POPULARITY
42 episodes with specialty care
14 episodes with specialty care
6 episodes with specialty care
4 episodes with specialty care
4 episodes with specialty care
3 episodes with specialty care
4 episodes with specialty care
4 episodes with specialty care
3 episodes with specialty care
What if the fastest way to grow your healthcare organization is to slow down? In this episode of The Disrupted Podcast, Scott Middleton returns from Scotland straight into the thick of a merger — and what he's learning is reshaping how he thinks about change itself. Scott takes us inside the integration of TCPA and Providence Care into Your Health, where two very different models are colliding. One organization built 640 billing codes last year; the other built 40. One puts a single nurse practitioner in a building with no support; the other surrounds providers with nurses and community health workers. The opportunity is enormous — but so is the risk of moving too fast and scaring everyone away. What if the fastest way to grow your healthcare organization is to slow down? In this episode of The Disrupted Podcast, Scott Middleton returns from Scotland straight into the thick of a merger — and what he's learning is reshaping how he thinks about change itself. Scott takes us inside the integration of TCPA and Providence Care into Your Health, where two very different models are colliding. One organization built 640 billing codes last year; the other built 40. One puts a single nurse practitioner in a building with no support; the other surrounds providers with nurses and community health workers. The opportunity is enormous — but so is the risk of moving too fast and scaring everyone away. In this conversation, Jamie and Scott explore: Why a nurse practitioner alone is a "single source of failure" — and how staffing changes everything How to enter a building without threatening the provider they already love Why billing isn't bureaucracy — it's how Medicare knows you made a difference The art of giving people what they think they need now, and the rest over time Advanced care planning, DNRs, and why the right message sometimes needs a different voice This is a masterclass in change management disguised as a healthcare conversation. Listen now — and rethink what "disruption" really requires. Why a nurse practitioner alone is a "single source of failure" — and how staffing changes everything How to enter a building without threatening the provider they already love Why billing isn't bureaucracy — it's how Medicare knows you made a difference The art of giving people what they think they need now, and the rest over time Advanced care planning, DNRs, and why the right message sometimes needs a different voice This is a masterclass in change management disguised as a healthcare conversation. Listen now — and rethink what "disruption" really requires. www.YourHealth.Org
Dr. Secil Aydinoz of Hamilton Physician Group – Specialty Care is board-certified in general pediatrics and in sleep medicine. He focuses on treating adults and children who have sleep-related conditions. He earned his medical degree in Turkey and his pediatric residency and sleep medicine fellowship at the University of Missouri.Dr. Aydinoz treats a range of sleep-related conditions, including sleep apnea, narcolepsy, various forms of insomnia and hypersomnia, nightmare disorders, sleep phase issues, restless leg syndrome, and more.If you're noticing the symptoms of sleep apnea, call Hamilton Physician Group - Specialty Care at 706-529-3072. More information is also available at www.vitruvianhealth.com/specialty care.
El Dr. Secil Aydinoz, de Hamilton Physician Group – Specialty Care, cuenta con la certificación de la junta médica tanto en pediatría general como en medicina del sueño. Se especializa en el tratamiento de adultos y niños que padecen afecciones relacionadas con el sueño. Obtuvo su título de médico en Turquía y completó su residencia en pediatría, así como su subespecialización en medicina del sueño, en la Universidad de Missouri.El Dr. Aydinoz trata una amplia gama de afecciones relacionadas con el sueño, que incluyen apnea del sueño, narcolepsia, diversas formas de insomnio e hipersomnia, trastornos de pesadillas, problemas de fase del sueño, síndrome de piernas inquietas y más.Si usted presenta síntomas de apnea del sueño, llame a Hamilton Physician Group - Specialty Care al 706-529-3072. También puede encontrar más información en www.vitruvianhealth.com/specialty care.
Dr. Secil Aydinoz of Hamilton Physician Group – Specialty Care is board-certified in general pediatrics and in sleep medicine. He focuses on treating adults and children who have sleep-related conditions. He earned his medical degree in Turkey and his pediatric residency and sleep medicine fellowship at the University of Missouri.Dr. Aydinoz treats a range of sleep-related conditions, including sleep apnea, narcolepsy, various forms of insomnia and hypersomnia, nightmare disorders, sleep phase issues, restless leg syndrome, and more.If you're noticing the symptoms of sleep apnea, call Hamilton Physician Group - Specialty Care at 706-529-3072. More information is also available at www.vitruvianhealth.com/specialty care.
El Dr. Secil Aydinoz, de Hamilton Physician Group – Specialty Care, cuenta con la certificación de la junta médica tanto en pediatría general como en medicina del sueño. Se especializa en el tratamiento de adultos y niños que padecen afecciones relacionadas con el sueño. Obtuvo su título de médico en Turquía y completó su residencia en pediatría, así como su subespecialización en medicina del sueño, en la Universidad de Missouri.El Dr. Aydinoz trata una amplia gama de afecciones relacionadas con el sueño, que incluyen apnea del sueño, narcolepsia, diversas formas de insomnio e hipersomnia, trastornos de pesadillas, problemas de fase del sueño, síndrome de piernas inquietas y más.Si usted presenta síntomas de apnea del sueño, llame a Hamilton Physician Group - Specialty Care al 706-529-3072. También puede encontrar más información en www.vitruvianhealth.com/specialty care.
Dr. Secil Aydinoz of Hamilton Physician Group – Specialty Care is board-certified in general pediatrics and in sleep medicine. He focuses on treating adults and children who have sleep-related conditions. He earned his medical degree in Turkey and his pediatric residency and sleep medicine fellowship at the University of Missouri.Dr. Aydinoz treats a range of sleep-related conditions, including sleep apnea, narcolepsy, various forms of insomnia and hypersomnia, nightmare disorders, sleep phase issues, restless leg syndrome, and more. If you're noticing the symptoms of sleep apnea, call Hamilton Physician Group - Specialty Care at 706-529-3072. More information is also available at www.vitruvianhealth.com/specialty care.
El Dr. Secil Aydinoz, de Hamilton Physician Group – Specialty Care, cuenta con la certificación de la junta médica tanto en pediatría general como en medicina del sueño. Se especializa en el tratamiento de adultos y niños que padecen afecciones relacionadas con el sueño. Obtuvo su título de médico en Turquía y completó su residencia en pediatría, así como su subespecialización en medicina del sueño, en la Universidad de Missouri.El Dr. Aydinoz trata una amplia gama de afecciones relacionadas con el sueño, que incluyen apnea del sueño, narcolepsia, diversas formas de insomnio e hipersomnia, trastornos de pesadillas, problemas de fase del sueño, síndrome de piernas inquietas y más.Si usted presenta síntomas de apnea del sueño, llame a Hamilton Physician Group - Specialty Care al 706-529-3072. También puede encontrar más información en www.vitruvianhealth.com/specialty care.
On this episode of This Week in Pharmacy, we examine three major forces shaping healthcare today: the global impact of conflict on health security, the continued evolution of personalized specialty pharmacy care, and the over-the-counter products patients rely on most. We open the show with Aman Gupta, Managing Partner, Asia-Pacific at SPAG FINN Partners, and contributor author at MedikaLife. Aman joins TWIRx to discuss his latest MedikaLife article, which argues that global conflict is quietly undermining health security by redirecting funding, attention, and infrastructure away from healthcare and toward defense priorities. As military spending rises, health systems—especially in low- and middle-income countries—face growing pressure from shrinking access, rising costs, workforce shortages, disrupted supply chains, weakened disease surveillance, and reduced emergency preparedness. Conflicts in Ukraine, Gaza, and Sudan demonstrate how attacks on healthcare systems, displacement, malnutrition, and shortages of essential medicines can rapidly turn health access into a survival issue. Aman urges policymakers to treat health as strategic security infrastructure, not as a secondary social expense. TWIRx also gives a special shout out to the Indian Pharmaceutical Association, recognizing its continued leadership and advocacy for the pharmacy profession. Next, we welcome Dr. Chris Antypas, PharmD, with Perigon Pharmacy 360, for a discussion on how specialty pharmacy is becoming increasingly personalized. As complex therapies continue to advance, pharmacists are playing a critical role in ensuring medications and treatment plans are customized to optimize patient care. We explore how technology, workflow processes, clinical expertise, and pharmacists who deeply understand specific disease states are essential to successful specialty pharmacy outcomes. To wrap up the episode, returning guest Shanley Chien Pierce, Senior Editor, Health at U.S. News & World Report, joins us to review the latest OTC medicine and health product evaluations. Top-rated products include Children's Delsym for coughs, Unisom for sleep, and Pedialyte for electrolytes, along with skincare favorites such as La Roche-Posay for retinol and Aquaphor for lip balm. For the full list covering more than 128 categories, visit the U.S. News Best OTC Medicine & Health Products rankings. Sponsored by Perigon Pharmacy 360 Listen & Subscribe Stay connected with This Week in Pharmacy and the Pharmacy Podcast Network for conversations with pharmacy leaders, healthcare innovators, policy experts, and industry voices shaping the future of care.
The U.S. healthcare system is facing a quiet but accelerating crisis: a widening gap between where specialists are needed and where they actually practice. In urology alone, there are roughly 1,100 open positions but only about 400 new specialists trained each year—a mismatch that's only getting worse. As physician burnout rises and more clinicians seek autonomy and flexibility, traditional care delivery models are being pushed to their limits. The stakes aren't abstract—they show up in delayed diagnoses, long travel distances, and communities left without access to care.So how do you deliver specialty care differently in a system that no longer fits how physicians want to work?On this episode of I Don't Care, host Dr. Kevin Stevenson sits down with Dr. Joe Pazona, CEO of VirtuCare, to unpack a deeply personal and highly practical journey: from clinical frustration to entrepreneurial innovation. The conversation explores how one physician turned systemic gaps into scalable solutions—rethinking how specialty care can be delivered across underserved communities while improving physician quality of life.Top insights from the talk…The physician workforce shortage is no longer just a rural problem—it's spreading into urban markets due to shifting lifestyle priorities and structural inefficiencies.“Top-of-license care” and team-based models are essential to scaling access without overburdening physicians.Entrepreneurship in medicine isn't glamorous—it's messy, risky, and full of failure—but it may be one of the most viable paths forward.Dr. Joe Pazona is a board-certified urologist and CEO of VirtuCare, where he develops scalable, team-based specialty care models that expand access and drive revenue for rural hospitals through hybrid care delivery. He has over a decade of clinical and leadership experience, including launching robotic surgery programs, building private practices, and pioneering telehealth-enabled service lines. As an entrepreneur, he specializes in healthcare innovation, physician workforce optimization, and aligning clinical operations with sustainable business models to address systemic gaps in specialty care.
Specialty care remains one of the biggest black boxes in healthcare, creating delays, unnecessary referrals, and major frustration for both patients and primary care providers. In this episode, Reza Sanai, co-CEO and co-founder of PicassoMD, discusses how his team is helping primary care providers access specialist expertise in near-real time while also improving the referral process when specialty care is truly needed. He explains why specialty access often breaks down at the point of care, how fragmented provider data makes navigation more difficult, and why better coordination between primary care and specialists can reduce unnecessary ER visits, improve triage, and speed access to the right care. Reza also shares how PicassoMD is supporting rural and underserved communities, why visibility into the patient journey matters so much, and how thoughtful partnerships are essential to making innovation work in real healthcare settings. Tune in and learn how smarter specialist access could help close one of healthcare's most persistent care coordination gaps! Resources: ● Connect with and follow Reza Sanai on LinkedIn or reach out via email. ● Follow PicassoMD on LinkedIn and visit their website!
This episode recorded live at the Becker's 16th Annual Meeting features Dr. Chris Gallagher, Founder and Chief Strategy Officer, Access TeleCare, who shares how telemedicine is helping rural hospitals retain patients, improve outcomes, and build sustainable specialty care programs.This episode is sponsored by Access TeleCare.
What does it actually take to market a direct specialty care practice in a city full of competitors? For Dr. Ashley Agan, otolaryngologist and founder of Scottie ENT in Dallas, Texas, the answer had nothing to do with billboards or ad spend, and everything to do with how patients felt when they left her office.In this episode, Dr. Agan shares her journey from nearly 13 years at UT Southwestern, including a clerkship director role, to opening her own cash-pay ENT practice named after her late grandmother. From her first pivot away from saying "I'm an otolaryngologist" to leading with "I help you breathe better," Dr. Agan breaks down the marketing mindset shift that changed everything for her practice growth.In this episode, you'll hear:Why Google reviews became the cornerstone of her marketing strategy and what patients consistently say that sets Scottie ENT apartHow she approaches the elevator pitch without feeling salesy and the mindset reframe that makes it feel naturalWhy she stopped offering superbills and what happened when she didHow transparent cash pricing on her website is attracting a patient population she never expectedThe one marketing mistake she would undo from day one, and what she would start doing before she even opened her doorsHow her physician podcast, Back Table ENT, became an unexpected referral engine for out-of-state and international patientsWhat DPC primary care physicians need to know about referring into a direct specialty care practice and how to make those referrals countHer approach to bundled surgical pricing and how she found a surgery center partner that makes cash-pay surgery accessibleHow she uses telemedicine to serve patients across Texas and beyond, including virtual second opinions for her niche specialty in patulous eustachian tube dysfunctionDr. Agan also speaks candidly about building a personal brand alongside a clinic brand, the role her executive MBA played in understanding the business of medicine, and why she believes marketing your practice is ultimately an act of service — not self-promotion.Connect with Dr. Ashley Agan: Scottie ENT | Dallas, Texas Back Table ENT PodcastResources mentioned in this episode: Take the FREE DPC Marketing Self Assessment from AlignedMD HERE. Find a My DPC Story Event near you! State Summits in CA, IL, a My DPC Story LIVE event and the DPC Women's Summit are all coming! Learn more at mydpcstory.com/upcoming-events! The DPC Directory: If you're a DPC doctor, you'll find resources to grow your practice! If you serve the DPC world, grab a FREE listing today and get discovered by doctors who need your services.
Recorded live at Vision Expo in Orlando, this episode of The 20/20 Podcast features a powerful and insightful conversation with Dr. Faten Edris—Miami-based optometrist, owner of eight clinics, and a leading voice in reshaping modern optometry.Dr. Edris shares her perspective on one of the biggest challenges facing optometry today: the disconnect between clinicians and decision-makers in industry. She emphasizes the importance of optometrists having a seat at the table to influence how the profession evolves—particularly when it comes to scope of practice, reimbursement, and public perception.The conversation dives deep into how optometrists can move beyond the outdated image of “glasses and contacts” and fully embrace their role as primary eye care providers. Dr. Edris highlights the need to shift both patient expectations and insurance models to better reflect the medical care optometrists provide.From a business standpoint, she offers practical insights into successfully implementing new technologies in practice—stressing that systems, training, and team alignment are far more important than simply purchasing equipment. Her approach blends clinical excellence with strong operational strategy, showing how growth can be both patient-centered and profitable.Looking ahead, Dr. Edris shares her excitement (and caution) about emerging trends like AI, telemedicine, and diagnostic kiosks. Rather than fearing disruption, she encourages optometrists to embrace innovation and actively shape how these technologies integrate into patient care.This episode is ultimately about leadership, ownership, and stepping into the future of optometry with intention.Key Highlights & Timestamps[00:01:20] – Dr. Edris' mission: breaking generational barriers in optometry[00:02:50] – The biggest pain point: optometrists not having a seat at the table[00:04:00] – Why optometry must shift beyond “glasses & contacts”[00:06:00] – The compensation challenge and its impact on patient care[00:09:00] – Early career struggles and developing a growth mindset[00:11:30] – Why most clinics fail with new technology implementation[00:12:30] – Aligning your team and doctors for successful adoption[00:14:00] – Using data and performance metrics to drive growth[00:16:00] – Systems and protocols > equipment[00:17:40] – The future of optometry: AI, kiosks, and disruption[00:20:30] – Why innovation should be embraced, not feared[00:22:00] – Personal advice: navigating difficult seasons in life[00:23:10] – Hard work vs. luck—and the reality of failure behind successKey TakeawaysOptometrists must actively engage with industry to shape the future of the professionThe perception of optometry needs to evolve toward full-scope medical careProper compensation is essential to delivering high-quality patient careSuccessful implementation of new services requires systems, training, and team alignmentData and transparency can drive accountability and growth within practicesAI and automation are coming—optometry must adapt, not resistTrue success is built on resilience, failure, and consistent effort—not luck Memorable Quotes“We weren't sitting at the table… and by the time decisions were made, it was too late.”“Our profession has been shaped as glasses and contacts—and we need to change that.”“If you always do right by the patient, you will make a difference.”“You can buy equipment—but if you don't implement it properly, it will just collect dust.”“Systems and protocols are more important than the equipment itself.”“We can't be afraid of change—we have to be part of it.”“You will make it through the darkness into the light.”“People call it luck—but they don't see the failures behind the success.”Connect with Dr. Faten EdrisInstagram: @blinkingowleyecareLinkedIn: https://www.linkedin.com/in/faten-edris-o-d-5934b43/
Specialty care remains one of the biggest black boxes in healthcare, creating delays, unnecessary referrals, and major frustration for both patients and primary care providers. In this episode, Reza Sanai, co-CEO and co-founder of PicassoMD, discusses how his team is helping primary care providers access specialist expertise in near-real time while also improving the referral process when specialty care is truly needed. He explains why specialty access often breaks down at the point of care, how fragmented provider data makes navigation more difficult, and why better coordination between primary care and specialists can reduce unnecessary ER visits, improve triage, and speed access to the right care. Reza also shares how PicassoMD is supporting rural and underserved communities, why visibility into the patient journey matters so much, and how thoughtful partnerships are essential to making innovation work in real healthcare settings. Tune in and learn how smarter specialist access could help close one of healthcare's most persistent care coordination gaps. About Reza Sanai: Reza Sanai, MD, FACC, is the co-CEO and founder of PicassoMD, a platform that gives primary care providers real-time access to a network of value-based specialists across major disciplines. Through curbside consultations and referral support, PicassoMD helps reduce unnecessary referrals and ER visits while improving care transitions, patient experience, and outcomes. In addition to leading PicassoMD, Reza has served in advisory roles with Mighty Health and VIDA Fitness & Aura Spa, and was previously a co-managing partner at Cardiocare LLC. He earned his Doctor of Medicine from The George Washington University School of Medicine and Health Sciences, where he was a member of the AOA Honor Society. Things You'll Learn: Specialty care often functions like a black box, making it harder for primary care providers to get timely input and coordinate the next step for patients. Real-time access to specialists can help primary care providers make better decisions, reduce unnecessary referrals, and avoid preventable ER visits. Referral quality depends on more than specialty type alone, since factors like language, mission fit, geography, and appointment availability all shape patient access. Rural and underserved communities benefit when technology connects providers and patients with specialist expertise that may not be available locally. Successful healthcare innovation depends not just on the product itself, but on strong partnerships and an iterative approach to implementation. Resources: Connect with and follow Reza Sanai on LinkedIn or reach out via email. Follow PicassoMD on LinkedIn and visit their website.
Episode 503 of Relentless Health Value features Stacey Richter with Adam Stavisky, Dr. Leo Spector (OrthoCarolina), and Ryan Wells (Health Here) discussing how self-insured employers and specialists rarely connect directly due to intermediaries and fee-for-service "rails." They outline three common pitfalls when bridging this gap: defining and measuring quality and appropriateness (limits of claims data and missing patient-reported outcomes), achieving scale across geographies and specialties, and ensuring benefit design and incentives so members actually use direct-contracting programs. The conversation frames the evolution of Centers of Excellence from 1.0 (travel to brand-name hospitals) to 2.0 (more local but administratively manual) to 3.0 (new infrastructure enabling direct, efficient contracting). Health Here is described as a digital bridge to support payment and communication pathways and reduce administrative waste. === LINKS ===
In this episode of The Health Disparities Podcast, host Dr. Mary O'Connor talks with Angela Strain, Executive Director of We Care Jax. For over 30 years, this organization has connected uninsured and under-resourced neighbors to lifesaving specialty care. Angela shares powerful patient stories and draws on years of experience to show what it takes to remove barriers, build trust, and create a safety net that truly helps people. She explains real-world obstacles like transportation, language barriers, and the financial burden of illness, and highlights community-driven solutions that help people get the care they need. Angela and Dr. O'Connor discuss We Care Jax's approach and share stories from the patients they serve, exploring topics such as: Community health workers use persistence, trust, and cultural insight to uncover the real reasons behind missed appointments or labels like “non‑compliant.” Common specialty needs include cardiology, pulmonology, oncology, and advanced imaging, supported by a network of volunteer physicians. Transportation support, hotel stays, translation services, and food access function as essential parts of healthcare, not optional add‑ons. Florida's expansion of the Volunteer Provider Program and the urgent need for increased dental funding are highlighted as key policy issues. Peer‑to‑peer physician recruitment, strong hospital partnerships, and donor investment help sustain a model rooted in community trust. Angela also talks about the heart of her work: making sure every patient leaves with no medical debt, their dignity intact, and a real chance to heal. Her stories, including patients moving from homelessness to stable housing and from fear to treatment, show why compassionate, community-centered care is so important. This episode is full of stories and insights for anyone working in health equity, community health, philanthropy, public health, or systems change. Subscribe to hear more conversations about community-driven solutions, health equity, and efforts to eliminate disparities.
Para más información, llame al 706-529-3072 o visite www.VitruvianHealth.com/specialtycare.Este programa no pretende diagnosticar ni tratar enfermedades ni reemplazar la atención médica profesional. Si tiene algún problema de salud, consulte a su profesional de la salud.
For more information, call 706.529.3072 or visit www.VitruvianHealth.com/specialtycare.This program in no way seeks to diagnose or treat illness or to replace professional medical care. Please see your healthcare provider if you have a health problem.
For more information, call 706.529.3072 or visit www.VitruvianHealth.com/specialtycare.This program in no way seeks to diagnose or treat illness or to replace professional medical care. Please see your healthcare provider if you have a health problem.
Para más información, llame al 706-529-3072 o visite www.VitruvianHealth.com/specialtycare.Este programa no pretende diagnosticar ni tratar enfermedades ni reemplazar la atención médica profesional. Si tiene algún problema de salud, consulte a su profesional de la salud.
For more information, call 706.529.3072 or visit www.VitruvianHealth.com/specialtycare.This program in no way seeks to diagnose or treat illness or to replace professional medical care. Please see your healthcare provider if you have a health problem.
Para más información, llame al 706-529-3072 o visite www.VitruvianHealth.com/specialtycare.Este programa no pretende diagnosticar ni tratar enfermedades ni reemplazar la atención médica profesional. Si tiene algún problema de salud, consulte a su profesional de la salud.
WBZ NewsRadio's Shari Small reports.See omnystudio.com/listener for privacy information.
https://funmedinstitute.com
Dr. Sumedha Sonde, pulmonologist and critical care physician at Hamilton Physician Group - Specialty Care in Dalton, Georgia. Dr. Sonde completed residency training in Anesthesia and Pain Management and additional residency training in Internal Medicine. She then completed a Pulmonary and Critical Care fellowship in New York.Dr. Sonde treats patients with sleep or pulmonary disorders. chronic obstructive pulmonary disease (also referred to as COPD), asthma, pulmonary fibrosis, lung cancer, COVID conditions, pneumonia, acute and chronic pulmonary hypersensitivity conditions, pulmonary hypertension, bronchiolitis, and more. For more information or an appointment at Hamilton Physician Group - Specialty Care, call 706-529-3072 or visit VitruvianHealth.com/specialtycare. This program in no way seeks to diagnose or treat illness or to replace professional medical care. Please see your healthcare provider if you have a health problem.
Dr. Sumedha Sonde, pulmonologist and critical care physician at Hamilton Physician Group - Specialty Care in Dalton, Georgia. Dr. Sonde completed residency training in Anesthesia and Pain Management and additional residency training in Internal Medicine. She then completed a Pulmonary and Critical Care fellowship in New York.Dr. Sonde treats patients with sleep or pulmonary disorders. chronic obstructive pulmonary disease (also referred to as COPD), asthma, pulmonary fibrosis, lung cancer, COVID conditions, pneumonia, acute and chronic pulmonary hypersensitivity conditions, pulmonary hypertension, bronchiolitis, and more. For more information or an appointment at Hamilton Physician Group - Specialty Care, call 706-529-3072 or visit VitruvianHealth.com/specialtycare. This program in no way seeks to diagnose or treat illness or to replace professional medical care. Please see your healthcare provider if you have a health problem.
Dr. Sumedha Sonde, pulmonologist and critical care physician at Hamilton Physician Group - Specialty Care in Dalton, Georgia. Dr. Sonde completed residency training in Anesthesia and Pain Management and additional residency training in Internal Medicine. She then completed a Pulmonary and Critical Care fellowship in New York.Dr. Sonde treats patients with sleep or pulmonary disorders. chronic obstructive pulmonary disease (also referred to as COPD), asthma, pulmonary fibrosis, lung cancer, COVID conditions, pneumonia, acute and chronic pulmonary hypersensitivity conditions, pulmonary hypertension, bronchiolitis, and more. For more information or an appointment at Hamilton Physician Group - Specialty Care, call 706-529-3072 or visit VitruvianHealth.com/specialtycare. This program in no way seeks to diagnose or treat illness or to replace professional medical care. Please see your healthcare provider if you have a health problem.
Your Nebraska Update headlines for today, Nov. 22, include: Tyson Foods announced that it will close beef plant in Lexington, new medical investments are reshaping specialty care in central Nebraska, Board of Regents approved joint accreditation for University of Nebraska-Lincoln and University of Nebraska Medical Center, Humanities Nebraska is cutting events and grants after federal funding loss, pertussis case trends vary widely across the state, high school football finals begin in Lincoln.
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 Evan S. Dellon, MD, and Elizabeth T. Jensen, PhD, about a paper they published on predictors of patients receiving no medication for treatment of eosinophilic esophagitis. Disclaimer: The information provided in this podcast is designed to support, not replace, the relationship 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: [:52] Co-host Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners GSK, Sanofi, Regeneron, and Takeda. Ryan introduces co-host Holly Knotowicz. [1:14] Holly introduces today's topic, predictors of not using medication for EoE, and today's guests, Dr. Evan Dellon and Dr. Elizabeth Jensen. [1:29] Dr. Dellon is an Adjunct Professor of Epidemiology at the University of North Carolina School of Medicine in Chapel Hill. He is also the Director of the UNC Center for Esophageal Diseases and Swallowing. [1:42] Dr. Dellon's main research interest is in the epidemiology, pathogenesis, diagnosis, treatment, and outcomes of eosinophilic esophagitis (EoE) and eosinophilic GI diseases (EGIDs). [1:55] Dr. Jensen is a Professor of Epidemiology with a specific expertise in reproductive, perinatal, and pediatric epidemiology. She has appointments at both Wake Forest University School of Medicine and the University of North Carolina at Chapel Hill. [2:07] Her research primarily focuses on etiologic factors in the development of pediatric immune-mediated chronic diseases, including understanding factors contributing to disparities in health outcomes. [2:19] Both Dr. Dellon and Dr. Jensen also serve on the Steering Committee for EGID Partners Registry. [2:24] Ryan thanks Dr. Dellon and Dr. Jensen for joining the podcast today. [2:29] Dr. Dellon was the first guest on this podcast. It is wonderful to have him back for the 50th episode! Dr. Dellon is one of Ryan's GI specialists. Ryan recently went to North Carolina to get a scope with him. [3:03] Dr. Dellon is an adult gastroenterologist at the University of North Carolina at Chapel Hill. He directs the Center for Esophageal Diseases and Swallowing. Clinically and research-wise, he is focused on EoE and other eosinophilic GI diseases. [3:19] His research interests span the entire field, from epidemiology, diagnosis, biomarkers, risk factors, outcomes, and a lot of work, more recently, on treatments. [3:33] Dr. Jensen has been on the podcast before, on Episode 27. Holly invites Dr. Jensen to tell the listeners more about herself and her work with eosinophilic diseases. [3:46] Dr. Jensen has been working on eosinophilic gastrointestinal diseases for about 15 years. She started some of the early work around understanding possible risk factors for the development of disease. [4:04] She has gone on to support lots of other research projects, including some with Dr. Dellon, where they're looking at gene-environment interactions in relation to developing EoE. [4:15] She is also looking at reproductive factors as they relate to EoE, disparities in diagnosis, and more. It's been an exciting research trajectory, starting with what we knew very little about and building to an increasing understanding of why EoE develops. [5:00] Dr. Dellon explains that EoE stands for eosinophilic esophagitis, a chronic allergic condition of the esophagus. [5:08] You can think of EoE as asthma of the esophagus or eczema of the esophagus, although in general, people don't grow out of EoE, like they might grow out of eczema or asthma. When people have EoE, it is a long-term condition. [5:24] Eosinophils are a type of white blood cell, specializing in allergy responses. Normally, they are not in the esophagus. When we see them there, we worry about an allergic process. When that happens, that's EoE. [5:40] Over time, the inflammation seen in EoE and other allergic cell activity causes swelling and irritation in the esophagus. Early on, this often leads to a range of upper GI symptoms — including poor growth or failure to thrive in young children, abdominal pain, nausea, and symptoms that can mimic reflux. [5:58] In older kids, symptoms are more about trouble swallowing. That's because the swelling that happens initially, over time, may turn into scar tissue. So the esophagus can narrow and cause swallowing symptoms like food impaction. [6:16] Ryan speaks of living with EoE for decades and trying the full range of treatment options: food elimination, PPIs, steroids, and, more recently, biologics. [6:36] Dr. Dellon says Ryan's history is a good overview of how EoE is treated. There are two general approaches to treating the underlying condition: using medicines and/or eliminating foods that we think may trigger EoE from the diet. [6:57] For a lot of people, EoE is a food-triggered allergic condition. [7:01] The other thing that has to happen in parallel is surveying for scar tissue in the esophagus. If that's present and people have trouble swallowing, sometimes stretching the esophagus is needed through esophageal dilation. [7:14] There are three categories of medicines used for treatment. Proton pump inhibitors are reflux meds, but they also have an anti-allergy effect in the esophagus. [7:29] Topical steroids are used to coat the esophagus and produce an anti-inflammatory effect. The FDA has approved a budesonide oral suspension for that. [7:39] Biologics, which are generally systemic medications, often injectable, can target different allergic factors. Dupilumab is approved now, and there are other biologics that are being researched as potential treatments. [7:51] Even though EoE is considered an allergic condition, we don't have a test to tell people what they are allergic to. If it's a food allergy, we do an empiric elimination diet because allergy tests aren't accurate enough to tell us what the EoE triggers are. [8:10] People will eliminate foods that we know are the most common triggers, like milk protein, dairy, wheat, egg, soy, and other top allergens. You can create a diet like that and then have a response to the diet elimination. [8:31] Dr. Jensen and Dr. Dellon recently published an abstract in the American Journal of Gastroenterology about people with EoE who are not taking any medicine for it. Dr. Jensen calls it a real-world data study, leveraging electronic health record patient data. [8:51] It gives you an impression of what is actually happening, in terms of treatments for patients, as opposed to a randomized control trial, which is a fairly selected patient population. This is everybody who has been diagnosed, and then what happens with them. [9:10] Because of that, it gives you a wide spectrum of patients. Some patients are going to be relatively asymptomatic. It may be that we arrived at their diagnosis while working them up for other potential diagnoses. [9:28] Other patients are going to have rather significant impacts from the disease. We wanted to get an idea of what is actually happening out there with the full breadth of the patient population that is getting diagnosed with EoE. [9:45] Dr. Jensen was not surprised to learn that there are patients who had no pharmacologic treatment. [9:58] Some patients are relatively asymptomatic, and others are not interested in pursuing medications initially or are early in their disease process and still exploring dietary treatment options. [10:28] Holly sees patients from infancy to geriatrics, and if they're not having symptoms, they wonder why bother treating it. [10:42] Dr. Jensen says it's a point of debate on the implications of somebody who has the disease and goes untreated. What does that look like long-term? Are they going to develop more of that fibrostenotic pattern in their esophagus without treatment? [11:07] This is a question we're still trying to answer. There is some suggestion that for some patients who don't manage their disease, we very well may be looking at a food impaction in the future. [11:19] Dr. Dellon says we know overall for the population of EoE patients, but it's hard to know for a specific patient. We have a bunch of studies now that look at how long people have symptoms before they're diagnosed. There's a wide range. [11:39] Some people get symptoms and get diagnosed right away. Others might have symptoms for 20 or 30 years that they ignore, or don't have access to healthcare, or the diagnosis is missed. [11:51] What we see consistently is that people who may be diagnosed within a year or two may only have a 10 or 20% chance of having that stricture and scar tissue in the esophagus, whereas people who go 20 years, it might be 80% or more. [12:06] It's not everybody who has EoE who might end up with that scar tissue, but certainly, it's suggested that it's a large majority. [12:16] That's before diagnosis. We have data that shows that after diagnosis, if people go a long time without treatment or without being seen in care, they also have an increasing rate of developing strictures. [12:29] In general, the idea is yes, you should treat EoE, because on average, people are going to develop scar tissue and more symptoms. For the patient in front of you with EoE but no symptoms, what are the chances it's going to get worse? You don't know. [13:04] There are two caveats with that. The first is what we mean by symptoms. Kids may have vomiting and growth problems. Adults can eat carefully, avoiding foods that hang up in the esophagus, like breads and overcooked meats, sticky rice, and other foods. [13:24] Adults can eat slowly, drink a lot of liquid, and not perceive they have symptoms. When someone tells Dr. Dellon they don't have symptoms, he will quiz them about that. He'll even ask about swallowing pills. [13:40] Often, you can pick up symptoms that maybe the person didn't even realize they were having. In that case, that can give you some impetus to treat. [13:48] If there really are no symptoms, Dr. Dellon thinks we're at a point where we don't really know what to do. [13:54] Dr. Dellon just saw a patient who had a lot of eosinophils in their small bowel with absolutely no GI symptoms. He said, "I can't diagnose you with eosinophilic enteritis, but you may develop symptoms." People like that, he will monitor in the clinic. [14:14] Dr. Dellon will discuss it with them each time they come back for a clinic visit. [14:19] Holly is a speech pathologist, but also sees people for feeding and swallowing. The local gastroenterologist refers patients who choose not to treat their EoE to her. Holly teaches them things they should be looking out for. [14:39] If your pills get stuck or if you're downing 18 ounces during a mealtime, maybe it's time to treat it. People don't see these coping mechanisms they use that are impacting their quality of life. They've normalized it. [15:30] Dr. Dellon says, of these people who aren't treated, there's probably a subset who appropriately are being observed and don't have a medicine treatment or are on a diet elimination. [15:43] There's also probably a subset who are inappropriately not on treatment. It especially can happen with students who were under good control with their pediatric provider, but moved away to college and didn't transfer to adult care. [16:08] They ultimately come back with a lot of symptoms that have progressed over six to eight years. [16:18] Ryan meets newly diagnosed adult patients at APFED's conferences, who say they have no symptoms, but chicken gets caught in their throat. They got diagnosed when they went to the ER with a food impaction. [16:38] Ryan says you have to wonder at what point that starts to get reflected in patient charts. Are those cases documented where someone is untreated and now has EoE? [16:49] Ryan asks in the study, "What is the target EGID Cohort and why was it selected to study EoE? What sort of patients were captured as part of that data set?" [16:58] Dr. Jensen said they identified patients with the ICD-10 code for a diagnosis of EoE. Then they looked to see if there was evidence of symptoms or complications in relation to EoE. This was hard; some of these are relatively non-specific symptoms. [17:23] These patients may have been seeking care and may have been experiencing some symptoms that may or may not have made it into the chart. That's one of the challenges with real-world data analyses. [17:38] Dr. Jensen says they are using data that was collected for documenting clinical care and for billing for clinical care, not for research, so it comes with some caveats when doing research with this data. [18:08] Research using electronic health records gives a real-world perspective on patients who are seeking care or have a diagnosis of EoE, as opposed to a study trying to enroll a patient population that potentially isn't representative of the breadth of individuals living with EoE. [18:39] Dr. Dellon says another advantage of real-world data is the number of patients. The largest randomized controlled trials in EoE might have 400 patients, and they are incredibly expensive to do. [18:52] A study of electronic health records (EHR) is reporting on the analysis of just under 1,000. The cohort, combined from three different centers, has more than 1,400 people, a more representative, larger population. [19:16] Dr. Dellon says when you read the results, understand the limitations and strengths of a study of health records, to help contextualize the information. [19:41] Dr. Dellon says it's always easier to recognize the typical presentations. Materials about EoE and studies he has done that led to medicine approvals have focused on trouble swallowing. That can be relatively easily measured. [20:01] Patients often come to receive care with a food impaction, which can be impactful on life, and somewhat public, if in a restaurant or at work. Typical symptoms are also the ones that get you diagnosed and may be easier to treat. [20:26] Dr. Dellon wonders if maybe people don't treat some of the atypical symptoms because it's not appreciated that they can be related to EoE. [20:42] Holly was diagnosed as an adult. Ryan was diagnosed as a toddler. Holly asks what are some of the challenges people face in getting an EoE diagnosis. [20:56] Dr. Jensen says symptoms can sometimes be fairly non-specific. There's some ongoing work by the CEGIR Consortium trying to understand what happens when patients come into the emergency department with a food bolus impaction. [21:28] Dr. Jensen explains that we see there's quite a bit of variation in how that gets managed, and if they get a biopsy. You have to have a biopsy of the esophagus to get a diagnosis of EoE. [21:45] If you think about the steps that need to happen to get a diagnosis of EoE, that can present barriers for some groups to ultimately get that diagnosis. [21:56] There's also been some literature around a potential assumption about which patients are more likely to be at risk. Some of that is still ongoing. We know that EoE occurs more commonly in males in roughly a two-to-one ratio. Not exclusively in males, obviously, but a little more often in males. [22:20] We don't know anything about other groups of patients that may be at higher risk. That's ongoing work that we're still trying to understand. That in itself can also be a barrier when there are assumptions about who is or isn't likely to have EoE. [23:02] Dr. Dellon says that in adolescents and adults, the typical symptoms are trouble swallowing and food sticking, which have many causes besides EoE, some of which are more common. [23:18] In that population, heartburn is common. Patients may report terrible reflux that, on questioning, sounds more like trouble swallowing than GERD. Sometimes, with EoE, you may have reflux that doesn't improve. Is it EoE, reflux, or both? [24:05] Some people will have chest discomfort. There are some reports of worsening symptoms with exercise, which brings up cardiac questions that have to be ruled out first. [24:19] Dr. Dellon mentions some more atypical symptoms. An adult having pain in the upper abdomen could have EoE. In children, the symptoms could be anything in the GI tract. Some women might have atypical symptoms with less trouble swallowing. [24:58] Some racial minorities may have those kinds of symptoms, as well. If you're not thinking of the condition, it's hard to make the diagnosis. [25:08] Dr. Jensen notes that there are different cultural norms around expressing symptoms and dietary patterns, which may make it difficult to parse out a diagnosis. [25:27] Ryan cites a past episode where access to a GI specialist played a role in diagnosing patients with EoE. Do white males have more EoE, or are their concerns just listened to more seriously? [25:57] Ryan's parents were told when he was two that he was throwing up for attention. He believes that these days, he'd have a much easier time convincing a doctor to listen to him. From speaking to physicians, Ryan believes access is a wide issue in the field. [26:23] Dr. Dellon tells of working with researchers at Mayo in Arizona and the Children's Hospital of Phoenix. They have a large population of Hispanic children with EoE, much larger than has been reported elsewhere. They're working on characterizing that. [26:49] Dr. Dellon describes an experience with a visiting trainee from Mexico City, where there was not a lot of EoE reported. The trainee went back and looked at the biopsies there, and it turned out they were not performing biopsies on patients with dysphagia in Mexico City. [27:13] When he looked at the patients who ended up getting biopsies, they found EoE in 10% of patients. That's similar to what's reported out of centers in the developed world. As people are thinking about it more, we will see more detection of it. [27:30] Dr. Dellon believes those kinds of papers will be out in the next couple of months, to a year. [27:36] Holly has had licensure in Arizona for about 11 years. She has had nine referrals recently of children with EoE from Arizona. Normally, it's been one or two that she met at a conference. [28:00] Ryan asks about the research on patients not having their EoE treated pharmacologically. Some treat it with food avoidance and dietary therapy. Ryan notes that he can't have applesauce, as it is a trigger for his EoE. [28:54] Dr. Jensen says that's one of the challenges in using the EHR data. That kind of information is only available to the researchers through free text. That's a limitation of the study, assessing the use of dietary elimination approaches. [29:11] Holly says some of her patients have things listed as allergies that are food sensitivities. Ryan says it's helpful for the patients to have their food sensitivities listed along with their food allergies, but it makes records more difficult to parse for research. [30:14] Dr. Dellon says they identify EoE by billing code, but the codes are not always used accurately. Natural Language Processing can train a computer system to find important phrases. Their collaborators working on the real-world data are using it. [30:59] Dr. Dellon hopes that this will be a future direction for this research to find anything in the text related to diet elimination. [31:32] Dr. Jensen says that older patients were less likely to seek medication therapy. She says it's probably for a couple of reasons. First, older patients may have been living with the disease for a long time and have had compensatory mechanisms in place. [32:03] The other reason may be senescence or burnout of the disease, long-term. Patients may be less symptomatic as they get older. That's a question that remains to be answered for EoE. It has been seen in some other disease processes. [32:32] Dr. Dellon says there's not much data specifically looking at EoE in the older population. Dr. Dellon did work years ago with another doctor, and they found that older patients had a better response to some treatments, particularly topical steroids. [32:54] It wasn't clear whether it was a milder aspect of the disease, easier to treat, or because they were older and more responsible, taking their medicines as prescribed, and having a better response rate. It's the flip side of work in the pediatric population. [33:16] There is an increasingly aging population with EoE. Young EoE patients will someday be over 65. Dr. Dellon hopes there will be a cure by that point, but it's an expanding population now. [33:38] Dr. Jensen says only a few sites are contributing data, so they hope to add additional sites to the study. For some of the less common outcomes, they need a pretty large patient sample to ask some of those kinds of questions. [33:55] They will continue to follow up on some of the work that this abstract touched on and try to understand some of these issues more deeply. [34:06] Dr. Dellon mentions other work within the cohort. Using Natural Language Processing, they are looking at characterizing endoscopy information and reporting it without a manual review of reports and codes. You can't get that from billing data. [34:29] Similarly, they are trying to classify patient severity by the Index of Severity with EoE, and layer that on looking at treatments and outcomes based on disease severity. Those are a couple of other directions where this cohort is going. [34:43] Holly mentions that this is one of many research projects Dr. Jensen and Dr. Dellon have collaborated on together. They also collaborate through EGID Partners. Holly asks them to share a little bit about that. [34:53] Dr. Jensen says EGID Partners is an online registry where individuals, caregivers, and parents of children affected with EGIDs can join. [35:07] EGID Partners also needs people who don't live with an EGID to join, as controls. That gives the ability to compare those who are experiencing an EGID relative to those who aren't. [35:22] When you join EGID Partners, they provide you with a set of questionnaires to complete. Periodically, they push out a few more questionnaires. [35:33] EGID Partners has provided some really great information about patient experience and answered questions that patients want to know about, like joint pain and symptoms outside the GI tract. [36:04] To date, there are close to 900 participants in the registry from all over the world. As it continues to grow, it will give the ability to look at the patient experience in different geographical areas. [36:26] Dr. Dellon says we try to have it be interactive, because it is a collaboration with patients. The Steering Committee works with APFED and other patient advocacy groups from around the world. [36:41] The EGID Partners website shows general patient locations anonymously. It shows the breakdown of adults with the condition and caregivers of children with the condition, the symptom distribution, and the treatment distribution. [37:03] As papers get published and abstracts are presented, EGID Partners puts them on the website. Once someone joins, they can suggest a research idea. Many of the studies they have done have come from patient suggestions. [37:20] If there's an interesting idea for a survey, EGID Partners can push out a survey to everybody in the group and answer questions relatively quickly. [37:57] Dr. Dellon says a paper came out recently about telehealth. EoE care, in particular, is a good model for telehealth because it can expand access for patients who don't have providers in their area. [38:22] EoE is a condition where care involves a lot of discussion but not a lot of need for physical exams and direct contact, so telehealth can make things very efficient. [38:52] EGID Partners surveyed patients about telehealth. They thought it was efficient and saved time, and they had the same kind of interactions as in person. In general, in-state insurance covered it. Patients were happy to do those kinds of visits again. [39:27] Holly says Dr. Furuta, herself, and others were published in the Gastroenterology journal in 2019 about starting to do telehealth because patients coming to the Children's Hospital of Colorado from out of state had no local access to feeding therapy. [39:50] Holly went to the board, and they allowed her to get licensure in different states. She started with some of the most impacted patients in Texas and Florida in 2011 and 2012. They collected data. They published in 2019 about telehealth's positive impact. [40:13] When 2020 rolled around, Holly had trained a bunch of people on how to do feeding therapy via telehealth. You have to do all kinds of things, like make yourself disappear, to keep the kids engaged and in their chairs! [40:25] Now it is Holly's primary practice. She has licenses in nine states. She sees people all over the country. With her diagnosis, her physicians at Mass General have telehealth licensure in Maine. She gets to do telehealth with them instead of driving two hours. [40:53] Dr. Jensen tells of two of the things they hope to do at EGID Partners. One is trying to understand more about reproductive health for patients with an EGID diagnosis. Only a few studies have looked at this question, and with very small samples. [41:15] As more people register for EGID Partners, Dr. Jensen is hoping to be able to ask some questions related to reproductive health outcomes. [41:27] The second goal is a survey suggested by the Student Advisory Committee, asking questions related to the burden of disease specific to the teen population. [41:48] This diagnosis can hit that population particularly hard, at a time when they are trying to build and sustain friendships and are transitioning to adult care and moving away from home. This patient population has a unique perspective we wanted to hear. [42:11] Dr. Jensen and Dr. Dellon work on all kinds of other projects, too. [42:22] Dr. Dellon says they have done a lot of work on the early-life factors that may predispose to EoE. They are working on a large epidemiologic study to get some insight into early-life factors, including factors that can be measured in baby teeth. [42:42] That's outside of EGID Partners. It's been ongoing, and they're getting close, maybe over the next couple of years, to having some results. [43:03] Ryan says all of those projects sound so interesting. We need to have you guys back to dive into those results when you have something finalized. [43:15] For our listeners who want to learn more about eosinophilic disorders, we encourage you to visit apfed.org and check out the links in the show notes below. [43:22] If you're looking to find specialists who treat eosinophilic disorders, we encourage you to use APFED's Specialist Finder at apfed.org/specialist. [43:31] 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. [43:41] Ryan thanks Dr. Dellon and Dr. Jensen for joining us today. This was a fantastic conversation. Holly also thanks APFED's Education Partners GSK, Sanofi, Regeneron, and Takeda for supporting this episode. Mentioned in This Episode: Evan S. Dellon, MD, MPH, Academic Gastroenterologist, University of North Carolina School of Medicine Elizabeth T. Jensen, MPH, PhD, Epidemiologist, Wake Forest University School of Medicine, University of North Carolina at Chapel Hill Predictors of Patients Receiving No Medication for Treatment of Eosinophilic Esophagitis in the United States: Data from the TARGET-EGIDS Cohort Episode 15: Access to Specialty Care for Eosinophilic Esophagitis (EoE) APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections apfed.org/research/clinical-trials Education Partners: This episode of APFED's podcast is brought to you thanks to the support of GSK, Sanofi, Regeneron, and Takeda. Tweetables: "I've been working on eosinophilic gastrointestinal diseases for about 15 years. I started some of the early work around understanding possible risk factors for the development of disease. I've gone on to support lots of other research projects." — Elizabeth T. Jensen, MPH, PhD "You can think of EoE as asthma of the esophagus or eczema of the esophagus, although in general, people don't grow out of EoE, like they might grow out of eczema or asthma. When people have it, it really is a long-term condition." — Evan S. Dellon, MD, MPH "There are two general approaches to treating the underlying condition, … using medicines and/or eliminating foods from the diet that we think may trigger EoE. I should say, for a lot of people, EoE is a food-triggered allergic condition." — Evan S. Dellon, MD, MPH "I didn't find it that surprising [that there are patients who had no treatment]. Some patients are relatively asymptomatic, and others are not interested in pursuing medications initially or are … still exploring dietary treatment options." — Elizabeth T. Jensen, MPH, PhD "We have a bunch of studies now that look at how long people have symptoms before they're diagnosed. There's a wide range. Some people get symptoms and are diagnosed right away. Other people might have symptoms for 20 or 30 years." — Evan S. Dellon, MD, MPH "EGID Partners is an online registry where individuals, caregivers, and parents of children affected with EGIDs can join. EGID Partners also needs people who don't live with an EGID to join, as controls." — Elizabeth T. Jensen, MPH, PhD
In this episode of the My DPC Story Podcast, host Dr. Maryal Concepcion interviews Dr. Sarah "Sassy" Weinstein, a triple board-certified physician in family, sports, and lifestyle medicine. Hear how Dr. Sarah Sassy Weinstein turned personal health experiences - including Lyme disease and sports injuries - into a compassionate approach for patient care. Discover why she left insurance-driven medicine for a direct specialty care model in Princeton, NJ, empowering her to focus on holistic, patient-centered treatment without time constraints. Learn her insights on starting a direct care clinic, tips for keeping overhead low, and building a thriving practice. She shares strategies for integrating lifestyle medicine, the importance of listening to patients' goals, and balancing her roles as doctor, mom, and fitness instructor. This inspirational episode is packed with advice for physicians interested in launching a direct care or direct specialty care practice. COMMERCIAL-FREE Episodes now on PatreonLearn about healthcare for your own family and about health shares today! Get your FREE DIGITAL COPY of The Toolkit, the magazine from My DPC Story at mydpcstory.com/magazine. Coming NOV 25th 12pm PST: our LIVE Webinar and Q&A on the OBBB, HR1, HSAs and DPC. Register at dpcare.org. Get your DPC Resources HERE at mydpcstory.com!Support the showBe A My DPC Story PATREON MEMBER! SPONSOR THE PODMy DPC Story VOICEMAIL! DPC SWAG!FACEBOOK * INSTAGRAM * LinkedIn * TWITTER * TIKTOK * YouTube
As The Make a Difference Series comes to a close, we're taking time to reflect on the incredible women whose stories have inspired all of us to lead with purpose and serve with heart. This episode is a celebration of how faith, courage, and authenticity can create ripple effects of change that touch countless lives.We revisit some of our favorite moments from the series — including Noelle Schnacky, Miss Florida's Teen 2025, whose Hope for Heart Kids Foundation was born out of love and loss, supporting families impacted by congenital heart defects. We also highlight Christy Ashby and Kate Slentz, the powerhouse mother-daughter duo behind Orange Appeal Magazine and The Orlando Women's Conference, who have built platforms that celebrate women and strengthen our community.Paris Richardson, Miss Florida 2025, continues to inspire us through her C.R.O.W.N. of Health initiative, bringing wellness and education to children and families across Florida. Jaeann Ashton, Executive Director of Community Engagement at AdventHealth Central Florida, reminds us how compassion-driven leadership and listening first can transform the way we care for our communities We also share updates from Keesha Scott, whose honesty and courage around motherhood and recovery continue to inspire; Karen Keene, whose strength and advocacy following tragedy uplift women through mentorship; and Dr. Karwanna Irving, whose passion for helping women create wealth with purpose is transforming the entrepreneurial space.Finally, we spotlight the continued work of Jessica Galo with Be a MindLeader and Johanna Kandel with The National Alliance for Eating Disorders, two women who continue to make monumental strides in mental health awareness and healing.Each of these stories reflects the heart of what The Make a Difference Series stands for — women using their voices, their gifts, and their experiences to create lasting impact. We hope this finale reminds you that your light, your story, and your purpose truly have the power to make a difference.…And because this series was such a success, we will be doing it again! Stay tuned for more information!
On today's episode of She Believed She Could™, host Allison Walsh welcomes Jessica Galo, Director of Specialty Care at AdventHealth for Children. With over 16 years of experience in pediatric care and a background in social work, Jessica has dedicated her career to supporting families facing the challenges of both physical and mental health.Jessica oversees the Be a Mindleader initiative, a community-wide effort powered by AdventHealth for Children and Heart of Florida United Way. This movement encourages open conversations about mental health, equips parents and educators with actionable tools, and empowers kids to step into leadership roles as advocates for themselves and their peers. Together, Allison and Jessica discuss:The rising pediatric mental health crisis and the importance of early action. How Be a Mindleader is reducing stigma and creating safe spaces for conversations at home, in schools, and across communities. The importance of community collaboration in making resources accessible for families. The growth of the Mindleader Ambassador Program and why peer leadership is so powerful. Expanding support through multilingual resources and grassroots partnerships across Central Florida. Listeners will also hear about real success stories, such as how AdventHealth's embedded mental health counselors in primary care practices are helping families uncover the root causes of children's struggles—including bullying and anxiety—and connecting them with the right support. This episode delivers inspiration, practical resources, and a reminder that one conversation can change, or even save, a life.Memorable MomentsOn starting the movement: “This idea to have a stigma reduction campaign—or destigmatization campaign—which is what the Be a Mindleader movement is, really bubbled up… If you can have conversations when things are not in crisis, when they're maybe littler feelings, then that allows you to have those bigger conversations later when the feelings are bigger and the stakes are higher.” On pandemic lessons: “The pandemic really shone a light on the impact to not only adults and mental health, but kids and mental health and well-being… that kind of was a spark to really get the attention of people that needed to be paying attention, including the healthcare world, but also donors, people in the community.” On community reach: “This is the first time in AdventHealth history where we have had a campaign in three different languages out in our community, and really targeted and meant to support the community.” On everyday parenting: “Car rides are a great time for us to connect with our kids. All of a sudden, they start opening up… And so it's really just being intentional about providing that time, providing that space.” On empowering youth: “Being a part of the ambassador program, it allows a kiddo to say, ‘I am a Mindleader'… And kids are so excited to do this work.” About Jessica GaloJessica Galo serves as the Director of Specialty Care at AdventHealth for Children, where she has spent more than 16 years leading efforts to support children with complex healthcare needs and their families. Trained as a social worker, Jessica has a passion for addressing the ripple effects of both physical and mental health challenges.She leads the Be a Mindleader initiative, a groundbreaking campaign in partnership with Heart of Florida United Way that equips parents, educators, and kids with resources to strengthen mental wellness and remove the stigma around asking for help.Jessica is also a proud mom of two and is passionate about teaching parents how to create intentional moments of connection with their children, fostering resilience and emotional well-being.Resources & LinksConnect with Allison: www.allisonwalshconsulting.comSubscribe to the Podcast: https://pod.link/1505347834Learn more about AdventHealth for Women: www.AdventHealthforwomen.comGet involved with Be a Mindleader: http://beamindleader.com/https://www.facebook.com/LifeAtAdventHealthCFL/https://www.instagram.com/lifeatadventhealthcfl/https://www.linkedin.com/company/adventhealthcfl/ Connect with AllisonInterested in working together? Fill out this form.www.instagram.com/allisonwalshwww.shebelievedbook.comwww.allisonwalshconsulting.comSignature Course | Build Your Brand On DemandDownload The Be Unforgettable PlaybookBeauty Must-Haves!
Ash welcomes another guest from the Southwest Dental Conference, Cindy Lozano from Nomad Mobile Dental Specialist. They talk about how general dental practices can keep more specialty work—and the related revenue—in-house by partnering with Nomad. Cindy shares how their model provides mobile specialists such as endodontists, periodontists, and oral surgeons directly to general dental offices. This arrangement allows general dentists to avoid referring patients out, while Nomad handles all clinical aspects and support, bringing everything needed except the dental chair and sterilization area.The discussion covers practical points like insurance liability, operational flexibility, and implementation steps. Cindy highlights the partnership-based approach, customizable scheduling, and support with everything from training to specialty insurance verification. Real-world examples illustrate significant revenue growth for practices utilizing the Nomad model, and Cindy explains how offices can get started, emphasizing how easy integration can unlock previously unrecognized potential for specialty production within general practices.You can find out more by visiting: https://www.nomaddentalspecialists.com/Key Topics DiscussedNomad Mobile Dental Specialist's mobile partnership model for general dental practicesKeeping specialty work and revenue in-houseServices provided by Nomad, including specialists, assistants, and equipmentPractice requirements and logistical considerationsInsurance and malpractice coverage detailsPayment structure and tax setup (W9/1099)Flexible scheduling based on practice needsResults and revenue improvement examplesImplementation timeline and onboarding stepsHow to contact Nomad for more information
Ryan Daniels, William Blair's group head of healthcare technology and services, returns to discuss the accelerating transformation of specialty care in the face of rising acuity, delayed diagnoses, and regulatory shifts. From bundled payments to AI-driven coordination, this episode explores how providers and investors are reshaping oncology, cardiology, and other high-impact disease states.
In this episode of the My DPC Story Podcast, Dr. Maryal Concepcion interviews Dr. Pouneh Alizadeh, founder of Flourish Gynecology, who shares her inspiring journey transitioning from a hospital-employed OB/GYN to combining locums work with launching her own direct specialty care (DSC) practice. Dr. Alizadeh opens up about the challenges of balancing motherhood, physician burnout, and the drive to practice medicine on her own terms through the Direct Primary Care (DPC) model. The conversation covers the practicalities of starting a DPC/DSC practice, managing finances, setting boundaries, and integrating locums work for stability and flexibility. Dr. Alizadeh offers insights on building a sustainable, patient-focused medical career, highlights the importance of networking and community, and emphasizes the empowerment DPC provides for women physicians. If you're interested in DPC, locums, direct specialty care, physician entrepreneurship, or women's health, this episode delivers firsthand advice and encouragement to take control of your career and redefine success in medicine.Join Hint's BOOTCAMP today! hint.com/bootcamp.Download Elation's FREE Startup Checklist HERE. Get a practice audit and 80 FREE hours of VA work for your DPC with Cool Blue VA! Check out the latest Cool Blue VA Episode HERE!Schedule a demo with Cerbo today!Spruce Health: All-In-One Patient Co Hint Clinical: Run your dream practice with Hint's DPC softwareA-S Medication Solutions: medication management made simple for DPC. Learn more about JumpStart DPC Solutions: Marketing solutions modeled after DPCSupport the showBe A My DPC Story PATREON MEMBER! SPONSOR THE PODMy DPC Story VOICEMAIL! DPC SWAG!FACEBOOK * INSTAGRAM * LinkedIn * TWITTER * TIKTOK * YouTube
Specialty pharmacy is one of the most critical areas of care—especially for patients with complex and chronic conditions—but scaling the business isn't always easy. In this episode, Lori Maraist shows how pharmacists can do both. Lori, the Chief Operating Officer at Professional Arts Specialty Pharmacy, shares how she scaled her team from a small operation to a nationally recognized pharmacy with over 100 employees. She dives into how to carve out niches in specialty care, build a strong culture across a large team, and hire intentionally in high-stakes clinical environments. Whether you're already in the specialty sector or just looking to learn more, Lori's episode is one you won't want to miss. 00:00 - Introduction to Lori Maraist and Professional Arts Pharmacy 02:11 - Lori's Early Pharmacy Journey and Leadership Origins 06:16 - Evolution from Compounding to a Diversified Pharmacy Model 10:22 - Lessons in Change Management and Staff Buy-In 14:11 - Clinical Programs and Commercial Product Expansion 22:14 - National Licensure and Wound Care Specialization 31:00 - Hiring Philosophy and Building a Scalable Team 38:42 - Advice for Scaling a Pharmacy and Picking Leaders Hosted By: Mark Bivins | Chief Growth Officer, RedSail Technologies Johnathon Duhon | Director of Sales, PioneerRx Guest: Lori Maraist | Chief Operating Officer at Professional Arts Specialty Pharmacy Looking for more information about independent pharmacy? Visit https://www.redsailtechnologies.com
PeerView Family Medicine & General Practice CME/CNE/CPE Video Podcast
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/YCM865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until July 17, 2026.AD-SAFE: An Initiative to Build Understanding of ARIA and Skills Needed to Improve Detection and Optimize Response in Specialty Care In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/YCM865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until July 17, 2026.AD-SAFE: An Initiative to Build Understanding of ARIA and Skills Needed to Improve Detection and Optimize Response in Specialty Care In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.
PeerView Neuroscience & Psychiatry CME/CNE/CPE Audio Podcast
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/YCM865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until July 17, 2026.AD-SAFE: An Initiative to Build Understanding of ARIA and Skills Needed to Improve Detection and Optimize Response in Specialty Care In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.
PeerView Neuroscience & Psychiatry CME/CNE/CPE Video Podcast
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/YCM865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until July 17, 2026.AD-SAFE: An Initiative to Build Understanding of ARIA and Skills Needed to Improve Detection and Optimize Response in Specialty Care In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/YCM865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until July 17, 2026.AD-SAFE: An Initiative to Build Understanding of ARIA and Skills Needed to Improve Detection and Optimize Response in Specialty Care In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/YCM865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until July 17, 2026.AD-SAFE: An Initiative to Build Understanding of ARIA and Skills Needed to Improve Detection and Optimize Response in Specialty Care In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.
PeerView Family Medicine & General Practice CME/CNE/CPE Audio Podcast
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/YCM865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until July 17, 2026.AD-SAFE: An Initiative to Build Understanding of ARIA and Skills Needed to Improve Detection and Optimize Response in Specialty Care In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.
What's the future of medical specialty care and medical specialists? Julie Murchinson and industry expert Dr. Molly Coye debate the possibilities on, “What the Future of Specialty Care Looks Like,” the new episode of the 4sight Health Roundup podcast, moderated by David Burda.
Send us a textYou only fail if you quit or you don't learn. Here are the 5 major lessons to learn from practices who tried leaving insurance but went back into it. Support the show--> FREE Direct Care Guide to get you started --> Join the Direct Care Society private Facebook group here. Monthly coaching sessions & a community that gets you. --> Own a DSC practice and want to share your story? Apply here EMR I'm currently using in my Direct Care practice Simple Practice HIPAA Compliant Email with Paubox Get $250 Credit Here Find me on LinkedIn https://linkedin.com/in/teadpm More resources teadpm.com
Send us a textYou only fail if you quit or you don't learn. Here are the 5 major lessons to learn from practices who tried leaving insurance but went back into it. Support the show--> FREE Direct Care Guide to get you started --> Join the Direct Care Society private Facebook group here. Monthly coaching sessions & a community that gets you. --> Own a DSC practice and want to share your story? Apply here EMR I'm currently using in my Direct Care practice Simple Practice HIPAA Compliant Email with Paubox Get $250 Credit Here Find me on LinkedIn https://linkedin.com/in/teadpm More resources teadpm.com
The EMJ GOLD podcast is back for a new season! In the first episode of season 10, the team are joined by Dheepa Chari, Vice President and Head of Global Scientific Communications, GSK, to discuss the past, present and future of scientific communications. Together, Dheepa and Isabel explore her journey from biostatistics to biopharma leadership — and the lessons learned along the way. They discuss what great science communication looks like, where it's heading next and why storytelling still matters in a digital-first world. Plus, expect practical insights on cross-functional collaboration and the growing role of AI. A little more on EMJ GOLD's guest… Dheepa Chari is the Vice President and Head of Global Scientific Communications at GSK. Here, she leads strategy and execution across Oncology, Vaccines, Specialty Care and General Medicine, driving innovation in how scientific narratives are delivered across channels. Before joining GSK in 2024, Dheepa held senior posts at Pfizer, Amgen and Novartis in both clinical and communications roles. Outside of work, Dheepa brings stories to life in a different way - as a singer-songwriter who regularly performs in New York City.
In this episode of Bright Spots in Healthcare, host Eric Glazer explores how leading healthcare organizations are transforming specialty care in Medicare Advantage through physician leadership and AI innovation. Hear from Julia McDowell (Highmark Health), Chuck Palermo (HAP), Dr. Mary O'Connor (Vori Health), and Dr. Krystal Revai (Health Alliance) as they share pragmatic strategies for improving care quality, enhancing member engagement, reducing administrative burden, and delivering meaningful clinical outcomes. Discover how AI is being used to streamline prior authorization, enable real-time gap closure, personalize care management, and deepen shared decision-making between providers and patients. Thank you to Vori Health for supporting this episode. Vori Health is the only nationwide MSK medical practice with doctor-led care teams – driving better outcomes. Vori helps with pain reduction in MSK issues, through their holistic approach, and by creating a personalized treatment plan from the convenience of your own home through their virtual-first platform. Their doctor-led team tailors care programs to reduce surgery by as much as 78%, avoiding pain, imaging, and injections and saving your organization the cost burden of unnecessary surgeries and increasing productivity. And all from the comfort of home! Vori is on a mission to empower humanity to lead a healthier life. Visit them at www.vorihealth.com/
California is full of hardworking people—nurses, teachers, delivery drivers, baristas—who keep our communities running. Many of them live paycheck-to-paycheck, making too much to qualify for most government benefits, but not enough to afford the basics. For nearly 2 million Californians, Covered California provides a critical lifeline, offering access to affordable health insurance and now basic needs support. Dr. Monica Soni, Chief Medical Officer of Covered California, joins Claudia to talk about the program's important and expanding role in the California landscape. We discuss:What the working poor really need: breathing room in their budgets to afford healthy foodOperating a startup within governmentHow collaboration across Covered California, Medi-Cal and CalPERS – which together cover 45% of Californians – will drive faster and more aligned health improvement in CaliforniaMonica's team uses experiments and user research to shape every aspect of the program:“But I do think in our DNA is this idea of innovation. In-house, we have a research team that does randomized controlled trials. We're committed to hyper transparency. Almost all of our data is released. We stratify it by everything we can think of to really identify where there might be pockets of coverage that aren't there or outcomes that are suboptimal. And we do a lot of deep listening with consumers and with the community to help inform what we do.“Relevant LinksRead more about Covered California's Innovative Program to Improve Population HealthSee the details on Covered California's Data and Research toolsAnnouncement of the launch of Covered Californians Population Health InvestmentsMore info on how Covered California uses email nudges for enrollmentAbout Our GuestDr. S. Monica Soni is the Chief Medical Officer, and a Chief Deputy Executive Director at Covered California, leading the organization's Health Equity and Quality Transformation division. In this capacity she is responsible for health equity, health care strategy, medical policy, and other clinical operations to continuously improve not only the health services provided through Covered California's contracted health plans, but also California's delivery system.She is a board-certified internal medicine physician with more than a decade of experience working in both inpatient and outpatient settings and continues to see patients. She is an Associate Professor within the UCLA Department of Medicine and the Charles R. Drew University Department of Internal Medicine, where she is committed to residency diversification and pipeline development.Prior to joining Covered California, Dr. Soni served as Associate Chief Medical Officer within Evolent Health focused on the delivery of high-quality, cost-effective specialty care for the over 16 million supported Medicaid lives across the United States. During her time at the organization, she played a critical role in clinical informatics, provider engagement, value-based strategies and innovation. Dr. Soni also served as the Director of Specialty Care for the Los Angeles County Department of Health
In this episode, we dive deep into the burgeoning trend of private equity investments in healthcare, with a particular focus on specialty care and medical aesthetics. Maureen Waddle, Senior Consultant, and Katrina Whitehair, Consultant, both at VMG Health, discuss the factors driving PE interest in these markets, the strategic considerations for growth through de novo […]
© 2020-2026 Ivy Podcast Discovery LLC
