV communities across the US where we implement small experiments so change is grassroots and ubiquitous. Then the status quo will concede.” And yeah, for sure with that. If anyone is interested in creating a meetup or something in your local area, reach out. I'll try to hook you up with others in the Relentless Tribe. Here's a third one, and this is by Miriam. Thank you so much for this, Miriam. Miriam says, “I scoured the podcast world to find a healthcare industry podcast that offers intelligent, relevant, clear information and dialogue. I found it. Stacey and RHV cover the US healthcare industry across all sectors while managing to go deep within those sectors. Most importantly, [RHV] highlights how all of those sectors interact, supposedly with the patient at the center, while performing as businesses that are really driven by capitalism.” Miriam says she never misses an episode. To the three of you, thank you so much. It's actually reviews like this that keep me and the team going over here.   You can learn more by connecting with Dr. Shrank on LinkedIn.     William H. Shrank, MD, MSHS, is serving as venture partner, bio and health, at Andreessen Horowitz. Previously, Dr. Shrank served as chief medical officer for Humana, where his responsibilities included implementing Humana's integrated care delivery strategy, with an emphasis on advancing the company's clinical capabilities and core objective of improving the health outcomes of its members. Dr. Shrank previously held the position of chief medical and corporate affairs officer, during which time he oversaw government affairs. From 2016 to 2019, Dr. Shrank served as chief medical officer, insurance services division, at the University of Pittsburgh Medical Center. Previously, Dr. Shrank served as senior vice president, chief scientific officer, and chief medical officer of provider innovation at CVS Health. Prior to joining CVS Health, he served as director of the Research and Rapid-Cycle Evaluation Group for the Center for Medicare and Medicaid Innovation. Dr. Shrank began his career as a practicing physician with Brigham and Women's Hospital in Boston and as an assistant professor at Harvard Medical School. He has published more than 270 papers on improving the quality of prescribing and the use of chronic medications. Dr. Shrank received his MD from Cornell University Medical College. He completed his residency in internal medicine at Georgetown University and his fellowship in health policy research at the University of California, Los Angeles. He also earned a master of science in health services from the University of California, Los Angeles, and a bachelor's degree from Brown University.   05:56 Can we cut healthcare waste while improving patient care? 06:35 What does “healthcare waste” consist of? 06:48 What are the six categories of “healthcare waste”? 09:25 EP363 with David Scheinker, PhD. 09:39 How much money does Dr. Shrank estimate is wasted each year in healthcare? 12:11 Where is that healthcare waste going, and why does it happen? 19:09 Uncaring by Robert Pearl, MD. 20:20 “We've built a backbone of extraordinary waste on a fee-for-service chassis.” 21:18 EP409 with Larry Bauer, MSW, MEd. 23:26 EP359 with Dan O'Neill. 25:04 Dr. Shrank's warning to providers out there. 29:04 Summer Shorts 2 with Scott Conard, MD. 30:43 Why there might be a generational shift among younger providers looking to work with different models.   You can learn more by connecting with Dr. Shrank on LinkedIn.   @WillShrank discusses #healthcarewaste, #vbc, and #PCPs on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Carly Eckert (Encore! EP361), Dr Robert Pearl, Larry Bauer (Summer Shorts 8), Secretary Dr David Shulkin and Erin Mistry, Keith Passwater and JR Clark (Summer Shorts 7), Lauren Vela (Summer Shorts 6), Dr Jacob Asher (Summer Shorts 5), Eric Gallagher (Summer Shorts 4), Dan Serrano, Larry Bauer  

More than 75,000 Kaiser healthcare workers are set to strike across several states this week as their current employment contract expires. Cigna will pay $172 million to settle its Medicare Advantage fraud suit. And, a new report finds that the Center for Medicare and Medicaid Innovation has raised federal spending, not lowered it. That's coming up on today's episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

The Congressional Budget Office released a report showing that the Center for Medicare and Medicaid Innovation, created under Obamacare to test new ways to pay for health care, will increase federal spending rather than reducing it. In 2010, CBO projected CMMI would reduce spending by $2.8 billion over 10 years, but current estimates show it increasing $1.3 billion from 2021 to 2030. Host Ben Leonard talks with Robert King about why.

Note: this episode is cross-posted with the Rx for Biotech podcast, hosted by Chris Leidli.  Emily Walsh Martin, PhD, at Tremont Therapeutics Consulting, works with gene and cell therapy companies and investors who are seeking to advance novel therapies in the clinic. ASGCT's Policy Summit is a big deal to her: It provides a full view of the clinical pipeline and helps her guide clients past the drug approval process and into considerations of patient access, manufacturing, and insurance reimbursement. In this special episode, Dr. Walsh Martin shares her highlights from the fifth annual Policy Summit: the chance to see top decision makers, patients, and advocates in the same room; the discussion of the recent CGT Access Model from the Centers for Medicare and Medicaid Innovation (with deputy director Laura McWright); and, of course, the first in-person speaking engagement of Nicole Verdun, MD, director of FDA CBER's new Office of Therapeutic Products (OTP). Hear Dr. Walsh Martin's thoughts on patient-focused development, public access to data, and FDA's support of platform designations for new CGT treatments. Her interviewer is Chris Leidli, host of the Rx for Biotech podcast and member of ASGCT's Communications Committee.  This year's Policy Summit featured its highest-profile line-up yet—and it's still available to view on-demand until October 23! Learn more at asgct.org/advocacy/policy-summit. Not sure if on-demand access is worth it? Let Dr. Walsh Martin convince you why you don't want to miss the event!Show your support for ASGCT!: https://asgct.org/membership/donateSee omnystudio.com/listener for privacy information.

In June, the Centers for Medicare & Medicaid Services (CMS) announced a new primary care model – the Making Care Primary (MCP) Model – that will be tested under the Center for Medicare and Medicaid Innovation in eight states. We welcome CMS Deputy Administrator and Center for Medicare and Medicaid Innovation Director Dr. Liz Fowler to discuss the Making Care Primary Model, the process in developing the model, and it's connections with health equity. 

The fragmentation of outpatient health care drives up the cost of care and worsens the quality of care that patients receive, posing a risk to patients' health. On this episode of Mathematica's On the Evidence podcast, guests James Lee of the Center for Medicare & Medicaid Innovation, Knitasha Washington of ATW Health Solutions, Bob Phillips of the Center for Professionalism and Value in Health Care, and Lori Timmins of Mathematica discuss recent research on the nature of the problem and federal initiatives that have sought to address it. A full transcript of the episode is available at https://www.mathematica.org/blogs/understanding-and-addressing-fragmented-outpatient-health-care Read a press release synthesizing key takeaways from a series of peer-reviewed journal articles on fragmented outpatient care based on studies conducted by Mathematica with support from the Centers for Medicare & Medicaid Services: https://www.mathematica.org/news/new-studies-reveal-that-fragmented-care-persists-despite-efforts-to-improve-primary-care-and-care Learn more about how the Innovation Center and Mathematica are advancing understanding of primary care through an evaluation of the Comprehensive Primary Care Plus model: https://www.mathematica.org/projects/evaluating-the-nations-largest-primary-care-delivery-initiative Learn more about an ongoing evaluation by Mathematica for the Center for Medicare & Medicaid Innovation to determine whether medical practices' participation in the Primary Care First alternative payment model improves quality and reduces costs for Medicare fee-for-service beneficiaries: https://www.mathematica.org/projects/evaluation-of-the-primary-care-first-model Read the 2021 report from the National Academies of Sciences, Engineering, and Medicine on implementing high quality primary care: https://nap.nationalacademies.org/catalog/25983/implementing-high-quality-primary-care-rebuilding-the-foundation-of-health

Those wishing to make a public comment on “Medicaid Program; Medicaid and Children's Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality,” a proposed rule by the Centers for Medicare & Medicaid Services, may do so here. Dr. Heaphy's slides are available here. This webinar will discuss the work of Dennis Heaphy on spiritual care in healthcare settings for individuals who are eligible for both Medicaid and Medicare coverage. It emphasizes the importance of coding chaplaincy services for these populations, particularly those enrolled in capitated care plans. Adapted from Heaphy's recent article in Health Affairs: Spiritual services are an oft neglected but important part of comprehensive care. While CMS and its Center for Medicare and Medicaid Innovation (the Innovation Center) have taken significant steps in the right direction, CMS could require providers in the Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs) and Program of All-Inclusive Care for the Elderly (PACE) to provide enrollees with spiritual assessments and spiritual care as optional services. We are joined by: Dennis Heaphy, DMin, MPG, MDiv, MEd joined the Disability Policy Consortium (DPC) in 2008. He engages in Community-Based Participatory Action Research and is also a policy analyst. He promotes legislation and policies at the state and federal level that positively impact social determinants of health. These and other barriers lead to inequities in healthcare access and outcomes for people with disabilities and ethnic and minority populations. Mr. Heaphy is active with the Massachusetts Public Health Association and Health Care for All, developing strategies to increase the utilization of public-health principles in the development, implementation and evaluation of healthcare policies. He is also active in a number of policy initiatives at the national level that increase the voices of persons most impacted by negative social determinants of health and gaps in access to home and community-based services. Mr. Heaphy is also interested in the role of spirituality and spiritual care in improving wellness and health outcomes for persons with disabilities. *** We thank our sponsor for this webinar, Interfaith America. Learn more at InterfaithAmerica.org.

IEC founder Dr. Mai Pham discusses their work transforming healthcare for people with intellectual and/or developmental disabilities Hoangmai (Mai) H. Pham, MD MPH, President and CEO of Institute for Exceptional Care (IEC), is a general internist and national health policy leader and mother to two beautiful young men, one of whom is autistic. Dr. Pham was previously Vice President, Provider Alignment Solutions at Anthem, Inc., responsible for value-based care initiatives at the country's second largest health insurance company. Prior to Anthem, she served as Chief Innovation Officer at the Center for Medicare and Medicaid Innovation, where she was a founding official, and the architect of Medicare's foundational programs on accountable care organizations and primary care. She has published extensively in the medical literature on provider payment policy and its intersection with health disparities, care coordination, quality performance, provider behavior, and market trends. Dr. Pham serves on the boards of Atlantic Health Systems and the Coalition to Transform Advanced Care, and the National Advisory Council for the Agency on Healthcare Research and Quality. She also serves on Faculty at the Institute for Healthcare Improvement. Dr. Pham earned her A.B. from Harvard University, her M.D. from Temple University, and her M.P.H. from Johns Hopkins University where she was also a Robert Wood Johnson Clinical Scholar. For information about Institute for Exceptional Care, visit: https://www.ie-care.org/ Follow Different Brains on social media: https://twitter.com/diffbrains https://www.facebook.com/different.brains/ https://www.instagram.com/diffbrains/ Check out more episodes of Exploring Different Brains! http://differentbrains.org/category/edb/

Host Katherine Ellen Foley talks with Robert King about some House Republicans' opposition to a cost-cutting proposal from the Center for Medicare and Medicaid Innovation that would reduce payments for drugs that have won FDA approval but haven't yet proven their clinical benefit. The GOP representatives argue it will curtail innovation and access to promising therapies.

Kevin Siebs, Moore & Van Allen, and Derek Skoog, Principal, PricewaterhouseCoopers, discuss the Center for Medicare and Medicaid Innovation's (CMMI's) latest ACO model, ACO Realizing Equity Access and Community Health (REACH) Model. They cover reasons for provider participation in ACO REACH and common characteristics among participants, the model's payment mechanisms, aspects of the model's benchmark methodology, and key compliance issues related to the model. From AHLA's Regulation, Accreditation, and Payment Practice Group.To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.

Every year, Mathematica publishes dozens of new papers and reports, some of which surface fresh insights about how public agencies and private organizations can be more effective at improving public well-being. For the 91st episode of Mathematica's On the Evidence podcast, we're launching an occasional series focused on examples of solutions that recent research suggests are effective. All three solutions in this episode involve financial incentives that seek to reduce health care costs while improving the quality of care patients receive. One seeks to reduce the incidence of heart attacks, strokes, or other events related to cardiovascular disease. Another is focused on bringing down the cost of health care and improving patient health by providing primary care services at home. And the last one, again, seeks to keep costs down while improving patient health, but this time by using a unique payment model that provides incentives to hospitals to change the way they do business. Email jwogan@mathematica-mpr.com to provide feedback about our approach to covering solutions on the podcast. A full transcript of this episode is available here: https://mathematica-mpr.com/blogs/solutions-for-preventing-heart-attacks-improving-patient-health-and-reducing-health-spending Read the fourth annual report from Mathematica for the Centers for Medicare & Medicaid Services on the evaluation of the Million Hearts Cardiovascular Disease Risk Reduction Model: https://www.mathematica.org/publications/evaluation-of-the-million-hearts-cardiovascular-disease-risk-reduction-model-fourth-annual-report Learn more about the ongoing evaluation of the Million Hearts Cardiovascular Disease Risk Reduction Model: https://www.mathematica.org/projects/million-hearts-cardiovascular-disease-risk-reduction-model Read the seventh annual report from Mathematica for Center for Medicare & Medicaid Innovation on the evaluation of the Independence at Home Demonstration: https://www.mathematica.org/publications/evaluation-of-the-independence-at-home-demonstration-an-examination-of-year-7-the-first-year Learn more about the ongoing evaluation of the Independence at Home Demonstration: https://www.mathematica.org/projects/evaluation-of-the-independence-at-home-demonstration Read the report from Mathematica for the Center for Medicare & Medicaid Innovation on impacts from the first three years of the Maryland Total Cost of Care Model: https://www.mathematica.org/publications/evaluation-of-the-maryland-total-cost-of-care-model-quantitative-only-report-for-the-models-first Learn more about Mathematica's ongoing evaluation of the Maryland Total Cost of Care Model for the Center for Medicare & Medicaid Innovation: https://www.mathematica.org/projects/evaluating-accountability-for-statewide-health-cost-and-quality-outcomes-cpc

Meet Elizabeth Fowler:Dr. Elizabeth Fowler is Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation at CMS. Dr. Fowler previously served as Executive Vice President of programs at The Commonwealth Fund and Vice President for Global Health Policy at Johnson & Johnson. Before that, she was special assistant to President Obama on health care and economic policy at the National Economic Council. From 2008 to 2010, she was Chief Health Counsel to Senate Finance Committee Chair, Senator Max Baucus (D-MT), where she played a critical role developing the Senate version of the Affordable Care Act. She also played a key role drafting the 2003 Medicare Prescription Drug, Improvement and Modernization Act (MMA). Dr. Fowler has over 25 years of experience in health policy and health services research. She earned a bachelor's degree from the University of Pennsylvania, a Ph.D. from the Johns Hopkins Bloomberg School of Public Health, and a law degree (J.D.) from the University of Minnesota. She is admitted to the bar in Maryland, the District of Columbia, and the U.S. Supreme Court. Dr. Fowler is a Fellow of the inaugural class of the Aspen Health Innovators Fellowship and was elected to the National Academy of Medicine in 2022. Key Insights:Dr. Fowler is committed to the goal of reducing healthcare spending on a net basis into the future.Efficiency. Part of the ACA passed in 2010, the CMS Innovation Center aims to reduce barriers to care delivery, making healthcare more affordable and efficient. Long Term Plans. Dr. Fowler suggests that changing our healthcare system for the better is a project of immense scope. Prepare to measure progress on a scale of decades. Realism and Risk. Value-based care remains the goal, but Dr. Fowler understands that many organizations still face challenges that prevent them from adopting value models.This episode was made possible by our partnership with Edwards Lifesciences.Relevant Links:Follow Dr. Fowler on TwitterLearn about the CMS Innovation Center

Hoangmai (Mai) H. Pham, MD MPH, is President and CEO of Institute for Exceptional Care, a nonprofit committed to transforming healthcare for people with intellectual and/or developmental disabilities. She is a general internist and national health policy leader. She was Vice President, Provider Alignment Solutions at Anthem, Inc., responsible for value-based care initiatives at the country’s second largest health insurance company. Prior to Anthem, Dr. Pham served as Chief Innovation Officer at the Center for Medicare and Medicaid Innovation, where she was a founding official, and the architect of Medicare’s foundational programs on accountable care organizations and primary care. She was Co-Director of Research at the Center for Studying Health System Change and has published extensively in the medical literature on provider payment policy and its intersection with health disparities, care coordination, quality performance, provider behavior, and market trends. Dr. Pham serves on numerous advisory bodies, including the National Advisory Council for the Agency on Healthcare Research and Quality, the Maryland Primary Care Program, and the National Business Group on Health, and was a member of the Board Executive Committee at the Health Care Transformation Task Force. She is an Adjunct Fellow at the Leonard Davis Institute of Health Economics of the University of Pennsylvania, and Faculty at the Institute for Healthcare Improvement. Dr. Pham earned her A.B. from Harvard University, her M.D. from Temple University, and her M.P.H. from Johns Hopkins University where she was also a Robert Wood Johnson Clinical Scholar. Here’s a glimpse of what you’ll learn: The importance of engagement strategies to achieve an inclusive healthcare environment. Understand that meaningful engagement can promote joy in healthcare practices. Learn resources and tools available that may not have been provided in traditional medical educational programs Collaboration with patients, families and caregivers is a key component when providing patient care In this episode…. This podcast features Hoangmai (Mai) H. Pham, MD MPH. She discusses how her organization provides training for clinicians and hospital staff around creating an environment of inclusion. IEC was founded by healthcare professionals who also have disabled loved ones. They share the anxiety and isolation of navigating an opaque, disconnected, and underfunded world of support services. Through their training and services healthcare providers can learn how to better engage with patients who have disabilities fostering an environment of inclusion.

In this episode, Dr. Liao speaks with Dora Hughes, MD, MPH, the Chief Medical Officer at The Center for Medicare & Medicaid Innovation, part of the Centers for Medicare and Medicaid Services.

Mass General Brigham joins other health systems in adopting a code of conduct for patients. A new study aims to prove–or disprove–the prevailing hypothesis about the cause of Alzheimer's. And the Center for Medicare and Medicaid Innovation updates its strategy for implementing value-based care. That's all coming up on today's episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

In our current healthcare system, patients can sometimes spend half a day waiting to see one healthcare provider. And the average wait time in the United States to schedule a consultation can take anywhere from six to eight weeks. The long wait to see a provider can be stressful for families, can raise healthcare costs, and limit provider impact and satisfaction. Kelsey Mellard realized that the system needs to be transformed through bigger, bolder changes. Kellsey is on a mission to revolutionize the system with Sitka - a virtual, value-based multi-specialty primary care network.  In this episode, Kellsey shares how Sitka started and how they are improving access and delivering healthcare across the nation through their partnerships with primary care providers.  About Our Guest: Kelsey P. Mellard is the CEO and Founder of Sitka, a virtual, value-based multi-specialty network that is expanding the scope of primary care. Kelsey has been a leader in healthcare innovation across companies within the healthcare, government, and technology industries. Previously, Kelsey led Health System Integration for Honor, a technology-backed home care company. Prior to this, she led the development of the Post-Acute Care Center for Research, where she served as Executive Director. Earlier in her career, she also served in VP roles at naviHealth and UnitedHealth Group and she was on the initial team to establish the Center for Medicare and Medicaid Innovation. Kelsey sits on the board of Crossover Health and volunteers with the National Investment Center for Senior Housing (NIC) Board. During her free time, she enjoys the great outdoors with her partner George, son Dalman, and pup Arlo.  Connect with Kelsey Mellard: Website | www.trustsitka.com LinkedIn | www.linkedin.com/in/kelsey-mellard Twitter  | @KelseyMellard Facebook | Kelsey Pope Mellard

You can't talk about Value Based Care without including CMS and the Center for Medicare in the conversation.  In many of the past episodes on VBC we repeatedly refer to Medicare.  Today we get their input with the help of Douglas Jacobs, MD, Chief Transformation Officer, Center for Medicare at the CMS.  I really appreciate CMS allowing this conversation to happen. Doug is going to help us understand what CMS is, more specifically what the Center for Medicare is, bundled payments, VBC, ACOs, The Center for Medicare and Medicaid Innovation, The council for technology and innovation, the importance of health equity and more.  We frequently relate these issues to MedTech. For anyone that wants to better understand the CMS and the Center for Medicare specifically, you will want to listen to this episode. Now Go Win Your Week!! Doug's LinkedIn link CMS website link Medicare Website link The overall Medicare vision link Medicare & Health Equity link Medicare and Accountable Care link Ted Newill's LinkedIn Profile link  More Medical Device Success podcasts link Medical Device Success website link  MedTech Leaders Community link Link to Ted's contact page 

Jacob sits down with Dr. Mandy Cohen - former Secretary of North Carolina's Department of Health and Human Services, COO of the Center for Medicare & Medicaid Services and current CEO of Aledade's newest business line Aledade Care Solutions. They discuss her work in North Carolina around Social Determinants of Health, how Medicaid policy and innovation works, the new business line she's building at Aledade and what's required for primary care practices to succeed under risk.

In this week's episode, Dr. Antraneise Jackson, DrPH, MPH shares her journey. She has recently started as a Social Science Research Analyst for the Center for Medicare and Medicaid Services within Centers for Medicare and Medicaid Innovation. She is an active Public Health Professional working to improve the health of communities through her work within the public health field and her passion for exploring ways to develop and improve processes within the public health field through various avenues. She got her Bachelor of Science in Health Services Administration at Keiser University – Tallahassee while working in Customer Service Management before getting her Master of Public Health at Florida State University and beginning her career within the public health field. She then got her Doctor of Public Health at Florida Agricultural and Mechanical University (FAMU).  Shownotes: https://thephmillennial.com/episode112Dr. Antraneise Jackson, DrPH, MPH on LinkedIn: https://www.linkedin.com/in/antraneise-jackson-drph-mph-81502b64/Omari on IG: https://www.instagram.com/thephmillennial Omari on LinkedIn: https://www.linkedin.com/in/omari-richinsAll ways to support The Public Health Millennial: https://thephmillennial.com/support/Shop at The Public Health Millennial Store for discount: https://thephmillennial.com/shop/Support the show

Jacob sits down with Adam Boehler - former CEO of Landmark Health, Head of the Center for Medicare and Medicaid Innovation and current CEO of Rubicon Founders. They discuss how building a value-based care business has changed, how Adam came up with the idea for Landmark and his other businesses, what makes different patient segments a fit for value-based models and where the space is headed. They also touch on Adam's hopes for future policy and the changes he's seen in healthcare talent.

In February, CMS announced a redesign of the Global and Professional Direct Contracting Model for 2023. The Center for Medicare and Medicaid Innovation also released an RFA to solicit a cohort of participants for the new version of Direct Contraction, the ACO REACH Model. Aisha Pittman and Mara McDermott discuss how the renamed model better aligns with the purpose of encouraging providers to coordinate care to people with Medicare and better reach participants in underserved communities.

Dr. Elizabeth Fowler, Ph.D., J.D., (https://www.cms.gov/about-cms/leadership/center-medicare-medicaid-innovation) is the Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation, at the Centers for Medicare & Medicaid Services (CMS), a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards. Dr. Fowler has over 25 years of experience in both health policy and health services research. She previously served as Executive Vice President of programs at The Commonwealth Fund and Vice President for Global Health Policy at Johnson & Johnson, where she focused on health care delivery system and payment reform in the U.S. and health care systems and reform in emerging markets. She was also special assistant to President Obama on health care and economic policy at the National Economic Council. In 2008-2010, Dr. Fowler was Chief Health Counsel to Senate Finance Committee Chair, Senator Max Baucus (D-MT), where she played a critical role developing the Senate version of the Affordable Care Act. She also played a key role drafting the 2003 Medicare Prescription Drug, Improvement and Modernization Act (MMA). She also served as Vice President of Public Policy and External Affairs for WellPoint, Inc. (now Anthem), as an attorney with the Washington law firm Hogan & Hartson, and five years as a health services researcher with Park Nicollet Foundation in Minnesota. Dr. Fowler earned her bachelor's degree from the University of Pennsylvania, where she studied the History and Philosophy of Science and Technology, a Ph.D. from the Johns Hopkins Bloomberg School of Public Health, where her research focused on risk adjustment, and a law degree (J.D.) from the University of Minnesota. She is admitted to the bar in Maryland, the District of Columbia, and the U.S. Supreme Court. Dr. Fowler is a Fellow of the inaugural class of the Aspen Health Innovators Fellowship and a member of the Aspen Global Leadership Network.

There's only one Black Mamba, but there are millions of BLACK MAMAS and it is as safe for us to be here in our pregnant and mothering awesomeness as it is for a fish in shark infested waters.   Works used in this episode:  1. “BIRTHING WHILE BLACK: EXAMINING AMERICA'S BLACK MATERNAL HEALTH CRISIS” Statement for the Record Submitted by Stacey D. Stewart, President and CEO, March of Dimes Hearing of the House Committee on Oversight and Reform. May 6, 2021; 2. "Why Is the Maternal Mortality Rate So High for Black Women?" Published: Apr 12, 2018, By: NWHN Staff. NWHN.com; 3. “How Serena Williams Saved Her Own Life” Serena Williams, April 5, 2022, Elle Magazine; 4. “Racial Disparities Persist in Maternal Morbidity, Mortality, and Infant Health” Gianna Melillo, June 13, 2020, AJMC.com; and   5. “Community-based Maternal Support Services: The Role of Doulas and Community Health Workers in Medicaid” Chloe Bakst Jennifer E. Moore, PhD, RN, FAAN Karen E. George, MD, MPH, FACOG Karen Shea, MSN, RN, May 2020, Institute for Medicaid Innovation. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

“For me, the beauty of diabetes was that it was the anchor but it allowed me to explore so many different areas of research and interest.” -Robert A. Gabbay, MD, PhD   In episode 158 of the podcast, we welcome Dr. Robert Gabbay. Dr. Gabbay is Chief Scientific and Medical Officer of the American Diabetes Association and Associate Professor at Harvard Medical School. DocWorking Founder and CEO, Dr. Jen Barna talks with Dr. Gabbay about how it all started for him, his journey in medicine, how he balances it all and what advice he was given and what advice he would give to his younger self. He speaks about difficult decisions he made that affected the direction of his career. Dr. Gabbay also talks about the importance that mentors have had in his life and how they helped to shape him.    Robert A. Gabbay, MD, PhD is Chief Scientific and Medical Officer of the American Diabetes Association and Associate Professor at Harvard Medical School. His research focuses on innovative models of diabetes care to improve diabetes outcomes and the lives of people with diabetes. Throughout his vibrant career he has had many accomplishments as a basic science researcher, developer of patient communication tools, creator of the first broad scale diabetes registry, designer of care management training programs, and leader of one of the largest primary care transformation efforts in the US around the Patient Centered Medical Home. The reach of his work has been recognized through leadership roles around the world to transform diabetes care including leading the International Diabetes Federation BRIDGES program that implements evidence based translational research to low resource global settings. Dr. Gabbay has received funding from the National Institute of Health Diabetes, Digestive and Kidneys Diseases (NIDDK), the Agency for Healthcare Research and Quality (AHRQ), and the Center for Medicare and Medicaid Innovation for his care transformation work. Along with an extensive peer reviewed publication record, his views have appeared in popular press such as the New York Times, CNN, the Washington Post, People, Oprah, and National Public Radio. Formerly, he held the role of Chief Medical Officer at Joslin Diabetes Center.   Find full transcripts of DocWorking: The Whole Physician Podcast episodes on the DocWorking Blog  DocWorking empowers physicians and entire health care teams to get on the path to achieving their dreams, both in and outside of work, with programs designed to help you maximize life with minimal time.   Are you a physician who would like to tell your story? Please email Amanda, our producer, at Amanda@docworking.com to be considered.   And if you like our podcast and would like to subscribe and leave us a 5 star review, we would be extremely grateful!   We're everywhere you like to get your podcasts! Apple iTunes, Spotify, iHeart Radio, Google, Pandora, Stitcher, PlayerFM, ListenNotes, Amazon, YouTube, Podbean   You can also find us on Instagram, Facebook, LinkedIn and Twitter.    Some links in our blogs and show notes are affiliate links, and purchases made via those links may result in payments to DocWorking. These help toward our production costs. Thank you for supporting DocWorking: The Whole Physician Podcast!   Occasionally, we discuss financial and legal topics. We are not financial or legal professionals. Please consult a licensed professional for financial or legal advice regarding your specific situation.   Podcast produced by: Amanda Taran

On this episode of On the Evidence, Mathematica's Mariel Finucane and John Deke join Tim Day of the Center for Medicare & Medicaid Innovation to discuss the application of evidence-informed Bayesian methods that not only confirm whether a policy or program works, but for whom. Learn more about Mathematica's work using evidence-based Bayesian methods in applied policy research: https://mathematica.org/features/bayesian-methods Read a brief about using a Bayesian framework for interpreting findings from impact evaluations prepared by Mariel Finucane and John Deke for the Office of Planning, Research and Evaluation at the Administration for Children and Families: mathematica.org/publications/moving-beyond-statistical-significance-the-basie-bayesian-interpretation-of-estimates-framework Read a paper co-authored by Mariel Finucane that compares Bayesian methods with the traditional frequentist approach to estimate the effects of a Centers for Medicare & Medicaid Services demonstration on Medicare spending: mathematica.org/publications/revolutionizing-estimation-and-inference-for-program-evaluation-using-bayesian-methods Read a paper co-authored by Tim Day describing an experiment to provide evidence that would be useful to policymakers and other decision makers through an interactive data visualization dashboard, presenting results from both frequentist and Bayesian analyses: https://www.researchgate.net/publication/335169870_Making_Evidence_Actionable_Interactive_Dashboards_Bayes_and_Health_Care_Innovation Read Emily Oster's newsletter article about why and how she applies Bayes's Rule to interpret new evidence in the context of existing evidence, including a recent study (https://emilyoster.substack.com/p/does-pre-k-really-hurt-future-test) about the effects of a preschool program in Tennessee on future student test scores: https://emilyoster.substack.com/p/bayes-rule-is-my-faves-rule

Co-host Brian (@chiglinsky) is joined by Dr. Farzad Mostashari (@Farzad_MD), CEO and co-founder of Aledade, and Dr. Richard Gilfillan, former Deputy Administrator of the Centers for Medicare and Medicaid Services and Director of the Center for Medicare and Medicaid Innovation from 2010 to 2013, for a special episode of The ACO Show. They discuss the future of Medicare and Dr. Gilfillan's recent co-authored, two-part piece in Health Affairs, “Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine'.”   

Investor money and venture capital funding is pouring into Medicare Advantage (MA) plans. Enrollment in MA plans has more than doubled from 12 million members in 2011 to 26 million in 2021. What does this mean for us and our patients? Do these plans deliver better care for vulnerable older adults? Or are they a money making machine driving up healthcare costs in the name of profit?  On today's podcast, we are joined by UCSF geriatrics fellow Alex Kazberouk to talk with Dr. Don Berwick (founder of the Institute for Healthcare Improvement, former administrator of Center for Medicare and Medicaid Services) and Dr. Richard Gilfillan (former CEO of Geisinger Health Plan and Director of the Center for Medicare and Medicaid Innovation). Their recent two part post on the Health Affairs Blog about the Medicare “Money Machine” has stirred up a debate about challenges and misaligned incentives within Medicare Advantage. We talk about: What Medicare Advantage is all about - its history, operations, potential benefits, and what it means for us and our patients Rick and Don's Health Affairs post on the downsides of MA plans and the Medicare “Money Machine” Policy solutions to improve the system without throwing the baby out with the bathwater We also touch upon prior podcast topics such as the area deprivation index and population health. As a special, Alex plays a superb rendition of this song which is definitely not a Rickroll. This is part one of a two part series on Medicare Advantage and healthcare financing. We have a follow-up with Claire Ankuda and Cheryl Philips on Special Needs Plans and the Medicare Advantage Hospice Carve-In coming soon.

The Medicare program has placed considerable emphasis on creating accountable care organizations (ACOs), which are groups of health care providers that together take responsibility for providing necessary care and can reap financial rewards if they do so at lower than projected costs.While the American Hospital Association reports that 56 percent of community hospitals participate in an ACO, ACOs have developed more slowly in rural than in urban areas.Observing that not all health care providers can afford the infrastructure cost necessary to make an ACO work, the Center for Medicare and Medicaid Innovation developed the ACO Investment Model (AIM) which supports physicians, clinicians, and smaller hospitals in their formation of ACOs.The AIM Program evaluation has some interesting lessons for those seeking to promote accountable care.Matthew Trombley from Abt Associates joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss how to support ACO creation in less populated areas.Trombley and coauthors published a paper in the January 2022 issue of Health Affairs examining outcomes following implementation of the Medicare Shared Savings Program in 41 rural ACO investment model facilities. They found significant savings net of program costs but also rapid exits from the program once providers were exposed to downside financial risks.If you enjoy this interview, order the January 2022 Health Affairs issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Liz shares how the Center for Medicare and Medicaid's (CMMI's) "Innovation Center" tests care and reimbursement models that often become the norm, including accountable care models and much of what we've have seen in the value movement.  

In addition to shining a light on health disparities, medical misinformation, and public health infrastructure, the COVID-19 pandemic has also propelled calls for the transition to value-based care in the United States. To discuss this topic, among others, we sat down with Mara McDermott, the executive director of the Value Based Care Coalition, formerly known as the Next Gen ACO Coalition. On this episode of Managed Care Cast, McDermott discusses the organization's recent re-brand, how its goals align with the Center for Medicare and Medicaid Innovation's strategic refresh, and the future of value-based care.

Early in Dr. Rahul Rajkumar's career, he wondered how he could help improve health outcomes at a population level. An interest in public policy led him to the realization that, at least in the U.S., the financing mechanisms of the health care industry are “the main lever” that we have to this end. The question of how these mechanisms should (or could) be reengineered has guided Dr. Rajkumar through a career that has taken him from the clinic to the health insurance industry to government, where as deputy director at the Center for Medicare and Medicaid Innovation, he experimented with different approaches to organizing and paying for health care systems. The problem is “really, really hard,” he tells host Dr. Rishi Desai. Every single case “is a puzzle with a human being at the center of it.” Rajkumar believes more attention should be paid to what he calls ‘the black hole of American Medicine' – the period after a patient is discharged from the hospital when coordinating care becomes more difficult. “Is there an accountable provider, or a quarterback outside of the hospital? Someone who, beyond their professional ethic, actually cares about what happens to this patient? That's the nut of the issue.” Tune in to hear about novel payment systems emerging in the wake of the Affordable Care Act, the true social meaning of health insurance, and what other nations try to emulate about the famously dysfunctional U.S. health care system.

Bronwyn Spira is the CEO of Force Therapeutics which is supplying tools to manage procedure-based care. CMS  created CMMI, the Centers for Medicare and Medicaid Innovation to evaluate new alternate payment models and service delivery models that were designed to reward high-value, high-quality care while also reducing payments. They would reduce the payments to clinicians who were not meeting the performance standards but preferentially reimburse high-quality and high-value providers. And these were called alternate payment models or APMs.  Bronwyn explains, "I think the important key here is that in order to reward quality, you first have to be able to measure quality and collect quality measures. So this is where patient-reported outcome measures and performance measures become so key. You actually now need those measures to submit for reimbursement based upon the services you're providing." "And this has changed provided behavior in a big way because before these APMS were implemented, a lot of providers actually didn't even have organized ways to collect or report quality measures, patient-reported outcomes. Some of them were using pieces of paper or mailing them to patients' homes and then spending a lot of money on nurses or medical assistants who would then have to input the data into some kind of a system." @ForceTherEx #carecoordination #carepathways #careredesign #COVID19 #digitalcare #HospitalatHome #patientengagement #patientexperience #PhysicalTherapy #PROMS #Recovery #Rehab #RehabatHome #Rehabilitation #RehabTherapy #Treatment #ValueBasedCare ForceTherapeutics.com Listen to the podcast here

Bronwyn Spira is the CEO of Force Therapeutics which is supplying tools to manage procedure-based care. CMS  created CMMI, the Centers for Medicare and Medicaid Innovation to evaluate new alternate payment models and service delivery models that were designed to reward high-value, high-quality care while also reducing payments. They would reduce the payments to clinicians who were not meeting the performance standards but preferentially reimburse high-quality and high-value providers. And these were called alternate payment models or APMs.  Bronwyn explains, "I think the important key here is that in order to reward quality, you first have to be able to measure quality and collect quality measures. So this is where patient-reported outcome measures and performance measures become so key. You actually now need those measures to submit for reimbursement based upon the services you're providing." "And this has changed provided behavior in a big way because before these APMS were implemented, a lot of providers actually didn't even have organized ways to collect or report quality measures, patient-reported outcomes. Some of them were using pieces of paper or mailing them to patients' homes and then spending a lot of money on nurses or medical assistants who would then have to input the data into some kind of a system." @ForceTherEx #carecoordination #carepathways #careredesign #COVID19 #digitalcare #HospitalatHome #patientengagement #patientexperience #PhysicalTherapy #PROMS #Recovery #Rehab #RehabatHome #Rehabilitation #RehabTherapy #Treatment #ValueBasedCare ForceTherapeutics.com Download the transcript here

In this minisode, Mindy, Ryan, and Jen discuss a few recent newsworthy items including: 23andMe's intended entry into telehealth with the acquisition of Lemonaid Health (00:35), the Center for Medicare & Medicaid Innovation strategic plan refresh (04:15), a new partnership between Walmart and Transcarent (08:13), and the launch of virtual-first health plans (10:55) Podcast Tags: primary care, genetic testing, telehealth, CMMI, Medicare, self-insured employers, health plans, healthcare, healthcare news Source Links: · https://www.fiercehealthcare.com/tech/23andme-jumps-into-telehealth-prescription-drug-delivery-400m-buyout-lemonaid-health?utm_source=email&utm_medium=email&utm_campaign=HC-NL-FierceHealthIT&oly_enc_id=3569J2000334E1H · https://fortune.com/2021/10/22/dna-testing-giant-23andme-expands-into-telemedicine-with-400-million-lemonaid-acquisition/· https://innovation.cms.gov/strategic-direction-whitepaper · https://www.fiercehealthcare.com/payer/cmmi-rolls-out-strategic-refresh-to-make-payment-models-more-equitable-and-streamlined?utm_source=email&utm_medium=email&utm_campaign=HC-NL-FierceHealthPayer&oly_enc_id=3569J2000334E1H · https://www.fiercehealthcare.com/payer/hlth21-unitedhealthcare-optum-collaborate-new-virtual-first-plan-design?oly_enc_id=3569J2000334E1H · https://healthpayerintelligence.com/features/how-payers-can-launch-a-virtual-first-health-plan · https://www.healthcarefinancenews.com/news/unitedhealthcare-and-optum-launch-virtual-first-health-plan-design· https://www.modernhealthcare.com/patient-care/walmart-makes-headway-self-insured-space-transcarent-partnership · https://www.healthcarefinancenews.com/news/walmart-and-transcarent-partner-lower-costs-self-insured-market · https://www.healthcaredive.com/news/walmart-transcarent-partner-to-pitch-self-insured-employers/608355/ · https://www.fiercehealthcare.com/payer/walmart-unveils-employer-market-team-up-transcarent?oly_enc_id=3569J2000334E1H   For additional discussion, please contact us at TrendingHealth.com or share a voicemail at 1-888-VYNAMIC. Mindy McGrath, Healthcare Industry Advisor mindy.mcgrath@vynamic.comRyan Hummel, Executive and Head of Provider Sectorryan.hummel@vynamic.comJen Burke, Healthcare Industry Strategistjen.burke@vynamic.com

Where Is CMMI Going and Will We Follow? David Johnson and Julie Murchinson unpacked and unloaded on the new strategic objectives of the Center for Medicare and Medicaid Innovation on the new episode of the 4sight Friday Roundup podcast moderated by David Burda. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

The Center for Medicare and Medicaid Innovation set a new course for itself. How will that affect the transition to value-based care? We talked about it on today's episode of the 4sight Friday Roundup podcast. Here the week's biggest news around market-based change. David Johnson is CEO of 4sight Health. Julie Vaughan Murchinson is Partner of Transformation Capital and former CEO of Health Evolution. David Burda is News Editor and Columnist of 4sight Health. Subscribe on Apple Podcasts, Spotify, other services.

The world of health care has changed a lot in the past decade, and the Center for Medicare and Medicaid Innovation has been behind a lot of that change. In this episode, host Rachel Woods sits down with Liz Fowler, director of CMMI, to talk about what innovations CMMI has worked on in the past decade and where it's heading next. Plus, policy and strategy expert Ben Umansky debriefs with Rae to share his take on the agency's next steps. Links: Innovation At The Centers For Medicare And Medicaid Services: A Vision For The Next 10 Years | Health Affairs Innovation Center Strategy Refresh | CMS.gov Our latest on Policy and Payment

Mental health conditions, such as mood and anxiety disorders are diagnosed in one of every five pregnant or postpartum people. Despite this high burden of morbidity and mortality and economic costs, perinatal mental illness is poorly addressed by the current US healthcare system.Jennifer Moore, founding executive director of the Institute for Medicaid Innovation, joins A Health Podyssey to discuss perinatal mental health and what we know about it. Moore was the advisor for the October issue of Health Affairs, which collects a number of articles all on perinatal mental health. Those papers discuss several dimensions of the issue, including the health and economic costs of poor perinatal mental health; the relationship between mental health and physical health; and the role of race and racism and how the US approaches mental illness among birthing people.In the issue, Moore co-authored two papers. In the overview, she and colleagues explore policy opportunities to improve the treatment of perinatal mental health conditions. In another paper, Moore and coauthors found that mental health conditions increase severe maternal morbidity by 50% and cost $102 million annually in the US.Listen to Health Affairs Editor-in-Chief, Alan Weil, interview Jennifer Moore on perinatal mental health and what policy option exist to improve it.If you like this interview, order the October Perinatal Mental Health Theme Issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Join Health Affairs Insider.In October, Health Affairs published an issue dedicated to perinatal mental health.There has long been an awareness of the harm associated with perinatal depression and mood disorders. Perinatal depression and mood disorders occur in the context of social, economic, and other health conditions that affect the well-being of birthing people, families, and communities. Prevention, screening, and treatment can promote mental health in pregnant and postpartum individuals, but it is sporadic, and there are many missed opportunities as individuals seek and obtain care within the health care system and community.The purpose of this theme issue is to explore the policy opportunities and evidence behind those options for improving support for people before, during, and after giving birth. In today's episode of Health Affairs This Week, Senior Editors Leslie Erdelack, Ellen Bayer, and Kathleen Haddad discuss the publication process and highlight the research insights from the issue.Order the October Perinatal Mental Health Issue.Health Affairs thanks Jennifer Moore, founding executive director of the Institute for Medicaid Innovation, for serving as theme adviser for the perinatal mental health papers in the October issue. We thank the California Health Care Foundation, Perigee Fund, and ZOMA Foundation for their financial support of this issue.Related Links: Health Affairs' Perinatal Mental Health Issue A Humane Approach To Caring For New Mothers In Psychiatric Crisis (Health Affairs) Preventing Pregnancy-Related Mental Health Deaths: Insights From 14 US Maternal Mortality Review Committees, 2008-17 (Health Affairs) Perinatal Mental Health Care In The United States: An Overview Of Policies And Programs (Health Affairs) Subscribe: RSS | Apple Podcasts | Spotify | Castro | Stitcher | Deezer | Overcast

New research indicates women with mental health challenges have a 50% higher chance of having sever clinical conditions during labor or delivery. We talked about the research with Dr. Clare Brown, an assistant professor at the University of Arkansas for Medical Sciences. She led the research in collaboration with colleagues from the Institute for Medicaid Innovation in Washington, D.C.

Health Innovation Voices: Deeper Conversations (HIV-DC) Podcast Episode 4: Dismantling Racism: Explicit Biases within HIV Care Join us for the last episode of Season One of HIV-DC. In this deeper conversation about HIV, we talk about bias and racism in the medical setting. Joining us this episode is Dr. Brandon Wilson, a social science research analyst and project officer for the Center for Medicare and Medicaid Innovation, as well as a health equity advisor on rotation to CMS Office of Minority Health. In this engaging conversation, Dr. Wilson talks about how explicit bias influences medical care for people living with HIV, and what providers can do to create a safe and trusting relationship with patients to improve care.  Learning Objectives:  -To understand the historical impact of medical neglect of communities of color, particularly same gender loving men -To discuss current implications of implicit bias in clinical settings -To educate providers on strategies to combat bias -To highlight the importance of addressing biases in clinical settings

This past year has sparked a major care transition and greater awareness of the need for and value of home-based care. And that is our topic today – focusing on Landmark Health I have with me today two experts in the field: Adam Boehler, the founder and CEO of Landmark Health for its initial five years, and since then, former head of the Center for Medicare and Medicaid Innovation, the first CEO of the new U.S. International Development Finance Corporation, and now founder & CEO of Nashville-based Rubicon Founders.  And Nick Loporcaro, CEO of Landmark Health, who has led the company since 2018 following Adam's departure to government service.  Landmark is the largest provider of in-home medical care for seniors with complex chronic conditions, and operates in 18 states and growing. Our conversation today is a fascinating look at how two brilliant leaders can make a seamless management transition that allows an innovative, fast growing-company to maintain its culture and continue to grow, thrive, and further its mission for seniors with chronic disease.

Dr. Seymour is a family and functional medicine physician who joined the staff of the Environmental Health Center in 2015.  She learned, witnessed, employed and experienced the techniques and knowledge of Dr. Rea as together they examined patients.      She earned her B.S. in Biology at Texas Woman's University in Denton, TX where she graduated Magna Cum Laude and was a member of the Phi Theta Kappa Honor Society.  She earned an M.S. in Health Services Administration at St. Joseph's College in Standish, Maine, and her medical degree at St. Matthews University School of Medicine, Grand Cayman, British West Indies.  Her Postdoctoral Training was at Oklahoma University Health Sciences Center in Oklahoma City, Oklahoma as an Intern in Family Medicine from July 2006 – June 2007 and as a resident in Family Medicine from July 2007 – June 2009.    She's been vitally involved in the community serving as Board Chair for the Denton Area Teacher's Credit Union, as President of the Denton County Medical Society, and as a board member of Medical City Denton Hospital.  She has served on the Committee to Keep Denton Beautiful and on the Texas Dept. of Insurance Advisory Committee for the Standard Request Form for Prior Authorization of Medical Care or Health Care Services.  She also was the Chairperson on the Health Care innovation Challenge Grant Review, Center for Medicare and Medicaid Innovation. Dr. Seymour has been a Rotary Member, Denton, TX, for a decade.   Her community service has seen her serve as a volunteer for the Special Olympics, and as a Stephens County Science Fair Judge. She served on the Citizen's Advisory Committee for Denton ISD, Secondary Schools subcommittee. She was a volunteer assisting in the Integris Oral, Breast, and Prostate Cancer Screening. She has also been an Emergency Room Volunteer for the Denton Regional Medical Center. She's currently vice president of the Denton Lacrosse Board.   She was appointed to serve on Leadership America in 2018.  From July 2016 to May 2017 she served on the Texas Medical Association, Leadership College. She was appointed to serve from March 2012 to February 2014 on the Texas Academy of Family Physicians, National Conference of Special Constituencies (NSCS), and as an International Medical Graduate Delegate. From May 2012 – May 2014 she was appointed to serve as a Delegate to the Texas Medical Association's Council on Practice Management Services.    Dr. Seymour is board certified by the American Board of Family Medicine and is certified by the Institute of Functional Medicine. Finally, she is a fellow of the American Academy of Family Physicians.  

BONUS EPISODEAs part of Policy Spotlight, a new virtual event series from Health Affairs, Editor-in-Chief Alan Weil welcomed Elizabeth "Liz" Fowler, the new deputy administrator of the Centers for Medicare and Medicaid Services and director of its Center for Medicare and Medicaid Innovation to an in-depth discussion of Biden administration's plans and priorities for health care.The interview was conducted on June 3, 2021.As chief health council to then-Senate Finance Committee Chair Max Baucus (D-MT) at the time of the passage of the Affordable Care Act, Liz Fowler was a major force in crafting and shepherding the landmark legislation through the Senate. Later, as a vice president at The Commonwealth Fund, she was a contributor to Health Affairs' 2020 special issue marking the 10-year anniversary of the signing of the Affordable Care Act: The ACA At 10. In her current post, Dr. Fowler will play a key role setting priorities for the future of the ACA, insurance exchanges, Medicaid expansion, and a host of other issues critical to the quality, accessibility, and affordability of American health care. Policy Spotlight features conversations with influential health policy experts in Washington, DC, and beyond. Interested in learning who is next as a speaker? Sign up for Health Affairs Today or Health Affairs Sunday Update newsletters to be the first to hear about the upcoming events. Health Affairs is grateful to the Robert Wood Johnson Foundation and The Commonwealth Fund for their support of the “Affordable Care Act Turns 10” issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Dr. John Sweetenham, associate director for clinical affairs at the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern and editor-in-chief of ASCO Daily News, discusses compelling approaches in cancer care featured at the 2021 ASCO Annual Meeting, including key studies on financial toxicity, drug prices, disparities in clinical trial accrual, and the impact of the COVID-19 pandemic on cancer screening.   Transcript ASCO Daily News: Welcome to the ASCO Daily News podcast. I'm Geraldine Carroll, a reporter for the ASCO Daily News. My guest today is Dr. John Sweetenham, associate director for clinical Affairs at UT Southwestern's Harold C. Simmons Comprehensive Cancer Center. Dr. Sweetenham also serves as editor-in-chief of ASCO Daily News. He joins me to discuss compelling approaches in cancer care featured at the ASCO Annual Meeting, including key studies on financial toxicity, trends in oncology drug revenue, disparities in clinical trial accrual, and the impact of the COVID-19 pandemic. Dr. Sweetenham reports no conflicts of interest relating to our discussion today. Full disclosures relating to all episodes of the podcast are available at asco.org/podcasts. Dr. Sweetenham, it's great to have you on the podcast again. Dr. John Sweetenham: Thanks, Geraldine. It's good to be here. ASCO Daily News: There's been a lot of interesting research on the impact of the COVID-19 pandemic on patients with cancer. Sadly, the pandemic caused the postponement or cancellation of countless screening procedures. Abstract 6501 looks at the impact of the pandemic on stage presentation of breast and colorectal cancers. What can you tell us about this study? Dr. John Sweetenham: I think this particular study is very important because it is a confirmatory study of observations that have been made in other environments. But in this case, it's a single institution study from UC San Diego. The implication, the basis of this study, obviously, is that screening programs have really been critical in reducing death rates from certain cancers. And breast and colorectal cancer would probably be the best examples of that. And as we know, during the pandemic, many people postponed or cancelled their screening procedures. And so there have naturally been concerns about what that will do to stage at presentation, and an anticipation that we will see more patients eventually showing up for our services with more advanced stage of disease. So in this study, the workers at UC San Diego looked at their patients who had been treated in the years 2019 and 2020. And the treating clinicians used stage at presentation, which was determined by standard AJCC staging modules pulled out of their electronic medical record. And they did a pretty straightforward comparison of the stage distribution for their patients between 2019 and 2020. And they focused especially on colorectal and breast cancer because those are diseases where screening is known to have a significant impact. The interesting data from this study are that the total number of new patient visits for cancer during 2019 and 2020 were actually remarkably similar. And if you look at the stage distribution across all cancer types and compare 2019 and 2020, there really isn't very much difference. But what's disturbing is that for patients with breast cancer, they observed a lower number of patients with stage I disease, which reduced from 64% in 2019 to 51% in 2020, and a higher number of patients presenting with stage IV disease, which went from 2% to 6%. And very similar trends were seen for the patients with colorectal cancer, where they saw a decline in stage I presentations and an increase in stage IV presentations. So these are, again, confirmatory data which highlight the problem with delayed screening. The investigators mentioned that they're going to continue to follow these numbers closely and are planning to present data from their experience in 2021 as well. I think that what this does is really--it emphasizes the need for us for ongoing efforts to encourage our patients to return to care, to return to their screenings, and frankly, to get vaccinated so that they will have more confidence in coming back and returning to care. ASCO Daily News: Thank you for sharing these data. There are a lot of financial toxicities associated with cancer care. And there's an interesting study, Abstract 6504, that uses data from patients' credit reports to measure the relative risk of adverse financial events in cancer patients after diagnosis compared to individuals without cancer. Can you tell us more about this? Dr. John Sweetenham: Yes. And my first disclaimer would be that I'm certainly not a health economist. But as someone who is a non-expert in this domain, I found this to be a very interesting study which looked at the relative risk of adverse financial events in patients with cancer compared with a control group. And it did this by using data that they pulled from the patient's credit reports, which, from my perspective, is a really interesting way of looking at the financial hardship. And the way they did this was they used the Western Washington SEER cancer registry for their cases who they investigated in this study. And they used the voter registry to identify their control patients or control cases, I should say. And then they used data from one of the credit reporting agencies to look for signals for what they describe as adverse financial events in the patients with cancer compared with the population. And they were able to identify levels of severity of adverse financial effects within this analysis. So to cut to the chase here, what's interesting is they identified more than 300,000 individuals, of whom just over 84,000 were patients with cancer. And the remaining 250,000 or so were control patients. And they looked at the available line of credit for these patients, and then also looked for signs of what they described as severe, or more severe, or most severe adverse financial effects. And the most severe would have been, for example, foreclosures on homes or repossessions of homes and properties. So obviously, pretty significant and very serious adverse financial effects. And if we just look overall at their results, so for example, severe adverse financial effects, there was a highly significant difference which demonstrated that these were significantly more common in the population of patients with cancer, the same being true for both the more severe and the most severe adverse effects. And so, in a way, you could argue not surprising. But I think it put some numbers around the fact that there are long lasting effects financially for our patients with cancer, for a significant proportion of them, as a direct consequence of their diagnosis and compared in quite a robust way against a non-cancer population. And these are real life and very long term consequences, so something that we just have to keep uppermost in our minds as we're planning the financial advice and the financial navigation that we provide to our patients during their cancer journey. ASCO Daily News: Absolutely. Well, let's focus on the price of cancer drugs. Abstract 6505 looks at trends in oncology drug revenue among the world's major pharmaceutical companies. The study's authors cite a 70% increase in the number of clinical trials for cancer drugs over the past decade, and a substantial increase in the price of cancer drugs. In fact, the study found a 96% increase in sales revenue from cancer drugs among the world's top pharmaceutical companies over the past decade. So what are your thoughts about this? And why, in your opinion, is this study important? Dr. John Sweetenham: Thanks, Geraldine. Yes, I think that this study is important on a number of levels. I think when one first looks at the results of this study, it would be easy to conclude that, well, this is just one more piece of data that shows that the cost of cancer drugs is rising and is too high. And that's reflected in the extraordinary financial toxicity that we see in our patients with cancer. And you know, I think that there are elements of that which are probably true. But I do think there are other interesting observations from this. For example, as you mentioned, they demonstrated that sales revenue from cancer drugs has increased by more than 96%. And interestingly, revenues from non-cancer drugs among the same companies have actually decreased during that time. I would also mention, because it may be relevant, that although the analysis primarily included true antineoplastic drugs, they did include a number of supportive care drugs in this analysis as well, which are primarily used in patients with cancer. And so, certainly, I think in addition to the antineoplastic drugs, probably, the supportive care drugs have been part of the driver of this increase in revenue. The other interesting part of this is that during the study period, oncology revenues have grown, whereas revenues for other non-oncology drugs across all of the companies involved have remained stagnant. So what can we draw from this? First of all, as I said, I think the message about the cost of drugs is familiar to all of us and is not a new one. I think it is very interesting that there's been a 70% increase in the number of clinical trials of cancer drugs. And I think what that's telling us is that clearly, there has been enormous activity and substantial opportunity for the development of new cancer drugs. So as we look at these numbers, I think one of the positive spins to put on this is the fact that there are a lot more anti-cancer drugs coming online, a lot more trial activity. And in the long run, I think that has to be good for our patients. And we should be, to some extent, reassured by the fact that there are so many more drugs. I think also, what's interesting, although I certainly wouldn't editorialize over this, is the fact that this apparent explosion in activity and revenue around anti-cancer drugs has apparently been at the relative disadvantage of patients with other diseases, not really a thing for us to comment on that from what I classify as an editorial perspective. But I think the message for us and for our patients from this study is mixed, that, yes, there does seem to be some imbalance in terms of the amount of revenue generated out of these drugs. On the other hand, there are many of these agents now in clinical trials and on the market that weren't there a number of years ago. And overall, I think that that indicates the positive side of this story. ASCO Daily News: Well, I'd like to address a very important and timely topic, access to care. Abstract 100 reports the outcomes of a 5-year initiative of community outreach and engagement to improve enrollment of adult Black patients in clinical trials. How would you assess this initiative? Dr. John Sweetenham: I think this initiative and the results that they've produced really underlines, more than anything else, number one, the complexity that is involved in addressing this issue and the sort of multifaceted approach one has to minority accrual. And secondly, it underlines to me that there's no quick readout. One has to wait a while to see the effects of this kind of intervention. And there have been successful attempts to improve minority accrual to clinical trials. There are many ongoing initiatives. What struck me as being interested about this study from the University of Pennsylvania was the kind of multi-pronged approach they took to this. So they report that in 2014, Black residents comprised 19% of their population, [and] 16% of the cancer cases seen in the Philadelphia area. But only 11% of patients at the Abramson Cancer Center at the University of Pennsylvania were Black. And the number of Black participants who were recruited onto their treatment and interventional studies were relatively low, ranging between 8% and 13%, depending upon the type of study. So they developed a center-wide program with a number of key elements, which included tailored marketing. They had plans within each individual protocol for how they were going to enroll African American patients. They developed partnerships with faith-based organizations and conducted educational events. They provided Lyft and Ride Health to address transportation barriers. They had patient education by nurse navigators and an improved informed consent process. So they really approached this addressing several of the factors that play into the disparity in clinical trials accrual. And what they found is after 4 to 5 years of taking this approach, the percentage of Black patients seen at their center had increased to 16.2 from 11.1. And when they looked at the percentages of African American patients who they accrued onto their trials, it was really quite substantially increased. So if you remember, prior to this intervention, the range was from 8% to 13%. At the conclusion of this study, the rate was from 22% to 33%. So they had seen a 1.7 to 4-fold increase in 5 years. So I think that this persistent multi-pronged approach addressing many of the factors that play into these disparities was really interesting. And it demonstrates that to really make a significant impact on some of these disparities requires a lot of work over a long period of time. And as I said, the readout may not come immediately. It takes a while for the effects to truly be seen. ASCO Daily News: Exactly. Some great approaches there for people to look at in Abstract 100. Well, my final question relates to concerns from health insurers, that clinical trial participation can increase the total cost of care for patients. So in this study, Abstract 6513, investigators looked at the impact of clinical trial participation on total costs paid by Medicare during the oncology care model program in a large community-based practice. Can you tell us more about this study? Dr. John Sweetenham: Yes. This is an interesting study which is based on patients enrolled into the oncology care model. For those who may not be aware of this model, it's an alternative payment model which has been developed by the Centers for Medicare and Medicaid Innovation to address improvements in quality of care, as well as address issues of cost of care for patients with cancer. This study is based out of the community-based practice of 90 oncologists who practice [at] over about 30 sites of care. And what they did in this study was to link trial data and electronic medical record data with data generated from the oncology care model for patients undergoing treatment for various cancers between 2016 and 2018. And important to point out that the OCM includes patients who are Medicare beneficiaries only, so represents patients over age 65. And what they were trying to address in this study was whether the entry of patients onto clinical trials actually results in increased costs, which is, I think, some of the sort of received wisdom that's out there, that clinical trials are expensive. The OCM provides a slightly more controlled environment in which to study that and find out whether costs of care associated with clinical trials actually do overall increase the cost of care, something which clearly will be of great interest to insurers. So in addition to exploring this from the perspective of antineoplastic treatment, the group also had the opportunity to look at some non-trial episodes, and in particular, study the impact of the receipt of active treatments in the last 14 days of life as well as hospice use and hospitalizations. So these are other kind of issues which are important to us now which the OCM provides a window on. So the study was conducted and included just over 8,000 OCM episodes which met criteria for the study. And of those, 459 of the episodes included patients who were on a clinical trial. And interestingly enough, on average, episodes when the patient were on a clinical trial cost almost $6,000 less than matched non-trial episodes. And it was independent of whether it was an early phase or a late phase study. And interestingly, but perhaps not surprisingly, the primary reason for these lower costs was because of the increased drug costs. Because typically, the cost of the drug would have been covered by the trial. Interestingly, there were no differences in the rates of treatment within the last 14 days for the patients who were on the study. And there was no difference in rates of hospitalization or hospice use for the patients who were on the studies either. So the take-home message from the study was that the inclusion of patients in a clinical trial actually, overall, led to a reduction in Medicare costs for Medicare beneficiaries. And so it didn't support the concern that many third party payers have, that entry of their covered patients onto clinical trials actually cost more. Just one possible note of caution is that this was a community oncology-based practice. And it's possible that the breakout of patients on early phase versus late phase clinical trials might have been very different from what we might encounter in a more academic oncology setting. But nevertheless, I found this to be an important study which, to some extent, explodes a misconception that putting patients on studies costs a lot more money. ASCO Daily News: Absolutely. Well, Dr. Sweetenham, thanks for highlighting some really interesting studies on a range of very important issues impacting the cancer care community. Dr. John Sweetenham: Thanks, Geraldine, a pleasure as always. ASCO Daily News: And thank you to our listeners for your time today. If you enjoyed this episode, please take a moment to rate and review us wherever you get your podcasts.   Disclosures:  Dr. John Sweetenham: None disclosed.  Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

This episode features a conversation between Lucia Rojas-Smith, DrPH, MPH, Director of the Center for Community Health Evaluation and Economic Research at RTI and Shannon O'Connor, PhD, MS, MA, a social science research analyst at the Center for Medicare and Medicaid Innovation. This session is the fourth in a series focused on health care sector efforts to provide Assistance to patients to reduce their social risks. Drs. Rojas-Smith and O'Connor discussed findings from the Accountable Health Communities (AHC) Model's first annual report. Recommended references: Accountable Health Communities (AHC) Model Evaluation. First Evaluation Report. 2020. CMS. Building strong community partnerships to address social needs: a case study in effective advisory board collaboration from the Accountable Health Communities model. 2021. Holcomb et al. Developing and evaluating a quality improvement intervention to facilitate patient navigation in the Accountable Health Communities model. Front Med. 2021. Gottlieb et al. Evaluating the Accountable Health Communities demonstration project. J Gen Intern Med. 2017.

  The episode opens with a discussion of what’s spurring these changes (00:50), including the importance of the establishment of the Center for Medicare and Medicaid Innovation (05:11) and the Quadruple Aim (06:45). Over the last decade, ACO models have been a huge source of savings and learnings for CMS (07:13), and even commercial markets (10:05). Reimbursement truly sets the tone and shape for care model innovation (13:17), whether we’re talking about Next Generation ACOs, Direct Contracting (14:28), or even Direct-to-Employer Contracting (18:00). As care model innovation continues, healthcare leaders should be thinking beyond the technical aspects (20:48), not overlooking the importance of change management, capability building, and culture development. Podcast Tags: healthcare, care models, innovation, ACO, direct contracting, quadruple aim Source Links - Below, we've listed links to some of the stories and resources discussed on this show. · https://innovation.cms.gov/innovation-models#views=models · https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs#:~:text=The%20Medicare%20Access%20and%20CHIP,the%20Quality%20Payment%20Program%20that%3A&text=Streamlines%20multiple%20quality%20programs%20under,Based%20Incentive%20Payments%20System%20(MIPS) · https://robertpearlmd.com/lessons-macra/ · https://www.fiercehealthcare.com/payer/naacos-calls-for-becerra-to-stem-losses-aco-participation-calls-for-increase-to-aco-savings?mkt_tok=Mjk0LU1RRi0wNTYAAAF7_ioIe6hTHSK2F64EV9LUrhxTPE2HHobV27D-br6GMS2McZnhTwnbCbARn-XYqXeQZKR0hxDk7zwo3jCO_HGwDI9r6-bt8PjKqfYW_ahOZHX3S5Iu_eA&mrkid=152778267 · https://innovation.cms.gov/innovation-models/gpdc-model · https://www.fiercehealthcare.com/payer/industry-voices-direct-contracting-providers-opportunity-for-forward-thinking-employers?mkt_tok=Mjk0LU1RRi0wNTYAAAF8HRFPlmGwEzapC2b0t14Ks8pYOt74YCWHjBNyzp6ltMGGTkhsg1WzuO7GYD5Jfufw6ninujRfZX6Px4mZyy4tXYxDnoIQ54Zl-ViUHmz8XNLJPnb9xYY&mrkid=152778267 For additional discussion, please contact us at TrendingHealth.com or share a voicemail at 1-888-VYNAMIC. Mindy McGrath, Healthcare Industry Learning Lead mmcgrath@vynamic.com Ryan Hummel, Head of Provider Sector rhummel@vynamic.com Jen Burke, Healthcare Industry Strategist jburke@vynamic.com  

Featuring articles on dexamethasone treatment in Covid-19, BCMA-specific CAR T cells in refractory myeloma, a cholinergic agonist and peripheral antagonist for schizophrenia, the Center for Medicare and Medicaid Innovation at 10 years, inflammation in ALS, and how structural racism works; a review article on β-thalassemias; a case report of a man with eye pain and decreased vision; and Perspective articles on last-mile logistics of Covid-19 vaccination, on telemedicine and medical licensure, and on the inequity of isolation.

In our latest episode, I had a chance to chat with Kelsey Mellard, Founder and CEO of Sitka. Sitka is a peer-to-peer, asynchronous video messaging platform and specialist network. Sitka connects clinicians to top specialists, alleviating the challenges of scheduling and geographic limitations and compressing the cycle of care by enabling rapid decision making. Sitka is backed by Optum Ventures, First Round Capital, Rock Health, Homebrew, Box Group, and Lifeforce Capital. Kelsey shares insights into the role telehealth plays in the transition to value-based care, how Sitka is bringing specialty expertise to the front lines, and the importance of trust, transparency, and reliability in healthcare delivery. We also reflect on Kelsey's personal career journey prior to founding Sitka, where Kelsey held positions at Honor Homecare, naviHealth, UnitedHealth Group, the Center for Medicare and Medicaid Innovation and the Kaiser Family Foundation.

SCAN Group and Health Plan CEO, Dr. Sachin Jain, discusses the "left turns" he took to become CEO of two large health systems and help launch the Center for Medicare and Medicaid Innovation all within the time it can sometimes take to finish fellowship. Join for a discussion around healthcare management, health policy, the MD/MBA pathway and getting out of the "PGY mindset". --- Send in a voice message: https://anchor.fm/tdio/message

As someone who has been in the middle of healthcare policy and reform in the U.S. for decades, John McDonough has a unique perspective on how the rapidly changing political climate in Washington will impact the healthcare industry.John’s dedication to public health began in 1985 after he was elected to the Massachusetts House of Representatives where he co-chaired the Joint Committee on Health Care until 1997. He later played a key role in the passage and implementation of the 2006 Massachusetts health reform law as Executive Director of Health Care for All, the state’s leading consumer health advocacy organization. With that experience, the U.S. Senate tapped John as Senior Advisor on National Health Reform from 2008 to 2010, where he worked on the development and passage of the Affordable Care Act. John is currently Professor of Public Health Practice at the Harvard T.H. Chan School of Public Health and is the author of three books including, Inside National Health Reform and Experiencing Politics: A Legislator’s Stories of Government and Health Care. In this edition of the Healthcare Is Hard podcast, Keith Figlioli asks John to draw upon his years developing and implementing healthcare policy to reflect on the outcome of the recent election and the implications it will have for the healthcare industry. The topics they address include:Steering a divided government. John talks about how historically rare it’s been for a Democratic president to take office without majorities in the House and Senate – something that hasn’t happened since Grover Cleveland in 1884. He discusses what that will mean for a Biden administration, unless Democrats are successful in their longshot bid for two Senate seats in Georgia’s runoff elections.Presidential regimes that define decades. John shares a theory about how era-defining presidents set a course that lasts well beyond their terms to cross decades and multiple administrations. The last era began with FDR who changed the national discussion and tone when he took office in 1933, and lasted until the end of the Carter administration. The Regan revolution set a new tone in the 1980s, rooted in competition and capitalism, that has impacted all areas of society including healthcare. Historically, each era has ended with a national calamity – the Great Depression during Hoover’s term, the energy and Iran hostage crisis for Carter – and a one term president. John ponders whether the coronavirus pandemic and President Trump’s single term could be the beginning of an era-defining Biden administration.The ACA’s little secret. After more than 10 years, John believes the ACA has stood the test of time, causing changes in delivery systems, accountable care organizations, bundled payments and the value-based care revolution to become embedded in the structure of the U.S. healthcare system. The secret about the ACA, he says, is that both Democrats and Republicans support this approach and don’t want to see it dismantled because they don’t have ideas to replace it.Strengthening CMMI. President Obama’s administration used the Center for Medicare & Medicaid Innovation as a vehicle for change, and John expects a Biden administration to rely on it even more. He sees a new administration testing the limits of executive authority and being aggressive at using CMMI to take risk and demonstrate feasibility of ideas that can then be implemented more broadly.To hear John and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

VPR Director of Operations Sean Bielawski talks with co-host Audrey McClurg (MPP '21) about how she became interested in health policy and her experience with the Institute for Medicaid Innovation (2:00). Sean and Audrey then speak with Batten Professor Adam Leive (10:45) about his research around the impact of work requirements on SNAP participation and labor supply, healthcare, and COVID's potential impact on social welfare programs. Related Reading Employed in a SNAP? The Impact of Work Requirements on Program Participation and Labor Supply (link) Medicaid Work Requirements – Results from the First Year in Arkansas (link) Is the Social Safety Net a Long-Term Investment? Large Scale Evidence from the Food Stamps Program (link) How Racism has Shaped Welfare Policy in America since 1935 (link) Does One Medicare Fit All? The Economics of Uniform health Insurance Benefits (link) Acknowledgments Music: Blue Dot Sessions Voiceover: Zach Mendez Editing: Ben Feldman, Ben Teese & Sean Bielawski Disclaimer Although this organization has members who are University of Virginia students and may have University employees associated or engaged in its activities and affairs, the organization is not a part of or an agency of the University. It is a separate and independent organization which is responsible for and manages its own activities and affairs. The University does not direct, supervise, or control the organization and is not responsible for the organization's contracts, acts, or omissions.

Insurance carriers have begun publicizing their 2021 Medicare Advantage plans, as seniors can start enrolling in the plans October 15. According to a recent announcement from the Centers for Medicare & Medicaid Services (CMS), carriers are including more supplemental benefits with each plan year cycle to address social determinants of health and chronic conditions, and to enable beneficiaries to age at home. Tyler Overstreet Cromer at ATI Advisory is a leading expert on supplemental benefits that began in 2019 after the CMS changed some of the rules surrounding plan development. In this episode of the Home Leadership Series, Doug Robertson and Tyler chat about the supplemental benefit changes and what they mean for home care. Tyler gained more than a decade of experience in federal health policy and budget at the Office of Management and Budget (OMB). She now advises ATI clients on innovative financing and delivery models. Most recently, Tyler served as a senior executive at the OMB providing oversight and expertise for budget development and execution across the U.S. Department of Health & Human Services. She is particularly interested in payment policy and healthcare delivery system reform and in providing insights to ATI clients from her years of experience shaping federal policy on these topics. Tyler was in on the ground floor of many of the reforms to traditional Medicare, having led efforts at the OMB related to the Center for Medicare & Medicaid Innovation since its inception until her arrival at ATI. Tyler also worked on the initial design and regulations implementing the Medicare Shared Savings Program. She has provided oversight of and guidance for various other health programs and agencies, including the Older Americans Act programs administered by the Administration for Community Living, federal policy related to electronic medical records, and the administrative budget of the CMS.

The way we deliver healthcare has changed enormously over the last century, shifting from house calls by doctors to your own to institutionalized settings like hospitals and clinics. But now that trend has started to shift again, as some of the care we get in the hospitals and clinics has been "unbundled" back towards home settings for chronically ill patients or seniors. And now, of course, the impact of COVID-19 has created a huge sudden demand for home-based care, as all of us try to figure out how to manage certain healthcare needs at home.So, is home-based healthcare better? And what do we truly need to deliver the best care to patients, in their own homes? What do we gain and lose in different care delivery settings, and what shifts of mindset and new logistical processes do we need now, to best accomplish unbundling healthcare into the home? In this conversation, Vijay Kedar, CEO and cofounder of Tomorrow Health, a tech platform that delivers the products and services needed for home-based care; Sachin Jain, physician, previous CEO of Caremore and Aspire Health; part of the founding team at CMMI, the Centers of Medicare and Medicaid Innovation, now incoming CEO of The Scan Group and Healthplan; and a16z General Partner Julie Yoo join a16z's Hanne Tidnam in conversation to talk about where we are today and where we are going in home-based healthcare.

In this episode, Adaeze Enekwechi, PhD, MPP, President at IMPAQ joins the show to discuss the importance of lived experience when talking about social determinants of health. We discuss government programs and policies that challenge SDoH, innovative solutions that stand out, and where we're headed as an industry. To connect with Adaeze: LinkedIn: https://www.linkedin.com/in/adaeze-enekwechi-phd/ Read Adaeze's article in Health Affairs: "It’s Time To Address the Role of Implicit Bias Within Health Care Delivery.” Dr. Adaeze Enekwechi is the President of IMPAQ, a 400 person policy research and analytics firm that comprises three entities: IMPAQ International, a public policy research and analytics firm; Maher & Maher, a learning solutions provider; and ASCEND, a technology and information product company. Dr. Enekwechi provides strategic oversight of all research, technical assistance, and technology services across all policy and program areas, including health care, workforce development, social programs, and international development. Prior to joining IMPAQ, Dr. Enekwechi served as Vice President for Policy, Strategy, and Analytics with a consulting firm. She also served as the Associate Director for Health Programs at the White House Office of Management and Budget (OMB) under President Obama. As the Federal government's chief health care budget official, she provided policy, management, and regulatory oversight for over $1 trillion in spending on a range of Federal programs, including the Centers for Medicare & Medicaid Services, Centers for Disease Control and Prevention, the National Institutes of Health, and all Federal health agencies. At the OMB, Dr. Enekwechi managed the review and approval of all major Center for Medicare & Medicaid Innovation reform proposals, Medicare Access and CHIP Reauthorization Act of 2015/Quality Payment Program rulemaking, and many Food and Drug Administration policies, Medicaid negotiations, Zika, and other public health funding requests. Dr. Enekwechi is highly experienced with the Affordable Care Act (ACA) implementation, playing a key role in driving ACA budget, policy, strategy, and operational coordination with various agencies, including the Department of Treasury, the Internal Revenue Service, and the Office of Personnel Management, among others. Dr. Enekwechi completed a BA at the University of Iowa, an MPP at the American University, and a PhD in Health Services and Policy from the University of Iowa. Her research area covers social determinants of health, long-term care, and evidence based policymaking. Dr. Enekwechi is a Research Associate Professor of Health Policy and Management at the Milken Institute School of Public Health at the George Washington University and was a Visiting Professor at Meharry Medical College in Nashville, TN. Her teaching focuses on Federal health policy, the US health care infrastructure, health equity, and evidence-based policymaking. She also serves on the boards of directors and advisors for a number of health care organizations.

Jay Want, MD, is Executive Director of the Peterson Center on Healthcare. He leads the Center’s expanding portfolio of initiatives and grants to identify high-performance models of healthcare, validate their impact on quality and cost, and facilitate their adoption on a national scale. Dr. Want brings decades of experience in healthcare delivery, improvement science, data transparency and executive leadership. His background as a primary care physician further grounds the Center in its work to enable physicians, partnering with patients and care teams, to transform healthcare delivery from within the system. Formerly Chief Medical Officer and Board Chairman at the Center for Improving Value in Health Care, Dr. Want has significant expertise in creating public-private partnerships that support the transparency necessary for healthcare transformation. He has also consulted for the Network for Regional Healthcare Improvement, the Center for Medicare and Medicaid Services, and the Robert Wood Johnson Foundation. Dr. Want has also served as an Innovation Advisor for the Center for Medicare and Medicaid Innovation and was the President and Chief Executive Officer of a management services organization that is now part of the Medicare Shared Savings ACO Program. He served on the board of the non-profit Rocky Mountain Health Plan and on task forces for the Colorado Division of Insurance, the Colorado Trust, the Colorado Hospital Association, the Governor’s Blue Ribbon Commission on Health Care Reform, as a commissioner on the Colorado Commission for Affordable Health Care, and as a fellow of the Colorado Health Foundation. Dr. Want received his internal medicine training at the University of Colorado Health Sciences Center, his medical degree from Northwestern University and his undergraduate degree from Wabash College. Click here to learn more.

In this episode of Health Fail, Steven & Zac sit down with Niall Brennan, former CDO of HHS & current President & CEO of the Health Care Cost Institute. They discuss Niall's fascinating story of immigrating to the US from Ireland with nothing but his "rucksack" on his back and his education from the "University of Life". In the conversation Niall shares his perspective on the failures of our health system, what it’s like working within the US government and why there is an unbroken line of rising healthcare costs. Resources:Health Care Cost Institute Martin Gaynor Hospital Merger ResearchPatrick Conway CEO of BlueCross BlueShield North CarolinaCenter for Medicare & Medicaid Innovation

This week hosts Mark Masselli and Margaret Flinter speak with Adam Boehler, Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services at HHS. They discuss ways the agency hopes to “blow up fee for service” and the efforts underway to propel the nation’s primary care reimbursement structure towards shared risk and value-based care, rewarding clinicians for better outcomes. The post Propelling Primary Care Towards Value-Based Care: Adam Boehler, Director of the Center for Medicare and Medicaid Innovation at HHS on Their Bold Agenda appeared first on Healthy Communities Online.

Lauren S. Hughes, MD, MPH, MSc, FAAFP, is a practicing family physician and Deputy Secretary for Health Innovation in the Pennsylvania Department of Health. In this role, she creates and leads statewide strategies to improve health and health care delivery for all Pennsylvanians, with a focus on initiatives combatting the opioid and heroin epidemic and transforming rural health care delivery. “The Pennsylvania Rural Health Model is designed to provide greater financial stability and predictability for rural hospitals.” Prior to joining the Department, she was a Robert Wood Johnson Foundation Clinical Scholar at the University of Michigan where she studied health services research. “(The Pennsylvania Rural Health Model) also provides rural hospitals with a volume to value pathway to transform how to deliver care to better meet the community’s health needs.” She holds degrees in zoology and Spanish from Iowa State University, an MPH in health policy from The George Washington University, and a medical degree from the University of Iowa. Dr. Hughes served as the national president of the American Medical Student Association for one year prior to completing her residency at the University of Washington in Seattle. She has volunteered through AmeriCorps in a federally qualified health center, worked for Iowa Senator Tom Harkin, and studied medicine and health systems in Brazil, Sweden, Tanzania, and Botswana. Dr. Hughes has also been a visiting scholar at the Robert Graham Center, ABC News Medical Unit in New York City, the Center for Medicare and Medicaid Innovation, and The Commonwealth Fund. In 2015, she was named a regional finalist in the White House Fellows program, and in 2016, a recipient of the Women Leaders in Medicine Award from the American Medical Student Association and the Early Career Achievement Award from the University of Iowa Carver College of Medicine. In 2017, she was elected to a five-year term on the American Board of Family Medicine Board of Directors, and in 2018, as a Presidential Leadership Scholar.

Recently, Barbara McAneny, MD, the current president of the American Medical Association (AMA), visited The American Journal of Managed Care® (AJMC®)’s office for a wide-ranging discussion on new payment models, transforming care, and the work of the AMA. McAneny is an oncologist who has been at the forefront of transforming care for patients with cancer. In 2012 she and her organization, Innovative Oncology Business Solutions, received a $19.76 million grant by the Center for Medicare and Medicaid Innovation to develop a community oncology medical home model. The model was implemented in 7 practices and aimed to improve patient care, outcomes, and satisfaction, while reducing costs. She will be the keynote speaker November 16 in Philadelphia at Patient-Centered Oncology Care®, AJMC®’s annual multistakeholder meeting featuring payers, providers, and patient advocates. Read more: The Future of Oncology? COME HOME, the Oncology Medical Home: https://www.ajmc.com/journals/evidence-based-oncology/2013/2013-1-vol19-sp1/the-future-of-oncology-come-home-the-oncology-medical-home/ AMA Chooses Oncologist Dr Barbara McAneny to Lead as President-Elect: https://www.ajmc.com/newsroom/ama-chooses-oncologist-dr-barbara-mcaneny-to-lead-as-president-elect Patient-Centered Oncology Care®: www.ajmc.com/pcoc2018 Implications of OCM Reports and the Future of the Program: https://www.ajmc.com/newsroom/implications-of-ocm-reports-and-the-future-of-the-program The Price of Innovation When Improving Cancer Care Delivery: https://www.ajmc.com/conferences/accc-2018/the-price-of-innovation-when-improving-cancer-care-delivery

Providing an open channel of communication between pharmacists and patients, medication therapy management (MTM) allows pharmacists to optimize medications for their patients and patients to take an active role in their healthcare. As MTM services help pharmacists better understand how different medications interact with each other, MTM has been recommended as a way to identify and prevent opioid misuse. In an effort to provide greater incentive for Part D sponsors to use MTM programs, the Center for Medicare and Medicaid Innovation launched in January 2017 the 5-year Part D Enhanced Medication Therapy Management (eMTM) Model. The model is assessing whether incentives, such as payment and regulatory flexibilities, will result in enhancements in the MTM program, ultimately leading to improved patient outcomes and reduced costs. In this podcast, we speak with Brian Litten, JD, chief strategic officer, Tabula Rasa HealthCare; and Calvin Knowlton, BScPharm, MDiv, PhD, chief executive officer and founder of Tabula Rasa HealthCare, to get more insight into MTM and the eMTM model.

Brownstein Policy Director Cate McCanless, Of Counsel Peter Goodloe and Policy Advisor Laura Johnson join Strategic Advisor Sen. Mark Begich for a discussion on the last gasp of the repeal and replace effort with the Graham-Cassidy health care bill and the recent request for information from the Center for Medicare and Medicaid Innovation on the future direction of the Innovation Center.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care stories included a new direction for the Center for Medicare and Medicaid Innovation; a bipartisan group of governors spoke out against the latest effort to repeal the Affordable Care Act; and the World Health Organization warned that antibiotics currently being developed were not enough to fight antibiotic-resistant infections.

What Should America’s Health System Look Like? Vikrum speaks with Emma Sandoe (profile), who previously worked for the Centers for Medicare & Medicaid Services serving as the Medicaid spokesperson and working on HealthCare.gov communications as well as the Center for Medicare and Medicaid Innovation. Center.  She also worked in the Department of Health and Human Services Budget Office as the Affordable Care Act coordinator and at the Center for American Progress. The Capitol Hill health care fight sure seemed dead. After Republican proposals to overhaul the Affordable Care Act, also known as Obamacare, failed to pass a Republican-controlled Congress, lawmakers looked poised to move on to other topics, like a tax overhaul. But this week, proposals from both the left and the right are grabbing headlines. (Meanwhile, some members are also wrangling over how they can stabilize Obamacare.) On Wednesday came a “Medicare for All” bill from Vermont Independent Sen. Bernie Sanders — his attempt to push single-payer health care, long one of his favorite causes. In a Wednesday op-ed in the New York Times, the former presidential candidate wrote about single-payer health care as a moral issue, giving it his familiar populist framing. “We remain the only major country on earth that allows chief executives and stockholders in the health care industry to get incredibly rich, while tens of millions of people suffer because they can’t get the health care they need,” he wrote. “This is not what the United States should be about.” Sandoe earned a Masters in Public Health from George Washington University and attended UC San Diego for undergraduate studies. Sandor is currently a PhD candidate in the Harvard Program in Health Policy studying Political Analysis.  

Date: February 24, 2011 Featuring: Rick Gilfillan, MD, Acting Director, Center for Medicare and Medicaid Innovation Most of us are familiar with the various demonstration projects the Centers for Medicare & Medicaid Services (CMS) has sponsored over the years. This year CMS is taking the notion of figuring out “what works” when it comes to better patient care to an entirely new level, with the launch of the Innovation Center at CMS. Rick Gilfillan, fresh from helping to redesign payment methods at the Geisinger Health System to align with quality outcomes — and gaining national recognition as a result — is now applying his passion for improvement to the country as a whole. As the Innovation Center ramps up, Dr. Gilfillan is eager to keep everyone up to date with what’s on the broader agenda and what’s most immediately in store. WIHI host Madge Kaplan talks with Dr. Gilfillan, who explains the strategy behind the Innovation Center and the prospects for seeding much more robust work with both new payment and service delivery models. Dr. Gilfillan is not alone in believing that a lot of great models exist already. The challenge comes in first harnessing these best practices and then spreading them. It’s this last issue that he has been hearing about in spades; the need to diffuse new models quickly and effectively has never been greater and requires a national learning network and infrastructure that currently doesn’t exist, but can be created.

Daneen Grooms, MHSA, is ASHA’s director of health reform analysis and advocacy. Her focus is on advocating for the inclusion of audiologists and speech-language pathologists in health reform initiatives, including alternative payment models.   She is liaison to the Center for Consumer Information & Insurance Oversight and the Center for Medicare and Medicaid Innovation in the Centers for Medicare & Medicaid Services (CMS).   This episode is not just for Speech Therapists. Daneen visits with Scott about how current and future healthcare changes are affecting not only therapy but private practice.    

Former Congressman Tom Price is our new Secretary of Health and Human Services, making him the chief law enforcement officer of health care policy in the United States. In this episode, hear highlights from his Senate confirmation hearings as we search for clues as to the Republican Party plans for repealing the Affordable Care Act. We also examine the 21st Century Cures Act, which was signed into law in December. Please support Congressional Dish: Click here to contribute with PayPal or Bitcoin Click here to support Congressional Dish for each episode via Patreon Mail Contributions to: 5753 Hwy 85 North #4576 Crestview, FL 32536 Thank you for supporting truly independent media! Recommended Congressional Dish Episodes CD048: The Affordable Care Act (Obamacare) CD123: Health or Profits Bill Outline H.R. 34: 21st Century Cures Act Bill Highlights Title I: Innovation Projects & State Response to Opioid Abuse Authorizes funding for research programs, if money is appropriated Authorizes $1 billion for grants for States to deal with the opioid abuse crisis The effects of this spending on the Pay as you Go budget will not be counted Title II: Discovery Creates privacy protections for people who participate as subjects in medical research studies Orders the Secretary of Health and Human Services to a do a review of reporting regulations for researchers in search of regulations to cut, including regulations on reporting financial conflicts of interest and research animal care. Allows contractors to collect payments on behalf of the Secretary of Health and Human Services Title III: Development Gives the Secretary of Health and Human Services additional data options for approving drug applications Expedites the review process for new "regenerative advanced therapy" drugs, which includes drugs "intended to treat, modify, reverse or cure a serious or life-threatening disease or condition" or is a therapy that involves human cells. Allows antibacterial and antifungal drugs to be approved after only being tested on a "limited population" The drugs will have have a "Limited Population" label Speeds up the FDA approval process for new medical devices that help with life-threatening or irreversibly debilitating conditions and that have no existing alternatives. Devices addressing rare diseases or conditions are allowed be approved with lower standards for effectiveness; this provision expands the definition of "rare" by doubling the number of people affected from 4,000 to 8,000. Each FDA employee involved in drug approvals will get training for how to make their reviews least burdensome. Title IV: Delivery The new Secretary of Health and Human Services will have to develop a strategy to "reduce regulatory and administrative burdens (such as doucmentation requirements) relating to the use of electronic health records" Prohibits health information technology developers from certification if their system allows information blocking. Developers, networks, or exchanges caught blocking information can be fined $1 million per violation. "Public-private partnerships" will develop the rules for exchanging health record information. Creates a job in the Medicare & Medicaid Services department for an investigator of pharmaceutical and medical device manufacturer complaints. Title V: Savings Reduced funding for the Prevention and Public Health Fund Sells more oil from the Strategic Petroleum Reserve Title VII: Ensuring Mental and Substance Use Disorders Prevention, Treatment, and Recovery Programs Keep Pace With Technology Authorizes money to be used for mental health services and substance abuse treatment Title IX: Promoting Access to Mental Health and Substance Use Disorder Care Creates a telephone and online service to help people locate mental health services and substance abuse treatment centers. Title XIV: Mental health and safe communities Creates a pilot program to test the idea of having court cases with mentally ill defendants heard in "drug or mental health courts" Title XVII: Other Medicare Provisions Prevents the government from canceling contracts with Medicare Advantage organizations due to their failure to achieve a minimum quality rating before 2019. Additional Reading Article: Trump's HHS Nominee Got A Sweetheart Deal From A Foreign Biotech Firm by Jay Hancock and Rachel Bluth, Kaiser Health News, February 13, 2017. Article: Tom Price belongs to a doctors group with unorthodox views on government and health care by Amy Goldstein, The Washington Post, February 9, 2017. Article: New stock questions plague HHS nominee Tom Price as confirmation vote nears by Jayne O'Donnell, USA Today, February 8, 2017. Article: HHS Pick Price Made 'Brazen' Stock Trades While His Committee Was Under Scrutiny by Marisa Taylor and Christina Jewett, Kaiser Health News, February 7, 2017. Article: Tom Price, Dr. Personal Enrichment by David Leonhardt, The New York Times, February 7, 2017. Article: Donald Trump's Cabinet Pick Invested in 6 Drug Companies Before Medicare Fight by Sam Frizell, TIME, January 17, 2017. Article: First on CNN: Trump's Cabinet pick invested in company, then introduced a bill to help it by Manu Raju, CNN, January 17, 2017. Publication: How Repealing Portions of the Affordable Care Act Would Affect Health Insurance Coverage and Premiums, Congressional Budget Office, January 17, 2017. Article: Under 21st Century Cures legislation, stem cell advocates expect regulatory shortcuts by Kelly Servick, Science, December 12, 2016. Article: Highlights of Medical Device Related Provision in the 21st Century Cures Act by Jeffrey K. Shapiro and Jennifer D. Newberger, FDA Law Blog, December 8, 2016. Article: Republicans reach deal to pass Cures Act by end of year, but Democrats pushing for changes by Sheila Kaplan, STAT, November 27, 2016. Article: Introduction to Budget "Reconciliation" by David Reich and Richard Kogan, Center on Budget and Policy Priorities, November 9, 2016. Article: PhRMA companies push hard on House bill to ease testing of new drugs by Alex Lazar, OpenSecrets.org, June 16, 2015. References Financial Disclosure: Periodic Transaction Report: Thomas Price, United States House of Representatives, September 6, 2016. OpenSecrets: Senator Mitch McConnell 42 U.S. Code: Office of the National Coordinator for Health Information Technology, Cornell University Law School. Senate Vote: H.R. 34: 21st Century Cures Act Innate Immunotherapeutics:Top 20 Shareholders Innate Immunotherapeutics: Company Overview GovTrack: H.R. 4848 (114th): HIP Act Sound Clip Sources Hearing: Health and Human Services Secretary Confirmation, Senate Health, Education, Labor and Pensions Committee, January 18, 2017 (Part 1) and January 24, 2017 (Part 2). Watch on CSPAN Part 1 Part 2 Timestamps & Transcripts Part 1 47:45 Senator Patty Murray: I want to review the facts. You purchased stock in Innate Immunotherapeutics, a company working to develop new drugs, on four separate occasions between January 2015 and August 2016. You made the decision to purchase that stock, not a broker. Yes or no. Tom Price: That was a decision that I made, yes. Murray: You were offered an opportunity to purchase stock at a lower price than was available to the general public. Yes or no. Price: The initial purchase in January of 2015 was at the market price. The secondary purchase in June through August, September of 2016 was at a price that was available to individuals who were participating in a private-placement offering. Murray:It was lower than was available to the general public, correct? Price: I don’t know that it was. It was the same price that everybody paid for the private-placement offering. Murray: Well, Congressman Chris Collins, who sits on President-elect Trump’s transition team, is both an investor and a board member of the company. He was reportedly overheard just last week off the House floor, bragging about how he had made people millionaires from a stock tip. Congressman Price, in our meeting, you informed me that you made these purchases based on conversations with Representative Collins. Is that correct? Price: No. What I— Murray: Well, that is what you said to me in my office. Price: What I believe I said to you was that I learned of the company from Congressman Collins. Murray: What I recall our conversation was that you had a conversation with Collins and then decided to purchase the stock. Price: No, that’s not correct. Murray: Well, that is what I remember you hearing it—say—in my office. In that conversation, did Representative Collins tell you anything that could be considered “a stock tip?” Yes or no. Price: I don’t believe so, no. Murray: Well, if you’re telling me he gave you information about a company, you were offered shares in the company at prices not available to the public, you bought those shares, is that not a stock tip? Price: Well, that’s not what happened. What happened was that he mentioned—he talked about the company and the work that they were doing in trying to solve the challenge of progressive secondary multiple sclerosis which is a very debilitating disease and one that I— Murray: I’m well aware of that, but— Price: —had the opportunity to treat patients when I was in practice. Murray: I’m aware— Price: I studied the company for a period of time and felt that it had some significant merit and promise, and purchased the initial shares on the stock exchange itself. Murray: Congressman Price, I have very limited time. Let me go on. Your purchases occurred while the 21st Century Cures Act, which had several provisions that could impact drug developers like Innate Immunotherapeutics, was being negotiated, and, again, just days before you were notified to prepare for a final vote on the bill. Congressman, do you believe it is appropriate for a senior member of Congress actively involved in policymaking in the health sector to repeatedly personally invest in a drug company that could benefit from those actions? Yes or no. Price: Well, that's not what happened. 1:06:50 Senator Bernie Sanders: The United States of America is the only major country on earth that does not guarantee healthcare to all people as a right. Canada does it; every major country in Europe does it. Do you believe that healthcare is a right of all Americans, whether they’re rich or they’re poor? Should people, because they are Americans, be able to go to the doctor when they need to, be able to go into a hospital, because they are Americans? Tom Price: Yes. We’re a compassionate society— Sanders: No, we are not a compassionate society. In terms of our relationship to poor and working people, our record is worse than virtually any other country on earth; we have the highest rate of childhood poverty of any other major country on earth; and half of our senior, older workers have nothing set aside for retirement. So I don’t think, compared to other countries, we are particularly compassionate. But my question is, in Canada, in other countries, all people have the right to get healthcare, do you believe we should move in that direction? Price: If you want to talk about other countries’ healthcare systems, there are consequences to the decisions that they’ve made just as there are consequences to the decision that we’ve made. I believe, and I look forward to working with you to make certain, that every single American has access to the highest-quality care and coverage that is possible. Sanders: “Has access to” does not mean that they are guaranteed healthcare. I have access to buying a ten-million-dollar home; I don’t have the money to do that. Price: And that’s why we believe it’s appropriate to put in place a system that gives every person the financial feasibility to be able to purchase the coverage that they want for themselves and for their family, again, not what the government forces them to buy. Sanders: Yeah, but if they don’t have any—well, it’s a long dissert. Thank you very much. Price: Thank you. 1:46:34 Senator Michael Bennet: So, I ask you, sir, are you aware that behind closed doors Republican leadership wrote into this bill that any replacement to the Affordable Care Act would be exempt from Senate rules that prohibit large increases to the deficit? Tom Price: As you may know, Senator, I stepped aside as chairman of the budget committee at the beginning of this year, and so I wasn’t involved in the writing of— Bennet: You have been the budget committee chairman during the rise of the Tea Party; you are a member of the Tea Party Caucus; you have said over and over again, as other people have, that the reason you’ve come to Washington is to reduce our deficit and reduce our debt. I assume you’re very well aware of the vehicle that is being used to repeal the Affordable Care Act. This is not— Price: Yes. Bennet: —some small piece of legislation. This is the Republican budget. Price: Yes, I'm aware of the bill. Yes. Bennet: But do you support a budget that increases the debt by $10 trillion? Price: No. What I support is an opportunity to use reconciliation to address the real challenges in the Affordable Care Act and to make certain that we put in place at the same time a provision that allows us to move the healthcare system in a much better direction— Bennet: Do you support the budget that was passed by the Senate Republicans— Price: I support— Bennet:—to repeal the Affordable Care Act that adds $10 trillion of debt to the budget deficit? Price: Well, the reconciliation bill is yet to come. I support the process that allows for and provides for the fiscal year ’17 reconciliation bill to come forward. 2:38:37 Senator Chris Murphy: But do you direct your broker around ethical guidelines? Do you tell him, for instance, not to invest in companies that are directly connected to your advocacy? Because it seems like a great deal: as a broker, he can just sit back, take a look— Tom Price: She. Murphy: —at the positions that you’re taking— Price: She. She can sit back. Murphy: She can—she can sit back— Price: Yeah. Murphy: —in this case—look at the legislative positions you’re taking, and invest in companies that she thinks are going to increase in value based on your legislative activities, and you can claim separation from that because you didn’t have a conversation. Price:Well, that’s a nefarious arrangement that I’m really astounded by. The fact of the matter is that I have had no conversations with my broker about any political activity at all, other than her— Murphy: Then why wouldn’t you tell her— Price: —other than her congratulating— Murphy: Why— Price: —me on my election. Murphy: But why wouldn’t you at least tell her, “Hey, listen; stay clear of any companies that are directly affected by my legislative work”? Price: Because the agreement that we have is that she provide a diversified portfolio, which is exactly what virtually every one of you have in your investment opportunities, and make certain that in order to protect one’s assets that there’s a diversified arrangement for purchase of stocks. I knew nothing about— Murphy: But you couldn’t have— Price: —those purchases. Murphy: But you couldn’t have a diversified portfolio while staying clear of the six companies that were directly affected by your work on an issue? Price: Well, as I said, I didn’t have any knowledge of those purchases. Murphy: Okay. 2:54:20 Senator Elizabeth Warren: One of the companies—it’s the company raised by Mr. Franken, Senator Franken—and that is Zimmer Biomet. They’re one of the world’s leading manufacturers of hip and knees, and they make more money if they can charge higher prices and sell more of their products. The company knows this, and so do the stock analysts. So on March 17, 2016 you purchased stock in Zimmer Biomet. Exactly six days after you bought the stock, on March 23, 2016, you introduced a bill in the House called the Hip Act that would require HHS secretary to suspend regulations affecting the payment for hip and knee replacements. Is that correct? Tom Price: I think the BPCI program to which I think you referred I’m a strong supporter of because it keeps the decision making in the— Warren: I’m not asking you about why you support it. I’m just asking, did you buy the stock, and then did you introduce a bill that would be helpful to the companies you just bought stock in? Price: The stock was bought by a direct—by a broker who was making those decisions. I wasn’t making those decisions. Warren: Okay, so you said you weren’t making those decisions. Let me just make sure that I understand. These are your stock trades, though. They are listed under your name, right? Price: They’re made on my behalf, yes. Warren:Okay. Was the stock purchased through an index fund? Price: I don't believe so. Warren: Through a passively managed mutual fund? Price: No. It’s a broker— Warren: Through an actively managed mutual fund? Price: It’s a broker-directed account. Warren: Through a blind trust? So, let’s just be clear. This is not just a stockbroker, someone you pay to handle the paperwork. This is someone who buys stock at your direction. This is someone who buys and sells the stock you want them to buy and sell. Price: Not true. Warren: So when you found out that— Price: That’s not true, Senator. Warren: Well, because you decide not to tell them—wink, wink, nod, nod—and we’re all just supposed to believe that? Price: It’s what members of this committee, it’s the manner of which— Warren: Well, I’m not one of them. Price: —members of this committee—Well, I understand that— Warren: So, let me just keep asking about this. Price: —but it’s important to appreciate that that’s the case. Warren:Then, I want to understand. When you found out that your broker had made this trade without your knowledge, did you reprimand her? Price: What—what I did was comply— Warren: Well, you found out that she made it. Price: What I did was comply— Warren: Did you fire her? Did you sell the stock? Price: What I did was comply with the rules of the House in an ethical and legal and— Warren: I didn’t ask whether or not the rules of the House— Price: —above-board manner— Warren: —let you do this. Price: —and in a transparent way. Warren: You know, all right. So, your periodic transaction report notes that you were notified of this trade on April 4, 2016. Did you take additional actions after that date to advance[audio cuts out] the company that you now own stock in? Price: I’m offended by the insinuation, Senator. Warren: Well, let me just read what you did. You may be offended, but here’s what you did. Congressional records show that after you were personally notified of this trade, which you said you didn’t know about in advance, that you added 23 out of your bill’s 24 co-sponsors; that also after you were notified of this stock transaction, you sent a letter to CMS, calling on them to cease all current and future planned mandatory initiatives under the Center for Medicare and Medicaid Innovation; and just so there was no misunderstanding about who you were trying to help, you specifically mentioned— Unknown Speaker: Your two minutes are up, Senator Warren. Thank you. Warren: —hip and knee replacement. 2:58:20 Senator Johnny Isakson: This is very important for us to all understand under the disclosure rules that we have and the way it operates, any of us could make the mistakes that are being alleged. I’m sure Senator Franken had no idea that he owned part of Philip Morris when he made the statement he made about tobacco companies, but he has a WisdomTree Equity Income Fund investment, as disclosed in his disclosure, which owns Philip Morris. So, it’s entirely possible for any of us to have somebody make an investment on our behalf and us not know where that money is invested because of the very way it works. I don’t say that to, in any way, embarrass Mr. Franken but to make a point that any one of us who have mutual funds or investment managers or people who do that, it’s entirely possible for us not to know, and to try and imply that somebody’s being obfuscating something or in otherwise denying something that’s a fact, it’s just not the fair thing to do, and I just wanted to make that point. Senator Al Franken: This is different than mutual funds. Isakson: It’s an investment in Philip Morris. Unknown Speaker: Alright. Unknown Speaker: Thank you. Warren: And my question was about what do you do after he had notice. Unknown Speaker: Senator Warren, your time has been generously… Senator Kaine. 3:21:09 Senator Tim Kaine: Do you agree with the president-elect that the replacement for the Affordable Care Act must ensure that there is insurance for everybody? Tom Price: I have stated it here and— Kaine: Right. Price: —always that it’s incredibly important that we have a system that allows for every single American to have access to the kind of coverage that they need and desire. Kaine: And he’s— 3:31:52 Senator Patty Murray: You admitted to me in our meeting that you, in your own words, talked with Congressman Collins about Innate Immuno. This inspired you to you, in your own words, study the company and then purchase its stock, and you did so without a broker. Yes or no. Tom Price: No. Murray: Without a broker. Price: I did not. Murray: You told me that you did this one on your own without the broker. Yes? Price: No, I did it through a broker. I directed the broker to purchase the stock, but I did it through a broker. Murray: You directed the broker to purchase particularly that stock. Price: That's correct. Murray: Yeah. 3:34:42 Senator Patty Murray: Will you commit to ensuring all 18 FDA-approved methods of contraception continue to be covered so that women do not have to go back to paying extra costs for birth control? Tom Price: What I will commit to and assure is that women and all Americans need to know that we believe strongly that every single American ought to have access to the kind of coverage and care that they desire and want. 3:36:38 Senator Patty Murray: The Office of Minority Health was reauthorized as part of the ACA. So will you commit to maintaining and supporting this office and its work? Tom Price: I will commit to be certain that minorities in this country are treated in a way that makes certain—makes absolutely certain—that they have access to the highest-quality care. Murray: So you will not commit to the Office of Minority Health being maintained. Price: I think it’s important that we think about the patient at the center of all this. Our commitment, my commitment, to you is to make certain that minority patients and all patients in this country have access to the highest-quality care. Murray: But in particular—so you won’t commit to the Office of Minority— Price: We—Look, there are different ways to handle things. I can’t commit to you to do something in a department that one, I’m not in—I haven’t gotten it yet— Murray: But you will be. Price: —and— Murray: You will be, and— Price: Let me put forward a possible position that I might find myself in. The individuals within the department come to me and they say, we’ve got a great idea for being able to find greater efficiencies within the department itself, and it results in merging this agency and that agency— Murray: I think—I think that— Price: —and we’ll call it something else. Murray: Yeah. I—okay. Price: And we will address the issues of minority health— Murray: I just have a minute left, and I hear your answer. Price: —in a big, big way— Murray: You’re not committed, okay. Price: —and make certain that it is responsive to patients. Part 2 14:50 Senator Ron Wyden: Congressman Price owns stock in an Australian biomedical firm called Innate Immunotherapeutics. His first stock purchase came in 2015 after consulting Representative Chris Collins, the company’s top shareholder and a member of its board. In 2016 the congressman was invited to participate in a special stock sale called a private placement. The company offered the private placement to raise funds for testing on an experimental treatment it intends to put up for FDA approval. Through this private placement, the congressman increased his stake in the company more than 500 percent. He has said he was unaware he paid a price below market value. It is hard to see how this claim passes the smell test. Company filings with the Australia’s stock exchange clearly state that this specific private placement would be made at below-market prices. The treasury department handbook on private placement states, and I will quote, they “are offered only to sophisticated investors in a nonpublic manner.” The congressman also said last week he directed the stock purchase himself, departing from what he said was typical practice. Then, there’s the matter of what was omitted from the congressman’s notarized disclosures. The congressman’s stake in Innate is more than five times larger than the figure he reported to ethic’s officials when he became a nominee. He disclosed owning less than $50,000 of Innate stock. At the time the disclosure was filed, by my calculation, his shares had a value of more than $250,000. Today his stake is valued at more than a half million dollars. Based on the math, it appears that the private placement was excluded entirely from the congressman’s financial disclosure. This company’s fortunes could be affected directly by legislation and treaties that come before the Congress. 30:49 Senator Orrin Hatch: First, is there anything that you are aware of in your background that might present a conflict of interest with the duties of the office to which you have been nominated? Tom Price: I do not. 51:36 Senator Ron Wyden: Will you commit to not implementing the order until the replacement plan is in place? Tom Price: As I mentioned, Senator, what I commit to you and what I commit to the American people is to keep patients the center of healthcare, and what that means to me is making certain that every single American has access to affordable health coverage that will provide the highest-quality healthcare that the world can provide. 1:24:34 Senator Richard Burr: Are you covered by the STOCK Act, legislation passed by Congress that requires you and every other member to publicly disclose all sales and purchases of assets within 30 days? Tom Price: Yes, sir. Burr: Now, you’ve been accused of not providing the committee of information related to your tax and financial records that were required of you. Are there any records you have been asked to provide that you have refused to provide? Price: None whatsoever. Burr: So all of your records are in. Price: Absolutely. Burr: Now, I’ve got to ask you, does it trouble you at all that as a nominee to serve in this administration that some want to hold you to a different standard than you as a member of Congress, and I might say the same standard that they currently buy and sell and trade assets on? Does it burn you that they want to hold you to a different standard now that you’re a nominee than they are as a member? Price: Well, I—we know what’s going on here. Burr: Oh, we do. Price: I mean— Burr: We do. Price: It’s—and I understand. And as my wife tells me, I volunteered for this, so… 1:26:49 Senator Richard Burr: As the nominee and hopefully—and I think you will be—the secretary of HHS, what are the main goals of an Obamacare replacement plan? Tom Price: Main goals, as I mentioned, are outlined in those principles, that is imperative that we have a system that’s accessible for every single American; that’s affordable for every single American; that is incentivizes and provides the highest-quality healthcare that the world knows; and provides choices to patients so that they’re the ones selecting who’s treating them, when, where, and the like. So it’s complicated to do, but it’s pretty simple stuff. 1:34:58 Senator Johnny Isakson: Any one of us can take a financial disclosure—and there’s something called desperate impact, where you take two facts—one over here and one over there—to make a wrong. Any one of us could do it to disrupt or misdirect people’s thoughts on somebody. It’s been happening to you a lot because people have taken things that you have disclosed and tried to extrapolate some evil that would keep you from being secretary of HHS when, in fact, it shouldn’t be true. For example, if you go to Senator Wyden’s annual report, he owns an interest in BlackRock Floating Rate Income Fund. The major holding of that fund is Valeant Pharmaceuticals. They’re the people we jumped all over for 2700 percent increases last year in pharmaceutical products. But we’re not accusing the ranking member of being for raising pharmaceutical prices, but you could take that extrapolation out of that and then indict somebody and accuse them. Is that not true? 1:51:30 Senator Michael Bennet: I wonder whether you also believe that it’s essential that there be a floor for insurance providers. You know, some of the things that the Affordable Care Act require for coverage include outpatient care; emergency services; hospitalization; maternity and newborn care; prescription drugs; rehab services; lab services; preventative care, such as birth control and mammograms; pediatric services, like vaccines; routine dental exams for children younger than 19. I’m not going to ask you to go through each one of those, but directionally, are we headed to a world where people in rural America have to settle for coverage for catastrophic care; are we headed to a place where there is regulation of insurance providers that say if you are going to be an insurance market, you need—particularly if we’re in a world where your son had crossed state lines —there has to be a floor of the services you’re willing to pay for? Tom Price: I think there has to be absolutely credible coverage, and I think that it’s important that the coverage—that individuals ought to be able to purchase this coverage that they want. 1:56:45 Senator Pat Toomey: When we talk about repeal, sometimes I hear people say, well, we’ve got to keep coverage of pre-existing conditions because, you know, we’ve got to keep that. And when I hear that, I think that we’re missing something here, and here’s what I’m getting at. There’s obviously a number of Americans who suffer from chronic, expensive healthcare needs. They’ve had these conditions sometimes all their lives, sometimes for some other period of time. And for many of them the proper care for those conditions is unaffordable. I think we agree that we want to make sure those people get the healthcare they need. Now, one way to force it is to force insurance companies to provide health-insurance coverage for someone as soon as they show up, regardless of what condition they have, which is kind of like asking the property casualty company to rebuild the house after it’s burned down. But that’s only one way to deal with this, and so am I correct: is it your view that there are other perhaps more effective ways—since, after all, Obamacare’s in a collapse—to make sure that people with these pre-existing chronic conditions get the healthcare that they need at an affordable price without necessarily having the guaranteed-issue mandate in the general population? Tom Price: I think there are other options, and I think it’s important, again, to appreciate that the position that we currently find ourselves in, with policy in this nation, is that those folks, in a very short period of time, are going to have nothing because of the collapse of the market. 2:18:05 Tom Price: Every single individual ought to be able to have access to coverage. 2:29:45 Senator Tim Scott: My last question has to do with the employer-sponsored healthcare system that we’re so accustomed to in this country, that provides about 175 million Americans with their insurance. In my home state of South Carolina, of course, we have about two and a half million people covered by their employer coverage. If confirmed as HHS secretary, how would you support American employers in their effort to provide effective family health coverage in a consistent and affordable manner? Said differently, there’s been some conversation about looking for ways to decouple having health insurance through your employer. Tom Price: I think the employer system has been absolutely a remarkable success in allowing individuals to gain coverage that they otherwise might not gain. I think that preserving the employer system is imperative. That being said, I think that there may be ways in which individual employers—I’ve heard from employers who say, if you just give me an opportunity to provide my employee the kind of resources so that he or she is able to select the coverage that they want, then that makes more sense to them. And if that works from a voluntary standpoint for employers and for employees, then it may be something to look at. Scott: That would be more like the HRA approach where— Price: Exactly. Scott: —employer funds an account, and the employee chooses the health insurance, not necessarily under the umbrella of the employer specifically. Price: Exactly. And gains the same tax benefit. 2:58:00 Tom Price: What I’m for is making certain, again, that the Medicaid population has access to the highest-quality care possible, and we’ll do everything to improve that because right now so many in the Medicaid population don’t have access to the highest-quality care. 3:20:50 Tom Price: Our goal is to make certain that seniors have access to the highest-quality healthcare possible at an affordable price. Senator Bob Menendez: Well, access without the ability to afford it, and I’ll end on this— Price: That's what I said, affordable price. 3:28:45 Senator Sherrod Brown: If you and he are working together, are you going to suggest to him that we find a way in repeal and replace to make sure there is guaranteed healthcare for our nation’s veterans? Tom Price: Well, I think it’s vital, again, as I’ve mentioned before, that every single American have access to affordable coverage that’s of high quality, and that’s our goal, and that’s our commitment. 3:30:52 [regarding a disabled child coverd by Medicaid] Tom Price: We are absolutely committed to making certain that that child and every other child and every other individual in this nation has access to the highest-quality care possible. Senator Bob Casey Jr.: Okay, so not an access—he will have the medical care that he has right now or better—if you can come up with a better level of care, that’s fine—but he will have at least the coverage of Medicaid and all that that entails that he has right now. And that’s either a yes or no; that’s not— Price: No, it’s not a yes or no because the fact of the matter is that in order for the current law to change, you all have to change it— Casey: No, but here’s— Price: —and if I’m given the privilege of leading at the Department of Health and Human Services— Casey: Here’s why it’s yes— Price: and I respond to— Casey: You should stop talking around this. You have led the fight in the House, backed up by Speaker Ryan, for years— Price: To improve Medicaid. Casey: —to block grant Medicaid, okay? Price: To improve Medicaid. Casey: To block grant Medicaid. What that means is, states will have to decide whether or not this child gets the Medicaid that he deserves. That’s what happens. So you push it back to the states and hope it works out… Cover Art Design by Only Child Imaginations

Jay Desai is Co-Founder and CEO of PatientPing, a company that connects health care providers across the country with real-time notifications to seamlessly coordinate patient care. They have raised funding from some of the best in the world including Google Ventures, First Round Capital and SV Angel. Prior to co-founding PatientPing, Jay worked at the Center for Medicare and Medicaid Innovation where he helped design and implement ACO, Bundled Payment, and other innovative payment models funded by the Affordable Care Act. Jay's previous experience includes Triad Isotopes, Parthenon Capital, and Lehman Brothers.  In Today’s Episode You Will Learn: 1.) How Jay came to found PatientPing? What was the a-ha moment for him? 2.) How does Jay assess the chemistry and alignment of VCs and their portfolio founders? How can founders detect if the VC is right for them? 3.) We always hear the importance of focus. How does Jay decide the single most important thing? Does this vary with stage and size? How does Jay look to balance such focus with a broader vision for the company? 4.) How important is internal entrepreneurialism for Jay? How does that play out in his management style? What boundaries need to be set? Does Jay agree with Suster, 'constraint enforces creativity'. 5.) Why does Jay have not internal budgets at PatientPing? What are the benefits? How does that affect the team's approach to spending, responsibility and accountability? Items Mentioned In Today’s Episode:  Jay’s Fave Blog: The Morning Consult Jay’s Fave Book: Pastoralia As always you can follow The Twenty Minute VC, Harry and Jay on Twitter here! Likewise, you can follow Harry on Snapchat here for mojito madness and all things 20VC. The Twenty Minute VC is proudly sponsored by Luma, Luma is the world’s first ever Surround WiFi system that brings speed, security and control to the home network. And Unlike traditional routers, Luma comes in a pack of two or three sleek devices to place in different rooms in your home. Luma then creates a mesh network that work together to create an outrageously-fast, ultra-secure Surround WiFi network.  Lastly, Luma’s app lets you easily see and control which devices, users and content are on your network. To buy your Luma, simply dead to getluma.com or amazon.com. So many problems start with your head: stress, depression, anxiety, fear of the future. What if there was some kind of exercise you could do, that would help you get your head in shape. That’s where the Headspace app comes in. Headspace is meditation made simple. The Headspace app provides guided meditations you can use whenever you want, wherever you want, on your phone, computer or tablet. They have sessions focused on everything from dealing with stress and depression, to helping you eat more mindfully. So download the Headspace app and start your journey towards a happier, healthier life. Learn more at headspace.com/20vc. That’s headspace.com/20vc.

Listen NowThe use of community health workers (CHW) dates back to the 1800s.  The impetus for these workers today is to provide peer support largely in poor or under-served communities since these communities typically suffer disparities in health care access, in the quality of health care delivery and consequently experience higher morbidity and mortality rates.  The ACA via the Center for Medicare and Medicaid Innovation is supporting CHW demonstration projects, states are testing their use via Medicaid programming and various providers are using CHW to improve self management support among high health care service utilizers.   During this 20 minute conversation, Dr. Fisher discusses the reasons why the use of CHW is increasing, who they are and how they're trained, in what provider setting they work, their level of success, how they're accepted by clinicians and patients and how their services are reimbursed.      Dr. Edwin Fisher is a University of North Carolina Gillings School of Global Public Health Professor and serves as Global Director for the American Academy of Family Physicians Foundation's Peers for Progress program.  Peers for Progress promotes peer support in health, health care and prevention around the world.  From 2002 to 2009 Dr. Fisher served as National Program Director for the Robert Wood Johnson Foundation's Diabetes Initiative.  Dr. Fisher has published widely in prevention, chronic disease management and quality of life addressing asthma, cancer, cardiovascular disease, smoking and weight management.  He is past-president of the Society of Behavioral Medicine and has served as a board member for the International Society of Behavioral Medicine and the American Lung Association.  He was graduated from the SUNY, Stony Brook with a Ph.D. in Clinical Psychology.       Information on Peers for Progress is at: peersforprogress.org.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

If you experience any technical difficulties with this video or would like to make an accessibility-related request, please send a message to digicomm@uchicago.edu. The University of Chicago is undertaking an ambitious plan to transform the health and health care environment of traditionally underserved and low-income communities, beginning on Chicago’s South Side. These communities have never had a coordinated health care system, an absence aggravated by such factors as outdated civil infrastructure, undereducation, violent crime, and high unemployment. An alternative, asset-based view of these communities, generated in part by local students, is revealing a wealth of resources—businesses, proprietors, civic leaders, community organizations, health care providers, and committed residents—that can be leveraged for good health, community vitality, and even business innovation. In this talk given in Morristown, New Jersey, Stacy Tessler Lindau discusses how her asset-based research is engaging South Side high school students and community-based organizations to build a working model for excellent urban health. Stacy Tessler Lindau, MD, AM’02, is an associate professor of obstetrics/gynecology and medicine-geriatrics at the University of Chicago and director of the South Side Health and Vitality Studies, which uses an asset-based, community-engaged approach to urban health improvement and innovation. A former Robert Wood Johnson Foundation clinical scholar (2000–02), Lindau is a population- and clinic-based scholar who studies issues of health justice across the life course. In June 2012, she received a Health Care Innovation Award from the US Center for Medicare and Medicaid Innovation to launch CommunityRx at the University of Chicago Medicine and in more than 30 community health centers on Chicago’s South Side. CommunityRx links electronic health record systems to high-quality, reliable information about South Side assets (businesses and organizations identified by the MAPSCorps program), which people can use to stay well and manage disease.

If you experience any technical difficulties with this video or would like to make an accessibility-related request, please send a message to digicomm@uchicago.edu. The University of Chicago is undertaking an ambitious plan to transform the health and health care environment of traditionally underserved and low-income communities, beginning on Chicago’s South Side. These communities have never had a coordinated health care system, an absence aggravated by such factors as outdated civil infrastructure, undereducation, violent crime, and high unemployment. An alternative, asset-based view of these communities, generated in part by local students, is revealing a wealth of resources—businesses, proprietors, civic leaders, community organizations, health care providers, and committed residents—that can be leveraged for good health, community vitality, and even business innovation. In this talk given in Morristown, New Jersey, Stacy Tessler Lindau discusses how her asset-based research is engaging South Side high school students and community-based organizations to build a working model for excellent urban health. Stacy Tessler Lindau, MD, AM’02, is an associate professor of obstetrics/gynecology and medicine-geriatrics at the University of Chicago and director of the South Side Health and Vitality Studies, which uses an asset-based, community-engaged approach to urban health improvement and innovation. A former Robert Wood Johnson Foundation clinical scholar (2000–02), Lindau is a population- and clinic-based scholar who studies issues of health justice across the life course. In June 2012, she received a Health Care Innovation Award from the US Center for Medicare and Medicaid Innovation to launch CommunityRx at the University of Chicago Medicine and in more than 30 community health centers on Chicago’s South Side. CommunityRx links electronic health record systems to high-quality, reliable information about South Side assets (businesses and organizations identified by the MAPSCorps program), which people can use to stay well and manage disease.