Podcast appearances and mentions of suzanne delbanco

For a full transcript of this episode, click here. Unintended consequences is a thing. ERCowboy wrote on Twitter a while back, “In any complex system, the likelihood of unintended consequences vastly outweighs the predictability of intended ones.” In this healthcare podcast, we're talking about two state laws where this is apropos: CON (Certificates of Need) laws and then COPA (Certificates of Public Advantage). Turns out, states actually have pretty much power to impact the competitive landscape in their state. They have a lot of levers they can pull. States really can make a difference in terms of improving real competition on value and on cost and quality. So, these two laws are, in a way, their attempt to do so. Before we kick into what's going on here, I think it is important to point out that these laws on their face aren't an obviously and overtly terrible mistake. This isn't like equivalent to accidentally putting ChapStick in the dryer. There were good people who spied a problem and had an idea for how to fix it. I'm reminded of something I read by Nicholas Kristof on a totally different topic, but he wrote, “The central problem is not so much that the effort was unserious as it's more focused on intentions than on oversight and outcomes.” And that pretty much sums up, I think, the gist of what's going on here. And I can say that because here we are in a position to Monday morning quarterback. So, I've invited Ann Kempski on the pod to point out what hindsight may reveal about these well-intentioned efforts, the CON and COPA laws. First up, let's talk about Certificate of Need laws, or the CONs. Currently, we have 35 states and Washington, DC, that operate CON programs with wide variations by state. The National Conference of State Legislatures has a good overview of each state's laws. Why did these laws originally get put into effect? They got put into effect to cut down on supply-driven demand that was considered to potentially raise total cost of care—because in healthcare, unlike Econ 101, more supply doesn't mean lower prices. In the real world, if you have more supply, volume goes up and total cost of care goes up, too. So, it could be considered good thinking to limit the amount of supply. Except there's four problems that wind up happening often enough, which is why some states are busy repealing these CON laws. We cover these four problems in the show that follows. Spoiler alert: What happens a lot of times is that the big get bigger. Consolidated entities have an upper hand, and we all know consolidated entities are generally not known for their competitive prices or their desire to rationalize volume. So, yeah … we dig into this and parse it out into, as I said, four main problems; but this is most commonly where it all winds up (ie, total cost of care does not go down). I have included links that Ann Kempski shared with me, including a statement from the Federal Trade Commission (FTC) and Department of Justice detailing the anticompetitive effects of state CON laws. There's also a document written by a former FTC commissioner that highlights how state CON laws can inhibit competition. And then lastly, a systemic review of 90 studies that find the costs of CON laws exceed their benefits. Okay, so let's move on to our number two state law that often does not go as planned; and this is the Certificate of Public Advantage, or the COPA, laws. Approximately 19 states have them, and these laws attempt to immunize hospital mergers from antitrust laws by replacing competition with state oversight. The idea here is that a state tells the FTC to stand down and gives their seal of approval to a merger to stop it from getting scrutinized for antitrust violations. So, like, a big dominant health system gets an okay to buy a rural hospital. Meanwhile, everybody realizes this will lead to a situation where there is a dominant health system and that dominant health system will reduce competition. But the state may choose to do this because … public advantage, as in the “PA” in COPA, Certificate of Public Advantage. But they'll do this because the state has decided that the public advantage of allowing the possibly problematic anticompetitive merger to move forward, the public advantage is a bigger advantage than having competition. Hmmm … what could go wrong here? Well, several things that Ann Kempski discusses in the show that follows. The Federal Trade Commission strongly advised the states against enacting these laws. Here is a link to this article that was on the FTC Web site. I was so thrilled to get the chance to chat with Ann Kempski, who knows so much about these topics. Ann Kempski is an independent healthcare consultant with a background in the labor movement, advocating for healthcare workers and purchasers for many years. Ann Kempski collaborates with clients to strengthen primary care, enhance union health funds, and reduce commercial prices. She often partners with academics from Johns Hopkins to analyze hospital transparency data for insights into market trends. Before we jump into the episode, we've had a loss in our community. We've had actually several, one of them being Marshall Allen, another one being Suzanne Delbanco. I know our guest today worked alongside of and really admired Suzanne. Ann Kempski says: “Suzanne was a kindred spirit and a real inspiration for me and many others. She founded two very influential nonprofit organizations: first, The Leapfrog Group and then, second, Catalyst for Payment Reform, which is dedicated to empowering purchasers to be more effective purchasers in the healthcare marketplace.” Additional Resources on State Laws and Policies That Promote Hospital Consolidation, Inhibit Competition Certificate of Public Advantage (COPA) Laws A recent story from Tennessee highlights the weak oversight and observed in COPA-related hospital mergers. Competition and Antitrust in Healthcare “Is There Too Little Antitrust Enforcement in the US Hospital Sector?” by Zarek Brot-Goldberg, Zack Cooper, Stuart Craig, and Lev Klarnet, April 2024 Catalyst for Payment Reform publications and white papers The Great Reversal: How America Gave Up on Free Markets, by Thomas Philippon, 2019   Also mentioned in this episode are Nicholas Kristof; Marshall Allen; Suzanne Delbanco; Brian Klepper, PhD; and Gloria Sachdev, PharmD.   You can learn more by following Ann on LinkedIn.   Ann Kempski is an independent health policy consultant with 30 years of experience as an analyst, advocate, and strategist advancing health reforms related to coverage, quality, and payment in public programs and commercial insurance. She has served in leadership roles in several organizations, including Kaiser Permanente, SEIU (Service Employees International Union), and the State of Delaware. Ann currently supports organizations and efforts to strengthen primary care payment and transition away from fee for service, promote competition in commercial healthcare prices and coverage, and expand access to evidence-based behavioral health services. Ann is especially grateful to collaborate with and learn from talented graduate students and faculty at Johns Hopkins Bloomberg School of Public Health on research and policy analysis to understand commercial market and price dynamics and provider behavior. She has an undergraduate degree in economics from the College of William & Mary and a master's degree in industrial and labor relations from Cornell University.   06:20 Ann remembers Suzanne Delbanco. 06:55 EP224 with Suzanne Delbanco. 07:40 What are state Certificate of Need laws? 08:44 Why are states getting rid of these CON laws? 13:26 Why CON laws are created. 15:43 EP437 with Brian Klepper, PhD. 16:09 What are the conflicts of interest and problems that arise when CON laws are created? 20:55 What happens when states get rid of these CON laws? 24:10 How are Certificate of Public Advantage laws different from CON laws? 27:58 Why does the research show that COPAs don't usually accomplish their goals? 31:34 What encouraging current events are happening in the realm of COPA laws? 32:08 Gloria Sachdev, PharmD, of Employers' Forum of Indiana.   You can learn more by following Ann on LinkedIn.   @kempann discusses #COPA and #CON state #healthcarelaws on our #healthcarepodcast. #healthcare #podcast #financialhealth #primarycare #patientoutcomes #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Marshall Allen (tribute), Andreas Mang, Abby Burns and Stacey Richter, David Muhlestein, Luke Slindee, Dr John Lee, Brian Klepper, Elizabeth Mitchell, David Scheinker (Encore! EP363), Dan Mendelson    

In this episode of Antitrust Matters, Constantine Cannon partner, Matthew L. Cantor, discusses economic and antitrust issues raised by the conduct of certain large hospital systems.  Joining him on the podcast as guests are Duke University Professor of Law, Barak Richman, and CEO of the policy group known as the Catalyst for Payment Reform, Suzanne Delbanco. 

Suzanne Delbanco speaks with Roslyn (Roz) Murray, a doctoral candidate at The University of Michigan School of Public Health and former Catalyst for Payment Reform Employee. Roz delves into her first peer-reviewed paper in Health Affairs, which concludes that the evidence on commercial value-based payment models is mixed. Suzanne and Roz dive into why there is such little research in the commercial sector on value-based payment and compare Roz's findings to research done in the public sector.

“80% of providers believe that the unpaid caregiver should have a seat at table, but only 20% believe they actually do.” Suzanne Delbanco speaks with Alexandra Drane, Co-Founder & CEO of ARCHANGELS, diving into the critical role of caregivers and why they must be part of the clinical care team. She also discusses how ARCHANGELS' Caregiver Intensity Index (CII) is designed to engage caregivers and help them see themselves in the role. It also calculates the level of “intensity” when measuring the impact of caregiver duties on caregiver health – the higher the intensity, the more likely caregivers are experiencing an adverse mental health impact. CII looks at the influence of multiple compounding impacts on caregiver health (cohorts include age, race, unpaid, essential worker, etc.). Lastly, Alexandra explains the role that ARCHANGELS plays in helping caregivers understand and assess their intensity, and connects people to existing resources (e.g., EAP programs and community, state, and local resources, etc.) to support them.

Suzanne Delbanco speaks with Dr. Irene Dankwa-Mullan, Chief Health Equity Officer at IBM Watson Health and Deputy Chief Health Officer within the Center for AI, Research & Evaluation. As an industry physician and scientist working at the intersection of AI, health equity, and health care, Dr. Dankwa-Mullan speaks to best practices for employers interested in measuring and addressing health inequities being experienced by those in their health benefits program, building on a Health Affairs article that she co-authored in December of 2020. Dr. Dankwa-Mullan cites definitions pioneered by Dr. Paula Bravemen for understanding what health equity and health disparities signify in the context of health care benefits. Health equity calls on stakeholders to focus on the unfair differences in health experienced by social groups based on the varying degrees of social advantages and disadvantages conferred to these groups, often across socially constructed racial and ethnic groupings. Diving deeper, Dr. Dankwa-Mullan highlights the lack of a uniform approach to collecting race and ethnicity data for use in addressing disparities. Amidst the lack of standardization and other challenges, the most important best practice is to have patients and/or plan members self-identify their race, ethnicity, primary language, and other cultural attributes that are important to their identity. Self-identification avoids inaccurate and incomplete categorizations. As employers and other stakeholders know all too well, health care benefits are a costly line item in any organization's budget. But inequitable health care adds even more costs. Dr. Dankwa-Mullan offers the following rationales for why employers should collect and measure health statistics by race and ethnicity. 1. To ensure that the employer's investment is reaching the full covered population in an equitable manner 2. To discover opportunities to improve population health 3. To demonstrate an organizational commitment to health equity Altogether, Dr. Irene Dankwa-Mullan highlights the need for employers and their business associates – including TPAs, consultants, and other partners - to acknowledge that health inequities exist and use their role as plan sponsors and benefits administrators to address them through comprehensive, data-driven, health equity strategies.

Suzanne Delbanco speaks with Jason Richmond, Head of Consultant Relations at Ginger, a digital mental health care provider. Jason Richmond explores the supply demand imbalance between mental health patients and providers in the United States right now, and why the traditional provider network model to access care doesn't carry over well into the mental health space. Jason describes the evolution that mental health care has gone through in recent years, transforming from a one-size-fits-all care program into a de-stigmatized spectrum of treatment plans, including behavioral health coaches. Finally, Jason offers advice for business leaders on how to de-stigmatize mental health care and use employee feedback to design a health benefits structure tailored to your covered population's needs.

Suzanne Delbanco speaks with Michelle Zettergren, President of Labor and Public Sector markets and Chief Sales and Marketing Officer for Brighton Health Plan Solutions, a health enablement company that serves as third-party administrator to self-funded employers and other health care purchasers. Michelle heads marketing, customer retention, and business intelligence units for the company, bringing over 30 years in the health insurance industry. Michelle Zettergren explores the barriers and benefits of employers contracting directly with a health system, and why this solution has earned a high Net Promoter Score among enrollees. Michelle also points to Centers of Excellence for high-cost procedures, like total joint replacement surgeries, as a proven way for employers to contain health care costs and secure high-quality care. Finally, Michelle shares what Brighton Health Plan Solutions is doing to help employer clients prepare for new ERISA regulations set to take effect in 2022 and 2023.

Suzanne Delbanco speaks with Scott Doolittle, CFO of Quantum Health, a health care navigation company providing care coordination and navigation support. Scott oversees Quantum Health's business intelligence units, where he leads a team that validates the company's actuarial results. Scott Doolittle provides insights into how Quantum Health engages both consumers and providers navigate the eligibility and coverage of each consumer's specific benefits plan. In this episode, you'll learn how health care navigation helps employers increase plan member uptake of benefits programs. Featured quote: “A provider is always going to want to get paid. They're always going to call to make sure the member's covered, and if we're that single point of entry and can provide that expertise and do it in a way that drives satisfaction for them, they're more likely to leverage us as we talk about care planning on a go-forward basis.”

Suzanne Delbanco consults Bob Berenson, MD, Institute Fellow at the Urban Institute, on what's going on with telehealth payment policy in both Medicare and the commercial sector and why employers should be paying attention. In May 2021, Bob Berenson testified at the Senate Finance Committee, where he laid out the reasons why fee-for-service is a not a viable way to continue paying for telehealth visits, especially in the primary care context. Listen in to learn about the intricacies of telehealth payment in Medicare, how the commercial sector has taken a different approach, and why a payment arrangement known as partial capitation holds the most promise for balancing the convenience of telehealth for patients with financial sustainability for health care purchasers.

Suzanne Delbanco speaks with Nate Freese, MBA, Senior Director of Data Strategy at Grand Rounds Health, a health care quality and navigation solution offering employers a data-driven clinical navigation platform paired with patient advocacy tools. Nate leads data strategy at Grand Rounds Health, where his team is responsible for building algorithms that match patients with the right providers based on billions of historical clinical interactions. Nate offers a helpful introduction to data science by describing the three types of analyses that data science tackles as well as use-cases that help physicians, pharmaceutical companies, and patients make informed value-oriented choices. He then explores the major challenges that health tech companies face in bringing their data use-cases to life, including the siloed and unstructured nature of health data and the talent shortage of data science professionals across the country. Finally, Nate shares the approach Grand Rounds Health uses to track and improve its ability to reduce health care disparities. Data science simplifies the unimaginably complex and predicts the future to help us make better decisions. In health care, the difference between the right and wrong decision can result in hundreds of thousands of dollars in spend, hospitalizations, or worse. In this episode, you'll learn how Grand Rounds Health is using data science to power its clinical navigation platform and patient advocacy tools, with an eye toward health equity and cost containment. Featured quotes: “Messy data is another challenge for applying data science in health care. The data often requires a lot further processing to make it useful, and is often inconsistent – you have systems with different definitions of the same concept or information. Ultimately, it takes very specific skills sets and domain expertise to make health care data sets useful. And that gets to the next big challenge, which is talent shortage.” “There's a big disconnect between the number of companies out there that have a compelling vision for how they could use data in a health care context, and the number of companies that are actually doing so. A big factor is finding the people they need to realize that vision.” “Data scientists are not one-size-fits-all. It's usually not that you need 1 or 5 data scientists at your company to realize your vision for using data. It's more likely that you need a couple of data engineers, you might need a couple of machine learning experts, a natural language processing expert, a statistician and a couple of epidemiologists. Each of these people are data scientists, but they bring a different skillset to the picture, and you need several of them to suite a particular use-case.”

Suzanne Delbanco talks with David Vivero, CEO and Co-Founder of Amino Health, a health care financial wellness solution that combines data, design, and consumer-first thinking to curate personalized recommendations for specific care needs. Prior to Amino, David was VP of Rentals at Zillow, a consumer internet company that has transformed the home and rental marketplace through increased transparency and a strong user experience. A self-described “product guy,” David Vivero shares his view on where price transparency can make the biggest impact for patients and plan sponsors in the commercial health care market. David and Suzanne discuss the federal government's recent price transparency legislations, including the Hospital Price Transparency Rule, the Transparency in Coverage Rule, and the No Surprises Act. Taken together, these three pieces of legislation have the potential to catalyze a “Cambrian Explosion” of new digital health tools, consumer experiences, and potentially even new types of health plans or business models that improve coverage and care delivery. As David wrote in a June 2021 commentary for Fast Company, these regulations bring “health care one step closer to obeying traditional market dynamics in which cost and value are correlated.” In this podcast, David Vivero explores why he's hopeful that the Transparency in Coverage Rule will create more of an impact than the Hospital Price Transparency rule has to date. A major difference lies in the penalties: the Transparency in Coverage Rule is a lot heftier at $100 per person per day for plans compared to $300 per day for hospitals in the Price Transparency rule. Finally, David shines a light on how new industries take time to reach their full potential, which is why he enthusiastic about the role of health technology products can play in helping make health care more affordable and user-centric moving forward. Featured quote: “In my view, price transparency is a platform. It's like Microsoft Windows, a basic platform or operating system. And, on top of that, all sorts of applications can be built that further the objectives of the U.S. health care system and the American economy.”

Suzanne Delbanco talks with Thi Montalvo, Health Analytics Practice Leader – Health and Benefits for Willis Towers Watson. In her role, Thi helps employers and other health care purchasers make data-driven decisions for their health benefits strategy. While she's seen many successful use-cases over her nine years specializing in health analytics, she's also seen firsthand the many problems that are hindering the acquisition and use of data for optimizing employer-sponsored health benefits. From onerous legal agreements limiting the use of the data, to incomplete data fields, to lack of visibility into necessary information like diagnosis codes or provider specialty information, employers and other health care purchasers are struggling to put their own benefits data to use, despite being the ones who are footing the bill. Learn how the proliferation of condition-specific benefit programs (often referred to as “point solutions”) has changed the data landscape in the employer-sponsored health care market, and what hoops benefit consulting firms like Willis Towers Watson have to jump through to perform the analyses that their clients need. Thi Montalvo and Suzanne also discuss what's necessary to improve data sharing moving forward, and how the secure and reliable flow of aggregated, de-identified health data is an important piece of the evolving journey to improve price and quality transparency in the commercial health care sector. “Are there opportunities to steer to a quality provider or facility down the street? If we can't do that with the data, then we're not serving the interest of our employers and their employees and getting them the health care that they need.” – Thi Montavlo, Willis Towers Watson

This week's episode features a conversation with Suzanne Delbanco, Executive Director at Catalyst for Payment Reform. Consolidation in the provider marketplace has detrimental effects on patients, such as provider unwillingness to change in favor of improved patient experience. In policy reform, the central issue is price transparency remains a battleground where Suzanne is very active. She also comments on the recent uptick in direct contracting solutions and the incoming changes ushered by the pandemic. You can find show notes and more information by clicking here:  https://bit.ly/3f9v3r4

Connect with Suzanne: https://www.linkedin.com/in/suzanne-delbanco-86071b4/Connect with Steve: https://www.linkedin.com/in/steve-watson-cpa/*************************And if you're looking for a speaker for you next event, please check out www.stevewatsonlive.com. 

Suzanne Delbanco calls CJ Stimson, MD, the Senior Vice President of Value Transformation at Vanderbilt University Medical Center (VUMC), to discuss Vanderbilt’s direct contract bundled payment arrangement for maternity care with Metro Nashville Public Schools (MNPS). This call serves as follow-up to the webinar hosted by CPR in March 2021, where Dr. Stimson and David Hines of MNPS shared their insights one year after the program’s implementation. Dr. Stimson received both medical and law degrees from Vanderbilt, and is currently an Assistant Professor at VUMC, as well as a practicing urologic surgeon. Here, he and Suzanne discuss why VUMC and MNPS decided to launch a direct contract program on maternity care, the scope and contents of the bundle, and how payers and providers have reacted to this innovative strategy. CJ also takes a guess at what may be ahead for direct contract bundled payments, and what it will take to get more organizations on board with a similar arrangement.

Suzanne Delbanco chats with Nathan Counts, a seasoned health benefits professional who recently joined Amtrak as Head of Total Rewards. Previously, Nathan was Assistant Vice President – Global Benefits for a leading telecommunications company, where he actively participated in CPR membership activities, helping shape CPR’s Shared Purchaser Agenda between 2017 and 2020. Nathan, who holds a master’s in mathematics and got his start as an Actuarial Consultant, is at the forefront of the data revolution in health benefits. In 2018, he was recognized by Workforce for helping make his former employer’s benefit design decisions “truly data-driven.” In this interview, he raises the need for a unified data set for the commercially-insured population, citing the usefulness of the Medicare’s data set in answering valuable population health questions. Listen in as Nathan Counts reflects on his career in health benefits, why he sees alignment between Medicare and the commercial sector as critical, and what he thinks are the most promising opportunities to improve member experience.

Host Don Antonucci and Suzanne Delbanco, Catalyst for Payment Reform Executive Director, discuss alternative payment models, virtual care, creating standardized quality measures, and opportunities and challenges to transform health care delivery. Catalyst for Payment Reform is a nonprofit, member-based organization committed to big changes in the health care system with a mission to help employers and other health care purchasers get better value for their health care dollar. 

Suzanne Delbanco chats with Rick Abbott, VP of Product and Market Solutions at Premera Blue Cross. Premera Blue Cross is a health plan in the Pacific Northwest, serving about 2.2 million members with customers ranging from large tech companies to family-owned grocery stores. Suzanne and Rick discuss if narrow networks, also known as high-performance networks, represent a viable way to lower prices in the employer-sponsored health insurance market. Historically, employers have demanded broad access PPO networks that include the vast majority of providers and hospitals in their region. This trend has somewhat impeded health plans from using their volume to negotiate steeper discounts from providers. Rick describes how creating narrow networks based on provider quality provides a real opportunity to lower costs by both reducing wasteful spending on unnecessary or harmful care and by negotiating discounts from higher-quality providers in exchange for higher volumes of patients. Suzanne and Rick also discuss the opportunities and obstacles for employers interested in pursuing alternatives to the incumbent health plans, like alternative third party administrators or group purchasing initiatives. Rick points to Premera’s 85-year history as an important value-add for customers, allowing the health plan to implement strategic initiatives at scale. For instance, Premera Blue Cross recently launched a “virtual-first” health plan that allows members to designate a virtual network of providers as their primary care providers.

Suzanne Delbanco connects with Chris Cigarran, CEO of Imagine Health, an alternative health plan offering curated provider networks in select markets across the country. Prior to Imagine Health, Chris built the employer and government sales division of a wellness company and has also served as Chief HR Officer. To begin the interview, Suzanne lays out a pain point many self-insured employers are facing: the significant consolidation on the hospital, health system, and provider market. As the buyers of health care, employers do not have enough leverage to keep prices in check. Chris approaches this obstacle from the provider point of view, explaining that health system CEOs, like CEOs in other businesses, require customers to deselect their competitors in order to receive discounts. If a health plan or employer isn’t willing to steer their plan participants to certain providers and away from others, it limits their ability to negotiate more effectively in the provider marketplace. Suzanne and Chris examine the historical insistence among employers for broad access Preferred Provider Organization (PPO) health plans as a root cause of health care price inflation. This may be changing, as employers prepare to weather the current recession. Prior to the COVID-19 pandemic, employers were looking to add services in health benefits as opposed to making changes to save money. Now, employers are looking at reducing their health care spending as a way to avoid laying off employees. Chris Cigarran speaks to the power of the status-quo from a change management perspective. What’s clear is that the health care status quo is not meeting the needs of consumers, with the most blatant example being a patient with chronic conditions having to reach an exorbitant family deductible before their insurance kicks in. Chris Cigarran and Suzanne Delbanco also discuss the Medicare Plus contracting model pioneered by Montana’s state employee health plan. Chris shares his fascination with this novel way to approach health care. While the viability of this model is unclear, what is clear is the need for further experimentation. This interview is part of CPR’s current work to understand whether group purchasing efforts can secure better health care value for employer-purchasers. Funded by the Commonwealth Fund, CPR is assembling insights into the forces that can facilitate or hinder purchaser efforts to amass volume. Keep an eye out for more interviews on this topic.

Suzanne Delbanco interviews Ashok Subramanian, CEO and Founder of Centivo Health, an alternative Third-Party Administrator (TPA) that emphasizes value-based direct contracting and utilization of high-quality providers. Prior to Centivo, Ashok founded Liazon, a private benefits exchange acquired in 2013 by Willis Towers Watson. Suzanne and Ashok explore how employers can put downward pressure on health care prices, a critical topic given how much consolidation is happening among providers. Ashok emphasizes that unit price can’t be ignored in the pursuit of lower total cost of care. He suggests that health care purchasers aggregate volume in order to reduce costs, a key purchasing strategy in other sectors of the American economy. In addition to describing Centivo’s method of structuring customized provider networks, Ashok provides health plan examples of programs that attempt to shift care to certain providers. Ashok highlights the obstacles large health plans face when trying to execute a curated provider network, especially when they operate in multiple lines of business. Suzanne’s final question to Ashok explores the possibility of employers joining in groups to purchase health care together. Ashok comments that this type of purchasing is just another avenue to aggregate volume in pursuit of better deals from health care providers. He reinforces that employers are also looking to secure other capabilities from their contracted providers, like same-day access and care continuity within virtual care delivery. These additional sources of value may be as important to employers as the potential cost savings. Ashok Subramanian leaves listeners with an empowering outlook. While a lot of purchasers may lack the confidence to have a voice in conversations with local providers, they actually have a lot more strength in these conversations than they might expect. This interview is part of CPR’s current work to understand whether group purchasing efforts can secure better health care value for employer-purchasers. Funded by the Commonwealth Fund, CPR is assembling insights into the forces that can facilitate or hinder purchaser efforts to amass volume. Keep an eye out for more interviews on this topic.

Listen in as Suzanne Delbanco connects with Alan Muney, MD, MHA, former Chief Medical Officer of Cigna, former CEO of Equity Healthcare, and current health care advisor to multiple venture equity firms. Suzanne asks Alan a fundamental question: how can employers counterbalance the high and rising prices of health care providers? His answer: look at health care spending in a total cost of care format instead of focusing on unit prices. Drawing on his wealth of experience examining health care marketplace dynamics, Alan shares why the major incumbent health plans, especially those who have been acquired or have acquired pharmaceutical management companies, have a competitive advantage. Because drugs are such an important cost component, integrating pharmaceutical and medical utilization management gives these larger health plans end-to-end control over total cost of care. Suzanne points to the fact that, despite aggregating volume and negotiating unit cost discounts, incumbent health plans have failed to keep prices in check. Now new entrants to the Third-Party Administrator (TPA) market are trying to seize on these pricing failures. Dr. Muney asserts that while the new carve-out vendors may bring innovative capabilities - like using data to build high-quality provider networks- they lack the economies of scale and the total cost of care control that the larger incumbent health plans have acquired. During the interview, Suzanne and Alan Muney discuss why past efforts among employers to purchase health care as a group have failed and strategies employers can consider moving forward. Alan Muney recommends that employer coalitions move to total cost of care contracts including pharmacy. This interview is part of CPR’s current work to understand whether group purchasing efforts can secure better health care value for employer-purchasers. Funded by the Commonwealth Fund, CPR is assembling insights into the forces that can facilitate or hinder purchaser efforts to amass volume. Keep an eye out for more interviews on this topic.

Listen in as Suzanne Delbanco chats with Anna Sinaiko, PhD, Assistant Professor at the Harvard T. H. Chan School of Public Health. Anna Sinaiko studies patient or individual decision making in health care settings, often referred to as consumerism in health care. She and her colleagues are currently wrapping up a synthesis of evidence from the last 40 years of health care consumerism initiatives. By looking backward at past price and quality transparency efforts and employer-led benefit design programs, Sinaiko hopes to inform future policies aimed at helping patients make informed decisions in today’s complex health care market. The research will be a welcome asset for benefit managers, helping them understand patient attitudes and preferences around health care choices as well as what types of policies have successfully steered patients toward higher-value providers. In the podcast, Anna Sinaiko also speaks to the ineffectiveness of shifting costs to consumers through higher deductibles, a strategy that may be tempting to employers as a way to reduce costs during the current economic downturn but that research shows is ineffective in helping patients be better consumers.

Suzanne Delbanco chats with Zach Brown, PhD, Assistant Professor of Economics at the University of Michigan. Zach Brown analyzed the impact of New Hampshire's price transparency website on health care spending. His research, which was featured in the Wall Street Journal (https://www.wsj.com/articles/one-states-effort-to-publicize-hospital-prices-brings-mixed-results-11561555562), examined spending on medical imagining services using a quasi-experimental approach. The research builds the case that price transparency - when delivered to patients in an easy to understand format - can help lower health care spending. Tune in to learn about the history of price transparency, the arguments for and against transparency, and where more research is needed.

This week, Health Care Rounds welcomes Suzanne Delbanco, executive director of Catalyst for Payment Reform. Suzanne shares her experiences in improving the health care system and gives an outlook on payment reform and thought leadership. In this episode, Suzanne notes that employers and other health  care purchasers focus on the importance of integrated care, overall value, and the main cost drivers in health care. Suzanne reveals the relevance in addressing social determinants of health and seeks a solution on how to make drugs both available and affordable for patients.

Recorded on February 28, 2020. Listen in as Suzanne Delbanco speaks with Marilyn Bartlett, CPA, CMA, CFM, Senior Policy Fellow with the National Academy for State Health Policy (NASHP). Prior to joining NASHP, Marilyn served as administrator of the Health Care and Benefits Division for Montana’s state employee health plan. There, she led the successful effort to establish a Medicare Plus contracting strategy, bringing the average price paid to hospitals down to 230% of what Medicare pays, when previous payment levels ranged from 200-600% of Medicare prices. Marilyn examines the factors that helped her bold strategy succeed, including political pressure from the state legislature as well as the absence of large health systems who could more forcibly push back against the purchaser’s strategy. In addition to answering Suzanne’s questions about the effort that landed her a spot in Fortune’s World’s 50 Greatest Leaders list, Marilyn also shares anecdotes from her time as a CFO for a third-party administrator (TPA) and insights on how employers can implement more initiatives like Montana’s.

Suzanne Delbanco calls Christopher Koller, President of the Milbank Memorial Fund, to discuss top strategies for containing health care cost growth. They discuss the insurance rate review process that Rhode Island enacted during Christopher's tenure as as the state's health insurance commissioner, and how that regulatory process brought down hospital prices for all commercial purchasers. Christopher highlights how opening the black box of commercial prices continues to be necessary to change the health care industry. Suzanne and Christopher explore how today's nearly full employment marketplace is leading to more employers having the courage to stand up to health plans and hospitals to push for affordability.

In this health care podcast, seven thought leaders talk about the areas of promise they see in health care in 2020. Seven thought leaders include: Kimberly Noel, MD, from Stony Brook Medicine Eric Weaver, from Innovista Health Solutions Suzanne Delbanco, from Catalyst for Payment Reform Sue Schade, from StarBridge Advisors Naomi Fried, from Health Innovation Strategies Joe Grundy, from Grundy Consulting Adrian Rubstein, from Merck Just a couple of comments up front here. I don’t want to further my reputation for dropping major spoilers, however, so I’ll keep this short. Many of the thought leaders today talk about AI in various contexts. Are you rolling your eyes right now? If so, let me remind everyone about the Gartner Hype Cycle. The first step is wild-eyed enthusiasm. The next step in the hype cycle is anger, the old trough of disillusionment. I’d suggest that as far as AI is concerned, we are coming out of that trough and AI—be it artificial intelligence or augmented intelligence or machine learning or deep learning or whatever you choose to call it—it is being used, for reals, for various applications. Other corroborations among our thought leaders include the importance of exalting primary care, in the form of what some may call direct primary care and Zeev Neuwirth calls complex-condition care or condition-specific care—a relationship model, if you will. Another idea that comes up in various ways is the idea of breaking down silos and getting everyone with a stake in patient health to the table and focused on achieving better patient outcomes using all the technology and wherewithal available to us in 2020. By all the stakeholders, I mean going beyond the usual suspects of providers and insurance carriers—meaning employers. Also meaning Pharma, in the sense of Pharma taking the opportunity to collaborate more deeply toward outcomes their medications can potentially confer … IRL with RWE. Today’s episode features the following guests: Kimberly Noel, MD, MPH, is a board-certified, preventive medicine physician. She serves as the telehealth director and deputy chief medical information officer of Stony Brook Medicine, where she provides leadership to all telehealth activities of the health system. Dr. Noel is also the chief quality officer of the patient-centered medical home (PCMH) for the family medicine department, working on quality improvement and population health management for National Committee for Quality Assurance (NCQA) designation. She practices occupational medicine clinically and provides digital solutions for employee wellness programs. She is an appointee the New York State Department of Health Regulatory Modernization Initiative Telehealth Advisory Committee and has won many service and innovation awards for health care. In academia, her research areas are in machine learning, risk models, and remote patient monitoring. Dr. Noel has developed several educational curriculums, including a 40-hour telehealth curriculum for the School of Medicine, as well as interprofessional educational curriculums with the School of Health Technology and Management, Nursing, Dentistry, and Social Work. Dr. Noel is a graduate of Duke, George Washington, and Johns Hopkins Universities. She is a proud graduate of the Stony Brook Preventive Medicine program, whereby she is now working collaboratively with the residency program leadership on development of a telehealth preventive medicine service. Eric Weaver, DHA, MHA, is nationally recognized for his work in primary care transformation and value-based care. As a corporate vice president for Innovista Health Solutions, he oversees enterprise strategy and technology adoption for a fast-growing population health management services organization. Dr. Weaver has been recognized for his contribution to the health care industry by receiving the ACHE Robert S. Hudgens Award for Young Healthcare Executive of the Year and the Modern Healthcare “Up & Comers” Award in 2016. Prior to joining the Innovista leadership team in 2015, he was the president and CEO of Austin, Texas–based Integrated ACO—one of the more successful physician-led accountable care organizations in the country. Suzanne Delbanco, PhD, is the executive director of Catalyst for Payment Reform (CPR), an independent, nonprofit corporation working to catalyze employers, public purchasers, and others to implement strategies that produce higher-value health care and improve the functioning of the health care marketplace. In addition to her duties at CPR, Suzanne serves on the advisory board of The Source on Healthcare Price & Competition at the University of California–Hastings and the Blue Cross Blue Shield Institute. Previously, she was the founding CEO of The Leapfrog Group. Suzanne holds a PhD in public policy from the Goldman School of Public Policy and an MPH from the School of Public Health at the University of California–Berkeley. Sue Schade, MBA, is a nationally recognized health IT leader and Principal at StarBridge Advisors providing consulting, coaching, and interim management services. She recently served as the interim chief information officer (CIO) at Stony Brook Medicine in New York. She was a founding advisor at Next Wave Health Advisors and in 2016 served as the interim CIO at University Hospitals in Cleveland, Ohio. Sue previously served as CIO for the University of Michigan Hospitals and Health Centers and, prior to that, as CIO for Brigham and Women’s Hospital in Boston. Her previous experience includes leadership roles at Advocate Health Care in Chicago, Ernst & Young, and a software/outsourcing vendor. Naomi Fried, PhD, is an innovative and digital health thought leader and founder and CEO of the boutique advisory firm, Health Innovation Strategies, which focuses on innovation program design and digital health strategy. Naomi was the first vice president of innovation and external partnerships at Biogen, the first chief innovation officer at Boston Children’s Hospital, and vice president of innovation and advanced technology at Kaiser Permanente. She served on the board of directors of the American Telemedicine Association and the Governor of Massachusetts’ Innovation Council. Joe Grundy has firsthand experience with nearly every aspect of primary care transformation. He has led policy and product development for the American Academy of Family Physicians, led in-the-trenches transformation of a primary care group, and served as national faculty for Medicare’s Comprehensive Primary Care Plus transformation project. He cofounded Grundy Consulting to work with stakeholders across the industry in order to accelerate the rate of effective transformation in primary care. Adrian Rubstein is a medical adviser and innovation manager at Merck KGaA, where he works to bring cutting-edge technologies to improve patients’ lives. He also helps new biotech companies in strategy development, investment, and business analysis.   02:41 Dr. Kimberly Noel and her thoughts on areas of promise. 02:53 Advocacy for inclusive innovation. 04:01 Why inclusive innovation is an area of promise in the advent of artificial intelligence (AI). 04:52 “Who is most likely to be disadvantaged?” 05:27 Eric Weaver’s thoughts on areas of promise. 05:42 Relationship-driven, team-based primary care. 07:14 What investors are focused on right now. 07:34 Where the tipping point is in value-based care. 08:03 AI as another trend that will help improve health care. 08:48 Incorporating social determinants into primary care and the transformative potential of AI. 11:07 Suzanne Delbanco of Catalyst for Payment Reform and her thoughts on areas of promise. 11:26 Employers making the health care space work better for them as an area of promise. 11:52 Employers seeking out high-value health care in nontraditional ways. 13:10 Where to look to seek high-value health care. 14:37 Employers bringing in really good data. 16:15 Sue Schade’s thoughts on areas of promise. 16:32 How leveraging electronic health records is an area of promise. 16:58 Why eliminating clinician burnout is also part of this area of promise. 17:26 Patient engagement and the patient journey as another area of promise. 18:08 “You have to approach all of these from a partnership between digital, IT, and operations.” 18:30 Enterprise resource planning (ERP) as a third area of focus/promise. 19:01 AI as an area of promise and an area of hype. 19:48 Naomi Fried’s thoughts on areas of promise in health care. 20:02 Digital health developments from the pharma perspective. 22:15 The digital health start-up world as another area of interest and promise. 22:37 The importance of data and the importance of validating those data for digital health solutions. 23:02 Personalized medicine and digital health. 24:32 More jobs in digital health within clinical-grade solutions. 25:01 Joe Grundy’s thoughts on areas of promise in health care. 25:06 The direct primary care model as an area of promise. 26:08 “Questioning the very validity of our understanding of ‘quality’ in health care.” 28:01 Adrian Rubstein’s thoughts on areas of promise in health care. 28:08 AI in emergency medicine as an area of promise. 28:53 CRISPR gene editing as an area of promise. 29:59 Virtual reality/augmented reality as another area of promise in health care. Check out our newest #healthcarepodcast where @SuzanneDelbanco of @CPR4healthcare, @adrianrubstein, @DrKimNoel, @NaomiFried, @Eric_S_Weaver, and @sgschade of @StarBridgeHIT give their thoughts on #areasofpromise in #healthcare. #podcast #digitalhealth #healthtech #healthIT #AI Why #inclusiveinnovation is an #areaofpromise in the advent of #artificialintelligence? @DrKimNoel explains on our #healthcarepodcast this week. #healthcare #podcast #digitalhealth #healthtech #AI “Who is most likely to be disadvantaged?” @DrKimNoel discusses on our #healthcarepodcast this week. #healthcare #podcast #digitalhealth #healthtech #AI #inclusiveinnovation Why does @Eric_S_Weaver believe relationship-driven, team-based #primarycare is an upcoming #areaofpromise in #healthcare? Listen to our #healthcarepodcast to find out! #podcast #digitalhealth #healthtech #AI Where’s the tipping point in #valuebasedcare? @Eric_S_Weaver discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #AI What’s the transformative potential of #AI in #healthcare? @Eric_S_Weaver discusses on our #healthcarepodcast. #podcast #digitalhealth #healthtech #AI Why is #employers seeking out #highvaluehealthcare in nontraditional ways an #areaofpromise in #healthcare to @SuzanneDelbanco of @CPR4healthcare? Find out on our #healthcarepodcast. #digitalhealth #healthtech #AI Where should #employers be looking to seek out #highvaluehealthcare? @SuzanneDelbanco of @CPR4healthcare discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech How can leveraging #EHRs be an #areaofpromise? @sgschade of @StarBridgeHIT discusses on our #healthcarepodcast. #healthcare #digitalhealth #healthtech #AI How does eliminating #clinicianburnout also play into #areasofpromise in #healthcare? @sgschade of @StarBridgeHIT discusses on our #healthcarepodcast. #healthtech #digitalhealth #AI #podcast “You have to approach all of these from a partnership between digital, IT, and operations.” @sgschade of @StarBridgeHIT discusses on our #healthcarepodcast. #healthcare #podcast #healthtech #digitalhealth #AI Where do #areasofpromise in #healthcare play into #digitalhealth developments from the #pharma perspective? @NaomiFried explains on our #healthcarepodcast. #podcast #healthtech #AI Why is the #digitalhealth start-up world an #areaofpromise in #healthcare? @NaomiFried explains on our #healthcarepodcast. #podcast #healthtech #AI “Questioning the very validity of our understanding of ‘quality’ in health care.” Joe Grundy discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #AI Why is #AI in #emergencymedicine an #areaofpromise in #healthcare to @adrianrubstein? Find out on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #GeneEditing and #VR/#AR as #areasofpromise in #healthcare. @adrianrubstein discusses on our #healthcarepodcast. #podcast #digitalhealth #healthtech #AI

Price transparency is not one-size-fits-all. The optimal price information for a patient is different from the price transparency a physician would find useful and different, too, from what an employer-purchaser needs in order to play it's role in the health care ecosystem. Suzanne Delbanco calls Chapin White, PhD, Adjunct Senior Policy Researcher at the RAND Corporation to learn about the innovative Employer Hospital Price Transparency project. For this project - now embarking on it's third iteration, Chapin White and Christopher Whaley in conjunction with the Employers Forum of Indiana, analyzed claims data data from 4 million people who received hospital services from 1851 hospitals in more than 20 states. The project garnered attention from major stakeholders, including coverage in the New York Times and Wall Street Journal. Listen and learn why the Medicare fee schedule provides a standard benchmark that allows employers to see how good - or how bad - they have it as health care purchasers in the metro-areas studied.

Listen NowLargely with the exception of the 2010 passage of the ACA, federal legislative (and regulatory) efforts to reform health care over the past few decades has lagged.   This is the result of an increasingly dysfunctional Congress.  For example, Congressional productivity, measured by the number of enacted laws, has decreased every decade since 1990 by over 20 percent.  For this reason and because states are required to balance their annual budgets (with the exception of Vermont and possibly North Dakota and Wyoming as well), health care policy innovation has shifted substantially to the states.  For example, the 2019 legislative session resulted in 29 states passing Medicaid-related legislation, 13 states passing health insurance legislation and 10 states passing health care assignment and billing legislation. During this 24 minute conversation, Dr. Delbanco begins by briefly explaining the Catalyst for Payment Reform's mission and members.  She moreover discusses state policy reforms related to data (i.e., All Payer Claims Databases) and price transparency, efforts to improve state market competition, delivery and payment reforms, for example, reference pricing or benchmarking to Medicare reimbursement and she identifies states that are particularly noteworthy in their efforts to improve care delivery and lower spending growth.Dr. Suzanne F. Delbanco is the Executive Director of Catalyst for Payment Reform (CPR), an independent, non-profit corporation working to catalyze employers, public purchasers and others to implement strategies that produce higher-value health care and improve the functioning of the health care marketplace.  In addition to her duties at CPR, Suzanne serves on the advisory board of the Blue Cross Blue Shield Institute.  Previously, Suzanne was the founding CEO of The Leapfrog Group.  Suzanne holds a Ph.D. in Public Policy from the Goldman School of Public Policy and a M.P.H. from the School of Public Health at the University of California, Berkeley. For information on CPR go to: https://www.catalyze.org/. Dr. Delbanco (and colleagues') recently published article, "The State of State Legislation Addressing Health Care Costs and Quality," is at: https://www.healthaffairs.org/do/10.1377/hblog20190820.483741/full/.Per Dr. Delbanco's reference to The Source, U. of CA Hastings College of Law's recently posted online database of state laws impacting health care cost and quality, go to: https://sourceonhealthcare.org/legislation/.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

How and why are social determinants of health making its way into the Medicaid managed care realm? To find out, Suzanne Delbanco calls Tricia McGinnis, MPP, MPH, Executive Vice President and Chief Program Officer of the Center for Health Care Strategies. The Center's December 2018 report, "Addressing Social Determinants of Health via Medicaid Managed Care Contracts and Section 1115 Demonstrations," analyzed 40 Medicaid managed care contracts and 25 approved § 1115 demonstrations across the country to analyze the trends in this emerging area of focus. Tricia McGinnis highlights states and health plans with programs and policies in place as well as new approaches to bringing social determinants of health investments to life. Through the Center's work in thinking through health equity, they have found that community-based organizations are well positioned to play an important role in bringing necessary and culturally-tailored support to patients.

Listen in as Mark Fendrick, Director of the University of Michigan Center for Value-Based Insurance Design and a practicing general internist, catches Suzanne Delbanco up on the new developments in the world of Value-Based Insurance Design (VBID). After years of bipartisan support and tireless advocacy, the federal government has made important changes to Medicare Advantage and private health plan programs and regulations to allow more generous coverage of high-value health care services. The greater question is, how can these important changes be implemented without increasing total cost of care for the private employers and public agencies who purchase health care? The answer: VBID X, a model plan that achieves cost-neutrality by specifying reduced or eliminated cost-sharing for high-value services and increased cost-sharing for select low-value services. Building upon a previous episode with Mark from back in July 2017, this is an episode you don't want to miss!

Suzanne Delbanco, Executive Director of Catalyst for Payment Reform, discusses employer sponsored healthcare and the role employers can play in solving the healthcare crisis. To read the full show notes and transcript visit us at illuminatehrpodcast.comSupport the show (https://www.patreon.com/illuminatehr)

Listen in as Suzanne Delbanco calls Cheryl DeMars, President & CEO of The Alliance - a cooperative of 240 self-funded employers pooling their purchasing power to control costs and improve quality. The Alliance contracts directly with health care systems to provide health care for over 90K employees and their families in Wisconsin, Iowa, and Illinois. Find out why the Alliance was formed in the early 90's and how it continues to deliver strong results in present day through innovative strategies, like Quality Path and high-value primary care.

Here’s a vital question, “How do you make sure that the physicians your employees or members are seeing are high quality in a given area of focus?” Getting to the right doctor matters when you consider that something like 70% of back surgeries are unnecessary and medical errors are the third leading cause of death in this country. And also because, as Suzanne DelBanco put it in EP224, if a payer simply cuts out the bottom performing 10% of practices, the returns are outsized from a cost and quality perspective. The challenge is how to actually accomplish this. How to measure quality in a sea of dirty data and noise and whatever the opposite of interoperability and aggregated data sets is. With the confounding factor also that outcomes are rarely if ever included in data sets, especially when you consider that the outcomes that matter to patients are really the outcomes that count. Today I speak with Suzanne Clough, MD. In a former life, Suzanne was a co-founder of Welldoc, the first FDA-approved digital health platform and also featured on EP102 of this podcast. Now, Suzanne is the chief-medical officer over at ArmadaHealth, a company that aims to become a GPS for health care helping to get patients to the right doctor quicker. You can learn more at www.armadahealth.com Dr. Suzanne Sysko Clough, MD, is Chief Medical Officer of ArmadaHealth, a health and data science company that navigates consumers to quality health care providers using big data, AI, and proprietary quality algorithms that together produce 360-degree profiles of physicians. The platform enables precision matching of physicians with patients based on diagnosis/condition and nonclinical attributes. Before ArmadaHealth, Suzanne was a co-Founder and Chief Medical Officer of WellDoc, the first FDA-approved digital health platform. Dr. Clough completed her medical training in internal medicine and a fellowship in endocrinology at the University of Maryland Medical Systems and served as an assistant professor in the Division of Endocrinology as well as Medical Director and as the Founder and Medical Director of the Center for Weight Management and Wellness. 02:10 Why finding the right provider is so important. 03:01 Higher quality health systems or the need for wider specialty coverage? 03:59 “We don’t recognize that there can be a quality...difference among physicians and...among health systems.” 06:08 Quality as the intersection of clinical acumen and the ability to form a relationship. 07:18 Determining what is or isn’t appropriate. 08:11 When it seems appropriate from a physician standpoint but isn’t from a patient standpoint. 11:01 When physicians could use more support. 11:49 Practicing wisely. 14:36 Do payers care about getting patients to the right doctor? 17:00 Center of Excellence model vs insurance policy methods. 23:06 “We’re not empowering people with the right information.” 23:41 How ArmadaHealth’s approach is different. 24:27 Claims data vs clinical data and outcomes data. 27:06 How ArmadaHealth pairs patients with physicians. 31:00 Who ArmadaHealth is deployed by. 31:31 Who ArmadaHealth gets their outcomes data by, and why this is important to assessing patient quality care. You can learn more at www.armadahealth.com Why is finding the right #provider so important? Suzanne Clough of @ArmadaHealth discusses on our #healthcarepodcast. #digitalhealth #healthcare #podcast #clinicaloutcomes #patientjourney #healthdata Higher #quality #healthsystems or the need for wider #specialtycoverage? Suzanne Clough of @ArmadaHealth discusses on our #healthcarepodcast. #digitalhealth #healthcare #podcast #clinicaloutcomes #patientjourney #healthdata “We don’t recognize that there can be a quality...difference among physicians and...among health systems.” Suzanne Clough of @ArmadaHealth discusses on our #healthcarepodcast. #digitalhealth #healthcare #podcast #clinicaloutcomes #patientjourney #healthdata #Quality as the intersection of #clinicalacumen and the ability to form a relationship. Suzanne Clough of @ArmadaHealth discusses on our #healthcarepodcast. #digitalhealth #healthcare #podcast #clinicaloutcomes #patientjourney #healthdata What is and isn’t appropriate for a #physician #diagnosis and #treatment? Suzanne Clough of @ArmadaHealth explains on our #healthcarepodcast. #digitalhealth #healthcare #podcast #clinicaloutcomes #patientjourney #healthdata When a treatment seems appropriate from a #physician standpoint but isn’t from a #patient standpoint. Suzanne Clough of @ArmadaHealth discusses on our #healthcarepodcast. #digitalhealth #healthcare #podcast #clinicaloutcomes #patientjourney #healthdata In what area could #physicians use (arguably) the most support? Suzanne Clough of @ArmadaHealth discusses on our #healthcarepodcast. #digitalhealth #healthcare #podcast #clinicaloutcomes #patientjourney #healthdata Practicing wisely. Suzanne Clough of @ArmadaHealth discusses on our #healthcarepodcast. #digitalhealth #healthcare #podcast #clinicaloutcomes #patientjourney #healthdata Do #payers care about getting #patients to the right #doctor? Suzanne Clough of @ArmadaHealth discusses on our #healthcarepodcast. #digitalhealth #healthcare #podcast #clinicaloutcomes #patientjourney #healthdata Center of Excellence model vs insurance policy methods—Suzanne Clough of @ArmadaHealth discusses on our #healthcarepodcast. #digitalhealth #healthcare #podcast #clinicaloutcomes #patientjourney #healthdata “We’re not empowering people with the right information.” Suzanne Clough of @ArmadaHealth discusses on our #healthcarepodcast. #digitalhealth #healthcare #podcast #clinicaloutcomes #patientjourney #healthdata How is @ArmadaHealth’s approach different? Find out in our #healthcarepodcast. #digitalhealth #healthcare #podcast #clinicaloutcomes #patientjourney #healthdata Claims data vs Clinical data and outcomes data - Suzanne Clough of @ArmadaHealth discusses on our #healthcarepodcast. #digitalhealth #healthcare #podcast #clinicaloutcomes #patientjourney #healthdata How does @ArmadaHealth pair #patients with #physicians? Find out in our #healthcarepodcast. #digitalhealth #healthcare #podcast #clinicaloutcomes #patientjourney #healthdata Why is #outcomesdata so important to assessing #patient #qualityofcare? Suzanne Clough of @ArmadaHealth discusses on our #healthcarepodcast. #digitalhealth #healthcare #podcast #clinicaloutcomes #patientjourney #healthdata

Suzanne Delbanco chats with Frank Opelka, MD, FACS, Medical Director for Quality and Health Policy with the American College of Surgeons, to understand how surgeons across the United States view bundled or episode-based payment. Frank describes the questions and concerns surgeons hold about moving away from fee-for-service payments, as well as the benefits to bundled payments from a surgeon's point of view. There's evidence that bundled payments can improve care and efficiency, yet uptake continues to be in the single digits of total health care spending. What are the ingredients necessary to help bundled payments take off successfully?

Suzanne Delbanco calls Rachel Brodie, Director of the Performance Information programs at Pacific Business Group on Health (PBGH) to discuss patient-reported outcomes (PROs). Listen in to learn how PROs work and why employers are paying attention to this new area of quality measurement.

Suzanne Delbanco catches up with Sam Arsenault, Director of National Treatment Quality Initiatives for Shatterproof, on the latest milestones in the work to bring provider quality ratings into the substance use disorder space. Sam goes over the dimensions that the provider quality ratings will cover, piloting the effort in five states, and how providers are reacting to the initiative. Listen in to learn what it takes to bring a provider rating system into fruition and what the ultimate goal of the project entails.

Listen in as Ateev Mehrotra, MD, MPH, Associate Professor of health care policy and medicine at Harvard Medical School and a hospitalist at Beth Israel Deaconess Medical Center, chats all things convenient care with Suzanne Delbanco. Between retails clinics, onsite clinics, and telemedicine, there are many new options cropping up for consumers. What do employers need to know about quality and costs when pursuing these options? What can purchasers and consumers expect to see in the future? Listen in to find out!

Listen in as Suzanne Delbanco chats with Gloria Sachdev, PharmD, President and CEO of the Employers’ Forum of Indiana. They discuss one of the hottest studies in health care: the RAND Hospital Prices In Indiana study published by Chapin White. The landmark employer-led study uses claims data from self-insured employers to report hospital prices by health system relative to Medicare. Tune in to find out how the study was born, how the data was produced, and what employers are doing with the results, including a glimpse at a new movement in health care: negotiating contracts on a Medicare+ basis.

“Those who say it cannot be done are usually interrupted by others doing it.” That’s a James Baldwin quote to keep in mind while considering employers ginning up real change in the health care industry. Generally speaking, employers who still don’t believe they could have an impact helping their employees get better health care at lower prices, don’t listen to this podcast. But if they did, I’d suggest this James Baldwin quote is apropos. It’s probably also apropos for providers, carriers, Pharma … anyone who isn’t paying a whole lot of attention to the success of organizations like Catalyst for Payment Reform. Americans, meaning employees, can no longer afford their health care. Deductibles are higher than savings, basically meaning that employees have health plans they can’t even afford to use; and it costs as much as a midsize sedan—a new one every single year. Furthermore, we have employer health care spend chewing up raises. Employers and their CFOs are increasingly in a position where they have to act. It’s no longer an option. I speak today with Suzanne Delbanco, PhD, executive director of Catalyst for Payment Reform. In one of her past lives, Suzanne was the founding CEO of The Leapfrog Group. You can learn more at catalyze.org. In addition, for a curriculum of podcasts to get you up to speed on what’s happening in the employer space, check out this blog post. Suzanne Delbanco, PhD, is the executive director of Catalyst for Payment Reform (CPR), an independent, nonprofit corporation working to catalyze employers, public purchasers, and others to implement strategies that produce higher-value health care and improve the functioning of the health care marketplace. In addition to her duties at CPR, Suzanne serves on the advisory board of The Source on Healthcare Price & Competition at the University of California–Hastings and the Blue Cross Blue Shield Institute. Previously, she was the founding CEO of The Leapfrog Group. Suzanne holds a PhD in public policy from the Goldman School of Public Policy and an MPH from the School of Public Health at the University of California–Berkeley.   02:25 The moment when Suzanne’s colleagues realized Leapfrog was needed. 03:58 Suzanne’s work at Catalyst for Payment Reform vs Leapfrog. 06:48 EP217 with Steve Watson—price points of hospitals and how the data evade us. 08:11 “At the end of the day, it’s very difficult to know if you’re getting good value if you don’t know what you’re paying.” 09:48 “The balance of power varies from market to market and has been changing over time.” 12:00 How employers can ban together to reduce their health care costs. 13:33 Price transparency. 16:04 Elevating the best practice. 16:51 A surprising contract point that everyone needs. 17:30 Getting rid of gag clauses. 19:26 “There’s never going to be 1 solution.” 19:38 Payment reform and what we mean by that. 20:42 Shared savings, shared risk, and bundled payments. 23:06 Today’s tipping point. 24:29 Trading choice for affordability. 26:43 Controlling costs 2 ways. 26:59 “Even if employers were … to … create a narrower network, not necessarily narrow, there’d be huge savings to be had.” 27:16 The limited sight of narrow networks. 27:36 Getting to a narrow network of high-quality, low-cost providers. 30:30 Suzanne’s advice for health care executives. 31:55 “Be prepared to demonstrate value, because employers [will] be asking.”

Listen in as CPR's Executive Director, Suzanne Delbanco, chats with Google's Healthcare Delivery Benefits Manager, Rob Paczkowski. Just like the HR department of many employers, the benefits team at Google works hard to build awareness among Googlers about in-network, high-value health care options, including telemedicine, on-site clinics, and even home health care. Listen in to hear about the innovative ways Rob Paczkowski and the Google benefits team use the employee communications channels available to them. Spoiler Alert: There are some Cloud solutions brewing!

Suzanne Delbanco chats with Jeffrey Davis, MD, MPH, Senior Health Management Consultant with Willis Towers Watson, about a rapidly expanding area of intrigue for employers: genetic testing. He breaks down the types of genetic testing out there, as well as concrete steps employers can take to navigate this space. Listen in to find out if and when genetic testing is more than just a "shiny new object" that Silicon Valley employers are using to retain top talent.

Suzanne Delbanco calls up Lisa Woods, Senior Director of Health Care Benefits at Walmart Stores Inc., to discuss Walmart’s efforts to control costs and deliver high-value health care using a Center of Excellence approach. Suzanne and Lisa catch up about Walmart’s COE strategy for spinal surgery, why Walmart initially began the program, and how these efforts have helped to reduce inappropriate care so far. Lisa also shares Walmart’s decision to expand its’ Center of Excellence approach and where Walmart’s COEs are headed in the future.

Suzanne Delbanco checks in with Mike Stull, Chief Marketing Officer at Employers Health Coalition, to talk all things pharmacy. Listen in as Suzanne and Mike discuss what employers and health care purchasers can do to stay afloat amid rising pharmacy costs, the role of the pharmacy benefit managers now and in the future, and much more.

Suzanne Delbanco, CPR's Executive Director, checks in with Debbie Welle-Powell, Chief Population Health Officer at Essentia Health, an integrated health system in the Midwest. Debbie and Suzanne discuss the definition of accountable care organizations (ACOs), how ACOs can impact the quality and cost of health care, patient experience in an ACO and the importance of incorporating risk. Listen in and learn!

Suzanne Delbanco dials up Emily Transue, MD, Associate Medical Director for Clinical Quality and Care Transformation at the Washington State Health Care Authority (HCA), to chat about HCA's shared decision making strategy and the results so far. Learn what shared decision making is, why HCA introduced shared decision making, how HCA is using shared decision making in tandem with its' Accountable Care program, and more.

Suzanne Delbanco dials up Ann Greiner, President and CEO of the Patient Centered Primary Care Collaborative (PCPCC), to discuss the patient centered medical home model. Ann shares where the PCMH came from, how the concept and use has evolved over time, how the PCMH can influence health care delivery, and the evidence on PCMHs so far.

Suzanne Delbanco checks in with David Schleifer, Ph.D.,Vice President and Director of Research at Public Agenda, a nonpartisan, nonprofit research and public engagement organization that works to strengthen democracy and expand opportunity in America by fostering thoughtful public opinion, meaningful public participation and responsive public institutions. They discuss the perspectives of Americans who have experienced either type 2 diabetes, maternity care or joint replacement on what makes for good quality health care, based on research funded by the Robert Wood Johnson Foundation: www.publicagenda.org/pages/qualities-that-matter. David also gives a preview of future research designed to shed light on whether or not New Yorkers think that state policy should play a larger role in improving transparency and accountability in health care quality.

Employers may not look forward to purchasing healthcare, but they are in the position to transform the market. Key opinion leaders like Suzanne Delbanco, PhD, MPH, of Catalyst for Payment Reform; Brian Marcotte of the National Business Group on Health; and Judy Berger of Southwest Airlines, discuss how employers are getting more involved in healthcare by championing alternative payment models and other more services to their employees. Learn more about the most recent news and updates in Medicaid: Employers Play an Increasingly Important Role in the Move to Value-Based Care: www.ajmc.com/conferences/acdc-spring-2018/employers-play-an-increasingly-important-role-in-the-move-to-valuebased-care Employer Support Is Needed to Help Payment Reform Succeed: www.ajmc.com/newsroom/employer-support-is-needed-to-help-payment-reform-succeed Percent of Employers Offering Health Coverage Increases for First Time Since 2008: www.ajmc.com/focus-of-the-week/percent-of-employers-offering-health-coverage-increases-for-first-time-since-2008 Employers Actively Exploring, Offering New Ways of Delivering Healthcare to Employees: www.ajmc.com/newsroom/employers-actively-exploring-offering-new-ways-of-care-delivering-healthcare-to-employees When Employee Healthcare Costs Move Stocks: www.ajmc.com/contributor/joseph-andelin/2018/09/when-employee-healthcare-costs-move-stocks

Suzanne Delbanco calls Mai Pham, MD, Vice President of Provider Alignment Solutions at Anthem Inc., and former Chief Innovation Officer at CMMI, to discuss the Medicare Physician Fee Schedule. They explore the history of the fee schedule, its repercussions across the entire health care marketplace, and what Anthem plans to do - in the long haul- to diverge from the status-quo for the sake of improving health care quality and affordability. With all the recent news about CMS' proposed changes to the fee schedule, you won't want to miss this exciting discussion!

NAHU CEO Janet Trautwein joins the Healthcare Happy Hour to interview Suzanne Delbanco from the Catalyst for Payment Reform (CPR). Their conversation focuses on CPR's mission of catalyzing employers, public purchasers and others to implement strategies that produce higher-value health care and improve the functioning of the health care marketplace. Suzanne and Janet discuss the changing healthcare marketplace, the need for employers to shift towards value-based strategies, and what every employer (and their broker) should be doing to shift toward higher-value thinking.

NAHU CEO Janet Trautwein joins the Healthcare Happy Hour to interview Suzanne Delbanco from the Catalyst for Payment Reform (CPR). Their conversation focuses on CPR’s mission of catalyzing employers, public purchasers and others to implement strategies that produce higher-value health care and improve the functioning of the health care marketplace. Suzanne and Janet discuss the changing healthcare marketplace, the need for employers to shift towards value-based strategies, and what every employer (and their broker) should be doing to shift toward higher-value thinking.

Suzanne Delbanco calls Peter Kilmartin, Consultant Effectiveness Leader and US Leadership Team at Mercer Health & Benefits, to discuss the four areas where employers can build out their health care purchasing strategy. With the Vitals For Change Scorecard, co-developed by Mercer and CPR, employers can benchmark their benefits purchasing strategy against their peers based on how they are 1) paying for value, 2) driving to quality, 3) personalizing the experience, and 4) embracing disruption. Peter shares anecdotes from the field, including how some CEO's are now viewing disruption with a positive connotation in their quest to improve the health care experience and outcomes of their employees.

What if people with substance use disorder could have a one-stop-shop for finding high-quality treatment options? Suzanne Delbanco checks in with Sam Arsenault, Director of National Treatment Quality Initiatives at Shatteproof on their provider rating system to tackle that very issue. Substance abuse is a critical health care area full of misconceptions, stigma, and low-quality providers forgoing evidence-based guidelines. Learn about Shatteproof's strategy for systemic change and how employers can benefit from their programs.

Suzanne Delbanco, PhD, MPH, of Catalyst for Payment Reform, and Patricia Salber, MD, MBA, of The Doctor Weighs In, discuss payment reform in the healthcare industry, including quality measurements and accountable care organizations.

Suzanne Delbanco dials up Jen Benz, founder and CEO of Benz Communications, to tackle a range of topics related to employee benefits communication, including personalized messaging, technology trends, privacy concerns, and the age old challenge of getting consumers to engage with their health.

Suzanne Delbanco, Executive Director of Catalyst for Payment Reform, dials up Jeff Selberg, Executive Director of the Peterson Center on Healthcare, to chat about the foundation's goal to make health care more affordable for our country and why we need to push within both the private and public sector to do it.

Suzanne Delbanco of Catalyst for Payment Reform and Anna Fallieras of GE join the podcast to share insights from their efforts to help the healthcare industry move towards value-based care. Look forward to Suzanne and Anna’s thoughts on the importance of transparency in terms of driving value in healthcare and how Catalyst for Payment Reform is driving towards value-oriented payment. More information at sitewirehealth.com/cruxpoints