Podcasts about pcps

Rosario Gennaro is a Professor of Computer Science at City University of New York (CUNY) and a Director for the Center for Algorithms and Interactive Scientific Software (CAISS). 1996, he received his PhD from MIT and was a researcher at the IBM T.J.Watson Research Center until 2012.  Rosario's most recent work includes privacy and anonymity in electronic communication, along with proactive security to minimise the effects of system break-ins. He has received over 24,500 citations on his work and has an h-index of 72, and has published classic papers of “Non-interactive verifiable computing: Outsourcing computation to untrusted workers” and “Quadratic span programs and succinct NIZKs without PCPs”.

Get confident supporting your patients with infertility in primary care! We cover who needs a workup, how to evaluate both partners, and when to refer—plus tips on coding, counseling, and emotional support. Reproductive endocrinologist Dr. Brindha Bavan shares practical insights to empower PCPs on the front lines of fertility care. Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Case from Kashlak Definitions of infertility Male factor infertility evaluation History Semen analysis lifestyle Female factor infertility evaluation Anatomical approach Basic testing More advanced testing Unexplained infertility treatment Success of infertility treatments Financial impact/advocacy Oocyte preservation Outro Credits Producer, Writer, Show notes, Cover Art, Infographics: Molly Heublein MD Hosts: Molly Heublein MD, Era Kryzhanovskaya MD Reviewer: Emi Okamoto MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Brindha Bavan MD Disclosures Dr. Brindha Bavan reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Sponsor: Grammarly Download Grammarly for free at Grammarly.com/PODCAST. Sponsor: FIGS We've teamed up with FIGS, and now Curbsiders listeners can get 15% off. Just go to wearFIGS.com and use code FIGSRX. Sponsor: Panacea Financial  Learn more at PanaceaFinancial.com. 

In this episode of What's Best For The Patient Is Best For Business, Jerry sits down with Angela Diaz, DPT, Vice President of Market Development for TailorCare, to explore the future of physical therapy in a value-based healthcare system. With decades of experience as a clinician, practice owner, and healthcare executive, Angela shares her insights on why PTs must lead—or risk being left behind—in the shift toward patient-centered, outcomes-driven care.Key Takeaways:-  Value-Based Care Is Here – Physical therapists must transition from fee-for-service models to payment structures that reward high-quality outcomes, cost efficiency, and patient satisfaction.-  Data Is Non-Negotiable – PTs need to track pain, functional outcomes, and patient satisfaction to prove their value. Angela emphasizes: "If you can't measure it, you can't improve it—or get paid for it."-  The Power of Shared Decision-Making – Angela shares a case study of a knee pain patient who avoided surgery through tailored PT and lifestyle changes—highlighting how aligning care with patient goals improves outcomes and reduces costs.-  PTs as First-Line Providers – In TailorCare's model, PTs triage musculoskeletal cases, collaborating with PCPs, orthopedists, and behavioral health to streamline care and prevent unnecessary procedures.-  Future-Proof Your Practice – Angela outlines four trends reshaping PT: hybrid care (telehealth + in-person), integrated care teams, AI/wearables for outcomes tracking, and patient choice driving reimbursement.-  "Step Up or Get Left Behind" – Angela's rallying cry: PTs have a unique role in prevention, recovery, and wellness—but must advocate for their place at the table in policy and payment reform.Whether you're a clinician, practice owner, or healthcare leader, this episode is a masterclass in positioning physical therapy as the cornerstone of value-based MSK care. Tune in and rethink what's possible for your practice and your patients. If you'd like to learn more about Strata EMR & RCM and achieving a 99.99% reimbursement rate for your PT, OT, or SLP Clinic head over to stratapt.com and book a demo with their team!

Franklin J. Rooks Jr. is a graduate of the Philadelphia College of Pharmacy and Science (“PCPS”), where he earned a Bachelor's Degree in Health Science and a Master of Physical Therapy Degree. After graduating from PCPS, he earned a Master of Business Administration (“MBA”), with a concentration in finance, from DrexelUniversity, in Philadelphia, Pennsylvania. Along with his college roommate, he went on to be a founding partner of PRO Physical Therapy, an outpatient physicaltherapy business based in Wilmington, Delaware. At the time that it was sold to the private equity firm KRG Capital, the business had 18 locations in Delaware, Pennsylvania, and Maryland. After selling PRO Physical Therapy, Mr. Rooks earned his juris doctor degree from Delaware Law School. He is licensed topractice law in the State of New Jersey and Commonwealth of Pennsylvania. Mr. Rooks also represents healthcare providers in breachof contract matters and also provides general legal advice pertaining to contracting and compliance with federal and state regulations. Since 2009, Mr. Rooks has been an operating partner of Shore Capital Partners, a private equity firm headquartered in Chicago, Illinois. Currently, he serves on the Board of Directors for Therapy Partners Group, a portfolio company of Shore Capital with 137 outpatient physical therapy clinics primarily located throughout California, Texas, Arizona, and Nevada. After graduating from law school, he and his partner from PRO PhysicalTherapy purchased a single-office occupational medicine business from a hospital system in Delaware. Mr. Rooks and his partner grew the occupational medicine businessto five locations and in 2015, sold it to In-Tandem Capital Partners, a New York-based private equity firm. In 2018, Mr. Rooks and a partner acquired a durable medical equipment business in New Jersey. In 2023, after tripling the business's EBITDA, Mr. Rooks and his partner sold the DME business to a strategic acquirer.  He is currently a partner with Iterum Physical Therapy, and outpatient physical therapy business with locations in Florida and Delaware.Mr. Rooks resides in Chester County, Pennsylvania.   He is married withthree children, 2 sons, one daughter 

This week on the Codcast, John McDonough of the Harvard T.H. Chan School of Public Health and Paul Hattis of the Lown Institute talk to Michael Barnett, who is both a primary care physician at Brigham and Women's Hospital and a professor of health policy at the T.H. Chan School, about the ongoing effort to unionize PCPs across the Mass General Brigham system.

It's been a busy year for influenza cases, but it's not what we've seen in our clinics and hospitals that has infectious disease experts most worried. They are concerned about avian flu, otherwise known as the H5N1 subtype of influenza A. Specifically, they are worried about stress what happens if H5N1 jumps to humans and potentially spreads. What is that risk for people and what challenges lie ahead? In this episode, we'll explore our current standing and whether we are approaching public health crisis. From virology to epidemiology to infection control strategies, we'll break down the science, the current data and practical considerations for clinicians on the front lines. To help us understand this ever-evolving virus and its threat, we are joined by two incredible infectious disease experts, Samuel Dominguez, MD, and Suchitra Rao, MD. They both specialize in infectious disease at Children's Hospital Colorado. Dr. Dominguez is the Medical Director of the Clinical Microbiology Laboratory. Dr. Dominguez is a professor of pediatrics at the University of Colorado School of Medicine and Dr. Rao is an associate professor. Some highlights from this episode include:  Overview of the current flu season and why it stands out  H5N1 transmission of H5N1 and the factors making this season concerning alarming How humans have been infected this season  Assessing the current risk to kids Key actions primary care providers (PCPs) can take right now  For more information on Children's Colorado, visit: childrenscolorado.org. 

Here's my new idea for an episode. Welcome to it. I want to talk about a major theme running through the last few episodes of Relentless Health Value. And this theme is, heads up, going to continue through a few upcoming shows as well. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. We have Matt McQuide coming up, talking about patient engagement, and Christine Hale, MD, MBA, talking about high-cost claimants. And we also have an encore coming up with Kenny Cole, MD, talking about a lot of things; but patient trust is one of them. But before I get to the main theme to ponder here, let me talk about what gets selected to talk about on Relentless Health Value. I will freely admit, how topics for shows get picked, it's not exactly a linear sort of affair. And furthermore, even if it were, I can't always get the stars to align to get a specific cluster of guests to all come on like one after the other. So, for sure, it might be less than obvious at times where my head is at—and sometimes, admittedly, I don't even know. This may sound incredibly scattershot (and it probably is), but in my defense, this whole healthcare thing, in case you didn't know, it's really complicated. Every time I get a chance to chat with an expert, I learn something new. I feel like it's almost impossible to sit in a vacuum and mastermind some kind of grand insight. Very, very fortunately, I don't need to sit in a cave and do all this heavy thinking all by myself. We got ourselves a tribe here of like-minded, really smart folks between the guests and you lot, all of you in the tribe of listeners who are here every week. Yeah, you rock! And I can always count on you to start teasing out the themes and the through lines and the really key actionable points. You email me. You write great posts and comments on LinkedIn and elsewhere. Even if I am a little bit behind the eight ball translating my instinct into an actual trend line, it doesn't slow this bus down. It's you who keeps it moving, which is why I can confidently say it's you all who are to blame for this new idea I came up with the other day after the podcast with Al Lewis (EP464) triggered so much amazing and really deep insight and dot connecting back and forth that hooked together the past six, I'm gonna say, or so shows. Let's just start at the beginning. Let's start with the topics that have been discussed in the past several episodes of the pod. Here I go. Emergency room visits are now costing about 6% of total plan sponsor spend on average. That was the holy crap moment from the episode with Al Lewis (EP464). Emergency room volume is up, and also prices are up. In that show with Al Lewis, I did quote John Lee, MD, who is an emergency room doctor, by the way. I quoted him because he told a story about a patient who came into the ER, winds up getting a big workup in his ER. Dr. Lee says he sees this situation a lot where the patient comes in, they've had something going on for a while, they've tried to make an appointment with their PCP or even urgent care, they could not get in. It's also really hard to coordinate and get all the blood work or the scans and have that all looked at that's needed for the workup to even happen. I've spoken with multiple ER doctors at this point, and they all say pretty much the same thing. They see the same scenario happen often enough, maybe even multiple times a day. Patient comes in with something that may or may not be emergent, and they are now in the ER because they've been worried about it for weeks or months. And the ER is like the only place where they can get to the bottom of what is going on with their body. And then the patient, you know, they spend the whole day in the ER getting what amounts to weeks' worth of outpatient workup accomplished and scans and imaging and labs. And there's no prior authing anything down. It's also incredibly expensive. Moving on from the Al Lewis show, earlier than that I had had on Rushika Fernandopulle, MD (EP460) and then also Scott Conard, MD (EP462). Both are PCPs, both talking about primary care and what makes good primary care and what makes bad primary care and how our current “healthcare marketplace,” as Dr. Conard puts it, incentivizes either no primary care and/or primary care where volume driven throughput is the name of the game—you know, like seeing 25 patients a day. These visits or episodes of care are often pretty transactional. If relationships are formed, it's because the doctor and/or the patient are rising above the system, not the other way around. And none of that is good for primary care doctors, nurses, or other clinicians. It's also not good for patients, and it's not good for plan sponsors or any of the ultimate purchasers here (taxpayers, patients themselves) because while all of this is going on, those patients getting no or not good primary care are somebody's next high-cost claimant. Okay, so those were the shows with Rushika Fernandopulle and Scott Conard. Then this past week was the show with Vivian Ho, PhD (EP466), who discusses the incentives that hospital leadership often has. And these incentives may actually sound great on paper, but IRL, they wind up actually jacking up prices and set up some weird incentives to increase the number of beds and the heads in them. There was also two shows, one of them with Betsy Seals (EP463) and then another one with Wendell Potter (EP384), about Medicare Advantage and what payers are up to. Alright, so let's dig in. What's the big theme? What's the big through line here? Let's take it from the top. Theme 1 is largely this (and Scott Conard actually said this flat out in his show): Primary care—good primary care, I mean—is an investment. Everything else is a cost. And those skyrocketing ER costs are pure evidence of this. Again, listen to that show with Al Lewis earlier (EP464) for a lot of details about this. But total plan costs … 6% are ER visits. Tim Denman from Premise Health wrote, “That is an insane number! Anything over 2% warrants concern.” But yeah, these days we have, on average across the country, 200 plan members out of 1000 every single year dipping into their local ER. That number, by the way, will rise and fall depending on the access and availability of primary care and/or good urgent cares. Here's from a Web site entitled ER Visit Statistics, Facts & Trends: “In the United States, emergency room visits often highlight gaps in healthcare accessibility. Many individuals turn to ERs for conditions that could have been managed through preventative or primary care. … This indicates that inadequate access to healthcare often leads to increased reliance on emergency departments. … “ED visits can entail significant costs, particularly when a considerable portion of these visits is classified as non-urgent. … [Non-urgent] visits—not requiring immediate medical intervention—often lead to unnecessary expenditures that could be better allocated in primary care settings.” And by the way, if you look at the total cost across the country of ER visits, it's billions and billions and billions of dollars. In 2017, ED visits (I don't have a stat right in front of me), but in 2017, ED visits were $76.3 billion in the United States. Alright, so, the Al Lewis show comes out, I see that, and then, like a bolt of lightning, François de Brantes, MBA, enters the chat. François de Brantes was on Relentless Health Value several years ago (EP220). I should have him come back on. But François de Brantes cemented with mortar the connectivity between runaway ER costs and the lack of primary care. He started out talking actually about a new study from the Milbank Memorial Fund. Only like 5% of our spend going to primary care is way lower than any other developed country in the world—all of whom, of course, have far higher life expectancies than us. So, yeah … they might be onto something. François de Brantes wrote (with some light editing), “Setting aside the impotence of policies, the real question we should ask ourselves is whether we're looking at the right numbers. The short answer is no, with all due respect to the researchers that crunched the numbers. That's probably because the lens they're using is incredibly narrow and misses everything else.” And he's talking now about, is that 5% primary care number actually accurate? François de Brantes continues, “Consider, for example, that in commercially insured plans, the total spend on … EDs is 6% or more.” And then he says, “Check out Stacey Richter's podcast on the subject, but 6% is essentially what researchers say is spent on, you know, ‘primary care.' Except … they don't count those costs, the ER costs. They don't count many other costs that are for primary care, meaning for the treatment of routine preventative and sick care, all the things that family practices used to manage but don't anymore. They don't count them because those services are rendered by clinicians other than those in primary care practice.” François concludes (and he wrote a great article) that if you add up all the dollars that are spent on things that amount to primary care but just didn't happen in a primary care office, it's conservatively around 17% of total dollars. So, yeah … it's not like anyone is saving money by not making sure that every plan member or patient across the country has a relationship with an actual primary care team—you know, a doctor or a nurse who they can get on the phone with who knows them. Listen to the show coming up with Matt McQuide. This theme will continue. But any plan not making sure that primary care happens in primary care offices is shelling out for the most expensive primary care money can buy, you know, because it's gonna happen either in the ER or elsewhere. Jeff Charles Goldsmith, PhD, put this really well. He wrote, “As others have said, [this surge in ER dollars is a] direct consequence of [a] worsening primary care shortage.” Then Dr. John Lee turned up. He, I had quoted on the Al Lewis show, but he wrote a great post on LinkedIn; and part of it was this: “Toward a systemic solution, [we gotta do some unsqueezing of the balloon]. Stacey and Al likened our system to a squeezed balloon, with pressure forcing patients into the [emergency room]. The true solution is to ‘unsqueeze' the system by improving access to care outside the [emergency room]. Addressing these upstream issues could prevent patients from ending up in the [emergency room]. … While the necessary changes are staring us in the face, unsqueezing the balloon is far more challenging than it sounds.” And speaking of ER docs weighing in, then we had Mick Connors, MD, who left a banger of a comment with a bunch of suggestions to untangle some of these challenges that are more challenging than they may sound at first glance that Dr. Lee mentions. And as I said, he's a 30-year pediatric emergency physician, so I'm inclined to take his suggestions seriously. You can find them on LinkedIn. But yeah, I can see why some communities are paying 40 bucks a month or something for patients without access to primary care to get it just like they pay fire departments or police departments. Here's a link to Primary Care for All Americans, who are trying to help local communities get their citizens primary care. And Dr. Conard talked about this a little bit in that episode (EP462). I can also see why plan sponsors have every incentive to change the incentives such that primary care teams can be all in on doing what they do. Dr. Fernandopulle (EP460) hits on this. This is truly vital, making sure that the incentives are right, because we can't forget, as Rob Andrews has said repeatedly, organizations do what you pay them to do. And unless a plan sponsor gets into the mix, it is super rare to encounter anybody paying anybody for amazing primary care in an actual primary care setting. At that point, Alex Sommers, MD, ABEM, DipABLM, arrived on the scene; and he wrote (again with light editing—sorry, I can't read), “This one is in my wheelhouse. There is a ton that could be done here. There just has to be strategy in any given market. It's a function of access, resources, and like-minded employers willing to invest in a direct relationship with providers. But not just any providers. Providers who are willing to solve a big X in this case. You certainly don't need a trauma team on standby to remove a splinter or take off a wart. A great advanced primary care relationship is one way, but another thing is just access to care off-hours with the resources to make a difference in a cost-plus model. You can't help everybody at once. But you can help a lot of people if there is a collaborative opportunity.” And then Dr. Alex Sommers continues. He says, “We already have EKG, most procedures and supplies, X-ray, ultrasounds, and MRI in our clinics. All that's missing is a CT scanner. It just takes a feasible critical mass to invest in a given geography for that type of alternative care model to alter the course here. Six percent of plan spend going to the ER. My goodness.” So, then we have Ann Lewandowski, who just gets to the heart of the matter and the rate critical for primary care to become the investment that it could be: trust. Ann Lewandowski says, “I 100% agree with all of this, basically. I think strong primary care that promotes trust before things get so bad people think they need to go to the emergency room is the way to go.” This whole human concept of trust is a gigantic requirement for clinical and probably financial success. We need primary care to be an investment, but for it to be an investment, there's got to be relationships and there has to be trust between patients and their care teams. Now, neither relationships nor trust are super measurable constructs, so it's really easy for some finance pro to do things in the name of efficiency or optimization that undermine the entire spirit of the endeavor without even realizing it. Then we have a lot of primary care that doesn't happen in primary care offices. It happens in care settings like the ER. So, let's tug this theme along to the shows that concern carriers, meaning the shows with Wendell Potter (EP384) on how shareholders influence carrier behavior and with Betsy Seals (EP463) on Medicare Advantage plans and what they're up to. Here's where the primary care/ER through line starts to connect to carriers. Here's a LinkedIn post by the indomitable Steve Schutzer, MD. Dr. Schutzer wrote about the Betsy Seals conversation, and he said, “Stacey, you made a comment during this fabulous episode with Betsy that I really believe should be amplified from North to South, coast to coast—something that unfortunately is not top of mind for many in this industry. And that was ‘focus on the value that accrues to the patient'—period, end of story. That is the north star of the [value-based care] movement, lest we forget. Financial outcome measures are important in the value equation, but the numerator must be about the patient. As always, grateful for your insights and ongoing leadership.” Oh, thank you so much. And same to you. Grateful for yours. Betsy Seals in that podcast, though, she reminded carrier listeners about this “think about the value accruing to the patient” in that episode. And in the Wendell Potter encore that came out right before the show with Betsy, yeah, what Wendell said kind of made me realize why Betsy felt it important to remind carriers to think about the value accruing to patients. Wall Street rewards profit maximization in the short term. It does not reward value accruing to the patient. However—and here's me agreeing with Dr. Steve Schutzer, because I think this is what underlies his comment—if what we're doing gets so far removed from what is of value to the patient, then yeah, we're getting so removed from the human beings we're allegedly serving, that smart people can make smart decisions in theoretical model world. But what's being done lacks a fundamental grounding in actual reality. And that's dangerous for plan members, but it's also pretty treacherous from a business and legal perspective, as I think we're seeing here. Okay, so back to our theme of broken primary care and accelerating ER costs. Are carriers getting in there and putting a stop to it? I mean, as aforementioned about 8 to 10 times, if you have a broken primary care system, you're gonna pay for primary care, alright. It's just gonna be in really expensive care settings. You gotta figure carriers are wise to this and they're the ones that are supposed to be keeping healthcare costs under control for all America. Well, relative to keeping ER costs under control, here's a link to a study Vivian Ho, PhD, sent from Health Affairs showing how much ER prices have gone up. ER prices are way higher than they used to be. So, you'd think that carriers would have a huge incentive to get members primary care and do lots and lots of things to ensure that not only would members have access to primary care, but it'd be amazing primary care with doctors and nurses that were trusted and relationships that would be built. It'd be salad days for value. Except … they're not doing a whole lot at any scale that I could find. We have Iora and ChenMed and a few others aside. These are advanced primary care groups that are deployed by carriers, and these organizations can do great things. But I also think they serve—and this came up in the Dr. Fernandopulle show (EP460)—they serve like 1% of overall patient populations. Dr. Fernandopulle talked about this in the context of why these advanced primary care disruptors may have great impact on individual patients but they have very little overall impact at a national scale. They're just not scaled, and they're not nationwide. But why not? I mean, why aren't carriers all over this stuff? Well, first of all—and again, kind of like back to the Wendell show (EP384) now—if we're thinking short term, as a carrier, like Wall Street encourages, you know, quarter by quarter, and if only the outlier, mission-driven folks (the knights) in any given carrier organization are checking what's going on actually with plans, members, and patients like Betsy advised, keep in mind it's a whole lot cheaper and it's easier to just deny care. And you can do that at scale if you get yourself an AI engine and press Go. Or you can come up with, I don't know, exciting new ways to maximize your risk adjustment and upcoding. There's an article that was written by Sergei Polevikov, ABD, MBA, MS, MA

We want to thank all our sponsors and supporters for helping AirgunWeb and Gateway To Airguns continue to provide you with this content!Tonight's show: Over the past few years, we've seen a lot of new affordable PCPs come to market.  Brands like Barra, Air Ventury, JTS, Snowpeak, Macavity, and now PINTY, just to name a few. We've shot a bunch of these guns, and they all have something in common.  They all seem to perform way above their weight class.  What have you experienced with budget PCPs?  Next, we are shooting .177 airguns here at AGW and GTA.  But is .177 even still relevant in 2025?  Is .22 the new .177?  Let's get into it and Let's Talk Airguns!#pcpairguns #letstalkairguns #theairgunexpo #targetshooting #outdoorsports #shootingsports #pelletgun #airgunweb #gatewaytoairguns #GRiPAirgunReviews Man, it's a great time to be an airgunner!Please subscribe to our NEW GTA YouTube page:https://youtube.com/THEGatewayToAirgunsTo learn more about us, google AirgunWeb, AirgunExpo, GatewayToAirguns, ************************************AGW / AGWTV Content Disclaimer************************************By viewing or flagging this video, you are acknowledging and are in full acceptance of the following:Our videos are strictly for documentary, educational, and entertainment purposes only. Imitation or the use of any acts depicted in these videos is solely AT YOUR OWN RISK. Treat Airguns as FIREARMS and observe all the same safety considerations as such.  Any and all work on airguns should be carried out by a qualified and insured individual. We (including YouTube) will not be held liable for any injury to yourself or damage to your airguns resulting from attempting anything shown in any of our videos. These videos are free to watch, and if anyone attempts to charge for this video, notify us immediately.

Hello Wonderful Readers,Last week, I interviewed Camilla Sievers, founder of Qi Health. Qi is a Traditional Chinese Medicine (TCM) company that creates personalized blends of natural herbs to solve various problems in women's health.Camilla was inspired to create her company from her journey using TCM to relieve her persistent period cramps and other symptoms. Now, her team has built a seamless digital experience to help people access one of the oldest medical systems in the world.I hope you enjoy our conversation! Feel free to reach out to Camilla on Instagram or LinkedIn to share your healing stories.Check out her interview in Entrepreneur!I hope you have a shamelessly sexy weekend

Please visit answersincme.com/NRR860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, an expert in the treatment of IgA nephropathy (IgAN) discusses novel therapeutic approaches in the management of IgAN. Upon completion of this activity, participants should be better able to: Outline the unmet needs in patients with IgAN; Discuss the clinical implications of new and emerging targeted therapies in IgAN; and Identify patient-centered strategies for long-term management of IgAN.

Description: Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Jason Ingraham, an adult living with eosinophilic fasciitis (EF), and Dr. Catherine Sims, a rheumatologist at Duke University and a Health Services Research Fellow at the Durham Veterans' Affairs Hospital. They discuss Jason's experiences living with EF and Dr. Sims's experience treating EF. They share Jason's journey to diagnosis and the importance of working with a group of specialists. They share tips on medication and physical therapy, how to communicate with your medical team, and manage your activity and mindset. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:50] Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron, and co-host, Holly Knotowicz.   [1:14] Holly introduces today's topic, eosinophilic fasciitis, with guests, Jason Ingraham and Dr. Catherine Sims.   [1:25] Jason is an adult living with eosinophilic fasciitis (EF). Dr. Sims is a rheumatologist at Duke University and a Health Services Research Fellow at the Durham Veterans' Affairs Hospital.   [1:52] Dr. Sims explains what EF is. Patients may present with symptoms of large plaques on their skin, edema of arms and legs, Raynaud's Phenomenon, contractures of arms or legs, limited mobility, or loss of the ability to do tasks they used to do.   [2:42] EF, as with most eosinophilic disorders, doesn't follow the textbook. Some people will present with one symptom and some with multiple symptoms. There is a disconnect between how we diagnose conditions like EF and how patients present.   [3:01] There are major and minor criteria for the diagnosis. As in Jason's case, it takes time for the symptoms to present. Things develop over time. It took multiple specialists to diagnose Jason.   [3:38] Eosinophilic conditions are incredibly different from each other. When Dr. Sims sees a patient with high eosinophils, she thinks of three major buckets: infection, autoimmune diseases, and cancer.   [4:12] Patients will often see many different specialists. In Jason's case, they had done a skin biopsy that wasn't as helpful as they hoped. That led him to get a deep muscle biopsy to collect the lining of the muscle.   [4:47] Fasciitis is the inflammation of the muscle lining or fascia. A sample of the fascia can demonstrate under the microscope if there is a thickening, swelling, or inflammation of the lining of the muscle.   [5:24] Dr. Sims as a rheumatologist treats a number of rare diseases. Eosinophilic fasciitis is an ultra-rare disease.    [5:43] Jason had a local primary care doctor and a rheumatologist who both did a really good job and referred him to Dr. Sims. She had the benefit of their hard work to guide her next steps. Because EF is so rare, she has pitched Jason's case twice in rheumatology grand rounds sessions.   [6:18] During one of these sessions, Dr. Sims was advised to get the fascial biopsy that ultimately led to the diagnosis. She benefited from the intelligence and input of dozens of doctors.   [6:59] In the Fall of 2022, while hiking on vacation with his wife, Jason was extremely fatigued, and his forearms and lower legs swelled. His socks left deep impressions. It was difficult to reach his feet to put socks on. He spent a lot of time uncharacteristically resting.   [8:09] Jason's primary care doctor ran lots of blood tests. He thought it might be a tick bite. Jason started seeing specialists, having tests and hospital visits.   [8:57] Jason worked with a rheumatologist in Wilmington, an infectious disease doctor, and a hematologist/oncologist who reached out to a Duke expert. He also saw a pulmonologist and a dermatologist. He got the referral to Dr. Sims for March of 2023.   [9:57] The first diagnosis Jason received was after his first hospital stay in January of 2023, when he had bone marrow biopsies, CT scans, ultrasound, and other tests. He was deemed to have idiopathic hypereosinophilic syndrome (IHES).   [10:30] It was only a few weeks before his local rheumatologist said his panels were back and one tipped it from an IHES diagnosis to eosinophilic granulomatosis with polyangiitis (EGPA). He joined the Vasculitis Foundation and researched EGPA.   [11:03] Dr. Sims told Jason that EGPA was a working diagnosis but he didn't check all the boxes. There was the underlying thought that maybe it was something else. He had a second flare when he came off of prednisone in June of 2023.   [11:48] Dr. Sims scheduled Jason for a muscle biopsy while he was off steroids. That's how he got the diagnosis of eosinophilic fasciitis (EF). Jason says the disorder is hard for him to pronounce and he can barely spell the words.   [12:52] Jason's wife Michelle encouraged Jason to track his symptoms and medications and keep track of data. Going from specialist to specialist, the first thing he did was give the history.   [13:31] Jason found it helpful to create a spreadsheet of data with blood test results, meds, how he was feeling each day, his weight, and even notes about when he had difficulty putting his socks on. Jason is an advocate of owning your continuity of care as you see different doctors.   [14:42] Jason says the doctors at Duke talk very well between themselves.   [14:49] Jason likes to look back at that spreadsheet and see how far he's come, looking at the dosage he was on during and after flares and the dosage he's on now, or zero, on some of the medications. That's a little bit of a victory.   [15:16] Holly works at a private hospital without Epic or CareEverywhere so she gives physical notes to her patients to give to their doctors. She comments that a great PCP, like the one Jason had, can make all the difference in the world.   [16:18] Jason's PCP, Dr. Cosgrove, referred Jason to Duke for a second opinion. That was where he met Dr. Sims. He's glad to have both Dr. Sims and his PCP accessible.   [17:35] Jason says the number of questions you have with this type of thing is immense. When you look up EF, you find very little and the literature isn't easily digestible by patients. Being able to reach out to your doctors for a quick question is super helpful. [17:56] Jason has been able to do telehealth follow-ups and not always have to travel or take off work, which has been extremely helpful. He has been at Duke a good handful of times for various things but remote follow-ups are helpful.   [18:52] Dr. Sims says people just don't know about EF as it is an ultra-rare diagnosis. Even physicians don't understand what causes it. It's lumped in with all other eosinophilic conditions but these disorders don't all present the same way.   [19:19] EoE doesn't look like EF, even though they're both driven by the same immune cells. Dr. Sims says the first need is educating providers and patients on what the diagnosis is; awareness in general when a patient is having this swelling of extremities.   [19:44] Dr. Sims says at his baseline, Jason is very active with multi-mile hikes. When Dr. Sims met him, he was off from the baseline of what he was able to do. Being aware of your baseline and changes from that is very informative for doctors.   [20:07] Dr. Sims talks about the patient being a liaison between multiple specialists. Bringing data to your subspecialist always helps facilitate care and come up with a bigger picture of what's happening.   [20:23] Jason first went to Dr. Sims with the diagnosis of EGPA. She said, let's treat the EGPA and see what happens but they kept an open mind. With ultra-rare diseases, sometimes it's difficult for patients not to have a label for their condition.   [20:45] Dr. Sims explains to her patients that sometimes we live in the discomfort of not having a label. She keeps an open mind and doesn't limit herself to just one diagnosis. She seeks feedback from providers who have seen this before and know what works.   [21:07] Just as Jason described, you will go through multiple diagnoses. Is this cancer? Is it a parasitic infection? Where did you travel? You will see many subspecialists. It's extremely anxiety-provoking.   [21:31] When Dr. Sims did her grand rounds, she gave a third of the presentation, and the other two thirds were presented by an infectious disease doctor and a hematologist. In these cases, you need more than one subspecialist to complete the workup.   [22:10] Dr. Sims says there are a lot of misconceptions that the patient will get the diagnosis right away and the right therapy and get better. There are multiple therapies, not just medications. There are lifestyle and work modifications; it's a gradual process.   [22:22] One of Dr. Sims's goals for Jason and Michelle is to get back to doing the things that they enjoy, tennis and hiking. That's a measurement of the quality of life that a patient has.   [22:34] Talking to your doctors about how you're feeling and how you're functioning is huge. It may be that this is your new normal, but it may also be that we can make adjustments to maximize your quality of life.   [23:00] There are misconceptions about the journey of diagnosis and treatment. Have a close relationship with your subspecialist. PCPs have a high burden of expectations. As a rheumatologist who treats rare diseases, it's helpful to take on a part of that burden.   [22:31] If you don't have good communication with your providers and they aren't listening to you, you can always go get another opinion. The provider relationship is life-long.   [23:43] It's important for your provider to take what's important to you into consideration when they make treatment decisions.   [25:00] As a rheumatologist, steroids are a first-line therapy for Dr. Sims. Their role is the quick control of inflammation. The goal is always to get you off of the steroids as soon as possible, in the safest way possible.   [25:17] When Jason came to Dr. Sims, he was on mepolizumab for the working diagnosis of EGPA. Mepolizumab is one of the primary therapies for EGPA. They talked about not making treatment changes as they were navigating what was happening.   [25:40] They didn't want to make a change of medication and then have that be mistaken for disease activity. They didn't want too many variables moving at once.   [25:47] Typically, the first-line therapy is steroids, meant to help with the swelling, pain, and tightness that patients will get lining their muscles and give them a bit more functionality and decreased pain.   [26:00] Long-term, Dr. Sims gives immunosuppressant medication. She prescribed methotrexate for Jason. In EF, the immune system is overly activated, attacking the lining of the muscles and causing the symptoms.   [26:51] If you suppress the immune system activity, that leads to decreased inflammation and symptoms in the patient. Steroid use, over a few months, is detrimental, with low bone density, weight gain, high blood pressure, and diabetes.   [27:14] Dr. Sims starts with prednisone and folds in medications like mycophenolate or methotrexate.   [27:19] Mepolizumab is an interleukin 5 blocker. Interleukin 5 is part of the immune system and is necessary for eosinophils to grow, function, and multiply. The goal of using mepolizumab is to lower the eosinophils that are contributing to the disease symptoms.   [27:48] Methotrexate, prednisone, and mepolizumab can work synergistically or independently. Most rheumatologists start with methotrexate or mycophenolate which have fewer side effects and have been around longer. We know how to manage those.   [28:08] If there is no response, we may add something like mepolizumab. As Jason was already on mepolizumab, Dr. Sims added methotrexate.   [28:20] IVIG, an infusion of immunoglobulin, has also been used as a quick way to control inflammation. It is used in other autoimmune diseases like myositis, which is inflammation of the muscle itself.   [29:08] With untreated eosinophilic fasciitis, the lining of the muscle may continue to be inflamed and can lead to fibrosis, damage that cannot be reversed. The patient can become very disabled. Contracture is one result of this.   [30:16] Jason says when he tried a new medication, he monitored if it was a good fit and if the side effects were less impactful than the underlying disease. Dr. Sims adjusted his dosages or tried to get off certain medicines as needed.   [30:59] After his muscle biopsy from his left calf, it took about a month to get back to walking easily. He was already in physical therapy, going many times for a variety of things. He had back pain, potentially related to his EF. His physical therapist was great.   [31:56] The stretches alternated between upper and lower body. Jason bought tools to do the stretches at home. When he's not feeling as well, he goes back to some of those same stretches. When he was on steroids, he took long walks to strengthen his bones.   [32:39] Jason started making phone calls to supportive family and friends on his walks and started listening to podcasts related to his condition or medications. Getting back to tennis and hiking is important to Jason. He's happy to be out there.   [33:20] Jason was open with his employer about his condition. Some of the weekly meds can make him not feel well. His employer gives him some flexibility. He has good days that far outnumber the bad days. He doesn't have to think about EF too much now.   [34:33] It's nothing like when he was in a flare, especially when he was in a flare before being diagnosed. What gets him through a bad day is giving himself some grace and understanding while he waits for his meds to catch up. He rests more than he wants to.   [35:33] Low-impact exercises like walking help Jason. He's trying to find a support network that gets EF. That led him to APFED, to find anyone experiencing something like what he was. He saw a conference that included a session on EF.   [36:09] Jason signed up for the conference and there he met Ryan's mother who has EF. They were each the first person the other had met with EF. They decided to connect after the conference. They talked on the phone for about an hour.   [36:39] She told Jason how she got into APFED and talked a lot about her son who had eosinophilic diseases. Soon after, Jason talked to Ryan as a primer for this podcast.    [38:15] Having a community to relate to, even if it's one person, is massive. It can make you feel less isolated.   [38:42] Holly says it's hard having a chronic illness. She thanks both Jason and Dr. Sims for sharing so much information and their journey and she asks for last words.   [38:58] Dr. Sims believes finding a community is critical. She interviews a lot of patients for research and isolation is a frequent theme. Even the doctor doesn't know what it's like to live with the condition you live with daily. As Jason said, give yourself grace.   [39:33] Dr. Sims tells her patients that they're different from the general population because they have to spend so much time and energy managing their condition that they can't do x, y, or z today, and that is OK. She says to stay motivated and positive.   [40:12] Find what works for you. Walking is good for your physical and mental health. Have the goal of getting back to what makes you happy. Take initiative and find non-medication ways to recuperate. You have control over ways you can feel better.   [40:43] Connect with others and share your story, like Jason did today. It may make someone's journey a little easier and make them feel less alone. Utilize your condition for good, for a bigger purpose.   [41:04] Jason had wished he could meet someone who could tell him what EF would be like over the years. He says to stay positive and find out what you have control over. Jason believes the future is bright for being able to do many things for a long time.   [42:26] For our listeners who would like to learn more about eosinophilic fasciitis, please visit APFED.org and check out the links in the shownotes.   [42:33] If you're looking to find a specialist who treats eosinophilic disorders, like Dr. Sims, you can use APFED's Specialist Finder at APFED.org/specialist.   [42:43] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at APFED.org/connections/.   [42:55] Ryan thanks Jason and Dr. Sims for joining us for this excellent conversation. Holly also thanks APFED's Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron for supporting this episode.   Mentioned in This Episode: Dr. Catherine Sims, rheumatologist Duke University Hospital Durham VA Medical Center   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of Bristol Myers Squibb, GSK, Sanofi, and Regeneron.   Tweetables:   “EF patients may present with large plaques on their skin, edema of arms and legs, Raynaud's Phenomenon, contractures of arms or legs, limited mobility, or loss of the ability to do tasks they used to do.” — Dr. Catherine Sims   “Steroids are … first-line therapy. Their role is the quick control of inflammation. The goal is always to get you off steroids as soon as possible, in the safest way possible.” — Dr. Catherine Sims   “Methotrexate, prednisone, and mepolizumab can work synergistically or independently. Most rheumatologists start with methotrexate or mycophenolate which have fewer side effects and have been around longer.” — Dr. Catherine Sims   “Stay positive and find out what you have control over. The future is bright for being able to do many things for a long time.” — Jason Ingraham

Transforming Behavioral Health Care: The Power of Collaboration and TechDescription: Join two leading experts in behavioral health as they dive into the pressing issue of the growing demand for mental health services versus limited access to equitable care in the United States. Discover how the Collaborative Care Model serves as a powerful framework to seamlessly integrate mental health services into primary care, with a focus on expanding access in rural communities. The conversation also explores innovative digital tools that can streamline care coordination and boost patient outcomes, paving the way for a more connected and efficient approach to mental health care.Objectives: Explain the factors contributing to the growing demand for mental health services. Discuss how the Collaborative Care Model can enhance mental health outcomes in various settings while supporting the Quadruple Aim.Discuss the role of digital tools in enhancing care coordination and improving patient outcomes within behavioral health services. Guests:  Luke RaymondSarah Oliver, PhD, MSWBios: Luke RaymondLuke Raymond is an accomplished leader in behavioral health strategy, operations, and innovation, with over 20 years of experience in the field.  A therapist by training, he has spent time in various clinical, strategic, and commercial leadership roles with a strong focus on improving access to care, reducing costs, and delivering effective outcomes. Luke co-authored an article in Psychiatric Times on implementing telepsychiatry in rural settings and has spoken at numerous national conferences, including the Healthcare Information and Management Systems Society (HIMSS), the American Telemedicine Association (ATA), and American Health Insurance Plans (AHIP). Luke has both commercialized and led initiatives that resulted in a 50% reduction in emergency department visits, improved patient and clinician satisfaction and delivered effective digital and virtual care at scale. Luke is certified in trauma-focused cognitive behavioral therapy and integrated primary care therapy.  His clinical interests include ADHD, anxiety, and trauma recovery.  Luke lives with his wife and daughter in central Illinois, where he enjoys endurance running, fishing, and bourbon outside of work.  Sarah Oliver, PhDSarah has nearly 30 years of experience in the social work field as a case manager and psychotherapist. She specializes in working with individuals who have experienced trauma. She earned her PhD in Clinical Social Work with a specialization in military and veterans issues and previously earned her MSW degree in Social Work from the University of Iowa. Sarah is the Director of Counseling at St. Ambrose University in Davenport, IA, and has worked with the college-age population for the last eight years. In addition, Sarah has a private practice where she sees Veterans and first responders who have experienced combat and other forms of trauma. Sarah is no stranger to Veterans or Veterans issues, having spent 17 years as a Clinical Social Worker for the Iowa City VA Health Care System.  During this time Sarah had specialized experience providing care to Homeless and at-risk Veterans and providing psychotherapy to Veterans.  She has been in a variety of front-line social work and leadership roles coordinating with community members and other interested groups to provide the best care to Veterans.     In addition, Sarah has taught as an Adjunct professor at the University of Iowa's School of Social Work for 16 years.  References American Foundation for Suicide Prevention Suicide Statistics, 2024 https://afsp.org/suicide-statistics/World Health Organization, COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide, 2022 KFF, KFF/CNN Mental Health In America Survey, 2022 https://www.kff.org/mental-health/report/kff-cnn-mental-health-in-america-survey/American Psychiatric Association Workforce Development, 2024 https://www.psychiatry.org/psychiatrists/advocacy/federal-affairs/workforce-developmentHealth Resources & Services Administration Workforce Projections, 2021 (Source)  National Library of Medicine, Understanding the expanding role of primary care physicians (PCPs) to primary psychiatric care physicians (PPCPs): enhancing the assessment and treatment of psychiatric conditions, 2010 https://pmc.ncbi.nlm.nih.gov/articles/PMC2925161/National Library of Medicine, Rural-urban prescribing patterns by primary care and behavioral health providers in older adults with serious mental illness, 2022, CMS Medicare Learning Network Bulletin (Source) 9-AIMS Center, Evidence Base for Collaborative Care (CoCM), https://aims.uw.edu/evidence-base-for-cocm/National Library of Medicine, From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider, 2014,

Dr. Kristin MacGregor, a clinical psychologist and senior clinical director of Integrated Behavioral Health at LifeStance Health, the largest outpatient mental health practice in the U.S., employing nearly 7,000 clinicians across 33 states to provide therapy, psychiatry, and psychological/neuropsychological services both in-person and virtually. They work with large medical practices and health systems to help build integrated behavioral health programs using the collaborative care model. Integrating mental health into primary care settings can help address early warning signs of cognitive decline, reduce stigma, and improve collaboration between providers to address both mental and physical health needs better and manage chronic diseases. Kristin explains, "I think anything that removes barriers to people accessing mental health care when they actually need it is a positive thing. The research shows that it takes 11 years, on average, between the time someone experiences a mental health symptom and the time that they get connected to care. And that is just far, far too long. There are, of course, many reasons for this. Still, one of them is that the longer time a person has to wait between the time they get referred to a mental health provider to the time that they have an appointment, the longer that time, the more likely it is the patient might actually talk themselves out of the appointment." "It's very challenging to do that in the way that the physical healthcare system and the mental healthcare system are currently set up. We're very siloed. There's not a lot of shared data that goes back and forth between PCP and mental health providers. However, in these integrated care settings, which I feel very strongly about, collaboration is incredibly important because there is something to learn. There's something to learn as a mental health provider about how physical symptoms can manifest themselves and about how chronic conditions can impact a patient." "But, bi-directionally, PCPs also really need to understand how mental health symptoms can present in different age groups and different cultures and ethnicities, and things like that. And when you're working side by side together on shared treatment plans, it's just so much easier to learn those things from one another as opposed to continuing to perpetuate these sorts of silos that we currently operate in with very little to no collaboration between the two parties."  #LifeStanceHealth #MentalHealthMatters #LFST #MentalHealth lifestance.com Download the transcript here

Dr. Kristin MacGregor, a clinical psychologist and senior clinical director of Integrated Behavioral Health at LifeStance Health, the largest outpatient mental health practice in the U.S., employing nearly 7,000 clinicians across 33 states to provide therapy, psychiatry, and psychological/neuropsychological services both in-person and virtually. They work with large medical practices and health systems to help build integrated behavioral health programs using the collaborative care model. Integrating mental health into primary care settings can help address early warning signs of cognitive decline, reduce stigma, and improve collaboration between providers to address both mental and physical health needs better and manage chronic diseases. Kristin explains, "I think anything that removes barriers to people accessing mental health care when they actually need it is a positive thing. The research shows that it takes 11 years, on average, between the time someone experiences a mental health symptom and the time that they get connected to care. And that is just far, far too long. There are, of course, many reasons for this. Still, one of them is that the longer time a person has to wait between the time they get referred to a mental health provider to the time that they have an appointment, the longer that time, the more likely it is the patient might actually talk themselves out of the appointment." "It's very challenging to do that in the way that the physical healthcare system and the mental healthcare system are currently set up. We're very siloed. There's not a lot of shared data that goes back and forth between PCP and mental health providers. However, in these integrated care settings, which I feel very strongly about, collaboration is incredibly important because there is something to learn. There's something to learn as a mental health provider about how physical symptoms can manifest themselves and about how chronic conditions can impact a patient." "But, bi-directionally, PCPs also really need to understand how mental health symptoms can present in different age groups and different cultures and ethnicities, and things like that. And when you're working side by side together on shared treatment plans, it's just so much easier to learn those things from one another as opposed to continuing to perpetuate these sorts of silos that we currently operate in with very little to no collaboration between the two parties."  #LifeStanceHealth #MentalHealthMatters #LFST #MentalHealth lifestance.com Listen to the podcast here

Learn more about NetSuite Planning and Budgeting: https://tinyurl.com/bdhm7phf   In this special episode of the NetSuite Podcast focusing on the CFO's agenda for 2025, cohost Megan O'Brien sits down with Jess Wijesekera, SVP of Global Accounting at Vytalize Health, a leading value-based care platform. They start the episode by discussing Jess' background and what brought her to her current role [1:55]. Jess then delves into Vytalize Health and its exponential growth over the last several years [6:26]. Megan and Jess discuss technology and talent issues [15:49]. They end the podcast episode by covering Vytalize Health's priorities for 2025 [31:52].   Follow Us Here:   Vytalize Health: https://www.vytalizehealth.com/   Jess Wijesekera LinkedIn: https://www.linkedin.com/in/jessica-wijesekera-7290196/   Oracle NetSuite LinkedIn: https://social.ora.cl/6000wKFhC X (Twitter): https://social.ora.cl/6007wK2zD Instagram: https://social.ora.cl/6003wK2Hv Facebook: https://social.ora.cl/6005wK2Dv   #NetSuite #CFOAgenda, #Accounting   --------------------------------------------------------   Episode Transcript:   00;00;04;21 - 00;00;28;20 Hello, all you Suite listeners. Thank you so much for tuning in to the NetSuite podcast. I'm Megan O'Brien, a co-host of the podcast. Now you all are in luck because today's episode marks the start of a mini series we are doing called The CFO Agenda. As we approach the end of 2024, we wanted to gauge what's on the docket for finance and accounting leaders.   00;00;28;23 - 00;00;50;23 In the first installment of the series, we have Jess Wijesekera, SVP of Global Accounting for Vytalize Health, a leading value based care platform. If you attended SuiteWorld or if you tuned into NetSuite OnAir to watch the main keynote, you would have seen her make an appearance with NetSuite Founder and EVP Evan Goldberg.   00;00;50;25 - 00;01;19;08 Vytalize Health has grown by a casual 90,778% over the last three years, so this episode is a great pulse check on what high-growth companies are prioritizing this coming year. We talk all about Jess' background and her current role of Vytalize Health, the company's exponential growth, and her plans for 2025. With that, let's go ahead and dive in.   00;01;19;11 - 00;01;45;23 You're listening to the NetSuite Podcast, where we discuss what's happening within NetSuite, why we're doing it, and where we're heading in the future. We'll dive into the details about the software and the people at NetSuite who are behind all the moving parts. We'll also feature customer growth stories discussing the ups and downs of running a company and how one integrated system can help your business continue to scale.   00;01;45;25 - 00;02;03;26 Hi, Jess. How are you today? Hey, Megan. Good. Really great to be here. Good. We're so happy to have you. Yeah. Thank you. All right, well, we're going to dive right in because we have so much to cover. We want to hear, first of all, about your background. Did you always know that you wanted to get into accounting?   00;02;03;29 - 00;02;26;29 I did not. But I was always very good at organizing people and organizing projects. And I think that organization has always really been a part of who I am. It's going to sound silly, but in kindergarten I used to and tell them where and how to jump rope, and they always just happily listened to what I had to say.   00;02;26;29 - 00;02;57;23 And I felt really like a natural leader and I knew I wanted to do something that captured my personality. So, for me, accounting is just a really nice because it's taking project management and organization and unpacking a puzzle takes a lot of patience, which I'm learning to have a lot of patience, but it takes a lot of kindness for interacting with other departments and some tenacity with dealing with service providers.   00;02;57;23 - 00;03;31;23 So, I didn't know I always wanted to do it, but it is feeling like a really good fit. I couldn't help but stalk you a little bit on LinkedIn. You majored in accounting at Villanova, which is where I went. Yeah, Wildcats, you know, so I know I just had a great experience there and I chose it really because they had a very solid business school and I had this accounting professor who taught financial accounting, and he told me that accounting was the hardest major in the business school.   00;03;31;26 - 00;03;58;08 And if I could do accounting, that I could do anything, I could do finance, I could do management, I could do marketing. And he was really right. And I followed my accounting degree up with a master's in finance at Boston College. And it's really worked well, I think, to have this understanding of everything that's accounting is past and everything that's finance is future and we meet in the present.   00;03;58;12 - 00;04;28;26 So it's kind of helped shape my career and where it's gone. That is such a cool perspective on it. And, and speaking of your career, could you talk a little bit about your past roles and your path to where you are now? Yeah, so like many accounting majors, I started at the Big Four, so I was at EY and I stayed longer than most. I was there about 15 years and I did a grand tour of about four offices.   00;04;28;29 - 00;04;55;29 So, I started in Palo Alto, and then did Boston, San Francisco, and I also did a three year secondment in the London office. And every time I felt I was going to leave public accounting, I stayed because I got a new opportunity or worked on a new client or with a new team. And it was this feeling that I could really add value, but also learn something completely new, which added to my skill set.   00;04;56;02 - 00;05;20;15 And I can't even tell you the number of times that I've cried in an audit room. I do think about those experiences and really how it shaped me. I got to work on Warner Brothers and Hawaiian Airlines, and towards the end of my career there, I was a national instructor for 606 when that Rev Rec standard was completely new and nobody knew what to do.   00;05;20;15 - 00;05;48;11 So that helped me with my foundation for where I am now. But after 15 years I decided to go into industry, so I started as an assistant controller. I was at a bottling company and my very first day on the job I realized I've never booked a journal entry in my whole life and a few roles since I have taken on kind of new areas of responsibility and kept growing my own skillset.   00;05;48;13 - 00;06;14;09 And I'm actually really lucky now to have brought on a couple of people I've worked with in the past, you know, kind of through EY and other companies because we just really enjoy working together. So that all of that brought me to my life. Well, I mean, I don't think you've really worked for a Big Four unless you've cried somewhere in an office, so you, you sent that experience home. Probably an office without windows.   00;06;14;11 - 00;06;40;07 Yeah, yeah, yeah, I did my crying in a phone booth, so. Yeah, yeah, No windows. We're all here now. We're all here. And better for it. So speaking of Vytalize, you ended up joining Vytalize Health about two years ago? Can you tell our listeners a little bit about what Vytalize Health does? Yeah, so Vytalize is a value-based care company.   00;06;40;09 - 00;07;10;11 Value-based care is a collection of doctors and service providers and payers that work collectively to have better outcomes for patients. And coincidentally, that's usually at a reduced cost. So, what we do is sit between the primary care physician and CMS, which is the Center for Medicare Services. So we help our physicians strengthen the relationship that they have with their patients.   00;07;10;13 - 00;07;41;13 And if we succeed in that and meet certain quality metrics and achieve these better health outcomes, then CMS as the payer, they give us a share of that. So, I'll use a fancy terminology, but it's really aligning incentives, right? So, we're all incentivized for providing better, higher quality care, not necessarily more care. And it's really working because we're giving these doctors more time to spend with their patients.   00;07;41;13 - 00;08;18;00 So, we provide services like care coordination and virtual home care, in-home care. And it's particularly important for the Medicare population. You know, if you think about 65 plus and then people that are, you know, often not able to get to the doctor, in-home care is so critical. And really, we see ourselves as an extension of the physician so that we operate as part of their practice and really preventing hospitalizations and improving the quality of life and, you know, for an accounting major, that's certainly something I can get behind.   00;08;18;00 - 00;08;42;02 And, you know, the mission and kind of what we're doing, it feels really good. What does a typical day in your shoes look like? So like many companies in the pandemic, we went remote. So I have a little office that I use in a coworking space and I bring my puppy with me and we have a lot of meetings.   00;08;42;02 - 00;09;07;10 So back-to back-video meetings, I do a lot of meetings direct with one on ones, with my direct reports. We are constantly meeting with our EY tax team, Connor Group accounting specialists, so treasury and tax report through me. And then I just took on the FP&A function as well. So, this week was a lot of meeting with department heads to try and craft our budget.   00;09;07;12 - 00;09;34;04 But I find my typical day is really helping my team make good decisions and collaborative points of view and just making sure that we're prioritizing the right thing at the right time. Because like so many companies growing as quickly as we are, you know, you're this can be really long and kind of helping decide what comes first and what can come when, as you know, is a really big part of my job when I also have the puppy.   00;09;34;04 - 00;09;57;04 So she's as cute as can be. And we try and get out of some walks in between all of the meetings. Yeah. So for our frequent listeners, the puppies she's referring to is actually the guide dog puppy that attended SuiteWorld that we talked about in our SuiteWorld. recap. We are obsessed with Mayberry. I think she might be the new NetSuite mascot she's so sweet.   00;09;57;04 - 00;10;19;10 So she's training to become a guide dog for the blind. And I'll have her through next June. And she's part of the Walnut Creek Club here in the San Francisco Bay Area. And she's just a little delight. So her having her experience SuiteWorld in Vegas, I think opened her eyes. I mean, she's doing really great.   00;10;19;12 - 00;10;53;13 She did so good. She was all scared of the casino. Yeah, we all are. So Vytalize Health has this crazy growth trajectory. So the company ranked number one on the Inc. 5000 across all industries after achieving $1.5 billion in revenue for 2023 and a three-year revenue growth rate of 90,778%. Can you delve into the Vytalize Health's growth story and how that all came about?   00;10;53;15 - 00;11;22;19 Yeah. So Megan, work with me here on some math backwards. So to get to 1.5 billion, that means we started as a single health care practice. So we had one practice. It was in Rockland, Maryland, and it still exists, but we've grown from about one medical practice to over 200, I'm sorry, 2600 primary care physicians. We found that we were very good at these additional services.   00;11;22;19 - 00;11;49;15 Right. The care coordination and helping the physicians make better decisions. And instead of growing our own practices, the business went through kind of the modeling approach that we would instead partner with physicians and they would join our value based care program, which is it's called Accountable Care Organizations. So those practices joined our ACO and we taught them value-based care.   00;11;49;18 - 00;12;18;21 And through that we shared a part of our savings with them. And in that model, we were really able to grow quickly. So we went from, you know, just a few thousand Medicare beneficiaries to now over 260,000 patients. And that's a staggering number because we're probably taking care of someone that, you know, and it's part of Medicare's goal to have every Medicare patient in an ACO by 2030.   00;12;18;24 - 00;12;41;04 So for people who don't know what value-based care is, all of the sudden they must participate in value-based care by 2030, in six years we'll be there. And Vytalize is really helping with that transition. And it's working. It's working really well. We're seeing a lot improved outcomes for patients and decreased hospital hospitalizations. And yeah, it's going really well.   00;12;41;10 - 00;13;06;23 Yeah, clearly, clearly clear. So were there any challenges that came with this rapid growth? And if so, how did Vytalize help tackle them? Do you remember Facebook? They used to have this tagline and slogan and it said, ‘Move fast and break things,' right? And I was googling it recently and I was like, I think they have abandoned that tagline.   00;13;06;25 - 00;13;35;10 Yeah, maybe with the move to Meta, they're like, Yeah, maybe not and break things. Yes. So that's the hardest part, right? Is because you can move too quickly and break things and sometimes that's an okay thing. But a lot of the times we should really be adding a lot more thought, a lot more time and a lot more considerations to some of the larger decisions that are going on.   00;13;35;10 - 00;14;02;29 So really, to me, the biggest challenge with this rapid growth is taking the time and the thought process to really think through decisions and not move as quickly as you can. So one of the other things that we've done to kind of circumvent that is adding a policy and procedures committee and a policy and procedures role in our organization.   00;14;02;29 - 00;14;37;20 And I'm not going to take any credit for that because it was already in existence and it was already working really well. But we were able to then write some policies pretty early on that helped our controls and helped our vendor contracts who could engage if vendor who could approve a payment. And a lot of those early policies and we're still writing them, but a lot of those early policies helped us, you know, be able to go to the rest of the business and say, ‘Hey, you know, you can't X, Y, Z because of this policy' or ‘You can, but you must do it in this way.'   00;14;37;24 - 00;15;07;28 And kind of making that consistent across the organization was really helpful for me. Well, that kind of leads into a good question for our listeners here. Any best practices for companies that might be looking to grow or any pitfalls to avoid? I think growth in general is having good technology to scale, right? So how do we make something a repeatable process and how do we put it in a system to be able to make it repeatable?   00;15;08;01 - 00;15;39;14 My app director, Lisa Kemper, and I joke all the time that life is full of one-offs, right? Like this is all a one off and if you're tackling something over here and over there, you would need 300 people in your accounting department to be able to support all of the one-offs. So, we very much we do use this Policy and Procedures Committee, but we're also standing up a lot of our tech products and using NetSuite to be able to get, you know, some standardization.   00;15;39;14 - 00;16;07;11 But also I'll call it kill the one offs, right? We can't be doing an exception. Everything has to fit into a process and become part of the rule. And how has Vytalize Health been using NetSuite? Oh my gosh. We're big, you know, signing some new statements of work all the time. So, yes, I love it. I know the one we just signed was the budgeting and planning tool right now.   00;16;07;11 - 00;16;33;05 So we started with the financials and budgeting and planning. But I would say we're really starting to use a lot of the subledgers in the way that they were intended to be used, and that has been really helpful for us. So, our biggest NetSuite, and I spoke about this at SuiteWorld, is our bank reconciliations. We have, you know, 47 bank accounts and transactions galore.   00;16;33;11 - 00;16;58;00 Right? And sort of as we talk about standardization and automation and killing, the one offs, what we're doing is making sure that we can put something in a process and make it repeatable. And the bank reconciliation module has started to learn the way that we're matching off our bank recs and the way that we're matching off transactions. And it will start to do that for us.   00;16;58;00 - 00;17;21;05 So every time we make a bill payment debit this account credit that account it learns it and then it'll just do it in the background and then we approve it. So this used to take three people their whole full-time job. Not to mention there are a lot of errors in this process. And now that we actually turned on the bank rec module, it's kind of all working for us in the background.   00;17;21;05 - 00;17;47;26 And I was even talking with my accounting manager, Kelly Allen, and I said yesterday I was like, Kelly, how's the bank matching going? And she's like, ‘You know, I don't even hear about it.' It's really working for us. And, and it's been helpful to start to automate these things so we don't have to think about it. And it previously it just felt like we were playing catch up, you know, 45 days.   00;17;47;29 - 00;18;06;14 It would take us to close the books. And, you know, 45 days ago was the end of August or August is long gone by now. Right? We're making business decisions all the time. Do we need more? You know, funding from investors? We want to take a loan, whereas, you know, where are these larger payments coming from? We're going to we can't wait 45 days for anything.   00;18;06;14 - 00;18;32;25 So it's helped us, you know, make some real-time decisions. Well, why is having a strong tech stack so important for Vytalize Health specifically and how did it perhaps help facilitate some of the massive growth that you mentioned previously? We had a previous controller at Vytalize and every time we needed financials, he would say, okay, like I need three days.   00;18;32;27 - 00;19;02;08 He would take, you know, we had QuickBooks and, you know, it was the right size and shape for us when we started. So, we're using QuickBooks and he would take three days to prepare a consolidation and then to do the elimination journal entries. And that was a very manual effort. And three days of those financials and, you know, the manual errors that could exist.   00;19;02;08 - 00;19;23;13 And, you know, it was almost like, well, I don't need it anymore that I asked for that three days ago. We've moved on. That wasn't at least, you know, last week. So finally I looked at him and I was like, we have to get this in NetSuite and we have to do like journal entries and post them on the system.   00;19;23;13 - 00;19;43;21 And, you know, we're going to need elimination entries and we're going to need to have this reporting in a moment's notice. And, you know, when we ask for the report, I need it in 20 minutes, not three days. So we moved it all into NetSuite We've also gotten a tool called Workiva and Workiva connects to NetSuite.   00;19;43;21 - 00;20;09;08 And I'll give a shout out to Ryan Mueller, who's our senior manager of tech accounting and NetSuite syncs with Workiva so we can produce financial statements and reports at a moment's notice. And I can say, you know, I want the Q2 report to investors and I want that Q2 report to include these entities and Workiva pulls the information from NetSuite.   00;20;09;08 - 00;20;32;08 And then we can have it ready for an investor immediately. And that has really been a game changer for us. We do a lot of reporting. We have board members and boards of each of our ACOs, so there's about six of those. We need frequent reporting for about six different entities. And then on top of that, we're supporting an audit from Deloitte right now.   00;20;32;08 - 00;20;58;13 For us to pull all of this reporting very quickly and only, you know, I have a team of five here in the US doing accounting, and that is really essential for us to have these tools so that we can, you know, keep our headcount costs low, keep the work interesting for the people that are here, and be also, you know, be providing that to investors.   00;20;58;15 - 00;21;24;18 NetSuite by Oracle, the number one cloud financial system is everything you need to grow all in one place. Financials, inventory, HR, and more. Make better decisions faster so you can do more and spend less. See how at netsuite.com/pod. Well, can you imagine the poor controller just getting an email saying, ‘Hey, we want the numbers' and thinking, ‘Well, there goes three of my days.'   00;21;24;21 - 00;21;47;29 My god, I'd be dreading emails. Yeah. And, you know, sad story about QuickBooks. You have to have separate legal entities. So, we had 16 legal entities that he had. Like, you can't run a report. So we got a bolt on tool. So it's fun. But you know, just to sort of highlight like if you think you can do it, it could probably be done.   00;21;47;29 - 00;22;13;10 So moving to the new technology helped us immensely. Yeah, thank god. Thank god for saving the controller on a click of a button. We've kind of alluded to this, but you participated in a keynote with NetSuite Founder and EVP Evan Goldberg at SuiteWorld this year. What was that experience like? It was so cool. That was really just kind of a highlight for me.   00;22;13;15 - 00;22;35;08 I think the best part was people coming up to me afterwards and saying, you know, they resonate with my message or, you know, they really liked whatever point I had to make. And, you know, yeah, it's cool to be on stage and meet Evan. But really, for me, it kind of came full circle when people, you know, could kind of even tell me back what I said, did I say that?   00;22;35;10 - 00;22;57;26 But yeah, that was that was a really great experience and, you know, fun to kind of share how Vytalize is doing. And, you know, this big award has, has really opened a lot of doors for the company as well. One of the anecdotes really stuck out to me personally in your keynote with Evan was how someone on your team essentially automated himself out of his job doing bank reconcilations.   00;22;57;28 - 00;23;21;26 But he ended up moving to FP&A, which arguably more of a value add for the company. So as more manual task and accounting and finance are automated, what do you think the future of those functions will look like? Yeah, and I have this funny title. My title is global, which you know, often means it's a global company.   00;23;21;28 - 00;23;48;29 But for me, this global title is actually represents to the people on my accounting team and we are all over the world. So the individual who automated himself out of his job, Dether, sits in the Philippines. So it's kind of this added layer, Meggan, that, my goodness, an outsourced role in the Philippines, just automated himself out of a job.   00;23;49;01 - 00;24;21;13 But the people are working to offshore stuff, but like my offshore person is working to automate. And just a quick update on Dether: he has been so helpful with the budgets for us. We are going through our budgeting process right now, as so many companies are, and that budgeting process is really leading to a lot of great conversations with our department heads about what costs we're needing, what vendors we're going to be needing for next year, what strategic initiatives do we have to plan more costs for, where is more revenue to compensate for that?   00;24;21;15 - 00;24;45;29 And he has been so incredibly helpful in that role and I think it's very fulfilling for him so often times, you know, what is the future of the function looks like? It just looks like it's at a higher level and we are starting at the baseline is just moving up, right? So your entry-level position is just doing higher quality work.   00;24;46;01 - 00;25;10;07 Hopefully fewer tears in the audit room now. I think the tears will exist, but I do think people will have a more fulfilling job, start for themselves right out of college or right into the workforce. What skills do you think will become must haves and kind of this new normal? Yeah, I think the go-to skill for me is just a willingness to learn.   00;25;10;10 - 00;25;44;25 You know, I think I even told Evan on stage I don't know everything and I really don't, but at least I know where I can look it up. Or I might know who to ask or, you know, in me and in my team is this willingness to learn and the willingness to change. And I think kind of that positive outlook and that positive environment is something that will forever be a must have, especially as we have all these new these new automation ideas and everything that's new and exciting.   00;25;44;27 - 00;26;09;28 We really just have to embrace it. And getting a little more granular here. What are you looking for when hiring talent? Are there any kind of talent gaps that you are trying to fill? Yeah, and I think especially as a scaling company, I think in any organization you often wear many hats, but as I'm scaling, I'll just use my senior manager of accounting projects as my go to example.   00;26;09;28 - 00;26;36;25 But I'd worked with him before and when I hired him I was like, ‘I just I need help.' And the first thing he says, all the time, Rob Dulgarian, is how can I help? And it's this willingness to learn new skills and the willingness to you know, get in and get your hands dirty, figure something out and, you know, kind of right size, whatever it is that you're working on that.   00;26;36;28 - 00;27;08;13 And that's a skill that the skill that I'm looking for when I hire people, you know, people we have people in Jordan, we have people in the Philippines, and we have people in the US, and kind of across the board. Anytime we're hiring, that's really what we're looking for is, you know, I've never done that before and I don't know how I'm looking for people that say, you know, I've never done that before, but let me explore, you know, how it's just this really positive outlook and where we are.   00;27;08;13 - 00;27;39;27 We especially get that from our global team members. They're just ever so, ever helpful. How do you assuage some of the fears in your team and your leadership, whatever it might be, about being automated out of a job? How do we get people to kind of embrace automation and AI and not really fear it? So I admittedly was unsuccessful at this at my last position, and I have been unsuccessful at this before.   00;27;39;29 - 00;28;24;18 I think it takes the tone from the top and really having, you know, the board, the C-suite, your investors, having those individuals excited and ready to embrace change is where it starts from because not to throw a cliche out there, but it really will all trickle down and having them excited and on board. At my last job, I think the only one that was excited and on board and it was really hard to get change, to get people excited about doing something else because, you know, they often have fear of losing their position and that that fear is very normal and very understandable.   00;28;24;18 - 00;28;51;05 But I think that as long as the, you know, the top of the company is willing to be flexible and encourage that change, I think it'll be a lot more effective. The accounting profession, it's been the news recently due to a shortage of professionals entering the role. So as a leader in accounting, how do you think companies can combat that shortage and attract accounting talent to their teams?   00;28;51;10 - 00;29;17;13 I feel like I'm going to bring this answer back to your previous questions, right? So it feels like automating and, you know, kind of holistically globally, looking at the talent workforce that's there. I mean, I think that's how companies are going to be able to continue to succeed. I kind of saw at the tail end of my career at EY how it was harder to get new accountants in.   00;29;17;13 - 00;29;57;15 And then also combined with COVID, was very difficult to start training people without being without being on site and in the same place together to be able to train. So, you know, from my perspective, I think it'll flex and change over time. Maybe I should teach some more accounting classes and get people excited about being accounting majors. But, you know, I, I do very much think it'll be a combination of roles like global accounting roles throughout the world, combined with this idea of people really embracing and getting change and automation and up and running and tech stack too.   00;29;57;15 - 00;30;31;17 I think one of the other things I wanted to mention is that we've been using Numero and Numero is a tool that we've used through Connor Group. And what Numero does is extract key terms out of documents and summarize technical accounting. So we're using AI to write our technical accounting memos, future state, and we're using a lot of this AI to kind of take and develop things that we would have done manually.   00;30;31;17 - 00;30;56;04 And you don't even think about how manual it is to create a technical accounting memo. But, you know, if I can give this bot a topic and my three lease agreements that can write an ASC 42 memo for me and you know, how cool is that? Because basically what we're doing then is taking the people who used to prepare the work and making them reviewers instead.   00;30;56;06 - 00;31;16;22 And I do think there are some additional challenges of like, how do you review something you've never prepared? But, you know, I think it'll create higher value work earlier in the process for people when they're launching their accounting careers. Yeah, I think taking some of the tedium out of it is going to be huge. So much tedious.   00;31;16;24 - 00;31;38;29 So much teedious staff work. Yeah. And now we have technology. Yeah. I wish I were starting my career now. I think I might consider an accounting career. If we had the. No, I would be terrible at accounting. I'm not organized enough. But then again, I could talk you into it. But maybe someday. But not today. I do come from a family of accountants.   00;31;38;29 - 00;32;06;02 Unknown My family is in medicine. So some helpful lessons for me. Yeah. For a health care company. Yeah. You blended it. Yes. So it was both. Well, we're kind of like coming up on the end of the year, so I wanted to pick your brain kind of around your 2025 agenda. So as SVP of accounting, what are your top priorities going into 2025?   00;32;06;05 - 00;32;32;07 So we are building out all kinds of really great reporting. So we're using the NetSuite Budgeting and Planning tool to also do our financial reporting for us. So what we're doing this year is building our budgets and we're building them at the vendor level. So it'll be able or it'll give us the opportunity to really analyze our budget versus actual at a new level that we've never done before.   00;32;32;07 - 00;32;57;25 So we're pretty excited about that. And then also meeting more regularly with our department heads to be able to have them reflect on how the month went, but then also make any changes in the future, planning for their new hires and any vendor expenses they have. And really, you know, having a well thought out budget and meeting that budget in 2025 is really our biggest priority.   00;32;57;28 - 00;33;22;22 Well, that's huge because, I mean, we keep writing about it, but the role of finance and accounting is becoming so strategy driven, so much about partnering across the rest of the business instead of kind of, you know, reporting after the fact to everyone. It's like working with them and collaborating during the process. Yeah, yeah. And seeing what new contracts are in the pipeline.   00;33;22;22 - 00;34;00;09 How are we going to take those contracts and pull certain levers to be able to maximize them? Yeah, there's a lot to kind of account marrying together, accounting and finance. Are there any challenges that you are worried about or anticipating? Yeah, I think the making sure that as an accounting department we remain inserted into each of the other operating units of the business and that we're working closely with the finance team and kind of ears to the ground with what's going on and when and being able to influence and do that at a much earlier time period.   00;34;00;09 - 00;34;36;21 So I am I am anticipating that to be a new challenge for us. But yeah, we're excited to work on that. And actually, my same bank reconciliation manager who used to do that, this is his new job instead. So we'll hopefully report back on how it goes with his new role. I love it. As advanced technologies such as AI, machine learning, RPA, all that proliferate, do you have any plans to upskill or reskill your existing workforce in the next year and how are you anticipating going about it?   00;34;36;28 - 00;35;07;20 Yeah, so Megan, this answer just makes my heart sing. So we are using our offshore Philippines team to use AI. So our offshore team is going through all of the contracts for us and they're using an AI tool, actually the same AI tool Numero. They're using that tool to go through all of the key contracts that we have and extract the key terms of the contracts.   00;35;07;23 - 00;35;44;07 That is a very typical, you know, staff one accountant role, right? That's what I did as a staff one accountant, and that was my whole job. So now it's been done by a computer. So cool. And it's being reviewed by, by somebody who's offshore and that I mean, it just really makes my heart sing because we're taking this lower-level work and giving more interesting work to the people who are onshore because now they're looking at these contracts and doing things in a way that that they wouldn't have the opportunity to do.   00;35;44;07 - 00;36;05;06 It's often hard to review your own work, right? So now we're getting new skill. We're just going to upskill the people that we have. I think our business right now, we're mainly focused on the current contracts that we have and then expanding our patient population within those contracts. So we're not necessarily taking on new physician practices.   00;36;05;06 - 00;36;28;06 So I think our accounting department will stay steady, but that is the thing we always like to keep on top of our finance folks to see how are we growing the business and how should we grow our accounting department as well. From a broader technology perspective, do you have any goals going into the next year? Yeah, I think just the great financial reporting.   00;36;28;06 - 00;37;01;16 And then we also have Salesforce as a system, and I was super excited to see Evan announce that Salesforce integrations are going to be made a lot easier. So from a tech stack perspective, we are going to start getting the information from Salesforce into NetSuite. And we're yeah, we're pretty excited about that because there's a lot of work that we do with onboarding our customers and that customer onboarding happens in Salesforce, but then it should become part of the customer record that's in NetSuite.   00;37;01;16 - 00;37;30;16 And right now, that's a manual process for us. So having Salesforce integrated would be, would be a really nice to have. Does Vytalize House as a whole company have any overarching objectives going into 2025? Yeah, so very much pure and stable growth. We are really focused on keeping the current physicians that we have and, and as I mentioned, the patients that we're serving or the Medicare patients.   00;37;30;16 - 00;37;56;01 Right. So if you imagine the doctor physician that you go to is your primary, maybe that primary care physician has 2000 patients and 500 of them are Medicare patients. Right. So those 500 lives, that's what's included in our count, right? That 260,000 that I mentioned before. So what we're trying to do next is get access to the other patients.   00;37;56;01 - 00;38;19;19 Right. That would look like contracts with Blue Shield or contracts with Aetna and other payers to be able to influence care over those lives as well. So I'll call that organic growth because we already have those relationships with the PCPs in place. But what we're wanting are contracts and relationships with the other payers, so that that's 2025 for us.   00;38;19;19 - 00;38;39;13 It sounds so exciting. I know. I feel like this business was so hard for me to understand and like the 10th time someone explained it to me, I got it. So I'm sure you guys are getting it in more than more than ten Innovation items. But yeah, it is a really exciting business here. We're thrilled to be a part of it.   00;38;39;17 - 00;39;12;14 Wrapping up here, just you have such a fascinating story coming in, like coming in and working for this high growth company. Is there any final thoughts or takeaways to leave our listeners with? Yeah, and one thing I do on my personal life is that I keep a gratitude journal and it helps me have a really positive mindset and having a positive mindset leaves me open for learning and growth of my personal development.   00;39;12;16 - 00;39;39;26 So I think that's one thing that's just really helped me to stay on top of my game of staying positive and kind of a can-do attitude. You know, I'm certainly not that way all the time. And sometimes my team shakes and says, Just pull back together. But I do really think that, you know, kind of being grateful for where we're at, how well we've done shapes us to have some positivity going into our next chapter for finals.   00;39;40;00 - 00;39;59;02 I love it. What a good note to end on. So being grateful really keeps you open for learning more. Jess, thanks so much for joining us. We really appreciate it. Yeah, thanks for having me. And again, I really am grateful for the opportunity. All right. Back to my journal today. Thank you so much, Megan.   00;39;59;06 - 00;40;26;21 Yeah, thank you. That brings us to the end of another great episode. It's such a great opportunity to get the perspective directly from a high-growth company and from someone like Jess, who has been there and facilitated so much of it. I think it was especially rewarding to hear how she personally was starting to implement AI in the accounting department to increase efficiency as the company expands.   00;40;26;23 - 00;40;47;10 Huge thanks to Jess for taking time out of her busy schedule to chat with us. And as always, a big thanks to our wonderful editing team over at Oracle and to all of you for tuning in. If you want more episodes just like this one, make sure you subscribe to our channel and give us a rating and review until next time.   00;40;47;13 - 00;40;59;08 You just listen to the NetSuite Podcast. Be sure to tune in every week with more NetSuite developments, stories, and insights into the benefits of one integrated system to help you run your business.

Back by popular demand, this fan-favorite episode is one you won't want to miss! Whether it's your first time tuning in or you're revisiting this classic, dive in now and enjoy one of our most listened-to episodes! Constant communication between dentists and the PCPs would only enhance patients' care experience and improve their health outcomes. In this episode, Claire Levesque talks about the future state interoperability between dental and medical providers in terms of diagnostics and prevention for general health issues like cancer and sleep apnea with hosts Dr. Jonathan and Mariya. She also explains the insurance business model perspective on the connection between dentistry and general health and how to navigate that field in order to make impactful changes. Tune in and learn more about the game-changing effect the integration between dentistry and the rest of health practices could have on patients' outcomes! Resources: Connect with and follow Claire Levesque on LinkedIn. Follow Point32Health on LinkedIn. Discover the Point32Health Website.

Two weeks ago on Radio Advisory, we told our listeners that the number one area of focus for health system growth is operational excellence, and a major part of that is capturing all of the revenue on the table from your medical group. Healthcare organizations have spent the last decade buying up medical groups and physicians, in part because of the “promise” of downstream referrals. It is a long-held belief that physician employment leads to higher referral integrity. But according to an Advisory Board data analysis, that doesn't hold true - just 55% of total referral revenue attributed to employed PCPs is realized in-network. This week, host Rachel (Rae) Woods invites Advisory Board physician experts Eliza Dailey and Colleen Wagner to unpack where referral leakage actually happens and share the real (and relatively easy) steps organizations can take to reduce referral leakage. Links: Tools to reduce referral leakage in the medical group Are employed PCPs more likely to refer within their health systems? Ep. 221: How will health system growth look different in 2025 and beyond? Medical group integration 3 shifts impacting medical groups: 2024 update on the physician landscape Strategic Planner's survey 2024 Survey insights: 6 priorities for health system strategists in 2024 Digital surgery: A way for orthopaedic programs to set themselves apart A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.

We explore the rising prevalence of allergies in the U.S., with nearly 1 in 3 adults and over 1 in 4 children affected. Gary Falcetano, a health care executive, explores how primary care providers are stepping up to fill the gap left by a shortage of allergists. We discuss the limitations of traditional allergy testing and the benefits of introducing allergen component testing to improve diagnosis, management, and patient care. Gary Falcetano is a health care executive. They discuss the KevinMD article, "Why you need allergen component tests to support your allergy diagnosis." Our presenting sponsor is DAX Copilot by Microsoft. Do you spend more time on administrative tasks like clinical documentation than you do with patients? You're not alone. Clinicians report spending up to two hours on administrative tasks for each hour of patient care. Microsoft is committed to helping clinicians restore the balance with DAX Copilot, an AI-powered, voice-enabled solution that automates clinical documentation and workflows. 70 percent of physicians who use DAX Copilot say it improves their work-life balance while reducing feelings of burnout and fatigue. Patients love it too! 93 percent of patients say their physician is more personable and conversational, and 75 percent of physicians say it improves patient experiences. Help restore your work-life balance with DAX Copilot, your AI assistant for automated clinical documentation and workflows. VISIT SPONSOR → https://aka.ms/kevinmd SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended GET CME FOR THIS EPISODE → https://www.kevinmd.com/cme I'm partnering with Learner+ to offer clinicians access to an AI-powered reflective portfolio that rewards CME/CE credits from meaningful reflections. Find out more: https://www.kevinmd.com/learnerplus

Dr. Sonia Singh is a Stanford-trained, board-certified internist, primary care physician, writer and consultant. In 2021, Dr. Singh designed and launched a solo, direct primary care (DPC) micropractice built to serve women in Houston, TX. She believes both PCPs and their patients deserve better than what our healthcare system offers. Alongside her own clinical practice, Dr. Singh helps other women in medicine build micropractices that allow them to practice medicine with autonomy, authenticity and joy via educational resources and 1:1 consulting. Dr. Singh hosts a weekly Micropractice Mama podcast and will also be launching an E-Course in Fall 2024. Her writing has been featured in NPR, The New England Journal of Medicine and Annals of Internal Medicine. Some of the topics we discussed were:3 key factors that contributed the most to making Dr. Singh's direct primary care micropractice successfulHow often Dr. Singh receives phone calls from patients outside of business hoursHow taking vacations works when you're running a DPC micropracticeWhat obstacles Dr. Singh faced in growing her micropractice and how she overcame themWhat helped Dr. Singh the most with marketingMarketing methods for her micropractice that Dr. Singh found the most valuable How Dr. Singh manages her micropractice on her own without hiring staffThe HIPAA compliant app Dr. Singh uses to communicate with her patientsHow Dr. Singh manages bloodwork and medications without staffHow Dr. Singh handles when her women patients ask to bring their husbands or adult children and how it adds a variety of patients to her micropractice What Dr. Singh does when a patient needs a procedureDr. Singh's final tip for listeners about running a successful micropracticeThe very useful free resources Dr. Singh offers on her website, newsletter, and podcast to help physicians start a micropracticeDr. Singh's e-course launching this fall that will detail step by step the process of launching your practice from just having the idea to opening your doorsAnd more!Learn more about me or schedule a FREE coaching call: https://www.joyfulsuccessliving.com/ Join the Voices of Women Physicians Facebook Group: https://www.facebook.com/groups/190596326343825/ Connect with Dr. Singh: Instagram: @soniasinghMDDr. Singh's Website for Education on the Micropractice Model:www.micropracticemama.com The Micropractice Mama Podcast:https://podcasts.apple.com/us/podcast/the-micropractice-mama-podcast/id1756769050Website for Dr. Singh's Practice: www.junipermodernprimarycare.com 

I was talking to one health plan sponsor, and she told me if she sees any charges for value-based care anything on any one of the contracts that get handed to her, she crosses them off so fast it's like her superpower. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. What, you may wonder? Shouldn't employers and plan sponsors be all over value-based care–type things to do things preventatively because we all know that fee-for-service rewards, downstream consequences–type medical care, no money in upstream. Let's prevent those things from happening. Listen to the show with Tom Lee, MD (EP445); Scott Conard, MD (EP391); Brian Klepper, PhD (EP437). My goodness, we have done a raft of shows on this topic because it is such a thing. So, why wouldn't a plan sponsor be all over this value-based care opportunity? Now, I'm using the value-based care words and big old air quotes. Let's just keep that very much in mind for a couple of minutes here. I'm stressing right now that value-based care isn't a one-to-one overlap with care that is of value. So, let me ask you again, why wouldn't a plan sponsor be all over this air-quoted value-based care opportunity? Let me count the ways, and we'll start with this one. Katy Talento told me about this years ago. She said, it's not uncommon for dollars that a plan sponsor may pay to never make it to the entity that is actually providing the care to that plan sponsor's plan members. So, I'm a carrier and I say, I'm gonna charge you, plan sponsor, whatever as part of the PEPM (per employee per month) for value-based care or for a medical home, or pick something that sounds very appealing and value-like. Some of that money—not all of it, because the carrier's gonna keep some, you know, for administrative purposes—but whatever's left over could actually go to some clinical organization. Maybe it's the clinical organization that most of the plan's members are attributed to. Or maybe it's some clinical organization that the carrier is trying to make nicey nice with, which may or may not be the clinical organization that that plan sponsor's patients/members are actually going to. Like, the dollars go to some big, consolidated hospital when most of the plan's members are going to, say, indie PCPs in the community, as just one example. So, yeah, if I'm the plan sponsor in this mix, what am I paying for exactly and for how many of my members? I've seen the sharp type of plan sponsors whip up spreadsheets and do the math and report back that there ain't much value in that value-based care. It's a euphemism for, hey, here's an extra fee for something that sounds good, but … The end. Then I was talking to Marilyn Bartlett the other day and drilled down into some more angles about how this whole “hey, let's use the value-based care word to extract dollars from plan sponsors” goes down. Turns out, another modus operandi beyond the PEPM surcharge is for carriers to add “value-based fees” as a percentage increase or factor to the regular claims payments—something like, I don't know, 3.5% increase to claims. These fees are, in other words, hidden within billing codes. So, right, it's basically impossible to identify how much of this “value-based” piece of the action is actually costing. These fees are allowable, of course, because they're in the contract. The employer has agreed, whether they know it or not, to pay for value-based programs or alternative pay, even though the details are not at all, again, transparent. And that not at all transparent also includes stuff like, what if the health systems or clinical teams did not actually achieve the value-based program goals? What if they failed to deliver any value-based care at all for the value-based fees they have collected? How does anybody know if the prepaid fees were credited back to the plan sponsor, or if anything was actually accomplished there with those fees? Bottom line, fees are not being explicitly broken out or disclosed to the employers. Instead, they are getting buried within overall claims payments or coded in a way that obscures the value-based portion. So, yeah, charges for value-based care have become a solid plan to hide reimbursement dollars and make carrier administrative prices potentially look lower when selling to plan sponsors like self-insured employers. Justin Leader touches on this in episode 433 about the claims wire, by the way. Now, caveat, for sure, it's possible that patients can get services of value delivered because someone uses that extra money. And it's also possible that administrative costs go up and little if any value is accrued to patients, right? Like one or the other, some combination of both. It goes back to what Dr. Tom Lee talked about in episode 445. If there's an enlightened leader who gives a “shed,” then indeed, patients may win. But if not, if there's no enlightened leader in this mix, it's value based alright for carrier shareholders who take bad value all the way to the bank. Al Lewis quotes Paul Hinchey, MD, MBA, who is COO of Cleveland-based University Hospitals. And Dr. Hinchey wrote, “Value-based care has increasingly become a financial construct. What was once a philosophy centered on enhancing patient care has been reduced to a polarizing buzzword that exemplifies the lack of alignment between the financial and delivery elements of the healthcare system.” And then on the same topic, I saw William Bestermann, MD, he wrote, “The National Academy of Medicine mapped out a plan to value-based care 20 years ago in detail. We have never come close to value-based care because we have refused to follow the path. We could follow it, but we don't, and we never will as long as priorities are decided by businessmen representing stockholders. It is just that simple.” Okay, now. Let's reset. I'm gonna take a left turn, so fasten your seatbelts. Just because a bunch of for profit and not-for-profit, nothing for nothing, entities are jazz-handing their ways to wealth by co-opting terminology doesn't mean the intent of value-based care isn't still a worthy goal. And it also doesn't mean that some people aren't getting paid for and providing care that is of value and doing it well. There are, for sure, plenty of examples where an enlightened leader was able to operationalize and/or incentivize care that is of value. Occasionally, I also hear a story about a carrier doing interesting things to pay for care that is of value. Jodilyn Owen talked about one of these in episode 421. Justina Lehman also (EP414). We had Larry Bauer on the show (EP409) talking about three bright spots where frail elderly patients are getting really good care as opposed to the really bad care that you frequently hear about when you even say the words frail elderly patient. And all of these examples that he talked about were built on a capitated model or on a model that facilitated patients getting coordinated care and there being clinicians who were not worried about what code they were gonna put in the computer when they helped a patient's behavioral health or helped a patient figure out how they were gonna get transportation or help them access community services or whatnot. There are also employers direct contracting with health systems or PCPs and COEs (Centers of Excellence) and others, contracting directly with these entities to get the quality and safety and preventative attention that they are looking for. And there are health systems and PCPs and practices working really hard to figure out a business model that aligns with their own values. So, value-based care—the actual words, not the euphemism—value-based care can still be a worthy goal. And that, my friends, is what I'm talking about today with Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health (PBGH). PBGH members are really focused on innovating and implementing change. We talk about some of this innovation and implementation on the show today, and it is very inspiring. Elizabeth argues for for-real alternative payment models that are transparent to the employer plan sponsors. She wants prospective payments or bundled payments, and she wants them with warranties that are measurable. She wants members to get integrated whole-person care in a measurable way, which most health plans (ie, middlemen) either cannot or will not administer. Elizabeth says to achieve actual care that is of value, cooperation between employers, employees, and primary care providers is crucial (ie, direct contracts). She also says that this whole effort is really, really urgently needed given the affordability crisis affecting many Americans. There's been just one article after another lately about how many billions and billions of dollars are getting siphoned off the top into the pockets of the middlemen and their shareholders. These are dollars partially paid for by employees and plan members. We have 48% of Americans with commercial insurance delaying or forgoing care due to cost. If you're a self-insured employer and you're hearing this, don't be thinking it doesn't impact you because your employees are highly compensated. As Deborah Williams wrote the other day, she wrote, “Co-pays have gotten high enough that even higher-income patients can't afford them.” And she was referencing a study to that end. So, yeah … with that, here is your Summer Short with Elizabeth Mitchell. Also mentioned in this episode are Purchaser Business Group on Health; Tom X. Lee, MD; Scott Conard, MD; Brian Klepper, PhD; Katy Talento; Marilyn Bartlett; Justin Leader; Laurence Bauer, MSW, MEd; Al Lewis; Paul Hinchey, MD, MBA; William Bestermann, MD; Jodilyn Owen; Justina Lehman; and Deborah Williams.   You can learn more at PBGH and by connecting with Elizabeth on LinkedIn.   Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health (PBGH), supports the implementation of PBGH's mission of high-quality, affordable, and equitable healthcare. She leads PBGH in mobilizing healthcare purchasers, elevating the role and impact of primary care, and creating functional healthcare markets to support high-quality affordable care, achieving measurable impacts. Elizabeth leverages her extensive experience in working with healthcare purchasers, providers, policymakers, and payers to improve healthcare quality and cost. She previously served as senior vice president for healthcare and community health transformation at Blue Shield of California, during which time she designed Blue Shield's strategy for transforming practice, payment, and community health. Elizabeth also served as the president and CEO of the Network for Regional Healthcare Improvement (NRHI), a network of regional quality improvement and measurement organizations. She also served as CEO of Maine's business coalition on health, worked within an integrated delivery system, and was elected to the Maine State Legislature, serving as a state representative and chair of the Health and Human Services Committee. Elizabeth served as vice chairperson of the US Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee, board and executive committee member of the National Quality Forum (NQF), member of the National Academy of Medicine's (NAM) “Vital Signs” Study Committee on core metrics and now on NAM's Commission on Investment Imperatives for a Healthy Nation, a Guiding Committee member for the Health Care Payment Learning & Action Network. She now serves as an appointed board member of California's Office of Healthcare Affordability. Elizabeth also serves as an advisor and board member for healthcare companies. Elizabeth holds a degree in religion from Reed College, studied social policy at the London School of Economics, and completed the International Health Leadership Program at Cambridge University. Elizabeth was an Atlantic Fellow through the Commonwealth Fund's Harkness Fellowship program.   10:36 What are members and providers actually asking for in terms of value-based care? 10:56 Why won't most health plans administer alternative payment models? 12:17 “We do not have value in the US healthcare system.” 12:57 Why you can't do effective primary care on a fee-for-service model. 13:30 Why have we fragmented care out? 14:39 “No one makes money in a fee-for-service system if people are healthy.” 17:27 “If we think it is not at a crisis point, we are kidding ourselves.”   You can learn more at PBGH and by connecting with Elizabeth on LinkedIn.   @lizzymitch2 of @PBGHealth discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation #vbc   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Will Shrank (Encore! EP413), Dr Amy Scanlan (Encore! EP402), Ashleigh Gunter, Dr Spencer Dorn, Dr Tom Lee, Paul Holmes (Encore! EP397), Ann Kempski, Marshall Allen (tribute), Andreas Mang, Abby Burns and Stacey Richter

Dr. Sonia Singh is a Stanford-trained, board-certified internist, primary care physician, writer and consultant. In 2021, Dr. Singh designed and launched a solo, direct primary care (DPC) micropractice built to serve women in Houston, TX. She believes both PCPs and their patients deserve better than what our healthcare system offers. Alongside her own clinical practice, Dr. Singh helps other women in medicine build micropractices that allow them to practice medicine with autonomy, authenticity and joy via educational resources and 1:1 consulting. Dr. Singh hosts a weekly Micropractice Mama podcast and will also be launching an E-Course in Fall 2024. Her writing has been featured in NPR, The New England Journal of Medicine and Annals of Internal Medicine.Some of the topics we discussed were:What led Dr. Singh to start her direct primary care micropracticeMyths that deter women physicians from getting into businessThe first steps Dr. Singh took to start her practiceHow working with a brand designer really helped Dr. Singh start her practiceHow building a brand and using it strategically benefits your practiceThe most important thing Dr. Singh learned throughout the process of building her own practiceAnd more!Learn more about me or schedule a FREE coaching call:https://www.joyfulsuccessliving.com/Join the Voices of Women Physicians Facebook Group:https://www.facebook.com/groups/190596326343825/Connect with Dr. Singh:Instagram: @soniasinghMDDr. Singh's Website for Education on the Micropractice Model:www.micropracticemama.com The Micropractice Mama Podcast:https://podcasts.apple.com/us/podcast/the-micropractice-mama-podcast/id1756769050Website for Dr. Singh's Practice: www.junipermodernprimarycare.com 

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.

Welcome back to your two favorite girlies and please welcome our guest this month, Functional Coach & Educator, Gillis Pellegrin!  Gillis shares about his own autoimmune disease journey, his PTSD from working in assisted living communities, and his best tips about finding a functional health coach for your needs! After completing time on active duty, Gillis went on to pursue his education further in Nutrition and Exercise & Nutritional Sciences, culminating with earning both a bachelors' degree as well as a master's degree which allowed him to become a functional nutrition consultant. He has worked with everyone from athletes to everyday individuals looking to make positive changes in their lives through nutritional improvements. Follow Gillis here on his instagram: https://www.instagram.com/gillis331?igsh=NnMwN3E5MXVsaHVu  Make sure to subscribe so you don't miss an episode and send us your health / relationship / life / just need advice on, questions to kindahotpod@gmail.com to have us answer your questions on the show.  Find us on all streaming platforms here, including the full video experience on our YouTube channel

Focusing on relationship-building with your patients is a surprisingly effective way to establish long-term success in the practice. Tiff and Dana discuss why these relationships are such difference-makers, the two methods most critical to creating connection, and how to start implementing that success today. Episode resources: Reach out to Tiff and Dana Tune Into DAT's Monthly Webinar Practice Momentum Group Consulting Subscribe to The Dental A-Team podcast Become Dental A-Team Platinum! Review the podcast Transcript: The Dental A Team (00:01.71) Hello everyone. I'm so excited to be here today. Dana, thank you for being here. You completely rearranged your schedule for me today. Moving all things around, I know you had kid stuff going on. It's kind of the beginning of the school year for us here on the West Coast. I know East Coasters, you guys have a different timeframe that you work with, but here in Arizona, we start really early and my kids been in school for almost a week now. Dana, I know your kids are in school and you've got all this stuff happening. So thank you so much. How are you today? I know you rushed.   to get here with me and we rescheduled it and all the pieces to fit my schedule. So thank you. How are you doing today? How are the kids? Are they ready for school?   Dana (00:39.79) Doing good, I'm doing good. Thank you so much for being willing and flexible. I know you know all about this time of year. Kids are doing good. I think it's mixed here in my house. I've got some that are ready to see their friends get back to more of like the social aspects of school and then I more focused more on the learning aspects and not super excited to get back.   The Dental A Team (00:54.953) Absolutely.   The Dental A Team (00:59.533) You've a mixed bag over there. You've got so many personalities in your household. You probably pretty well fit every every genre you possibly could on most things in life. So I love that Brody is like whatever. He's like whatever. He's been super proactive because he's a junior this year and he's got to start thinking about college and he's being super proactive. So I'm a mom that's like cool. Take care of that. Tell   tell me what I have to do later. So I'm in the lucky stages of life and praying for you over there with all your littles. Good luck. Today, I really thought it would be fun for us to chat about relationship building and what that looks like in the dental practice and how that can positively affect long term success in general. I know we've chatted about this before and you and I had a good conversation about it a couple weeks ago.   But really looking at all of the pieces that encompass what a good relationship looks like within the dental practice. I think for us in the dental world, it's hard to differentiate health from, you know, relationship and mixing those two things can be a little bit difficult because we want to stay professional. I want to stay super like, you know, I kind of think it's a little cold or icy or medically, right? We want to be seen as a medical professionals that we   So it kind of can be difficult to mix those two things together, but I really wanted to chat about how that positively affects long -term success in the dental practice. So I think, Dana, from my perspective, I think relationships affect long -term success in general. And I think in the dental practice, our patients are really looking for that. I think in the dental world, you know, we're not really seen as the medical professionals all the time. We're not always seen as the same space as your PCPs and your pediatricians and all of   primary care physicians are seen. We're looked at in a different realm and I think we need to remember that. We need to take that to heart and we need to see what we can do with that information. It's very easy for that medical side to gain new patients and to gain recurring patients because there's just not a lot of places for them to go and they follow their insurance. But in dental, people are looking to understand. They're looking to feel seen and feel heard. So I think that relationship aspect makes a huge difference. Dana?   The Dental A Team (03:21.604) I know you've got a ton of clients that you work with all the time on things just like this. A lot of the systems that you work on with practices are wrapped around the idea of relationship building. What are some of the key tips and takeaways I think that you've been working on recently with some of your clients that have really turned the corner for them on that relationship piece?   Dana (03:43.32) Yeah, and I think that that's truly what makes dentistry unique in the medical profession is the relationships that we get to build because not only do we get to see them multiple times in a year, oftentimes it's for decades and it's that relationship piece I think that keeps patients coming back and they send their family and then you end up having generations all in one practice, which I think it is just highlighting that to teams that this is really a special unique place where we get to take care of our patients but also build   relationships with them. And so I think it is something in the health industry that's super unique to dentistry. I think other professions see them maybe when something is wrong or, you know, once a year or for a short term. And we get to see them again throughout decades of their lives. And so it is truly unique and I think it has to be purposeful. And so that's really what I highlight with teams. is finding those systems and finding those ways to make building that relationship purposeful in a practice.   you know, adding personal pieces to the handoff, making sure that we're asking personal questions as we seat the patient, making sure that there's a spot in our software system to put notes about patients and the things that we learn so that we don't forget to touch base on it when we see them again, because we've got lots of patients and we always want to make it seem as if we remember the last time you were here, we're just jumping off from where we left off with you. So it is one, getting team members to understand that that's what sets you apart. All the   really focus on the big things. It's the practices that well, that focus on the little things and relationship building is one of those things that is a big thing, but little things that we do make the magic there.   The Dental A Team (05:24.378) Yeah, I totally agree. I love that. I love that you said the word purposeful. think that's huge. And I think getting the team buying in on that is something that we overlook and allow that to be overshadowed by other pieces and other like busyness within the dental practice. And really it's just all of those busy things, all of the things that we don't have time to get done in a day, all of the things that we're complaining about or saying we need help with, those are distractions from the ultimate goal.   And I think we get lost in that. So I love that you said purposeful. And I think to me, when I look at my practices and just Dental A Team practices in general, and the practices that are really thriving in this purposeful space of building that relationship and maintaining and keeping that relationship, they also have happier team members. Because I know for me, one of my favorite pieces of my entire day was when a patient walked in the door and we could have a conversation. took me out of   and put me in this like social aspect that didn't require my team members to fulfill and satisfy that social piece for me. I was really able to just be like, my gosh, Ms. Newman, I'm so excited to see you today. Tell me about your grandkids. What Lego set did you buy? I know you had a birthday, whatever it was. Like I would recall these things and it was fun for me to know my patients. And it made me feel like I was making a bigger impact on the people that were coming to our practice than if I were sitting in a position where   I couldn't do that or at a practice where they didn't allow it. So I think purposeful was like such a perfect word for you to use because not only are you putting purpose behind what you're doing with a relationship, but you're making people feel as though they have purpose in their positions and in their jobs and in what they're providing. So purpose was absolutely perfect. I think that flows into retention too, right? When we have a purpose and we have a place to be and we understand.   the impact that we're making on a community, we're much more likely to stay where we're at. With that comes the other side that you talked about, the systems behind it that make it purposeful, that keep those lines very clear and keep it very clear as to what your objective is. Because I can sit and chat with a patient all day long, but still not accomplish what I set out to as far as my job. So,   The Dental A Team (07:42.227) You noted some awesome things, making sure that the notes are in there, making sure we're asking personal questions. And I think to make it easy on people, because we definitely overcomplicate it, we could give some recommendations or some examples of things that just make it really easy. And I usually I tell practices and I know you work on this too with your practices, Dana, to look for three non dental questions that you can ask. I have to remind people Dana, you probably   go through this too, I have to remind people that you don't have to have 20 different options or 21 options of three different questions because you're asking each person as if it's a new conversation because to them, they've not had this conversation yet with you today. So my clients oftentimes get caught up in the minutia of trying to make things harder than they need to be. So that three question thing can kind of stump them. I tell practices, just make sure   Whatever information you gather from your patient, you're then passing off to your doctor because when it becomes repetitive is when your three questions are the same as your doctor's three questions. Your doctor comes in the room, you don't share your information and they're like, are you going back to work today? And that's what you just asked. So have variations for sure, but have at least three non -dental questions that you can ask your patient when they walk in. Have a really solid   from you to your doctor or the next team member that's gonna be working with them. Oftentimes we'll have patients that have exam and x -rays or fillings or whatever on doctor side and they're with a dental assistant first and our dental assistant knows their entire weekend plans and then hygiene comes in, grabs the patient and the patient has to repeat themselves and have that conversation. So even if you're passing off to another team member and maybe not you're providing doctor.   still have that handoff ready to go with that personal information, that personal touch. I think that was brilliant, Dana. And I think that's something that oftentimes we're missing. So keep that going. What are some non dental questions? Like I think there's some easy ones, right? What are you doing this weekend? I say it's Wednesday. When it's Wednesday, it's like, we can ask about last weekend or next weekend, which way are we going to go? So there's last weekend, next weekend, are you going back to work? Any fun vacations coming   The Dental A Team (09:57.449) What are some other good questions, Dana, that you've heard that are easily transferred in a personal   Dana (10:03.374) Yeah, I mean, one thing I always like to say is what have you been doing with your free time? Right? Like just a general question. Done anything fun or been to any new restaurants lately, right? Anything that you can ask as far as like, what do people do day to day? That's just an easy open space for them to start opening up.   The Dental A Team (10:20.785) I love that. And that kind of takes you into like the hobbies section as well. Right? I know, Brody and I got our cleanings at one of my practices I was just at in North Carolina. And this was his first time having his cleaning there and the first his first time really meeting the specific hygienist. He's a new team member to that practice. And Brody, I when I got back from consulting that day, he says, my gosh, I didn't know the hygienist Justin.   that he did rock climbing. And I'm like, that's a random conversation for you to have. He's like, Yeah, he asked me if I want to go rock climbing with him. And I'm like, What are you talking about? But he asked Brody that question, like, what do do in your free time? Like, what do you like to do? You know, what do you like to do for fun? I think is what he asked Brody. And so Brody starts talking about what he likes to do for fun, and they get on rock climbing. And I'm like, that was I told Brody in that moment, I was like, that was brilliant. Because this guy has no relationship to you at all. He has relationship with   no relationship to Brody, but Brody was bought in. Brody felt like he could go rock climbing with this hygienist, right? And I was like, gosh, you don't have to invite your patients to a rock climbing, that's not what I'm saying. I'm just saying it was very easy for him to find a space to have a solid conversation with Brody the entire duration of that appointment. They talked about rock climbing, they talked about mountain biking, they talked about all of the pieces that go into those types of hobbies for the whole appointment, and Brody was amped up and excited. And this is a 16 year old.   Not super easy to get a 16 year old amped up and excited about anything. So I felt like, gosh, that's one of those easy questions that you ask. Like, what do you do in your spare time? What have you been doing? I love the new restaurant question. gets you invested and involved in your community. And it allows people to give you a recommendation. We love as human beings sharing the things that we know. We love telling people what we know. We love giving them advice. We unsolicited or solicited. And we love telling people the things that we enjoy.   So when you ask a question like that, even the hobbies question, right? Dana can really spur some new activities in your community you didn't know about, or just conversation in general. Now, when we see this with practices, and Dana, I agree or disagree, when we see this with practices, I really see, like I said, the team unify. I see the team just excited to have a purpose individually and as a unit, but I see doctors more excited. I see practices more excited, and I see   The Dental A Team (12:42.923) the goals we're aiming to hit are a little bit easier because we're in that relationship space and we're having more fun getting to know each other than driving towards goals. So the goals actually come more naturally. Dana, do you see that as well? And what do you feel like are a couple of systems? We talked about the questions and we talked about making the notes in the system of those questions, passing it off. What are some systems really that you feel like solidify and dive into?   that space where it's like these goals are easy to meet because we're doing these things.   Dana (13:15.342) Yeah, and I think that it's easy as we're getting to know our patients to get to know each other. So if we say, Hey, Mr. Smith shared this new restaurant, it's great for the doctor to jump in and say, my gosh, I love Italian food. Do you? Right. And it's a three way engaged conversation. So we start to get to know our team members while we're engaging and getting to know our patients. You asked about systems specifically, and I do feel like morning huddle is a really good space here to kind of add on to those things when we're bringing personal pieces about our patients to morning huddle to make sure that team members   hitting on that. Hey, don't forget, know, Mrs. Jones just had a baby, right? Don't forget to touch on that or hey, it is Bob's birthday, right? So just making sure that when we bring those things up, it gets us excited for the day. And so I think that that's a really good system that ties that in. I think if you have something that you do to celebrate patients birthdays, where it comes to like sending out cards or sending out little video messages from the team or posting on social media, those pieces are systems that   us engage with our patients, get to know our patients, build relationships, but it also gets our team excited. And when we're excited about taking care of patients, when we're excited about building relationships and getting to know them, it for sure makes hitting goals easier because we know why we're there.   The Dental A Team (14:30.518) Yeah, I totally agree. I love that. I love that. So I think key takeaways, things that we can really look at for implementation wise that make this easy, you guys, because like we said at the beginning, the relationships really are the key to long term success, I think in anything that you do. Solid relationships are a solid foundation. So I think some key takeaways, gosh, guys, morning huddles is   the best place to start at the start of your day. So I think really just make sure that you're all unified as a team. You all have the same goals. You all are looking for the same things and you're sharing information about your patients that you guys may know. Two, make sure everybody is just like ready to go and you're armed with three non -dental questions and a system for passing off that information. I think if you do those three things, you're gonna see things really spear and change in your practice. Doctors, if you're not getting those handoffs from your support team,   or support team if your doctors aren't hearing the handoffs, okay, if it's a two way street there. If we're not able to accomplish those handoffs, break and say, hey, let's tackle this. We've got to make sure that this works. This is a huge piece of what we're trying to accomplish. And I want to make sure that our patients feel seen and feel heard as well as our team. So make sure that you really break your perfect handoff. We've talked about it before, and this is not NDTR. This is something completely different. But your perfect handoff is really going to have   that personal touch you're going to introduce, whether the doctor or a team member has met them before or not, you're introducing them to the room, not necessarily just the person. So make sure they're introduced to that party because you've been having this little dinner party without them. You've got to invite them in there. So make sure that there's an introduction. Make sure we're complimenting something. We're bringing that vibe up. We're saying something is fantastic. I like to get it towards them, so if you can. And we're recapping what we did, which is also   your time to co -diagnose and we're passing off something personal. And that personal piece comes from the conversation that you've had. So like Dana said, this is the restaurant that they recommended. This is the vacation they just had. They love going to the Bahamas. They just had a grand baby. There are so many things. They just had a baby. There's so many things that you guys can pass off to make a lasting impression where the patient feels heard by you, feels remembered and feels seen.   The Dental A Team (16:42.797) And it makes it that much easier not only to retain that patient, but to diagnose and get the case acceptance that you're looking for on those pieces. So if you don't implement anything else, I would implement at least three non -dental questions and a handoff. Morning huddle is strongly advised. For my ladies and gents who are sitting front row, front lines of the dental practice, you're the people when they walk in, make sure you've got some solid systems for acknowledging your patients when they walk in. How are you gonna know who they   I can't tell you enough, I don't know how to say this gently. I hate when I'm in a practice and I hear somebody say, what was your last name? Or who are you? Or what's your name? Like just make an educated guess. Just like you can ask, but guys, it's just not that hard. I used to look at the schedule, I was that position, and I used to look at the schedule and I'd evaluate. I'm like, all right, I've got four people, six people coming in at 10 a Four out of the six are male.   This is a female walking in, one of my females, age range, I don't know, 60 plus, the other one, 22. How old does she look? I'm gonna use deductive reasoning to figure out who the patient is that's walking through the door. And I cannot tell you how many times my patients walking through that door were like, Tiff, how do you do it? How do you always know who I am? And a couple of times I'd be like, I'm not gonna lie, I'm really good at deductive reasoning, and you're the only man coming in right now.   and they would laugh. They're like, that's brilliant. And I'm like, but I really do care. And I really do know who you are, right? But use your deductive reasoning skills, you guys figure it out and be more invested in the patients and that relationship than you are to whatever it is that's distracting you. So pass off that information, make sure you've got a solid system for handoffs. Make sure you've got three non dental questions, get your morning huddle going if it's not.   And ladies and gents on the front lines and that front facing, make sure you've got some really good systems up there to be present, to be with your patients and be super aware. Dana, can you think of anything else that we may have missed or something you want to dive in further on that has come up in practices recently? I feel like this is pretty dang solid right now, but what else do you have, if anything?   Dana (18:56.951) I think we hit it from a lot of different angles and I think just jump in and get started and make sure that patients always know that you're the top priority when they walk in the door.   The Dental A Team (19:06.459) I love that. I totally agree. I totally agree. You guys, we do this with practices all the time. We have group coaching that people are eating up this information right now. These are the systems that we're teaching in our group coaching courses and our online platforms. So reach out to us. Let us know how we can help. If you want ideas, if you need questions, you need whatever, reach out. Hello@TheDentalATeam.com. You know, we're always open and willing to help. And remember it's typically consultants   Dental A Team professionals always on the other side answering those questions. If it's something that our admin team doesn't know, it comes straight to us. So please reach out, drop us a five star review so we know that this was beneficial for you. And guys, we can't wait to catch you next time. Bye. 

In this episode of the Small Firm Philosophy podcast, Ingrid Goldbloom-Bloch, Director of Career Development and Engagement at AAFCPAs, talks with PCPS manager Erin Hartman to share how her firm is making waves and doing things differently in the profession. When Ingrid joined AAFCPA, she was tasked with elevating the people and culture pillars of the firms strategic plan. Ingrid's day to day focus is to uncover challenges that get in the way of teams feeling happy, engaged, and productive at work. It is this work, and how it transformed AAFCPAs business model, that Ingrid and Erin discuss in detail.   SFP is produced by AICPA & CIMA's firm services team, aka the Private Companies Practice Section (PCPS). This episode is part of an ongoing series on accounting firm business model transformation that PCPS is leading for AICPA & CIMA. For more on the series, check out the Transforming Your Business Model landing page. 

Listen to ASCO's JCO Oncology Practice essay, “Patient is Otherwise Healthy” by Dr. Scott Capozza, Board Certified Oncology Physical Therapist at Smilow Cancer Hospital Adult Cancer Survivorship Clinic at Yale Cancer Center. The essay is followed by an interview with Capozza and host Dr. Lidia Schapira. Capozza shares his personal experience with the long-term effects of cancer treatment. TRANSCRIPT ‘Patient Is Otherwise Healthy' by Scott J. Capozza, PT, MSPT  Let me start by saying: I know I am one of the fortunate ones. Being diagnosed with cancer at any age puts many in a tailspin. I was no different when I was diagnosed with stage II testicular cancer at age 22 years. I was still in graduate school, completing my physical therapy program; suddenly, I had to schedule an orchiectomy, retroperitoneal lymph node dissection, and two cycles of chemotherapy around lectures, laboratory work, and practical examinations. Fast forward 20 years and I have an unbelievably supportive wife who has seen me through so much of my long-term survivorship concerns.   Despite my fertility challenges, we are so very fortunate that my wife was able to conceive three healthy, happy, and strong kids (conceived only through the roller coaster that is fertility preservation and reproduction medicine, which so many adolescent and young adult survivors must deal with and is emotionally very challenging, but that is a discussion for another day). I have a great career as a board-certified physical therapist in oncology, where I can help enhance the physical well-being of patients throughout the cancer care continuum. The journey to this path as a survivor was not a straight line, though that also is a discussion for another day.  What I do not remember signing up for was all the late and long-term side effects of cancer treatment, or maybe I did sign for them in a sort of deal with the devil so that I could finish PT school on time and return to my precancer life of running and being with my friends. We sign on the dotted line to rid the cancer from our bodies, but just like the mortgage, student loans, and back taxes, we end up having to pay in the end. Unfortunately, paying off this debt comes with a high interest rate (a multitude of adverse effects) heaped on top of the principal balance.  And while it would be very easy to blame my hyperlipidemia on my cancer treatments,1 I am pretty sure there is a likely strong genetic component. My grandmother had high cholesterol for as long as I could remember. As your quintessential Italian grandmother, she was 105 pounds soaking wet and ate like a bird (while being insulted if I did not have a 4th helping of her lasagna) but had to take her blasted pills for high cholesterol for all her adult life. She died a month short of her 103rd birthday and was still sharp as a tack until the very end. I will gladly sign on the dotted line for that outcome. My immediate postcancer treatment years were great. I resumed running and ran several marathons, returned to a relatively normal social life, and started along my career. I met my wife, and she was enthusiastically willing to live her life with a cancer survivor. Marriage, house, kids, job…everything was going great. Until things started going downhill. About 10 years postchemotherapy, I noticed that my exercise tolerance was decreasing. It was harder and harder to keep up with friends on our long runs. I felt more fatigued overall. I went from running 10 miles to seven to five to now barely being able to complete two miles. My chest would feel tight as if a vise was clamping down on my ribs. Running up short hills in my neighborhood, which I had routinely done in the past, felt like I was ascending Mount Everest without supplemental oxygen or Sherpa support.  When I brought this up to my primary care physician, he looked perplexed. I am young(ish), no family history of heart disease, nonsmoker, healthy weight, and only enjoy a hard cider once a week. He performed an ECG in the office, just to double check to make sure I was not crazy.   When my heart rhythms started throwing out inverted T-waves, his eyes got larger. He said that I did not fit the description of someone who should be experiencing these symptoms.  “I had cancer, remember?” I remind him although he is very familiar with my medical history and we know each other well. “Oh. Yeah.” My doctor nods….  My doctor thankfully took my concerns seriously and directed me to a series of referrals to cardiac and pulmonary specialists. Through the Pandora's box which is patient access to electronic medical records, I was able to read his postvisit report. He very accurately described the results of the physical examination and our conversation. He did write in his report that he would be placing referrals to cardiology and pulmonology. It was a very thorough evaluation, and I could tell that he was truly listening to me and not dismissing my concerns. What caught my eye, though, was the opening line to his assessment: “Patient is an otherwise healthy 42-year-old male…” Otherwise healthy? I have high cholesterol; had to endure heartache and struggle to have a family because of treatment-induced fertility issues; I wear hearing aids because of cisplatin induced ototoxicity; and now, I have to go for a full cardiopulmonary work-up, all because, I had testicular cancer at age 22 years. To me it did not feel like that I was otherwise healthy. To further work up my symptoms, I was scheduled for cardiac testing. I have a new appreciation for what my own patients go through when they have to get magnetic resonance imaging (MRI) after I had a cardiac stress MRI. I had no idea just how tiny and claustrophobia-inducing an MRI machine is, so now I nod my head in agreement with my patients when they tell me how anxiety-producing it is to get an MRI. I had a treadmill stress test and echocardiogram, and these all came to the same conclusion: I have a thickened left ventricle in my heart, which throws off the ECGs but is just my normal anatomy. Phew.  When I went for my pulmonary function test (PFT), though, the results were different. The pulmonologist came in with that same perplexed look, as he is expecting to see someone other than an early 40s, healthy weight individual sitting there. Our conversation went something like this: Pulmonologist: Do you, or did you ever, smoke? Me: No. Pulmonologist: Do you have carpets, rugs, or animals at your house?  Me: No. Pulmonologist: Do you work in a factory or someplace where you're surrounded by potentially toxic chemicals? Me: No. Pulmonologist: Do you think you gave your best effort on the PFT? Me (slightly annoyed): Yes. Pulmonologist: I don't get it; you have the lungs of someone with chronic obstructive lung disease, but you don't fit into any of the risk factors. Me: I had bleomycin as part of my chemotherapy regiment for testicular cancer 20 years ago.  Pulmonologist: Oh. Yeah. Oh.  This is the crux of long-term survivorship: We look OK on the outside, but inside our body systems deteriorate faster than the noncancer population.2 For pediatric cancer and adolescents and young adult cancer survivors who could potentially have decades of life ahead of them, these late and long-term side effects are a perpetual consequence for surviving cancer. There is no light at the end of tunnel for us; the tunnel extends endlessly, and we grasp for any daylight we can to help us navigate the darkness moving forward. While there have been multiple studies addressing the long-term toxicity sequelae of cancer therapy, there is still inadequate understanding of optimal screening, risk reduction, and management and inadequate awareness of potential late effects among both medical professionals and survivors alike.3 Given the complexity of long-term toxicities for long-term survivors, a multidisciplinary team of health professionals can provide a comprehensive approach to patient care. For me, a key member of this team was the cardiac advanced practice nurse, who called me at 4:45 pm on a Friday afternoon to tell me that my cardiac evaluation was normal. Physical therapists do this by addressing fatigue, balance deficits, and functional decline through our multitude of rehabilitation tools. Cardiologists, pulmonologists, primary care physicians, dietitians, and mental health care workers can all meaningfully contribute to the well-being and long-term care of cancer survivors. The many health care providers in the lives of cancer survivors can also empower through education. However, the education pathway ends up being a two-way street, as so often it is the survivor who has to educate the nononcology provider about our internal physiological needs that belie our external appearance.  As for me, I am trying out new inhalers to help with my breathing. I take a low-dose statin every morning with breakfast. I am now plugged into annual cardiac follow-ups. I do not run anymore, though, as the psychological toll of not being what I once was has affected me more than the physical toll. I march on, trying to be the best husband, father, physical therapist, and cancer survivorship advocate that I can be.  While we may be living clinically with no evidence of disease, we live with the evidence of the history of our disease every day. Like petrified trees or fossilized shells, cancer treatments leave permanent physical and psychological reminders of our cancer experience. As greater attention is being focused on the optimized management of long-term toxicities in cancer survivorship, my sincere hope is that there will be effort to educate cancer and noncancer medical staff alike about the real physical and psychosocial adverse effects as well as advances in treatment that will both prevent development of long-term toxicity and yield better solutions for when they do occur. I hope better options will be available to all cancer survivors with all stages and all disease types in the not-so-distant future. I am OK, really, but I am not sure ‘otherwise healthy' really applies to me. Dr. Lidia Schapira: Hello and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the field of oncology. I'm your host, Dr. Lidia Schapira, Professor of Medicine at Stanford University. Today we're joined by Scott Capozza, Board Certified Oncology Physical Therapist at Smilow Cancer Hospital at the Yale Cancer Center. In this episode, we will be discussing his Art of Oncology article, “Patient is Otherwise Healthy.”   At the time of this recording, our guest has no disclosures.   Scott, welcome to our podcast and thank you for joining us. Scott Capozza: Thank you very much for having me. This is a great honor. Dr. Lidia Schapira: I look forward to chatting with you about this. First of all, what a great title. How did the title and the idea of sharing your experience with this audience, the readers of JCO OP and JCO publications, come to you? Tell us a little bit about the motivation and the inspiration. Scott Capozza: So the title actually came from my doctor's note, as I alluded to in the article, the Pandora's Box, so to speak, of patient access to medical records. I was reading his assessment of my regular wellness visit. And in that visit, I had discussed that I was having some breathing issues and some endurance issues with running, and I just didn't feel myself. And I knew that I hadn't had any significant cardio or pulmonary workups anytime recently. On top of that, we'd already discussed some of my other comorbidities, like my blood pressure, that sort of thing. So his intro line was “Patient is a 42-year-old otherwise healthy male.” Well, that's what caught my eye. I said, “Am I really otherwise healthy? I've got high cholesterol. I have this history of cancer. I am dealing with all kinds of late effects, and we're working those late effects up. And so am I truly otherwise healthy?” And I love my PCP, and he listens to me. And so I'm grateful for him and for him taking me seriously, because not everybody has that. Not every survivor has that person, that quarterback, so to speak.   So that was really what kind of drove me to write the article. It was just an idea that it was in my head. I did not write the article right away. I'm now 48. So this was actually even a couple of years ago. But I think I wrote it because I really was writing it more for the non oncology provider, for the PCPs, and for the pulmonologists and the cardiologists who don't work in the oncology space like you and I do, to be cognizant of these late effects. And just because somebody is a year out from treatment, five years out from treatment, or in my case, 20 years out from treatment, that these late effects are real and they can play havoc with our quality of life. Dr. Lidia Schapira: So let me talk a little bit about nomenclature and the semantics. You know this field very well, and you know that not every person with a history of cancer identifies as a survivor. But the term is really helpful for us. And in the original article that Fitzhugh Mullan wrote in New England Journal called the “Seasons of Survival,” he reflected as a physician with cancer that you go through different periods in your survivorship, journey or life. Can you tell us a little bit about that and what it's been for you? When did you feel that you were a cancer survivor? Do you use the term and what have those seasons or those stages felt like for you? Scott Capozza: That's a great question. And for my old patients, I have this conversation with them as well. For me specifically, yes, I do identify as a cancer survivor. I will say, though, that when I was going through my treatments, I did not identify with that word. I also think that because I was young, I was 22, 23 at the time of my diagnosis, and I did not want any association with cancer, that I really did not want that label attached to me. At that time, I was a physical therapy student and a runner. Full disclosure, I'm a Boston Red Sox fan. You can hold that against me if you want. So I didn't want this extra label, so I didn't want it anyway in the first place. I do, I remember having a conversation with my nurses, and they said, “Oh, you should go to this walk or whatever that was happening for cancer survivors.” And I said, “But I'm in the middle of chemo. I've still got my port. And I don't think I should go because I'm not done with treatment.” And so that's why I think it's great that we have, the American Cancer Society and NCI have come out with very clear definitions that say that a person is a cancer survivor from the mode of diagnosis, and I use that for my own patients as well, because they have that same question. They ask me, “Am I really a survivor? Am I really done?” That sort of thing. And I say, no, I go by those definitions now. And so I always frame it as, you have to survive the words “You have cancer.” So that's me with the relationship with the term survivor.   To your other point of the question, as far as the seasons of survivorship. Absolutely. And I think that we see this more prevalently with our younger population, with our pediatric survivors, and for me, as an adolescent, young adult survivor, an AYA. So I have gone through these seasons of survivorship. When I was diagnosed, I was young and I was single and I was finishing school. That's one thing. I was not dating anybody. So when I did just start to date somebody and move towards marriage and that sort of thing, and all of a sudden, now my fertility issues, because of my treatments, now that came to the forefront. So that became a new season, so to speak. How are we going to tackle that? And now as a father, that's a different season because I have three children, two boys, and it's on my mind that they have my genetic makeup. So are they at higher risk of developing testicular cancer because of me? So I'm in a different season now than I was when I was single and 25.  Dr. Lidia Schapira: And so you also talk about having cisplatin induced ototoxicity. And now this latest problem, which is the bleomycin induced lung problem. That is what sort of unraveled this new season of trying to put these pieces together. How have you thought about this and perhaps shared it with your wife and your family? This idea that the exposures you had to toxic drugs which cured you and gave you this fortunate possibility of being a long term survivor keep on giving, that they keep on manifesting themselves. And fortunately, you have, it seems, a very receptive primary care doctor who listens but may not be particularly able to guide you through all this and may not know. So he's sort of taking his cues from you. How do you negotiate all this? The idea that there may still be something that's going to happen to you as a result of these exposures? Scott Capozza: Being vigilant, I think, is really important. And I think open lines of communication with my providers, open lines of communication with my wife. And also, again, my children are at this point now where I can have those conversations with them. I don't think that I could have done that when they were younger, but now I think they can start to understand why daddy wears hearing aids now is because daddy had to get a certain medicine to help get him healthy, to help get rid of the cancer. So to frame it in that context, I think it makes it easier for them to understand why I have this cytotoxicity from cisplatin. And they even know now with my pulmonary issues that daddy can't necessarily run with them. That was always going to be a goal. I was going to be able to run with my children, and I can't do that. I am still able to bike. It does not stress my pulmonary system as much as running does. So we are able to cycle as a family, and so we are able to do that.  But as far as other late effects that might show up another five years or 10 years from now, those are things that I will continue to have those conversations with my PCP to say, do we need to continue to do cardiac screening every so often? Do we need to continue to do pulmonary screenings, blood work, that sort of thing? I also know that I am very fortunate that I work in the field, so I am surrounded by it, which sometimes is good and sometimes can be a little discerning, knowing what's out there also. So it is an interesting balance to be able to wear both of those hats at the same time. Dr. Lidia Schapira: I have a couple questions that arose to me reading your essay. Now, I am an oncologist, so I know you know about these late effects. One of your lines is, this is the crux of long term survivorship that is appearing healthy, being labeled as otherwise healthy, but really having these exposures that predispose you to getting other illnesses and diagnoses. Do you think it would help if your PCP and pulmonologist wrote that you had an exposure to bleomycin in requesting the PFTs? Instead of just saying 42-year-old with such a symptom, 42-year-old with an exposure to bleomycin and dyspnea. Do you think that writing that in your chart, instead of just saying ‘otherwise healthy', just putting cancer survivor, testicular cancer survivor, and adding the exposures every time they require a test, could that in any way have made your life easier as you reflect back on the last few years?  Scott Capozza: That's a really interesting question. I never thought of that before, and I think that could go one of two ways. A, it could be validating, but I could see the flip side of that where it's, you're constantly reminded of it. So I don't know that there's a perfect answer to that. I don't know what I would prefer, honestly. If we could hop back in time and change the documentation, then we make an addendum to the documentation. I don't know that I would really want that because obviously I know it. But do I want to continue to see that every time I open up my chart? I don't know. And I can see how it can be frustrating for my patients that when they get through my chart notifications or whatever it might be, that they're constantly reminded by it, and then that can lead to fear of occurrence, and that can lead to anxiety and depression. And all the things that you and I know, being providers in the oncology space, we know that these are all things also that our patients experience. So I don't know. I'll have to think about that a little more. Dr. Lidia Schapira: Maybe the next essay you send to us is about shared decision making, even, and how this is used, playing it forward a little bit in the cancer record, it's there and prominent. But in your primary care and other records, how important is that as a qualifier? All of these things are really interesting, and I wonder how you have used your personal experience in treating other patients and whether or not you disclose to your own patients that you are a cancer survivor.  Scott Capozza: I don't lead with it because it's not my story. It's their story. It's their experience. So I never lead with it. I do think that patients are savvy. They do want to know who's on their care team. So I tell this story often that I was working with a young woman with breast cancer. She was still in the middle of treatment. She was very understandably upset. And I was about to say something along those lines of, “I can appreciate what you're going through, because I went through this, too.” And she said, “I know who you are. I looked you up.” Dr. Lidia Schapira: Wow.  Scott Capozza: Yes. But she followed that up with saying, “And because I looked you up and because you're a survivor, that's why I want you working with me.” So again, it goes both ways. So in that instance, it did, it did work out. So, no, I never lead with it. I think patients a lot of times just figure it out on their own. If I'm working with a patient and we've been working together for a while, we might have that conversation, then it might come up. But again, it's about our patients. It's about making sure that they have the highest quality care. And so that's why they're at the center of everything that we do. So, no, I don't lead with it. Dr. Lidia Schapira: So as we wrap up, I have two questions. One is, did you share your essay with your primary care doctor? Scott Capozza: I have not yet. I have not actually seen him since it was published. My annual physical is coming up later in the summer. I was thinking that I would bring it to him to see what his reaction would be. Dr. Lidia Schapira: That sounds cool. Will you let me know what he says or she says? And the other question is, since you did decide to put your story in front of an audience of oncology professionals, what is your message to them? Scott Capozza: I think the message, again, is to listen to your patients. And again, you alluded to it a moment ago, the shared decision making, I think that's so critical. I think that's where we are now, and that's where we need to continue to move as a profession, not just in oncology, but I mean, across all health domains. And so I think that for oncology providers specifically, listen to our patients and to validate those concerns, to educate and then do something about it also, I think, is really critical. Dr. Lidia Schapira: And involving other members of the multidisciplinary team is key. I mean, we acknowledge we need that during treatment, but I think post-treatment, it's equally important to refer people to think about it, to think about referring for rehabilitation or prehabilitation in certain cases. To minimize the baggage that people carry into survivorship.  Scott, thank you. Thank you for writing. I wish you good health, and I thank you very much for sending us your story.   So until next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review, and be sure to subscribe so you never miss an episode. You can find all of ASCO podcast shows asco.org/podcast.    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. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Like, share and subscribe so you never miss an episode and leave a rating or review.  Guest Bio:  Dr. Scott Capozza is a Board Certified Oncology Physical Therapist at Smilow Cancer Hospital at the Yale Cancer Center.

The healthcare industry has been rocked by the pandemic and thrown headfirst into a new era of technological and therapeutic revolution. Yet, in the midst of all this change and uncertainty, healthcare leaders are expected not just to survive, but actually drive value for their organizations, patients, and communities. The problem is, “driving value” is not only complex, but it's also ambiguous. Leaders who talk about value across the industry may not even be talking about the same thing. So, how should the industry think about driving value and what does it take to get this right? In this episode, live from Advisory Board's 2024 Value Summit, host Abby Burns invites Stacey Richter, healthcare entrepreneur, co-president of Aventria Health Group, and host of the Relentless Health Value podcast, to break down what “value” in healthcare actually means, where organizations go wrong, and how we can work to improve value across the industry. Links: Raising the Value Bar Virtual Summit Our Value-Based Care playlist EP358: How Health Insurance Plan Design Can Lead to Patients Sacrificing Needed Care, Their Mental Health, and (Sometimes) Buying Groceries, With Wayne Jenkins, MD | Relentless Health Value™ EP391: Lessons for Private Equity and Others Trying to Do Right by PCPs and Their Patients, With Scott Conard, MD | Relentless Health Value™ EP427: How Do Digital Health Vendors Deliver Patient Outcomes and Experiences? With Rik Renard | Relentless Health Value™ EP432: The Knifepoint Intersection of Margin and Mission and the Peril of Cutting Clinical “Waste,” With Kate Wolin, ScD | Relentless Health Value™ The challenges with migraine care — and what health systems can do about it A transcript of this episode as well as more information and resources can be found on radioadvisory.advisory.com.

Dr. Jack Cush reviews the journal reports and articles from this past week on RheumNow.com.  The ACR (and Cush) address their new website designed to educate PCPs and APP's - what do you think?

Founded in 2020, Pearl Health was incubated by AlleyCorp and has raised a total of $95M in funding from 8 investors, led by Andreesen Horowitz and Viking Global Investors. Pearl now has over 100 employees and closed a $75M Series B in January of 2023. Pearl Health is a provider enablement and value-based care technology company that helps primary care providers and healthcare organizations succeed in value-based care, starting with ACO REACH and, soon, MSSP and Medicare Advantage.. Pearl does this by helping PCPs and their staff focus attention on high-risk patients and conditions, enabling practices with insights to programs deliver high quality, holistic care to patients at the right time. In 2024, Pearl is partnering with about 1,800 primary care providers, who collectively serve more than 80,000 patients, across the US in 43 states and Washington, D.C. With over 20 years of experience in healthcare, Jennifer started her career at Triage Consulting Group. She then served as a consultant at Deloitte for 5 years and moved on to Takeda Oncology where she was an Associate Director in market access. She then spent six years at athenahealth where she served in a series of roles in product management, ultimately concluding as an Executive Director for product management.  After Athena, Jennifer moved onto a VP / Head of Product role at Hint Health and finally became the Chief Product Officer at Pearl Health in 2021. Jennifer holds a BA from University of California, Berkeley and an MHA from University of North Carolina at Chapel Hill. In this episode, we learn how Pearl Health is trying to improve primary care provider workflows in value-based care, how Jennifer thinks about product management, and where Pearl Health is going next, with their partnerships with retail pharmacies.

In this episode, learn how early and sustained HBV care can be enhanced by expanding the role of primary care providers in HBV management. Learn how to:Engage key stakeholders in the provision of HBV care​Provide HBV management resources to support PCPs who are doing screening​Consider specialty and primary care collaborations that empower PCPs with clear guidance on how to manage patients living with HBVPresenters:Su Wang, MD, MPH, FACPMedical DirectorCenter for Asian Health and Viral Hepatitis ProgramsCooperman Barnabas Medical CenterRWJBarnabas-Rutgers Medical GroupAssociate MemberHealth Care Policy and Aging ResearchThe Rutgers Institute for HealthSenior AdvisorGlobal Health, Hepatitis B FoundationFlorham Park, New JerseyRichard R. Andrews, MD, MPHPresident, Houston Viral Hepatitis Task ForceFormer Co-Chair, National Task Force on Hepatitis BBoard-Certified Family MedicineAddiction Medicine PhysicianHouston, TexasRuth Brogden, MPHPatient AdvocateAmy S. Tang, MDFormer Co-Chair, National Task Force on Hepatitis BDirector of Immigrant HealthNorth East Medical ServicesSan Francisco, CaliforniaLink to full program: https://bit.ly/3TuqFHILink to the slides:https://bit.ly/44hXpHuGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

Most patients with migraine require acute treatment for at least some attacks. There is no one-size-fits-all acute treatment and multiple treatment trials are sometimes necessary to determine the optimal regimen for patients. In this episode, Teshamae Monteith, MD, FAAN, speaks with Rebecca Burch, MD, FAHS author of the article “Acute Treatment of Migraine,” in the Continuum April 2024 Headache issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Burch is an assistant professor in the Department of Neurological Sciences at Larner College of Medicine, University of Vermont, Burlington, Vermont.  Additional Resources Read the article: Acute Treatment of Migraine Subscribe to Continuum: continpub.com/Spring2024 Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Guest: @RebeccaCBurch Transcript Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by visiting the link in the Show Notes. Subscribers also have access to exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the Show Notes. AAN members, stay turned after the episode to get CME for listening. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. Today I'm interviewing Dr Rebecca Burch on acute treatment of migraine, which is part of the April 2024 Continuum issue on headache. Dr Burch is an Assistant Professor at Larner College of Medicine at the University of Vermont in Burlington, Vermont. Well, hi, Rebecca - thank you so much for being on our podcast. Dr Burch: Thank you so much for having me. It's always such a pleasure to talk with you. Dr Monteith: You wrote a really excellent article on acute management of migraine - really detailed. Dr Burch: Thanks so much. I'm glad you enjoyed it. I had a lot of fun writing it. Dr Monteith: Why don't you tell our listeners, what did you set out to do in writing this article? Dr Burch: Whenever I write a review article on a topic, I aim for two things, and these were the same things that I was aiming for here with this one. One is practicality and just for it to be really applicable to clinical practice and every day what we do - the ins and outs - and that was the case here as well. I really love a good table in a paper like this. I spend a lot of time on tables. I want people to be able to print them out, use them as reference, bookmark them. So, that was one thing that I aimed for - was just for this to be really useful. The other thing is, I really wanted to instill a sense of confidence in people after reading this article. I think the management of migraine can be very overwhelming for people taking care of people with migraine. And there are so many acute treatment options, so I wanted to give a framework for how to think about acute treatment (how to approach it), and then within that framework, to really go into the nuances of all the various options, and how to choose between them, and what to do in specific circumstances. And I also really wanted to cover what to do when the first couple of options don't work. Because I think most neurologists, PCPs, are comfortable prescribing sumatriptan, and then the question is, what happens when that doesn't work or the patient doesn't tolerate it? What do you do for rescue therapy? What do you do for your fifth-line treatment? And I think that was an area that I really wanted to cover as well. Dr Monteith: Yeah, you got a lot done, for sure. So, I agree - there's been so many options, new options, even over the past five or definitely ten years. One of the things that excited me about going into headache medicine were all the options, thinking of migraine and other headache disorders as a treatable disorder. What made you interested in headache medicine? Dr Burch: Like so many other people who ended up going into headache medicine, I had a fantastic mentor in residency who was really great at treating headache patients - as Brian McGeeney at Boston Medical Center (he's now at Brigham and Women's). He was really passionate about headache medicine, and seeing patients with him was always such a delight because he always had something to try. And many other situations, it would be, like, “Well, this person, we've tried something; we don't know what else to do.” But when you work with a headache specialist as a mentor or as a preceptor, they have so many things they can do, and people largely get better. And they're so grateful - it changes people's lives to be able to treat their migraine, their other headaches effectively. So that was really inspiring. And then when I started doing headache rotations and sort of thinking about whether this was the right subspecialty for me, I quickly realized two things about headache medicine that ended up being what I really love about it to this day. One is the longitudinal relationships that we have with patients - we take care of people for a long time. And it doesn't always have to be that we're seeing people every three months and making tweaks - sometimes it's once a year. But we do get to know people. You know, I have two children. Many of my patients saw me through both of those pregnancies and ask about my kids, and it's just lovely to have that sort of personal relationship over time. And then the other aspect that I really love is that we can't see patients in isolation just as their migraine disorder or headache disorder; we really have to think about who they are as a whole person. What's going on in your life? What are your stressors? How's your job, how's your family? How are you sleeping? How's your mood? Are you exercising? What's your diet like? All of these things impact how someone's migraine disorder is going. And I like to joke, “I'm half life coach, you know, and half pharmacologist,” and I love that. I love that I bring my whole self every time I see a patient and see their whole self, too. Dr Monteith: I can just imagine how well you do that. You mentioned the power of mentorship, and that seems to be a theme when interviewing authors (that mentors are super important). And I know you've been an incredible mentor. Why don't you tell us a little bit about your academic journey? I mean, I see you in the halls at these major conferences, but I've never pulled you aside and said, “Hey, what's your journey - your academic journey – like, other than your great editorial work for neurology, of course?” Dr Burch: I did my fellowship at Brigham and Women's and then stayed on there as an attending, and ultimately took over as fellowship director before I took a break, which I'll talk about in a minute. In that time, I was doing clinical care and I had a research program and I was doing education - doing a lot of teaching for CME work, and teaching primary care and subspecialists about migraine - and I really love that piece of things - and precepting fellows. And then, I also had my editorial work on top of that. I have been a medical journal editor as long as I have been a headache specialist. We were talking about mentors, and I want to talk, at some point, about my fantastic mentor, Elizabeth Loder, who is also a research editor, in addition to being an outstanding headache medicine clinician and researcher and educator. But she got me started as an Assistant Editor for Headache in my fellowship year - the journal Headache - and I continued as an Associate Editor there. I worked as a Research Editor for the British Medical Journal for a while and then joined the journal Neurology, where I am one of the eight Associate Editors. I cover the general neurology portfolio, which includes a lot of things - includes headache medicine, includes traumatic brain injury, pain, spine, neuro-oncology, neuro-otology - there's a whole bunch of different things that I have learned a lot about since starting as an editor. So, I have always had a lot of different parts to my job, which keeps me interested. It's also a lot, and I do always talk about the fact that I ended up taking a year off because I think it's important to be real about the lives that we lead and our jobs as academic neurologist. So I ended up having a bunch of family health issues that came up in 2021, and combined with all of the other things that we're doing, I just couldn't keep it all going. And I ended up getting sort of burned out a little bit and was having trouble balancing all of that and the family health issues that were going on. And I ended up taking about a year off from clinical work. I continued with my editorial work and kind of got everything sorted out with my family, and then just started my current position in January. I'd just like to bring that up to show that – you know, not everyone's going to be able to take a year off - I recognize that. But I think it's important to normalize that just being “pedal to the metal” all the time is not feasible for anyone. And we need to recognize that it's okay to take breaks periodically. So, I'm kind of an evangelist for the “taking-a-break model.” Dr Monteith: Yeah, you took a break but you kind of didn't, because you've been doing a lot for us in neurology, and I certainly appreciate that. Speaking about all of that and feeling burnt out - what inspires you; what does keep you going? Because I know you keep going. Dr Burch: I do. Well, it's really funny - when I took my time off, I used that as an opportunity to really think about, “Okay, is this really what I want to be doing? Is this the right path for me? Do I want to rethink things?” And I ended up in the same job that I left, just in a different place. I'm still doing clinical care, and I'm the fellowship director of my current institution, and I still do all this education, and I'm getting my research program going, and I'm still an editor. So, I think the bottom line is, I have always loved what I do; it's just a question of making it all fit. So, you know, when I get up in the morning, when it's a clinic day, I am so excited to just go and talk to my patients and see how they're doing and see if there's something I can do to make them feel better. And it's just delightful to be able to play that role in people's lives, even if they're not getting better. You know, I think sometimes just being there with them is of service and is worth doing, and that feels very meaningful to me. And I have a fellow now. I love working with my fellow and teaching, and I love just talking about headache medicine and, you know, “What can we do to help people?” So, that really inspires me. On an editorial day, I'm interested in what research people are doing and seeing how neurology can publish the best research possible. We're all moving the field forward and it's just delightful to see what people are doing. I don't know - I like all of it. Dr Monteith: Yeah - you spoke about talking to patients and having that interaction. I'm thinking about migraine and patients going into status, having severe attacks. Is there any case that really moved you, made you think differently? Dr Burch: What really sticks out in my mind when I think about acute treatment, in particular, is what doesn't necessarily fit neatly into the algorithms that we develop. The situations where creativity and persistence and working together really make a big difference for a patient. I am the first person to tell you we do not know everything yet, and maybe we will never know everything. And I think sometimes we need to think outside the box. We need to “listen between the lines” to what people are telling us, and really work together to figure out a very individualized, well-crafted plan. I'm thinking about times that - for example, someone came to me and said, “I'm having these intermittent episodes where I get all of the symptoms of migraine but I don't get headache pain. You know, I get the nausea and I get the photophobia and I'm irritable and, you know, what do I do about this?” And we ended up saying, “Okay, well, take your triptan and let's see what happens,” after trying some other things. And it worked, and it turned out to be the only thing that worked. And that's maybe something we wouldn't think about because we talk about pain all the time and that was really key to improving that person's quality of life. Or, you know, trying to figure out - if there's a situation that provokes an attack pretty reliably, how do we decide when this person is going to take their acute medication ahead of time to try and prevent that from happening? So, for example, somebody who always gets a migraine when they get on the airplane - can we maybe think about doing that? Is it part of the algorithm that we all think of? No, but it's what's right for that person. I feel like I am doing my best work when I really sit with the person and their individual story and listen to how they describe their experience, and then partner with them to come up with something that really works for their specific situation. Dr. Monteith: Give us a few tips. You mentioned the use of triptans, even thinking about most bothersome symptoms, associated symptoms. Let's say they tried the triptan, they have a severe migraine, and still with pain two hours later - what do we say? Dr Burch: Yeah, and I think this is - like I said at the beginning, this is where people often start to feel a little anxious sometimes; you've tried the triptan, it's not necessarily working - what do you do? I think there's a couple of things. First of all, triptans are still first line for migraine - in the absence of vascular risk factors, that's still what we start with. The guidelines ask us to try two different triptans before we try switching to a different class. So, the first thing - most people start with sumatriptan (it's the oldest one; it's usually covered well by insurance). So, first thing to ask is, what was the patient's experience with it? Was it not strong enough? Did it not work fast enough? Was it too strong? And then you think about - based on that response, are we going to go to eletriptan, which is kind of considered to be the strongest or most effective of the triptans? Are we going to go to rizatriptan, which is faster onset? Are we going to go to naratriptan or frovatriptan, which lasts longer? Then, if the second triptan doesn't work, we think about moving to a gepant - that's what the guidelines are currently recommending. The other thing to consider is whether someone needs an antinausea medication or an antiemetic, because if people are feeling queasy, they're worried about vomiting, then they may be reluctant to take medication. Or it could be that their GI system just isn't working as well, so we need to think about better absorption of the oral medications as well. There are lots of other tips and tricks also. I don't want to go through the whole list, but one of the things that I put in the article is a whole set of things to do if triptans are not effective or if your acute treatment is not effective. It's also things like making sure they're treating early, using combinations of medications - there's a whole list. Then that brings us to rescue therapy. And I think that's also essential; we don't talk enough about rescue therapy. We do think about it, but we think about it when we get the phone call to our clinic, where we get the message that says, “I took my treatment didn't work. And this is the second time this has happened. And I'm desperate, and what do I do?” That's not when you want to be managing this. You want to be managing this at the visit, before it happens. So, I think anybody who has an attack occasionally that doesn't respond to treatment needs a rescue plan. There's a bunch of different things you can do - I talk about this in the article as well - but some backup, like an injectable sumatriptan, might be helpful. Sometimes we use sedating medications to just try and help people go to sleep. I personally really like to give phenothiazine antiemetics because they have intrinsic antimigraine properties as well as being sedating and helping with nausea, so I sometimes use those. But there are a lot of different strategies and it's just worthwhile looking through them and getting comfortable with a few of them to give patients as a backup plan. Dr Monteith: I loved – I did love your tables. I love that you put the devices in the tables because usually when we think about neuromodulation, that's almost like usually a separate article. But you went ahead and combined it because all of the devices may have some acute benefits for patients. So, how do you think about devices? How do you talk to patients about devices? Dr Burch: Yeah, well, all of them were originally tested for acute treatment before their preventive indications. So, I think it's appropriate; if we're thinking about a plan, we want to have everything in one place, which is why I always include neuromodulation. The neuromodulation device that has the strongest evidence is remote electrical neuromodulation, which is the band that patient wears on their arm and uses as an acute strategy. The others may be helpful for individual patients, but I tend to lean towards the remote electrical neuromodulation as my acute treatment of choice just because of the strength of the evidence. I also haven't had as much trouble getting it for patients. The big barrier for all of these neuromodulation devices is cost because, relatively - I mean, they're not cheap and they're almost never covered by insurance (sometimes they are, but not always), and many of our patients are going to be able to access them and many of our patients are not. So, I'm always judicious in the way that I talk about them because I don't really want to put people in the situation of having to say, “I can't afford this thing that you think would be great for me.” Which, of course, comes up - not just with neuromodulation but with medication as well. But, you know, I think they're good for people who don't want to take medication or who are taking medications too often, and we need something to throw in there that is not a medication to prevent the development of medication overuse headache. Some people just prefer them. The evidence is not as strong for neuromodulation as it is for acute medications - and some of that just has to do with the challenges in blinding people to treatment arm in a clinical trial - but I think they have their place. Dr Monteith: When I'm just looking at the data, and then, as you mentioned, there are multiple options in terms of the latest developments. What are the things that you're most excited about in terms of either nonpharmacological, pharmacological interventions, or even patient populations like pregnant patients or patients with cardiovascular disease. Dr Burch: It is such an exciting time to be a headache specialist. I feel like things are coming out all the time, even in between writing this article and sending the final draft in, and now new things have come out. The zavegepant nasal spray is now FDA approved for acute treatment of migraine, and that was not the case when I wrote the final draft of this article. So, new formulations of medications are coming out and that's just really exciting. I think different patients prefer different things, and so I kind of like having different options to give them. I'm really interested in a couple of different things. There's been a lot of research coming out recently about the migraine prodrome - this sensation or symptom constellation that some patients get before what we think of as the more typical migraine – so, before the pain, maybe even before the more typical sensory hypersensitivity. Some patients know that an attack is coming, and there has been some research very recently coming out showing that, with gepants, taking the gepant before the attack actually happens in the prodromal phase can stave off an attack. I think that's cutting edge. I haven't really started talking to patients about it, but I'm interested to see what happens when that research is fully published and we kind of start test driving it. I'm also interested in the way that gepants don't seem to cause medication overuse headache in the same way that triptans or frequent use of NSAIDs do. I'm kind of thinking that the line between acute treatment and preventive treatment may start to get blurred a little bit with gepants. Dr Monteith: It's already blurred. Dr Burch: It's already blurred! It's pretty blurred, right? Dr Monteith: I agree. And it'd be cool to see an update on this article. It might need to be just a whole - imagine a whole kind of issue on its own, on just acute treatments. Dr Burch: Yes, for sure. Dr Monteith: Great. Thank you so much for being here. Dr Burch: Thanks. It's always a pleasure to talk to you, and I'm really excited for this article to make it out into the wild in the real world and for people to get a chance to take a look at it. Dr Monteith: Yeah, I know our listeners are going to love this article - they're going to get a lot out of it. And most importantly, their patients are going to get a lot out of it. Dr Burch: That's my goal. Dr Monteith: Again, today we've been interviewing Dr Rebecca Burch, whose article on acute treatment of migraine appears in the most recent issue of Continuum, on headache. Be sure to check out Continuum audio podcasts from this and other issues. And thank you to our listeners for joining me today.   Dr. Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practice. Right now, during our Spring Special, all subscriptions are 15% off. Go to Continpub.com/Spring2024, or use the link in the episode notes to learn more and take advantage of this great discount. This offer ends June 30, 2024. AAN members: go to the link in the episode notes and complete the evaluation to get CME. Thank you for listening to Continuum Audio.

Accounting firms planning for future success may want to rethink their approach to new opportunities. In this episode of the Small Firm Philosophy podcast, Elizabeth Hale, founder and CEO of eeCPA, shares with PCPS manager Erin Hartman how her firm is revolutionizing the traditional CPA model by putting people first and driving client success. SFP is produced by AICPA & CIMA's firm services team, aka the Private Companies Practice Section (PCPS). This episode is part of an ongoing series on accounting firm business model transformation that PCPS is leading for AICPA & CIMA. For more on the series, check out the Transforming Your Business Model landing page. 

In today's episode, Teresa Camp-Rogers, MD, MS analyzes a study published in the Annals of Internal Medicine, the journal of the American College of Physicians, entitled Inappropriate Prescribing to Older Patients by Nurse Practitioners and Primary Care PhysiciansThe article, which seems to call for an expansion of unsupervised practice for NPs, contends that NPs and physicians showed no differences in inappropriate prescribing to seniors based on Beers criteria, however, notes that NPs were overrepresented among clinicians with the highest and lowest rates of inappropriate prescribing. Dr. Camp-Rogers points out that since most NPs are practicing under physician supervision, with an estimated 2-6% of NPs practicing without physician supervision, this study may simply prove what other studies have established: the physician-led care model works - NOT that unsupervised practice is safe.  Further, she argues that this study begs a follow-up question: with such variation in potentially inappropriate prescribing by NPs, what do we know about which NPs were in the top and which were in the bottom?  https://www.acpjournals.org/doi/10.7326/m23-0827Get the books! https://www.amazon.com/Imposter-Doctors-Patients-at-Risk/dp/1627344438/PhysiciansForPatientProtection.org

For a full transcript of this episode, click here. Here's a great musing that I read on LinkedIn: How will alternative primary care models fare when growth mode gets balanced with profitability and VC-supported burn rate is transformed to Big Retail bottom-line expectations? Mission v. margin. I'm gonna add to this: How will alternative primary care models, or even just doing good primary care, fare when it encounters the current system rife with perverse incentives of all kinds, including, yeah, for sure, Big Retail bottom-line expectations but also Big Health System and Big Payer bottom-line expectations and current business models? This show from last year was wildly popular—maybe one of our most popular shows—and relisten to it in the current context of what's going on right now in the primary care and MSO (Managed Services Only) space. Coming up, I'm gonna probably do a whole show on this if I can get my act together; but this encore is really relevant right now. One piece of podcast business before we get into the episode: Please sign up for our weekly email if you haven't already, especially if you consider yourself part of the Relentless Health Tribe. I am mentioning this not only because it's a great way to keep track of our shows because you can do an email search to remember where you heard something, since a good deal of the show intros are in the emails, but also, there's a plan afoot to hold some Zoom meetings to talk about different topics etc—and you won't be notified of such goings-on unless you're subscribed. You can unsubscribe whenever you want, by the way; and I am way too busy to send more than one email a week or spam if that was a concern. On Relentless Health Value, I don't often get into our guests' personal histories. There are a bunch of reasons for this, which, if you buy me beer, we can talk podcast philosophy and I will tell you all about my personal, very arguable opinion here. Nevertheless, in this healthcare podcast, we are going rogue; and I am talking with Scott Conard, MD, who shares his personal story. You may ask why I decided to go this route for this particular episode, and I will tell you point-blank that Dr. Conard's experience, his narrative, is like the perfect analogue (Is analogue the right word [allegory, composite example]?). His story just sums up in a nutshell what happens when a PCP (primary care provider) does the right thing, manages to improve patient care for real, and then at some point gets sucked into the intrigue and gambits and maneuvering that is, sadly, the business of healthcare in the United States today. Before we kick in, I just want to highlight a statement that Scott Conard makes toward the end of the show. He says: So, this isn't about punishing or blaming aspects of care that are being overrewarded today. It's really about what's the path forward for corporations, for middle-class Americans, and for primary care doctors who don't choose to be part of a big system. We have to figure out how to solve this problem. I hope people don't hear this and think that there are horrible people at some not-for-profit hospital systems, for example. There are some great people at not-for-profit health systems, but they have some really screwed-up incentives. A few notable notes from Dr. Scott Conard's journey and words of wisdom that I will just highlight up front here: He says that as a PCP, you actually can produce high-value care in a fee-for-service model … if you think differently and you change practice patterns. I have heard this from others as well, including most recently David Muhlestein, PhD, JD, who says this in an episode (EP393). As Dr. Scott Conard says later in this episode, healthcare organizations must embrace the art of medical leadership. So, I guess that's a spoiler alert there. Another point that Dr. Conard makes very crisply toward the end of the show is that doctors can kinda get pushed and pulled around in this mix. You have docs just trying to provide good care, and they work for one entity that gets bought and now it's some other entity … and what's happening upstairs and the prices being charged or somebody somewhere deciding not to make prices transparent, or deciding to sue low-income patients for unpaid medical bills or what charity care to offer or not to offer. These are not doctors in clinics making these calls, and we need to be careful here not to homogenize what some of these health systems are choosing to do like some kind of democratic vote was taken by everybody who works there. Health systems, hospitals, are many-celled complex entities. And a third takeaway—there are a bunch of takeaways in this show, but a third one I'll highlight here from Dr. Conard's story—is the old fiduciary responsibility code word being used by health system administrators as a euphemism for strategies that might need a euphemistic code word because the strategy has questionable community benefit. In the case study that we talk about today, the local health system managed to raise healthcare spend in North Texas by $100 million year over year. Employers and employees in North Texas communities wound up paying $100 million more year over year in healthcare one particular year. This was prices going up. It also was removing a big systemic initiative to keep heads out of hospital beds. Reiterating here, we are not talking about doctors here particularly because, of course, the vast majority of doctors are trying to prevent avoidable hospitalizations. But suddenly in North Texas, physicians did not have the population health efforts and the team really standing behind them helping to prevent avoidable hospitalizations. That sucks for everybody trying to do the right thing, and, as has been said, burnout is moral injury in a cheap Halloween costume. Moral injury happens when you have good people, clinicians, doctors, and others who realize that what is going on, at best, is not helping the patient. Also mentioned in this episode are Benjamin Schwartz, MD, MBA; David Muhlestein, PhD, JD; Brian Klepper, PhD; Al Lewis; Robert Pearl, MD; Karen Root, MBA, CCXP; and Wendell Potter.   You can learn more by emailing Dr. Conard at scott.conard@converginghealth.com.   Scott Conard, MD, DABFP, FAAFM, is board certified in family and integrative medicine and has been seeing patients for more than 35 years. He was an associate clinical professor at the University of Texas Health Science Center at Dallas for 21 years. He has been the principal investigator in more than 60 clinical trials, written many articles, and published five books on health, well-being, leadership, and empowerment. Starting as a solo practitioner, he grew his medical practice to more than 510 clinicians over the next 20 years. In its final form, the practice was a value-based integrated delivery network that reduced the cost of care dramatically through prevention and proactive engagement. When this was acquired by a hospital system, he became the chief medical officer for a brokerage/consulting firm and an innovation lab for effective health risk–reducing interventions. Today, he is co-founder of Converging Health, LLC, a technology-empowered consulting and services company working with at-risk entities like self-insured corporations, medical groups and accountable care organizations taking financial risk, and insurance captives to improve well-being, reduce costs, and improve the members' experience. Through Dr. Conard's work with a variety of organizations and companies, he understands that every organization has a unique culture and needs. It is his ability to find opportunities and customize solutions that delivers success through improved health and lower costs for his clients.   06:54 What triggered Scott's career journey? 07:31 What caused Scott to rethink what is good primary care? 08:11 Why did Scott realize that he is actually a risk-management expert as a primary care doctor rather than someone who treats symptoms? 09:25 EP335 with Brian Klepper, PhD. 09:53 How did Scott's practice change after this realization? 10:04 What is a “Whole-Person Risk Score”? 11:08 Scott's book, The Seven Numbers (That Will Save Your Life). 13:05 “You start to move from a transactional model to a relationship model.” 15:31 Did Scott have any risk-based contracts? 16:08 Why is it so important to look at total cost of care and not just primary care cost? 21:08 Scott's book, The Art of Medical Leadership. 22:13 EP381 with Karen Root. 30:43 Why did Scott move over to help corporations? 33:10 EP364 with David Muhlestein, PhD, JD. 33:51 “Everybody thought they were honoring their fiduciary responsibility, and the incentives are completely misaligned.” 34:31 EP384 with Wendell Potter. 34:43 “It's the system that's broken; it's not bad people.”   You can learn more by emailing Dr. Conard at scott.conard@converginghealth.com.   @ScottConardMD discusses #primarycare #marginvsmission on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Jerry Durham, Kate Wolin, Dr Kenny Cole, Barbara Wachsman, Luke Slindee, Julie Selesnick, Rik Renard, AJ Loiacono (Encore! EP379), Nina Lathia, Marshall Allen

Dr. Caissa Troutman, a board-certified family medicine, obesity medicine, and culinary medicine physician, joins Dr. Amy Vertrees to share her journey of over 20 years in the medical field. With experience in primary care and urgent care, Dr. Troutman's insights into the challenges faced by primary care providers offer a unique perspective on the realities of the medical profession. Through her own experiences and professional expertise, she sheds light on the impact of paperwork, work-life balance, and the transition between different medical roles. Dr. Troutman's personal journey of overcoming burnout and delving into lifestyle medicine adds depth and authenticity to her understanding of the complexities that primary care providers encounter. "The security is not in the job. The ability to create money, or money is within me, I do it. I can make the money. I can." - Dr. Caissa Troutman Find her at: Website - www.weightremdy.net Facebook /IG - @weightremdy Youtube - @WEIGHTreMDyinPA

Join us on the latest episode, hosted by Jared S. Taylor! Our Guest: Abhinav Shashank, Cody Simmons, CEO at DermaSensor.What you'll get out of this episode:Cody Simmons' Background: Cody discusses his journey from a biomaterials lab at Stanford and roles at Genentech, leading to his involvement with DermaSensor, a health tech startup.DermaSensor's Evolution: Founded in 2009, DermaSensor was initially a research-focused virtual startup. Cody joined in 2016, transforming it into a fully-fledged company, leading to the recent FDA clearance.FDA Clearance Milestone: DermaSensor's device, which has transitioned from a 30-pound machine to a portable size, received FDA clearance, marking a significant achievement for the company and a relief for the team.Impact on Primary Care: The device provides primary care physicians (PCPs) with dermatologist-level skin cancer triage capabilities, addressing a longstanding need for improved skin cancer assessment tools in primary care.Use of AI in DermaSensor: DermaSensor employs AI for lesion assessment, using a locked algorithm to ensure accuracy and adherence to FDA requirements. The technology allows for a standardized analysis, offering a real-time quantitative result for skin cancer risk.To learn more about DermaSensor:Website: https://www.dermasensor.com/LinkedIn: https://www.linkedin.com/company/dermasensor/Guest's Socials:LinkedIn: https://www.linkedin.com/in/codyvsimmons/Our sponsors for this episode are:Sage Growth Partners https://www.sage-growth.com/Quantum Health https://www.quantum-health.com/Show and Host's Socials:Slice of HealthcareLinkedIn: https://www.linkedin.com/company/sliceofhealthcare/Jared S TaylorLinkedIn: https://www.linkedin.com/in/jaredstaylor/WHAT IS SLICE OF HEALTHCARE?The go-to site for digital health executive/provider interviews, technology updates, and industry news. Listed to in 65+ countries.

Credits: 0.50 AMA PRA Category 1 Credits™, 0.50 ABIM MOC or 0.60 AANP    CME/CE Information and Claim Credit: https://www.pri-med.com/online-cme-ce/podcast/a-comprehensive-approach-to-obesity-management  Overview: In this podcast expert faculty will discuss the Obesity Medicine Association's 4 pillars of clinical obesity treatment as a comprehensive, evidence-based approach to management, comprised of nutrition, physical activity, behavior, and medication. The discussion will encompass strategies and resources that PCPs can use to aid in implementing holistic care for people with obesity, including the roles and benefits of a multidisciplinary team and patient support networks in long-term planning for sustained weight management. 

If you're having trouble getting in to see your doctor, you're not alone. Access to primary care providers in Massachusetts has been declining for three straight years, according to a recent survey from Massachusetts Health Quality Partners. This comes as factors including industry staffing challenges, salary discrepancies, and burnout, contribute to a shortage of PCPs nationwide. Today, WBUR Senior Health Reporter Priyanka Dayal McClusky joins The Common with more on what's behind this concerning trend, locally and across the country. Greater Boston's daily podcast where news and culture meet.

Join us this week for an insightful and encouraging discussion with Drs. Mandal and Grant, the founders of The Rheumatology Access Expansion Initiative (RAE). RAE is a project designed to support the Navajo Nation, an underserved community with respect to rheumatic disease. Our guests explain how leveraging the established educational model, Extension for Community Healthcare Outcomes (ECHO), was used to remotely train PCPs among the Navajo in the diagnosis and evidence-based treatment of rheumatoid arthritis (RA). 

Letterwriting is the topic that took the PCPS by storm! When we asked you for your thoughts and stories about the letters you wrote and received growing up, we got more responses than any other topic to date. This certainly validates our assertion that letterwriting was vital to the Gen X experience. Before email and texting there was only one way to keep in touch with our important people that didn't involve long-distance charges (which your dad said was "highway robbery!") -- we put pen to paper and poured our hearts out in ways we would never do via text. Grandparents, pen pals, camp friends, and boyfriends/girlfriends, our relationships to all of them were nurtured and deepened by the handwritten word. Join us for our stories, your stories, and lots of hilarious readings of pubescent yearning and shenanigans.Follow the PCPS on Instagram, Facebook and TikTokSupport the PCPS on Patreon. Become a patron and get lots of extra perks here.Help the PCPS keep on truckin' by making a one-time donation on Paypal.Subscribe to the PCPS email newsletter, “The Weekly Reader” here.

Do you need a little refresher on ortho? Are you a primary care, urgent care, or ER provider who sees a lot of orthopedic conditions in your practice but can never quite remember if you're supposed to splint or not splint, use lidocaine with epinephrine or not, or how many X-ray films you're supposed to order? You're in the right place! Join me today as I chat with Vanessa Smith, an orthopedic PA who specializes in hand surgery. Vanessa shares several clinical pearls that she's learned in her 14 year career. She also dives into exactly what the non-orthopedic provider needs to know when treating orthopedic injuries and conditions. We discuss tips and tricks for non-surgical interventions as well as how to appropriately refer to ortho.  Vanessa also introduces OrthoRefresh.com, a website dedicated to giving PCPs and non-ortho providers a refresher on how to treat common orthopedic injuries. OrthoRefresh contains several resources, including short videos by prominent ortho specialists to educate and equip PCPs to effectively treat orthopedic complaints.  Press play for a fantastic overview of treating common orthopedic injuries and conditions. Vanessa makes everything very approachable and easy to understand. Let's get started! SPONSORS PROMISED LAND MEATS www.promisedlandmeats.com  ADVANCED PRACTICE PLANNING https://www.advancedpracticeplanning.com/ COACHING ⁠1-ON-1 NEGOTIATION CONSULT https://calendly.com/the-pa-is-in/negotiate⁠  ⁠FREE 30-MINUTE COACHING CONSULT⁠ ⁠https://calendly.com/the-pa-is-in/gen-call⁠   LINKS EPISODE BLOG POST https://www.tracybingaman.com/blog ⁠TRACY ON INSTAGRAM https://www.instagram.com/mrstracybingaman/⁠ ⁠TRACY ON LINKEDIN https://www.linkedin.com/in/tracybingaman/⁠ ORTHO REFRESH www.orthorefresh.com  --- Support this podcast: https://podcasters.spotify.com/pod/show/thepaisin/support

Jimmy Pruitt, PharmD, Founder & CEO of Pharmacy & Acute Care University, shares insights on his entrepreneurial journey and the EMPower Rx Conference. Summary In this week's episode, join our conversation with Dr. Jimmy Pruitt, a Clinical Pharmacy Specialist in Emergency Medicine at Atrium Health. Dr. Pruitt wears multiple hats as the Founder & CEO of Pharmacy & Acute Care University and the brains behind the EMPowerRx Conference. Our conversation delves into his fascinating entrepreneurial journey, exploring the roots of why and how he embarked on this path. Throughout the episode, we gain valuable perspectives on the intricacies of balancing professional commitments and entrepreneurial endeavors. Dr. Pruitt shares his experiences, lessons learned, and the strategies he employed to overcome obstacles on his journey. Dr. Pruitt also shares his vision for the EMRower Rx Conference - a  unique conference and continuing education experience for professionals in emergency medicine pharmacotherapy.  Tune in to this insightful conversation with Dr. Jimmy Pruitt to glean wisdom from his unique blend of clinical expertise and entrepreneurial spirit. Whether you're navigating the realms of healthcare, entrepreneurship, or both, this episode offers valuable insights and inspiration for the road ahead. About Today's Guest Dr. Jimmy Pruitt is originally from Orlando, FL, and is a combination of nerd and gym junky having a background as a division 1 cornerback then turned Doctor of Pharmacy from Presbyterian College School of Pharmacy in 2017. He completed a PGY-1 Pharmacy Residency at Florida Hospital Orlando, and then went on to Grady Health System in Atlanta GA for his PGY2 Emergency Medicine Residency. Dr. Pruitt is currently an Emergency Medicine Clinical Pharmacy Specialist at the Medical University of South Carolina in Charleston, SC. Dr. Pruitt was honored with the Excellence in Diversity from MUSC College of Pharmacy, Presbyterian College School of Pharmacy (PCSP) Alumni of the Year, and keynote speaker for the 2021 PCPS graduation. Dr. Pruitt's professional interests include cardiac arrest, shock syndromes, trauma, and hosting the #1 Emergency Medicine Pharmacy Podcast “Pharm So Hard” and operation his new pharmacy academy called Pharmacy & Acute Care University. Mentioned on the Show EMPowerRx Conference 2024 (use code YFP2024 for 15% off registration) YFP Episode 284 Start by Jon Acuff Procrastinate on Purpose by Rory Vaden Your Financial Pharmacist Your Financial Pharmacist on Facebook  Your Financial Pharmacist on Instagram Tim Ulbrich on LinkedIn Jimmy Pruitt on LinkedIn YFP Disclaimer YFP Newsletter Pharm So Hard Podcast

Variety shows were as much a part of 1970s television as reality shows were a part of the early 21st century, and today we're saving two of the most iconic — The Carol Burnett Show and Sonny & Cher, plus one very short-lived YET STILL ICONIC show for us GenXers, The Brady Bunch Variety Hour (which may or may not have been created in a drug-induced fever dream). Listen for lots of fun facts about these unforgettable shows that were such cultural touchstones for us 70skids, as well as memories of many of the skits, songs, and silliness that still bring us such joy today. “And The Beat (most definitely) Goes On …”Follow the PCPS on Instagram, Facebook and TIkTok.Support the PCPS on Patreon. Become a patron and check out the fun extras you get here.Help the PCPS keep on truckin' by making a donation here.Subscribe to the PCPS email newsletter, “The Weekly Reader” here.

Today we're saving many of the things from our youth that our own kids' generations will never understand … like what the heck a phone book is (not to mention how to use it). From smoking sections on airplanes (why bother??) to having to WAIT for your favorite song to play (the agony!) to the migraines the microfiche machine triggered (and which the memory still does), we're breaking down some of the staples of our childhoods that continue to puzzle the most recent generations. But really, how did we survive without computers to do all our work for us? And here's a head-scratcher: was it better?Follow the PCPS on Instagram, Facebook and TikTok.Become a supporter of the PCPS on Patreon. Check out all the extra perks you'll receive here.Help the PCPS keep on truckin' by making a one-time here.Subscribe to the PCPS email newsletter, “The Weekly Reader” here.

In today's episode, we'll be saving the competition show responsible for the rash of broken arms suffered in basements, backyards and TV rooms while trying the latest trick seen on the disco-era dance show … DANCE FEVER. This was the pop culture nugget that gave us Deney Terrio, a name no Gen Xer will ever forget. But it wasn't just the spandex and dance moves that kept us glued to the TV -- it was also the parade of celebrity judges, awkwardly pretending like they knew anything at all about disco and/or dancing. If you were good enough for Love Boat, you were good enough for Dance Fever! Which judge focused his scoring on the contestant's legs? Which one tried to do the bump with Motion -- but missed? Who/what is Motion anyway (and what famous athlete are they married to???)? And which judge literally barked their score for the audience? Listen today and find out!Follow the PCPS on Instagram, Facebook and TikTokBecome a supporter of the PCPS on Patreon. Check out all the perks you get here.Help the PCPS keep on truckin' by making a one-time donation on PayPal.Subscribe to the PCPS email newsletter, “The Weekly Reader” here.

Welcome to our second tribute to Dynamite Magazine, the star-studded, joke-filled People Magazine knock-off for kids that we ordered through our Scholastic book orders. Dynamite was the news source most trusted by Gen X children and, in this episode, we'll perform dramatic readings of the important scoop Dynamite fed to us; do you know why Willie Aames spells his name with two A's? We do! And so will you after listening to this important episode! Stay informed! Tune in today!Follow the PCPS on Instagram, Facebook and TikTokSupport the PCPS by becoming a patron on Patreon. Check out all the perks you get here.Help us keep on truckin' with a one-time donation on Paypal.Subscribe to the PCPS email newsletter, “The Weekly Reader” here

Join us for the latest installment of our ongoing series called AM Radio Gold, celebrating the songs we heard when AM radio was king. In this episode, we'll be focusing on the radio hits from the year 1979-- which gave us some of the most memorable music in history. But this episode is not a history lesson. It's personal. And the three of us will share the songs WE waited for on the radio. We'll tell you who we were, where we were, and what these songs meant to us. Which song is the soundtrack to a birthday party gone wrong? Which song makes Michelle think of Rumpelstiltskin? And which song -- or songs. Many, many songs actually -- did we listen to alone in our rooms while feeling sorry for ourselves? If you're wondering if there will be singing, the answer is yes. Sorry not sorry.Check out the awesome AM Gold: 1979 playlist we curated. Listen hereFollow the PCPS on Instagram, Facebook and TikTokFor more PCPS fun and extra perks, support the PCPS on Patreon.Help the PCPS keep on truckin' by making a one-time donation on Paypal.Subscribe to the PCPS email newsletter, “The Weekly Reader” here.

Hello listeners! Today is Christmas Day and the PCPS is taking the week off to rest and recharge -- and so today's episode is an encore of “The Most Seventiest of 70s Christmas Albums.” But before the episode begins, we're dropping in a little gift to you; in November, Kristin appeared onstage in a production called Listen to Your Mother, an annual event featuring local writers and their essays about motherhood where she told a hilarious story about the Christmas she became a Guitar Hero. Trust us, she'll have you rolling (and digging in your basement for your old plastic guitar and drum kits). Enjoy!

Join Carlene MacMillan, chief medical officer at Osmind, to explore the evolving role of primary care physicians in addressing mental health challenges, particularly in the context of emerging therapies like ketamine. We delve into misconceptions surrounding ketamine use, factors to consider when prescribing it, and its potential benefits when combined with psychotherapy. Carlene MacMillan is chief medical officer, Osmind, a public benefit corporation dedicated to aiding clinicians and researchers in advancing life-saving mental health treatments. In this role, she concentrates on product development, growth initiatives, and medical affairs. Dr. MacMillan is also a co-founder of Fermata Health, an interventional psychiatry practice located in Brooklyn, NYC. She can be reached on X @CarleneMac. She discusses the KevinMD article, "Ketamine for mental health conditions: What every primary care physician needs to know." Careers by KevinMD is your gateway to health care success. We connect you with real-time, exclusive resources like job boards, news updates, and salary insights, all tailored for health care professionals. With expertise in uniting top talent and leading employers across the nation's largest health care hiring network, we're your partner in shaping health care's future. Fulfill your health care journey at KevinMD.com/careers. VISIT SPONSOR → https://kevinmd.com/careers Discovering disability insurance? Pattern understands your concerns. Over 20,000 doctors trust us for straightforward, affordable coverage. We handle everything from quotes to paperwork. Say goodbye to insurance stress – visit Pattern today at KevinMD.com/pattern. VISIT SPONSOR → https://kevinmd.com/pattern SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended GET CME FOR THIS EPISODE → https://earnc.me/cd5ryA Powered by CMEfy.

Join the PCPS as they celebrate their favorite thing about Thanksgiving -- TV! Today's encore of episode 92, “Turkeys on TV,” takes a deep dive into three of our favorite Thanksgiving TV episodes as well as a peek into our 1970s classroom festivities. (Which one of us puked up Thanksgiving dinner lunch in the library?)We're also giving you a brand new intro conversation where we all agree on WHO we are most thankful for (do you have a mirror handy??) as well as paying tribute to Matthew Perry and all the wonderful memories he left us with. Thankful for our friends, indeed.