Podcasts about triple aim

How can healthcare organizations harness the power of predictive analytics, AI, and member-centric strategies to achieve the Triple Aim of better care, lower costs, and improved population health? In this episode of the Care Catalyst series hosted by Chenny Solaiyappan, mPulse CPO Saeed Aminzadeh shares his insights on leveraging data and advanced technologies to transform healthcare. He discusses his journey in building data-driven solutions that empower health plans to proactively engage members, improve experiences, and drive better outcomes.

On this special edition of PopHealth Week Fred Goldstein and Gregg Masters discuss critical healthcare issues, systemic challenges, and political developments. The episode opens with the tragic news of Brian Thompson, the United Healthcare CEO's death and its potential implications on the healthcare landscape. Key themes include: Healthcare System Challenges: A critique of the managed care model's failure to meet its promises and the burden it places on individuals, highlighting inefficiencies, rising costs, and access disparities. Political Forecasting: Exploration of the incoming administration's healthcare policies, including potential changes to Medicaid, privatization of Medicare, and efforts to repeal the Affordable Care Act, coupled with skepticism about the lack of a coherent replacement plan. Public Health and Policy Appointments: Commentary on controversial nominations for federal healthcare leadership roles, raising concerns about public health direction under individuals with anti-vaccine sentiments or alternative scientific stances. Structural Reform Needs: Advocacy for a shift towards addressing systemic inefficiencies, such as the dominance of large healthcare entities, and a call for reimagined care delivery to align with the Triple Aim of improved outcomes, patient experience, and cost efficiency. Personal Reflections: The hosts reflect on their professional and personal encounters with healthcare's operational challenges, emphasizing the system's inability to support mission-driven healthcare professionals. The conversation is rich with professional insights and underscores the urgency of addressing longstanding issues within the U.S. healthcare system while navigating political and industry dynamics.

In this episode, host Stacey Richter delves into the complexities of the Third Party Administrator (TPA) Request for Proposal (RFP) process with guest Claire Brockbank from 32BJUnion.  The discussion highlights the critical role of contracts in managing health plans effectively and the potential pitfalls of accepting contracts crafted by TPAs without thorough review. Drawing from Claire's experience, they explore tactics like starting with your own contract paper in RFP processes to gain negotiation leverage, and the benefits of employer coalitions in navigating health care complexities. To Read the full article which includes mentioned links visit the episode page. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to become a member of the Relentless Tribe. Real-world examples underscore the financial impacts of poorly negotiated contracts and highlight successful strategies for health plan sponsors to optimize costs and services. The episode aims to empower employers with tools and insights to negotiate effectively and ensure their health plan contracts align with their strategic goals, ultimately paving the way for better population health management and cost-effective care delivery. As but one example—and Cora Opshal spoke about this last week and Claire talked about this today—it's about how allowing upside-down payments, for example, that are in a lot of ASO contracts, this allowing of upside-down payments. I mean, it turns out that 32BJ spent around $10 million paying more than the bill was for one year. If somebody signs that contract as handed to them by the carrier, then the plan is now contractually obligating themselves to pay more than the price the clinical practice was charging. So, doc sends bill for $100, and the carrier pays that practice $200 on behalf of the plan sponsor. So now the plan sponsor is paying $200 for a $100 bill. Is this conflict of interest? Is it imprudent? Is it not reasonable? Said another way, is that a bit of a fiduciary breach on the plan sponsor? So it's understandable why the team at 32BJ pushed back and pushed back hard. We all can see why the leading edge of plan sponsors and more and more C-suites are hotfooting it into conference rooms to plan their RFP process and doing it in the way that Claire Brockbank talks about today. For an open-source contract and some other free tools, please do head over to the 32BJ Insights Web site. 05:36 How does the initial contract writing affect how events in your healthcare plan will go? 06:56 What happens if a plan sponsor or employer doesn't do the contracting right? 10:42 How much could be saved by doing contracting right? 11:01 EP433 with Justin Leader. 12:22 How do you start an RFP process with your own contract? 14:06 What Claire Brockbank recommends doing to do a TPA RFP process in a way that's best for you. 19:46 What factors do carriers need to get an ASO or TPA to respond to using your contract? 21:11 Open-source contract available from 32BJ. 21:57 Why it's important to really probe brokers, despite loyalty to your broker/consultant. 24:30 Who are the reliable agents and experts when carriers are looking to start this process? 26:24 EP428 with Julie Selesnick. 27:56 What's the silver lining to this effort? 29:17 Why is it important to make it clear why you're doing what you're doing for your lawyers and any other support team you need? 31:39 What does “good” look like in this process? 34:15 Why is it important to continue to hold your ASO accountable?

Using the Triple Aim framework to dissect the current status of allergy care in America, this episode delves into the per capita cost, population health, and patient experience of care, emphasizing the importance of accurate diagnosis and appropriate referrals. Tune in for insights on improving healthcare efficiency, reducing costs, and enhancing patient outcomes. Don't miss this informative episode designed to help clinicians better serve their patients. Episode resources and references available at https://www.thermofisher.com/phadia/us/en/resources/immunocast/s2e5.html?cid=0ct_3pc_05032024_9SGOV4

Population health flips the usual model of US healthcare on its head. Instead of waiting until patients get sick and then billing on a fee-for-service basis when they seek care, population health is proactive. It addresses the root causes of disease in the community by focusing on prevention and the social determinants of health.It sounds great in theory, but is anyone actually doing it?TOPICS(0:54) Tracing the career of TriHealth President & CEO Mark Clement (5:31) What is population health?(7:13) The Triple Aim in Healthcare(11:34) Perverse incentives in the healthcare system(15:52 )Transforming Healthcare for the Better(24:00) Addressing health disparities and challenges in the US(27:36) Cradle Cincinnati and reducing infant and maternal mortality(32:08) Building community coalitions for health equity

Welcome to episode 159 [originally broadcast on Wednesday 10 April 2024] of #mhTV​​​​​​​​. This week Nicky Lambert and David Munday spoke with guest Auzewell Chitewell about Using quality improvement in practice. AC - Auzewell "Auz" Chitewe is an experienced healthcare leader, passionate about Quality Improvement and transformational change. Responsible for delivering the quality improvement plan at East London NHS Foundation Trust (ELFT) - a mental health, community health and primary care provider rated 'outstanding' by the Care Quality Commission (CQC). Also an Improvement Advisor and faculty on the application of quality improvement methods with the Institute for Healthcare Improvement (IHI). Auz trained as a nurse and is an Improvement Advisor working as Associate Director for Quality Improvement at ELFT. In addition to his support of frontline improvement projects, Auz is experienced in developing and delivering system-wide work programmes, collaboratives and learning systems. Some of his work has centered on improvement to reduce bed occupancy, improve access to services, joy in work, and improving population health using the Triple Aim framework (patient experience, population health outcomes and value for money). He has experience providing strategic and operational leadership in organisations looking to building a culture of continuous quality improvement that involves everyone. He is a recipient of the NHS Leadership Academy Award in Senior Healthcare Leadership and is a senior member of faculty for coaching and teaching on improvement science across professional, communities and organisational boundaries. His leisure interests include shooting 360º photography. Some X links to follow are: VG - https://www.x.com/VanessaRNMH NL - https://www.x.com/niadla​​​​​​​​ DM - https://www.x.com/davidamunday AC - https://www.x.com/auzewell Credits: #mhTV Presenters: Vanessa Gilmartin, Nicky Lambert & David Munday Guest: Auzewell Chitewell Theme music: Tony Gillam Production & Editing: David Munday

This summer short is about the dynamic between payers and providers. An opening point that Jacob Asher, MD, my guest in this healthcare podcast, makes in the interview that follows is that, for a payer, it's super hard to competitively differentiate from both a cost and/or a quality perspective when you and all of your payer competition use the exact same PPO (preferred provider organization) networks. I mean, what? Are these same exact doctors gonna somehow do a better job with your members than with the rest of their patients? This is even more true if you think about this from a physician or a practice point of view. Will clinical teams in their clinical workflow figure out who your members are, first of all, which is a thing, and then switch up what they choose to do for your members that is special? Even theoretically, that sounds like an executional fandango, which is exacerbated in markets with lots of payers. I guess I am not shocked when I hear stories like Dr. Asher was talking about: Doctor sits down at desk after a long day and sees 27 “Dear Doctor” letters from all of the payers in his or her payer mix. “Hey, Doc. Let me tell you about our amazing new thing.” And Doc's like, “Pajama time awaits.” And—boom!—the letters, unopened, right in the recycle bin. From a payer's standpoint, back to square one, I guess. Now, I will chuck in the mix here—and this has nothing to do with the conversation with Dr. Asher that follows—but one thing I've spent my entire career doing is helping organizations set up programs to collaborate with other organizations. If I authentically solve an actual, authentic, prioritized problem, I usually can find many people who seem pretty pleased to work with me. Now, is this easy to do? No. It takes strategic thinking and executional competence and/or grit to see it through. You really have to understand and account for vested interests and all the weird perverse incentives. Personally, I gotta work with a whole team of others coming at this from all different directions to untie this Gordian knot. But anyone who really wants to or needs to reach across the aisle and engage with other stakeholders or customers, even in any sort of systemic way, it's just not possible to phone it in. Anyway, I just want everyone to succeed in working together. It is impossible to have a longitudinal patient journey if everybody is all up in their own silos fragmenting care.   You can learn more by connecting with Dr. Asher on LinkedIn.   Jacob Asher, MD, completed a residency in otolaryngology–head and neck surgery at the University of California, San Francisco, after receiving degrees from Brown University and the Boston University School of Medicine. Dr. Asher then practiced as an ENT (ear, nose, and throat) surgeon with Kaiser Permanente in Northern California and also served on the board of directors of The Permanente Medical Group, where he focused on physician compensation reform, member satisfaction initiatives, and retirement benefits. After transitioning to full-time health plan management, Dr. Asher served as a California commercial market medical director between 2008 and 2022 for Anthem Blue Cross, Cigna, and UnitedHealthcare. In those roles, he supported membership growth and retention in both fully insured and self-funded product lines and promoted value-based reimbursement, including capitation. He has led utilization management teams, collaborated with internal and external population healthcare advocates, and worked to develop clinical initiatives that sought to achieve the Triple Aim. In his role as the clinical face of the health plan to the local market, he worked with network colleagues on accountable care organization partnerships and hospital and physician contract renewals with integrated pay for performance, supported Obamacare exchange participation, engaged in quality improvement collaboratives, and supported regulatory compliance efforts. Currently, Dr. Asher is serving as a mentor for the Stanford Master in Medical Informatics program while exploring innovative solutions to healthcare delivery.   03:38 Why providers contracted with multiple health plans don't have a financial incentive to do something unique with one payer over another. 04:01 Why it doesn't make sense for providers to offer unique pathways for different payer organizations. 05:23 Why, broadly speaking, standards of care between payer policies aren't really differentiators in clinical practice. 06:47 Why financial incentives might not be aligned to make providers want to standardize their care. 09:16 What improvement has there been in plans making providers more aware of the benefits they offer? 11:47 Why won't providers off-load their pop health?   You can learn more by connecting with Dr. Asher on LinkedIn.   @JacobAsher18 discusses #payers and #providers on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Eric Gallagher (Summer Shorts 4), Dan Serrano, Larry Bauer, Dr Vivek Garg (Summer Shorts 3), Dr Scott Conard (Summer Shorts 2), Brennan Bilberry (Summer Shorts 1), Stacey Richter (INBW38), Scott Haas, Chris Deacon, Dr Vivek Garg  

This week on Sg2 Perspectives, we're talking about clinically integrated networks (CINs) with Sg2 Associate Principal Joseph Maher. Joe discusses how CINs have evolved; their challenges and advantages; and how they can help improve health outcomes, patient experience and costs. We are always excited to get ideas and feedback from our listeners. You can reach us at sg2perspectives@sg2.com, find us on Twitter as @Sg2HealthCare, or visit the Sg2 company page on LinkedIn.

Camille Burnett, PhD, MPA, APHN-BC, BScN, RN, DSW, FAAN, CGNC, Vice President of Health Equity at the Institute of Healthcare Improvement, discusses the Institute's initiatives including the Triple Aim, the 100 million lives and the lastest program, the Rise to Health Coalition and how individuals and institutions can participate in the movement individually or collectively by Barbara Lewis, MBA. 

On this episode, former Governor of Oregon and ER Doctor John Kitzhaber joins Nate to discuss the shortcomings of the medical system in the United States. With health outcomes below average compared to other developed nations and healthcare spending at nearly 20% of GDP, creating medical systems that are less costly while also keeping people healthier is critical to the well-being of the country and its citizens. Dr. Kitzhaber's hands-on experience working in medicine and systemic perspective as a policymaker gives him a unique perspective on healthcare resource allocation, the effectiveness of medicine, and the real world effects of how we incentivize medical care. Can we extend our time horizons by making long-term investments in the most effective preventative care? How do we take care of more people with fewer resources available? Most of all, can we come together to think critically about how we can create a system that prioritizes holistic health, based in community and accessible to everyone? About John Kitzhaber John Kitzhaber has more than 40 years of experience in health care and health policy in both public and private sectors. He practiced as an emergency room physician for 15 years; served 14 years in the Oregon Legislature, and served three terms as Governor of the State of Oregon. Kitzhaber is the author of the groundbreaking Oregon Health Plan, through which hundreds of thousands of low- and moderate-income Oregon families gain access to health care. During his third term as Governor, Kitzhaber was the chief architect of Oregon's Coordinated Care Organizations, the first effort in the country created on a statewide basis to meet the Triple Aim—better health, better quality, lower cost—with a focus on community and population health. To watch this video episode on Youtube: https://youtu.be/Z4cjl77rj78  Show Notes & Links to Learn More: https://www.thegreatsimplification.com/episode/70-john-kitzhaber 

Yeah, so while the commercial payer marketplace is completely boring, the reasons it's boring are not. Let me walk you through this conversation I have in this healthcare podcast with Jacob Asher, MD. First, we establish that the relative number of each carrier's commercial members in California don't seem to change year over year … and this has been true for years. When you rank order carriers by member count, the song remains the same. It's Groundhog Day. Here's a link to the 2022 CHCF (California Health Care Foundation) enrollment almanac, which shows for the large group market, Kaiser has captured and retained just over half of enrollees. Anthem comes in next with 14%, Blue Shield gets 9%, and then bringing up the rear we have UHC, Aetna, Cigna, Centene, and all others in descending order splitting the remaining 21%. Hmmm … intriguing, the whole idea that these relative member counts remain so consistent. Then Dr. Asher and I dissect what is anybody actually doing to cut into the Kaiser market share or try to grab share from the two blues plans, if anything. Dr. Jacob Asher was a great guy to have this conversation with. He was a practicing head and neck surgeon with Kaiser Permanente, and then he also served on the Permanente Medical Group Board of Directors. Then he changed careers and became a full-time health plan chief medical officer for, first, Anthem, then Blue Cross, then Cigna, then UHC (UnitedHealthcare). Now he's “retired” and reflecting back on unsolved and unaddressed issues within healthcare. And we've covered one here: Why is the commercial payer market as boring as it appears to be in California? Now, after I had this conversation with Dr. Asher, I called up Wendell Potter, who everybody already knows (EP384), and Lauren Vela, who everybody also probably already knows, but she has spent her career at various employer coalitions and now works at a big employer transforming their health benefits (and she lives in California). I learned a few things that really helped me frame my thoughts on some of the issues that surfaced in the conversation that I had with Dr. Asher and that you'll hear today. So, let's get to it. Why doesn't the relative market share of the big payers change year over year in California in the commercial space. May I present six reasons: 1. Everybody I talked to—Dr. Asher, Wendell Potter, Lauren Vela—first thing right out of the gate that practically everybody mentioned is employer inertia. Trying to get an employer to switch carriers is like trying to pull Excalibur from its stone. And right, not so surprising, it's disruptive and obnoxious for employees and also benefit teams if carriers are switching all the time. 2. EBCs (employee benefit consultants). They have deals with carriers and others, and they also have a lot of power over employers. Listen to the show with AJ Loiacono (EP379) and Paul Holmes (EP397) for more on this. 3. As Wendell Potter put it, “The commercial market is [as a whole] stagnant. No real growth nationally. And in many states, the real money for carriers is not in the self-funded market; so they don't care much about aggressively competing for market share.” Given that chart that just came out the other day showing the insane relative gross margins that carriers are making on Medicare Advantage patients, which is over double other lines of business … yeah, totally. 4. Just keep this in mind before we barrel into reason #4 here for a stagnant and maybe not exactly competitive market. Kaiser excluded, all of the rest of the California payers have what amounts to largely the same provider network. I'm exaggerating slightly here, but largely the same hospitals, the same consolidated integrated delivery networks. And one thing that's pretty clear (not just in California but across the country): Plans who bring the most members get the best prices from these hospitals and other provider organizations. Also, as Dr. Asher mentions in the show today, he never saw an employer buy on quality. Most were far more concerned about discounts. So, right … we have some circular reasoning here or circular logic. The big plans get the best prices, and then, because they have the best prices, they maintain their market share. But wait … there's more to this one, and it's not just big gets you lower prices. Remember from episode 395 with Brennan Bilberry? He talked about the concept of the Most Favored Nation (MFN) anticompetitive clauses in hospital contracts. This concept is also super relevant here for payers as well if you think about it. This MFN Most Favored Nation anticompetitive clause, this is where a big hospital and “big carrier” have a chat … in a back room. The hospital agrees to not give any other carrier a lower price than the “big carrier.” These MFN clauses are, of course, terrible for competition and plan sponsors and any patient with cost sharing. A lot of states have started to ban, restrict, and limit these clauses. The DOJ brought a case in Michigan about this, and here's a great federal government summary of the problem: “The department and the state of Michigan alleged … that the MFN clauses in [Blue Cross Blue Shield of Michigan's (BCBSM's)] contracts with Michigan hospitals decreased competition among health plans. Some … clauses required hospitals to charge competitors more than the hospitals charged BCBSM, often by a specified percentage. Moreover, BCBSM often agreed to raise the prices that it paid hospitals, in part to obtain [the] MFN clauses.” Oh, hey … I'll let you raise your price so I can have a Most Favored Nation clause, just as long as I get a lower price, which is higher than it was originally. And this was actually back in 2013. I have no insight at all or knowledge, or I am not suggesting in any way that what was going on in Michigan is going on in California. However, this anticompetitive practice is common enough. If you're interested in how common, count the lawsuits. 5. Employers are unaware a lot of times of how they are being charged more than what might be appropriate. And they are largely unaware of options other than Blue Cross, United, Cigna, Aetna … the big payers. 6. As Dr. Asher talks about and which I never really thought about, Kaiser doesn't have Medicaid patients. [Correction: Kaiser does have some Medicaid members—just less than others.] And because their network and hospitals to a large extent are closed, they also don't have uninsured patients to a large extent. So, no charity care to speak of and, therefore (at least as it is posited), they can be cheaper because they don't have to cost offset. So, their price advantage has a structure element here that could make it even more untouchable. So, there's your six reasons. You can start to see basically all of these things solidify into the same thing. It's less about trying to get new business and more about locking in the existing business. It's not really a secret that this market is rock hard. Plans realize that. They realize that the cost of keeping an enrollee is cheaper than acquiring a new enrollee. So, carriers focus sales and marketing efforts on holding on to their existing customers, especially the coveted jumbo accounts. Interestingly (and I was talking about this with Lauren Vela), the more clinical programs a carrier has deployed for an employer, the more the carrier is locked in there. So, the more the clinical value proposition resonates, the more clinical stuff that gets integrated. Changing plans becomes even more disruptive, and employers are even more likely to remain where they are. So, there's more to clinical programs than payers catching themselves a little PMPM (per member per month) something something upcharge recurring revenue or trying to get new business. It's also locking in customer retention. Is any of this specific to California? Some of it is—like a lot of the Kaiser stuff—but most, not. Meaning a lot of the country doesn't exactly have a functioning commercial small group or large group marketplace either. To a certain extent, it's no wonder big employers don't change plans that often. Why would they bother, given probably fairly incremental differences between these big payer carriers? I realize I'm scrambling out on a limb here and making assumptions, but to achieve more than incremental improvements, a BUCA (Blue Cross, United, Cigna, Aetna) would need to invest all kinds of resources into being that shining star. And why would they do that when nobody can take down Kaiser? And for all the reasons that we just talked about, it's a hard row to hoe to grab new clients. There's a lot of ramifications to this, but this show can't be seven hours long.    You can learn more by connecting with Dr. Asher on LinkedIn.   Jacob Asher, MD, completed a residency in otolaryngology–head and neck surgery at the University of California, San Francisco, after receiving degrees from Brown University and the Boston University School of Medicine. Dr. Asher then practiced as an ENT (ear, nose, and throat) surgeon with Kaiser Permanente in Northern California and also served on the board of directors of The Permanente Medical Group, where he focused on physician compensation reform, member satisfaction initiatives, and retirement benefits. After transitioning to full-time health plan management, Dr. Asher served as a California commercial market medical director between 2008 and 2022 for Anthem Blue Cross, Cigna, and UnitedHealthcare. In those roles, he supported membership growth and retention in both fully insured and self-funded product lines and promoted value-based reimbursement, including capitation. He has led utilization management teams, collaborated with internal and external population healthcare advocates, and worked to develop clinical initiatives that sought to achieve the Triple Aim. In his role as the clinical face of the health plan to the local market, he worked with network colleagues on accountable care organization partnerships and hospital and physician contract renewals with integrated pay for performance, supported Obamacare exchange participation, engaged in quality improvement collaboratives, and supported regulatory compliance efforts. Currently, Dr. Asher is serving as a mentor for the Stanford Master in Medical Informatics program while exploring innovative solutions to healthcare delivery.   10:00 What is the competitive picture of California's health plans? 11:28 What was everyone doing in order to get market share? 15:07 EP387 with Betsy Seals. 15:22 EP379 with AJ Loiacono and EP397 with Paul Holmes. 15:26 Why is it difficult to take market share? 16:16 Who was Dr. Asher pitching to and why? 18:49 Did employers ever buy plans for quality? 22:43 What does this look like from the payer perspective? 27:01 What improvements have there been to engagement in health plans? 29:07 Have plans gotten better at communicating with employers? 30:38 Why is it hard to compare the Kaiser world to the non-Kaiser world? 33:00 EP390 with Gloria Sachdev, PharmD, and Chris Skisak, PhD.   You can learn more by connecting with Dr. Asher on LinkedIn.   @JacobAsher18 discusses California's #commercialpayer marketplace on our #healthcarepodcast. #healthcare #podcast Recent past interviews: Click a guest's name for their latest RHV episode! Paul Holmes, Anna Hyde, Dea Belazi (Encore! EP293), Brennan Bilberry, Dr Vikas Saini and Judith Garber, David Muhlestein, Nikhil Krishnan (Encore! EP355), Emily Kagan Trenchard, Dr Scott Conard, Gloria Sachdev and Chris Skisak  

This week, CEO & Founder of Papa Andrew Parker joins the podcast and discusses how his company is empowering a new kind of healthcare built on human connection. Papa, a platform that connects older adults with Pals who provide companionship and assistance, seeks to address the caregiving shortage and support the US healthcare system's Triple Aim.

Dr. Silver's research has demonstrated a disconnect with women disproportionately conducting and disseminating pay equity research and men in leadership positions making most of the compensation decisions. Furthermore, it is misguided to think that achieving pay equity alone is enough when in fact this is necessary but not sufficient, because we must simultaneously ensure promotion equity as well as a psychologically safe workplace that supports wellness—accomplishing these 3 things at once is similar to the “Triple Aim” in valued based clinical care.

HFS Research and Genpact collaborated on a unique study to learn about care management opportunities and explore the commercial viability of social determinants of health. The study included 100 US health plan CXOs and 250 CXOs are US-based self-insured employers. In this videocast, we discuss: Care management insights from the study pose an opportunity for both health plans and self-insured employers Critical insights on how health plans and employers think about social determinants of health and what they plan on doing about it The opportunities for service providers to partner with employers and health plans to help them take care management and social determinants of health to the next level You can read the related POVs here: Employers are steps away from helping expand social determinants of health Enhanced data analytics must power health plan SDoH and care management solutions

Zorgverzekeraars houden zich voornamelijk bezig met zorg en ziekte. Hoe kun je dan binnen zo'n organisatie ruimte maken om een gezonde leefstijl of een betere buurt te bevorderen? En wat moet een transitiemaker met een titel als manager regioregie? Transities zijn toch overal?In deze derde aflevering van seizoen twee reist Wouter samen met oude bekende Igno af naar Sittard om te praten met Wiro Gruisen, die al lange tijd bij zorgverzekeraar CZ werkt aan de transitie naar positieve gezondheid. Hij pleit voor een brede blik op wat gezondheidszorg is. Niet alleen focussen op zorg en ziekte, maar ook aandacht voor gezondheid en levensgeluk.Daarover filosoferen is een ding, maar Wiro kan ook goed uitleggen wat er allemaal bij komt kijken als je dat in de praktijk wil gaan brengen. Weerstand overwinnen, bijvoorbeeld. Of dat je verder moet kijken dan de realiteit van marktwerking en met onverwachte partners en concurrenten om tafel wil komen. En hoe je regionaal samenwerkt met huisartsen, ziekenhuizen en thuiszorg, terwijl dat op landelijk niveau lastig kan zijn. --- Handige linkjes:Artikel over 'Triple aim': https://www.healthaffairs.org/doi/10.1377/hlthaff.27.3.759Korte flyer regioregie: https://www.cz.nl/-/media/zorgaanbieder/documenten/regioregie-digitale-snackversie.pdfWebsite van Pluspraktijken: https://www.mijnlevengezond.nl/initiatieven/pluspraktijkenAls jij ook aan de slag wilt met transities, of er gewoon meer over wilt weten, ga dan naar drift.eur.nlMet dank aan: Maria Fraaije voor voice-over, Marius Kooy voor montage, Igno Notermans voor ontwikkeling, Walvisnest voor muziek, Lieven Heeremans voor allerhande adviezen, en alle collega's van DRIFT voor steun & inspiratie.

I wanted to resurface this episode because when it originally aired over a year ago, the topic may have been ever so slightly ahead of its time. Look, here we are right now with everybody trying to do three big things relative to measuring PCP (primary care provider) performance: Come up with a fair measure for PCP performance. Account for diverse populations with diverse risks so that some docs don't get dinged because their patient populations have lots of comorbidities or behavioral health challenges or live in food deserts, or any one of the other social determinants of health. Not make measuring performance a total procedural nightmare. Right? We want fair measures, we want to account for equity issues essentially, and we want this whole measurement fandango to be as easy as possible. Enter Rebecca Etz, PhD, and The Larry A. Green Center with a really well-validated “instrument,” as she calls it, to measure primary care performance. I can think of more than one PCP frankly right off the top of my head who would be thrilled to be measured using this methodology. Even more so because it's one thing that's simple and not a jumble of numerators with various mix-and-match denominators. PCPs are really important to population health. Primary care is the foundation of any well-functioning health system, I am sure many listening to this podcast know well. For the Triple Aim to happen, patients really need access to robust primary care. This has been affirmed by almost anyone who looks into it. And yet, in this country, our system sort of anemically supports our primary care colleagues. As a general statement, poking and prodding and procedures are compensated at a far higher rate than anything requiring cognitive services. What a PCP or a pediatrician mainly does all day is really cognitive. It's listening and thinking and counseling and coordinating. But here is maybe an underappreciated point: If we're going to measure PCP performance, then we need the right measures to measure that performance. You might be doing this measurement as a basis for incentives or maybe for continuous improvement programs. Either way, if you don't have the right measures, then maybe great primary care is under-rewarded or your continuous improvement process is counterproductive—you're incenting the wrong things, you get the wrong activity. And to add to that, PCPs (ie, practices) can spend upwards of $40,000 a year of uncompensated time trying to add and subtract and tote up the difference in all these varied and potentially inapplicable measurement standards coming at them from all manner of directions. My guest in this healthcare podcast is Rebecca Etz, PhD. Dr. Etz and the team over at The Larry A. Green Center have worked hard to create a set of 11 performance measures for primary care. These measures went through the wringer as far as their creation and validation. These 11 measures take into account what patients want, what primary care clinicians (including pediatricians, nurse practitioners, and others) think is most important and possible to provide, and what payers want to pay for. These 11 measures are aligned across the three stakeholders, and they are actionable. Rebecca Etz, PhD, is associate professor of family medicine and codirector of The Larry A. Green Center, which is in Richmond, Virginia, at the Virginia Commonwealth University. You can learn more at green-center.org.   Rebecca S. Etz, PhD, is an associate professor of family medicine and population health at Virginia Commonwealth University (VCU) and codirector of The Larry A. Green Center—Advancing Primary Health Care for the Public Good. Dr. Etz has deep expertise in qualitative research methods and design, primary care measures, practice transformation, and engaging stakeholders. Her career has been dedicated to learning the heart and soul of primary care through three main lines of inquiry: (1) bridging the gap between the business of medicine and the lived experience of the human condition, (2) making visible the principles and mechanisms upon which the unique strength of primary care is based, and (3) exposing the unintended, often damaging consequences of policy and transformation efforts applied to primary care but not informed by primary care concepts. As a member of the VCU Department of Family Medicine and Population Health and previous codirector of the ACORN practice-based research network, Dr. Etz has been the principal investigator of several federal and foundation grants, contracts, and pilots, all directed toward making the pursuit of health a humane experience. Recent research activities have included studies in primary care measures, behavioral health, simulation modeling, care team models, and adaptive use of health technologies. Dr. Etz currently leads the fielding of a weekly survey regarding the response to and impact of COVID-19 on US primary care practices. She also serves on the National Academies of Medicine consensus study, “Implementing High-Quality Primary Care.” 04:58 Why is primary care one of the “best-kept secrets” of better health outcomes? 09:45 “Measures are a form of communication.” 09:58 “If the way that you are assessed does not actually match up with the work you do or what you find to be important, it's pretty demoralizing.” 12:48 “It is the outcome of healthcare, but it is not the same thing as quality.” 17:18 “It creates a financial incentive to hit a target by any means necessary.” 18:53 “We incentivize people to have good outcomes, and what that means is that electronic medical records are no longer simply databases that tell us what the health of the population is. They are databases that tell us what is the optimal picture that a clinician is able to paint of their patients.” 21:54 “Primary care is a relational field.” 23:02 “How does this relate to cost and utilization?” 27:45 How has the measure of PCPs in the time of COVID held up? 28:03 What measure performs worse in the time of COVID? 29:59 EP270 with Dave Chase and EP272 with Guy Culpepper, MD.  You can learn more at green-center.org.   Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week's #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp “Measures are a form of communication.” Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week's #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp “If the way that you are assessed does not actually match up with the work you do or what you find to be important, it's pretty demoralizing.” Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week's #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp “It is the outcome of healthcare, but it is not the same thing as quality.” Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week's #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp “It creates a financial incentive to hit a target by any means necessary.” Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week's #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp “Primary care is a relational field.” Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week's #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp How has the measure of PCPs in the time of COVID held up? Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week's #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp   Recent past interviews: Click a guest's name for their latest RHV episode! Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O'Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes  

Brian has a unique career background, building his foundation in the retail sector before diving deep into the world of healthcare at Banner Health. His foundation offers a fresh perspective on the retail consumer side of the industry. Brian and Dan enthusiastically discuss new and unexpected retailers that are entering the healthcare market and how this can change the game for the patient experience including what services can be offered, how the services are consumed, how they can integrate with their current products/services, and how retailers can benefit by expanding into new markets. Brian is confident that this is the most exciting time to be in the healthcare retail space as the near future promises great innovation.0:57 – Brian's Role at Banner Health1:45 – An Untraditional Path to Healthcare3:36 – Retail as an Advantage5:46 – The Triple AIM7:47 – Transitioning Away From "Patient"10:11 – Big News for Amazon!12:43 – Are Big Retailers a Threat?14:47 – A New Type of Urgent Care18:23 – Dollar General as a Healthcare Provider24:40 – "Rightsizing" Business27:16 – Looking Into the Crystal Ball

Featuring articles on supplemental vitamin D and incident fractures, brentuximab vedotin in advanced Hodgkin's lymphoma, litifilimab for cutaneous lupus erythematosus, genetic protection against liver disease, and on lawmakers v. the scientific realities of human reproduction; a review article on tobacco addiction; a case report of a man with hypoglycemia; and Perspective articles on the history of health law in the United States, on primary care and financial risk, and on achieving the Triple Aim for sexual and gender minorities.

The American Academy of Pediatrics defines culturally sensitive care as “the delivery of care within the context of appropriate physician knowledge, understanding, and appreciation of all cultural distinctions leading to optimal health outcomes.”  In addition, providing culturally safe and sensitive care enhances patient-centered care which is one of the 6 aims of quality as defined by the Institute of Medicine and a part of the Triple Aim for populations as defined by the Institute for Health Improvement.  Today, we are going to hear from the authors of a review article that identified culturally sensitive interventions in pediatric primary care settings.  It was published in the February 2022 issue of Pediatrics. Today, I am happy to be speaking with Dr. Maya Ragavan and Dr. John, JC, Cowden. Maya is an Assistant Professor of Pediatrics at the University of Pittsburgh and UPMC Children's Hospital of Pittsburgh. Maya is also a Community Partnered Researcher, and a general Pediatrician. JC is Professor of Pediatrics, a qualified bilingual primary care pediatrician, the Culture and Language Coaching Program Director and the Health Equity Integration Project Leader at Children's Mercy Kansas City.

AHRMM presents a four-part series on successful collaboration with suppliers. In part one, Mike Schiller, director of supply chain at AHRMM, discusses AHRMM's CQO Movement and IHI's Triple Aim and how they are affecting the health care supply chain today. As primary care shifts its focus to prevention, suppliers need to partner with providers to provide best practices and tools for prevention and health promotion.

Summer Knight, MD, MBA, a former firefighter/paramedic-turned primary care and emergency room doctor, is a Managing Director in Deloitte Consulting's Life Sciences & Health Care practice.  She is a passionate advocate for humanizing healthcare, an innovative leader in digital and virtual health, and a pragmatic futurist who helps clients act upon today's rapid changes in healthcare.Dr. Knight maintains an active physician license, is board certified in family medicine and was Chief of Staff of a 4-hospital healthcare system and Emergency and Urgent Care Department Chair. She is an accomplished leader having held key executive positions in F100 Plan, Digital Health, Provider, Government and Private Equity.  She also has academic credentials having been an adjunct Professor and Executive-in-Residence for Healthcare at the Fox School of Business at Temple University. Her perspective on healthcare is informed not only by her professional experience, but also by her role as a patient and sandwich generation caregiver. John Marchica, CEO, Darwin Research GroupJohn Marchica is a veteran health care strategist and CEO of Darwin Research Group. He is leading ongoing, in-depth research initiatives on integrated health systems, accountable care organizations, and value-based care models. He is a faculty associate in the W.P. Carey School of Business and the graduate College of Health Solutions at Arizona State University.John did his undergraduate work in economics at Knox College, has an MBA and M.A. in public policy from the University of Chicago, and completed his Ph.D. coursework at The Dartmouth Institute. He is an active member of the American College of Healthcare Executives and is pursuing certification as a Fellow. About Darwin Research GroupDarwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin's client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.

Discussion of the Health and Care Bill across the NHS tends to focus on the structural changes it will bring. This is of course understandable given the focus on delivery of the backlog and concerns about the impact of any reorganisation. However, in the long run, it is the statutory Triple Aim which has the greatest potential to change how the NHS works for the benefit of patients, staff and communities.

Health systems and laboratory diagnostics leaders are exploring new strategies and solutions to help enhance patient and population health and to deliver value to their organizations.   In this episode, Dr Pat Alagia and Mike Lukas discuss:  The clinical, operational, and business complexities health systems currently face  How strong laboratory partnerships can create sustainable healthcare delivery organizations   Important attributes of a strong partnership between laboratory diagnostics companies and health systems, and what these entities should expect from each other   About our guest Mike Lukas is the vice president and general manager for Health Systems at Quest Diagnostics, the nation's leader in the rapidly evolving diagnostic information services market.  In his current role, Mike oversees a team of professionals who design, contract, and execute lab services agreements across the country within the hospital segment. He has led this effort since it launched in 2013. Mike joined Quest Diagnostics in 2007 as vice president of finance. Prior to coming to Quest Diagnostics, Mike was at General Motors for 17 years, where he held a wide range of progressively expanding responsibilities including assistant treasurer, treasurer of GM's European Operations, director of business development, and manager of investor relations.   Mike graduated from the University of Notre Dame with an MBA in finance and Saint Meinrad College with a BA in history. Mike makes his home in northern New Jersey with his wife and 3 children. ------------------------------ Quest Diagnostics empowers people to take action to improve health outcomes. Derived from the world's largest database of clinical lab results, our diagnostic insights reveal new avenues to identify and treat disease, inspire healthy behaviors, and improve healthcare management. Quest Diagnostics annually serves 1 in 3 adult Americans and half the physicians and hospitals in the United States, and our 47,000 employees understand that, in the right hands and with the right context, our diagnostic insights can inspire actions that transform lives. More information is available at www.QuestDiagnostics.com   mXKdU7fWxMrbmHFnDyM2  

EMS brings innovation, nimbleness and much-needed value to the healthcare community with MIH/CP programs of various shapes and sizes.  So how can EMS organizations best prepare community paramedics for this expanded role? Rob and Hilary interview two originators of successful MIH/CP programs: Anne Jensen of San Diego FR and Adam Heinz of REMSA (Reno, NV).  Our discussion explores training, partnerships, resource management, funding, the Triple Aim, time scales, SDOH, and how to start up.  Because CPs "don't do easy." Reach Anne at ajensen@sandiego.gov and Adam at aheinz@remsa-cf.com This podcast is sponsored by EMS Gives Life.  Would you consider becoming a living organ donor? Visit emsgiveslife.org for more info. Get your CE at www.prodigyems.com.  Follow @ProdigyEMS on Twitter, FB, YouTube & IG.

TakeawaysTechnological Innovation Meets Reality Patient volume has increased exponentially since the 80s, making time the most significant commodity for health systems and physicians.With narrow margins, health systems cannot sacrifice patient volume and therefore must find ways to operate more efficiently.Technology is often developed independently from the clinical user experience, resulting in inefficiencies that defeat the purpose of the technology.Electronic medical records (EMRs) can add value to health systems. However, if developed without the patient and clinician experience in mind, EMRs can become too cumbersome for patient and clinician needs.Tales from the "dark side" Examples of what goes wrong when innovators don't understand clinical needs:  Carolyn gave the example of EMR prescription entries. With a pen and paper, it would typically take 30 seconds. But with numerous fields and seemingly infinite options, writing scripts has become time-consuming.More input options are not necessarily better, as too many choices can become overwhelming. A clinical perspective could help developers prioritize EMR fields.The patient's user experience is often missed in technology development because their convenience isn't always factored into development decisions.For example, Chris worked with a health system that was implementing a new EMR. The marketing team was brought into the project after the developers had created multiple logins for patients across different units (hospital, urgent care, primary care clinics). Had the patient experience been considered, only one login would be necessary.Technology done right Before EMRs, patients communicated with providers via fax and received responses through the mail. This process didn't allow clinicians to confirm that patients had received their messages.New EMR technology allowed Carolyn to close the communication loop by notifying her when the patient had received her communications.Machine learning for prescriptions is another example of a positive technology-to-clinical experience in which the technology made recommendations based on past prescriptions.Improving the patient experienceClinicians know that listening is crucial, but listening becomes challenging with limited time due to significant data entry requirements.Facilitating clinician workflows results in more time with patients to listen and understand their problems. More time with the patient leads to better connections, better diagnoses, and more referrals.Historically health systems have focused on the "Triple Aim" – population health, patient experience, and resource stewardship. Now, Carolyn believes it should be the "Quadruple Aim," adding clinician experience as a pillar of focus.

How will the Four Forces shaping healthcare affect your sales and marketing strategies and tactics?  Do you know how these forces align with the “Triple Aim”?  Mark Dixon once led one of the largest healthcare systems in the US.  Now he is a consultant for both healthcare systems and some of the largest life science companies in the world.  From this unique vantage point, Mark walks us through the Four Forces and their potential impact on vendors/suppliers.  This is particularly important for small to medium sized medtech companies that traditionally don't view the healthcare ecosystem as strategically as the large medtech companies.  This is also very important for Non US companies trying to better understand the US healthcare market.Near the end of the podcast, we talk about what this means about the way startups design the clinical studies they will use for FDA clearance or approval.  The links below include a number of publications that will help you keep your finger on the pulse of healthcare in the United States. Last week, after the podcast on prospecting, a number of listeners requested examples of embedded videos and the slide deck.  It was fun interacting with you. Now Go Win Your Week!! Mark Dixon LinkedIn Link Mark does not have a website.  He doesn't need one. If you need his email address or phone, contact me. Publications and groups recommended by Mark: Becker Hospital Review - https://www.beckershospitalreview.com (Newsletter is free)Advisory Board - https://www.advisory.com  (requires paid membership)Dail-enews - http://dailenews.mdsi.org (free)Association of National Account Executives (ANAE) - https://www.nationalaccountexecutives.com (newsletter is free) Ted Newill's LinkedIn Profile link Medical Device Success website link MedTech Leaders Community link Link to Ted's contact page  

This is a special two-part Grand Rounds series with Dr. Steven Flanagan, Professor and Chairman of Rehabilitation Medicine and Medical Director of Rusk Rehabilitation.  In Part 1 of his presentation, Dr. Flanagan discusses the contributions of Dr. Howard Rusk, the father of rehabilitation medicine. He brought it to the forefront as a recognized specialty by showing that rehabilitation contributed to improving the lives of patients with disabilities. Dr. Flanagan referred to various efforts over the decades to manage health care costs through managed care and other means. Even today when it is evident that a inpatient care is necessary, barriers can offer resistance because of the costs involved. What makes the case of inpatient care more challenging is the need to have more data to justify the decision to provide care at that level. He predicts that cost containment will continue well into the future. Our aims are to improve health care outcomes and increase efficiency. He concluded Part 1 of his presentation by stating that PM&R has a critical role to play in attaining the Triple Aim. In Part 2 of his presentation, Dr. Flanagan discusses challenges involved in justifying the need for the provision of inpatient rehabilitation care in the context of controlling expenditures and the critical role that physical medicine and rehabilitation play in attaining the Triple Aim. We know that the intensity of some of our rehabilitation therapies are associated with better outcomes, for example, aphasia therapy. Early mobilization results in better outcomes with cost savings. Nonetheless, we still need more data to show that what we do is important. Mention was made of expansions at Rusk, such as a new division on Technology and Innovation to advance rehabilitation science. Health care is changing and education must change with it.  

This is a special two-part Grand Rounds series with Dr. Steven Flanagan, Professor and Chairman of Rehabilitation Medicine and Medical Director of Rusk Rehabilitation.  In Part 1 of his presentation, Dr. Flanagan discusses the contributions of Dr. Howard Rusk, the father of rehabilitation medicine. He brought it to the forefront as a recognized specialty by showing that rehabilitation contributed to improving the lives of patients with disabilities. Dr. Flanagan referred to various efforts over the decades to manage health care costs through managed care and other means. Even today when it is evident that a inpatient care is necessary, barriers can offer resistance because of the costs involved. What makes the case of inpatient care more challenging is the need to have more data to justify the decision to provide care at that level. He predicts that cost containment will continue well into the future. Our aims are to improve health care outcomes and increase efficiency. He concluded Part 1 of his presentation by stating that PM&R has a critical role to play in attaining the Triple Aim. In Part 2 of his presentation, Dr. Flanagan discusses challenges involved in justifying the need for the provision of inpatient rehabilitation care in the context of controlling expenditures and the critical role that physical medicine and rehabilitation play in attaining the Triple Aim. We know that the intensity of some of our rehabilitation therapies are associated with better outcomes, for example, aphasia therapy. Early mobilization results in better outcomes with cost savings. Nonetheless, we still need more data to show that what we do is important. Mention was made of expansions at Rusk, such as a new division on Technology and Innovation to advance rehabilitation science. Health care is changing and education must change with it.

Have you never heard of the Nuka System of Care? If that’s the case, it is an award-winning and really remarkable health system in Alaska. In this 5-minute “An Expert Explains,” Dr. Douglas Eby, medical director over at Nuka, gets directly to the point. A key component to making sure that the people/customers in your plan get the best care is to make sure that they have access to a team of providers who know them well enough to have earned their patient consumers’ trust. Both the trust and the access part of that last sentence are important. Both are needed in spades to reduce downstream costs. The access part might be a little counterintuitive and has a disclaimer or two that Dr. Eby articulates. But, yup, when you restrict access, what winds up happening is that people demand more when they finally get seen. They want their money’s worth, so to speak, and will nab any lab diagnostic or expensive follow-up they can get while they’re there, since they may never have the opportunity or the money or the time to arrange being seen again—or at least how it might feel to them at the time. Circling around to trust, listening to Dr. Eby talk, it makes me even more frustrated by providers who regard shared decision making endeavors or building trust with patients as a waste of time unless they’re getting paid for it directly somehow. If a patient isn’t going to do anything you tell them to do because they don’t trust you, and if they have to do what you tell them to do to get the outcomes that they probably should be getting, then it’s a bigger contemplation for providers and provider organizations than whether there’s a billing code for that—for provider organizations trying to create the best patient outcomes for their patients, that is. If you’re an employer and you recognize the criticality of access and trust, select your network accordingly would be my advice. Douglas Eby, MD, MPH, CPE, is the physician executive/VP of medical services at the Southcentral Foundation Nuka System of Care. This “An Expert Explains” sums up Dr. Eby’s advice for employers, but if you haven’t listened to it yet, when you’re done with this “mini-sode,” you might want to go back to the main episode I just did with Dr. Eby that gets into the how to provide effective health care from the provider organization clinician and kind of community standpoint.  You can learn more at southcentralfoundation.com. Douglas K. Eby, MD, MPH, CPE, is vice president of medical services for Southcentral Foundation’s Malcolm Baldrige Award–winning Nuka System of Care. Doug is a physician executive who has done extensive work with the Institute for Healthcare Improvement and other organizations around the Triple Aim, accountable care organizations (ACOs), patient-centered medical homes, whole system transformation, workforce, cultural competency, health disparities, and other topics. His speaking and consulting include work across the US, Canada, and portions of Europe and the South Pacific. Doug has spent more than 20 years working in support of Alaska Native leadership as they created a very innovative integrated system of care that has significantly improved health outcomes. Doug received his medical degree from the University of Cincinnati in Ohio and his master’s in public health degree from the University of Hawaii. 03:19 “The employer is the total-cost provider.” 03:23 “The people who don’t like us are people who are trying to make profits … extremely high use of high-end medicine.” 03:47 “Health care, for chronic disease management, should be provided when, where, and how the person on the receiving side wants and needs it.” 07:05 “People think demand is driven by … paranoia … but when you replace all of that by trust … that’s a massive replacement for all of that other stuff.” You can learn more at southcentralfoundation.com. @deby59 of @SCFinsider discusses #selfinsuredemployers on our #AEE #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth “The employer is the total-cost provider.” @deby59 of @SCFinsider discusses #selfinsuredemployers on our #AEE #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth “The people who don’t like us are people who are trying to make profits … extremely high use of high-end medicine.” @deby59 of @SCFinsider discusses #selfinsuredemployers on our #AEE #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth “Health care, for chronic disease management, should be provided when, where, and how the person on the receiving side wants and needs it.” @deby59 of @SCFinsider discusses #selfinsuredemployers on our #AEE #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth “People think demand is driven by … paranoia … but when you replace all of that by trust … that’s a massive replacement for all of that other stuff.” @deby59 of @SCFinsider discusses #selfinsuredemployers on our #AEE #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth

This episode is a master class in raising health outcomes at lower costs from an award-winning health care system in … Alaska?! Who knew? In fact, I learned about the work of the Southcentral Foundation and the Nuka System of Care only because I happen to listen to Swedish health care podcasts and heard about them on one of those shows. Color me surprised when the interview suddenly switched to English and the guest was from Alaska. Here’s the short version of what’s happening with the Nuka System of Care, which serves Alaska Native and American Indian people. They have gone as close to the Triple Aim as I’ve seen in this country. Health outcomes are superior at costs about half the average. Patients—or, as they call them, customer owners—are happy. So are clinicians. How this was achieved (spoiler alert here) was not through incrementally trying to jigger the earlier and pretty much failing model of health care delivery that had been going on in Alaska for Alaska Natives at that time. No can do! The Nuka System of Care was rebuilt pretty much from the ground up to be, for reals, patient- and community-centric and to be relationship based, not transactional. Behavioral health is a built-in, not dangling off the back bumper. It’s also about assembling a multidisciplinary primary care team, one in which each clinician on the team really can work at the top level of their license. In this health care podcast, I had the honor and pleasure of speaking with Douglas Eby, MD, MPH, CPE. Dr. Eby is the physician executive/vice president of medical services, Southcentral Foundation Nuka System of Care. This episode is sort of two parts. There is the main episode, which you’re listening to now, that gets into the how to provide effective health care from the provider organization, clinician, and community standpoint. In a few days, we’ll release “An Expert Explains” episode, where Dr. Eby specifically goes over the lessons a self-insured employer might take away from all of this. If you are intrigued by what you hear in this episode, Dr. Eby will also be speaking on July 14, 2021, at the Aspirational Healthcare Conference, which will be virtual. Go to aspirationalhealthcare.com for more info. Yours truly will be there as well on July 15, and I’m very much looking forward to it.  For those of you into more immediate gratification, some of the themes that Dr. Eby covers in this health care podcast are expanded on in my interview with Greg Makoul (EP203) about listening to patients and Darrell Moon, who is the founder of the Aspirational Healthcare Conference. You can hear in EP305 talking about the 1% year over year most expensive claimants and the best way to help them and help your cost management at the same time.  You can learn more at southcentralfoundation.com. Douglas K. Eby, MD, MPH, CPE, is vice president of medical services for Southcentral Foundation’s Malcolm Baldrige Award–winning Nuka System of Care. Doug is a physician executive who has done extensive work with the Institute for Healthcare Improvement and other organizations around the Triple Aim, accountable care organizations (ACOs), patient-centered medical homes, whole system transformation, workforce, cultural competency, health disparities, and other topics. His speaking and consulting include work across the US, Canada, and portions of Europe and the South Pacific. Doug has spent more than 20 years working in support of Alaska Native leadership as they created a very innovative integrated system of care that has significantly improved health outcomes. Doug received his medical degree from the University of Cincinnati in Ohio and his master’s in public health degree from the University of Hawaii. 03:52 What’s the what and where of the Nuka System of Care? 04:49 What does the word Nuka mean? 05:25 “It’s all built around this idea that we’re raising … the ability for people to take control of their own health issues, and then we are just advisors … on that journey.” 06:39 “The reason why people do pay attention to us is … the proof in the pudding.” 09:09 What did the Southcentral Foundation do to create an ideal health system? 11:09 “It’s access, it’s relationship, it’s partnering, it’s being known … it’s getting at the whole family and the whole person.” 12:02 “There’s two huge problems with modern medicine all across the world. One is how money is handled … [and the other] is this blind acceptance of the medical model.” 14:14 “For 20 years, we’ve established a base of companionship and relationship.” 16:06 What does advanced primary care look like? 19:25 How does this new style of chronic management work, and why does it get better results than Centers of Excellence and other health system models? 23:25 “We refer out to specialists 65% less often than we used to.” 24:17 “It’s a ballet; it’s continual … all day, every day.” 25:33 How big are the patient panels in this system? 28:49 “I would say that 95% of what we do here is directly translatable to any location in the world.” 29:20 “Your workforce needs to look and feel like the community you’re trying to influence.” 32:12 “This is all designed and driven by the community that I am hired to support.” You can learn more at southcentralfoundation.com. @deby59 of @SCFinsider discusses #populationhealth on our #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth What’s the “what” and “where” of the Nuka System of Care? @deby59 of @SCFinsider discusses #populationhealth on our #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth “It’s all built around this idea that we’re raising … the ability for people to take control of their own health issues, and then we are just advisors … on that journey.” @deby59 of @SCFinsider discusses #populationhealth on our #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth “The reason why people do pay attention to us is … the proof in the pudding.” @deby59 of @SCFinsider discusses #populationhealth on our #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth What did the Southcentral Foundation do to create an ideal health system? @deby59 of @SCFinsider discusses #populationhealth on our #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth “There’s two huge problems with modern medicine all across the world. One is how money is handled … [and the other] is this blind acceptance of the medical model.” @deby59 of @SCFinsider discusses #populationhealth on our #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth “For 20 years, we’ve established a base of companionship and relationship.” @deby59 of @SCFinsider discusses #populationhealth on our #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth What does advanced primary care look like? @deby59 of @SCFinsider discusses #populationhealth on our #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth “We refer out to specialists 65% less often than we used to.” @deby59 of @SCFinsider discusses #populationhealth on our #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth “It’s a ballet; it’s continual … all day, every day.” @deby59 of @SCFinsider discusses #populationhealth on our #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth “Your workforce needs to look and feel like the community you’re trying to influence.” @deby59 of @SCFinsider discusses #populationhealth on our #healthcarepodcast. #healthcare #podcast #pophealth #digitalhealth

Our health care industry excels at rescue care – when a patient needs to be saved, our system has answers. However, we are not well suited to address the challenges associated with serious illness, death and dying. Evidence shows that palliative care and advanced care planning improve health value. These tools lead to better management of pain and symptoms and improve both the quality and length of life. The preferences of patients and their families and caregivers are better accounted for, and their satisfaction is much higher. Healthcare utilization is reduced and outcomes are improved. ACOs that have successfully implemented a palliative care program have demonstrated reductions in 30-day readmissions, avoidable hospital admissions, and ED visits. So why do only 10% of ACOs have palliative care as one of their foremost strategies? Our guest this week is Stephen J. Bekanich, M.D., the co-founder and Chief Medical Officer of Iris Healthcare, a disease-specific advance care planning service. Prior to this he served as the CEO of Ascension Health's Texas ACO (with 2,500 physicians and shared savings across government and commercial contracts), as well as the Chief Medical Officer of the health insurance joint venture between Cigna and Ascension Health. Before moving to Austin, he held the rank of Associate Professor of Medicine at the University of Miami Miller School of Medicine and the University of Utah's Medical Center where he started and directed their palliative medicine programs. Episode Bookmarks:  05:00 A journey in health value that is heartfelt and deeply personal, as it is associated with a personal tragedy 06:45 The loss of grandparents to serious illness and the call to change medical specialization to palliative care 07:21 “The era of antibiotics and airbags” – people no longer dying from infections and trauma like they did historically 08:10 Serious illnesses (COPD, Dementia, late stage malignancies, CHF, etc.) have become the new killer in an evolved society 08:31 Society is not prepared to deal with serious illness and the inevitability of death 10:30 “It is incumbent upon us to get people better prepared for what they will be facing. Almost 85% of us will face serious illness, yet healthcare literacy skills are so low. Something is clearly wrong.” 11:00 Research showing 70-80% of people with incurable cancer believing they will be cured is a failure of physicians to appropriately set expectations. 12:30 Stephen's shares the personal story of his grandmother's terminal illness and the difficulty of confronting death 14:00 Palliative care as a force for value and the appointment of a palliative care expert to lead CMMI (Brad Smith) 15:00 “Over the past five to ten years, a number of studies have repeatedly demonstrated how advanced illness programs can consistently provide high patient and family satisfaction, reduce hospitalization by nearly 50%, and decrease costs in the last year of life by 20% to 25%.” (Brad Smith) 16:00 Algorithms in population health incorrectly focus on last 6-12 months of life instead of providing a pathway to earlier intervention with Advanced Care Planning (ACP) 17:20 “In the last year of life, we are often delivering care that is unwanted, unnecessary, or nonbeneficial. That is not a good experience for patients and their loved ones.” 17:45 Patients with high symptom burden and in distress cannot focus in discussions about setting goals in care. 19:00 A calm environment prior to serious illness onset results in a better ACP conversation (better for patients). 19:30 Nonbeneficial care starts to occur in the last 12-15 months of life as a second reason to move interventions upstream (better for ACO bottom line) 20:20 Treatment plans should occur only after a patient is educated 22:35 “So much of palliative care is Advanced Care Planning.” (>70% of palliative care consults related to goals of care and ACP)

An industry inflection point is coming in the transition to value: federal and state governments are feeling an insurmountable level of pressure as public debt and spending increase, large employers are reeling from high healthcare costs, and provider organizations are being crushed by the current environment as they realize that FFS is perilous in the middle of a pandemic. Health system executives not leading with a strategy in health value are increasingly facing significant financial uncertainty. The coming industry shift to value is all but inevitable, however, pivoting successfully will require long-term strategic planning and investment in cultural alignment, technology and infrastructure, and partnerships. When Travis Turner heard Dr. Don Berwick speak about the transformation to population health and value-based payments, he listened. Berwick had said the worst position to be in when transitioning from fee-for-service is static, stuck with a foot in each canoe – the change must be fast to achieve critical mass that enables modifying provider behavior. This became a priority for Travis, something that has been aggressively pursued and which has driven to his organization's success. This week, we speak with Travis Turner, SVP Chief Population Health Officer and COO of Mary Washington Medicare Advantage at Mary Washington Healthcare. Mary Washington Health Alliance is a physician-led, physician governed CIN – founded in 2013, the ACO has 437 participants that cover around 60,000 lives. During the 2017 MSSP performance year, the ACO achieved $11.9 million in savings. For the first three years it participated in the CMS Bundled Payment for Care Improvement program, it achieved $12.6 million in savings. The ACO now participates in the Next Generation ACO model and is active in the BPCI Track 2 for all 48 episodes of care. Episode Bookmarks: 3:30 The inflection point in value-based care for employers, providers, and government 4:40 The value-based care journey of Mary Washington Health Alliance (MWHA) over the last 7 years 6:15 Transitioning from the upside-only MSSP to taking institutional risk in the NextGen ACO and BPCI programs 7:25 Entering downside risk by applying lessons learned from other value-based contracts 7:40 Reaching a critical mass in value to change the behavior of providers 8:00 Don Berwick's influence on MWHA's fast transition to value 10:00 “There has to be a bottom-up, top-down acceptance at every level for population health to succeed in a value-driven organization.” 10:30 Travis reflects on the slow uptake of value-based care in the national landscape and how learning environments will catalyze adoption 11:10 VBC is key to partnering with independent physicians 11:30 “Reaching critical mass in value is all about achieving the Triple Aim. That will overcome any perceived risks of demand destruction.” 12:15 The challenges of adapting to CMS changes to payment models 13:30 NEJM on care patterns in Medicare and the challenges of fragmented, uncoordinated care 14:30 “A true, clinically integrated network will be able to drive enterprise-level change with data.” 15:30 The challenges in siloed initiatives like Oncology Care Model and ESRD Treatment Choices Model in driving system change 16:00 Democratization of data with FHIR-based technologies and how that will improve population health analytics 16:45 Success in clinical integration means treating all patients the same (even those that are not attributed to value-based contracts) 19:15 Taking advantage of clinical integration by entering into single-signature commercial agreements 19:45 Stark and Anti-Kickback concerns associated with clinically integrated networks 20:15 The win-win-win advantages of employer and health system partnerships 20:45 Single negotiated rate advantages with clinical integration 22:25 How FFS can co-exist with VBC in reaching critical mass in value

Interview with Donald Berwick, MD, author of The Triple Aim Applied to Correctional Health Systems

In this health care podcast, I speak with Steve Blumberg, VP of practice transformation for GuideWell Health, a subsidiary of GuideWell. How’s this for an interesting career trajectory? Steve spent the last decade working on population health and value-based care delivery ... on the provider side. Recently, he transferred over to the payer side, working for GuideWell Health, which is the health services arm of GuideWell, which is part of a family of companies including Florida Blue. So, a payer, in other words. I wanted to find out a bunch of things from Steve, but the main one is this: How do—if they, in fact, do—payviders improve care for patients? Or what does it take for an organizational structure to drive Triple Aim results? Going into this conversation, here is what I was thinking about: Payviders have access to longitudinal data (potentially) that siloed entities will certainly not. They also have a goal to keep care affordable in a really real way, especially if the patient/member/client is on the ACA (Affordable Care Act) marketplace and shopping for premiums. My big concern with payviders, though, is whether they’re an “HMO in drag,” as they say. On the other hand, payers and providers, in the most cynical sense, have wildly divergent goals. Search #medtwitter any day of the week—you will find a galaxy of tweets wherein doctors complain about payers—to just get a tiny sense of those wildly divergent goals. Do separate payers working with separate providers offer a kind of check and balance? A historical knock on this hypothesis is the inarguably crappy outcomes for chronic conditions that US patients have the privilege of paying comparatively ridiculous sums for. I couldn’t tell you whether those crappy outcomes are a result of the separateness of payers and providers or some other factor, but so it is. Here’s the short version of one of Steve’s main points: It’s not about control. It’s about connection. It’s about being able to connect with patients over their continuum of care. It’s also about how consumers and employers are increasingly trading out choice and broad networks for an assurance of quality. You can learn more at guidewell.com. Steven Blumberg serves as vice president, practice transformation, for GuideWell Health. In this role, he is responsible for developing and implementing strategies for the further establishment of a high-quality, economically effective clinical system across Florida. He also provides guidance on value-based care and population health models. Prior to joining GuideWell in June 2019, Blumberg served as vice president for value-based care at Baptist Health South Florida, where he led the strategy and implementation for Baptist’s population health and value-based care efforts. Prior to that, he was senior vice president and executive director of AtlantiCare Health Solutions, the New Jersey division of the Geisinger Health System, where he was responsible for population health, the organization’s provider physician group, and home care and hospice continuum services. Earlier in his career, he was chief planning and business development officer at UHealth–The University of Miami Health System. Blumberg also held leadership roles at UF Health–Shands Healthcare and Baptist Health Jacksonville. Blumberg has been active in community and professional organizations, including serving on the boards of the Ronald McDonald House, Community Hospice, and the Northeast Florida Health Planning Council. He has also served nationally on the Premier Population Health Steering Group and on the National Institute of Standards and Technology’s Baldrige Board of Examiners. Blumberg holds a bachelor’s degree in business administration and marketing from the University of Florida and a Master of Business Administration from Florida State University. He is a fellow of the American College of Healthcare Executives. 03:30 How does thinking like a payer change the way you build out a primary care provider practice? 04:37 “When I was on the provider side, I definitely worried about the total cost of care … but making the products affordable was … someone else’s concern.” 09:12 How would you define practice transformation? 13:29 “We’re curating networks.” 16:56 “If they come to the market, they’ll be hard to ignore.” 17:38 How integrated is the physicians network? 18:35 “Control isn’t the right word … it is the connection with the patient … that’s where we think the most effective primary care takes place.” 18:59 Where does attempting team-based care fall apart the most? 21:25 Are employers trading out for an assurance of quality? You can learn more at guidewell.com. Steve Blumberg of @_GuideWell discusses #healthcare transformation on our #podcast. #healthcarepodcast #healthcaretransformation #payer #pophealth How does thinking like a payer change the way you build out a primary care provider practice? Steve Blumberg of @_GuideWell discusses #healthcare transformation on our #podcast. #healthcarepodcast #healthcaretransformation #payer #pophealth “When I was on the provider side, I definitely worried about the total cost of care … but making the products affordable was … someone else’s concern.” Steve Blumberg of @_GuideWell discusses #healthcare transformation on our #podcast. #healthcarepodcast #healthcaretransformation #payer #pophealth How would you define practice transformation? Steve Blumberg of @_GuideWell discusses #healthcare transformation on our #podcast. #healthcarepodcast #healthcaretransformation #payer #pophealth “We’re curating networks.” Steve Blumberg of @_GuideWell discusses #healthcare transformation on our #podcast. #healthcarepodcast #healthcaretransformation #payer #pophealth “If they come to the market, they’ll be hard to ignore.” Steve Blumberg of @_GuideWell discusses #healthcare transformation on our #podcast. #healthcarepodcast #healthcaretransformation #payer #pophealth How integrated is the physicians network? Steve Blumberg of @_GuideWell discusses #healthcare transformation on our #podcast. #healthcarepodcast #healthcaretransformation #payer #pophealth “Control isn’t the right word … it is the connection with the patient … that’s where we think the most effective primary care takes place.” Steve Blumberg of @_GuideWell discusses #healthcare transformation on our #podcast. #healthcarepodcast #healthcaretransformation #payer #pophealth Where does attempting team-based care fall apart the most? Steve Blumberg of @_GuideWell discusses #healthcare transformation on our #podcast. #healthcarepodcast #healthcaretransformation #payer #pophealth Are employers trading out for an assurance of quality? Steve Blumberg of @_GuideWell discusses #healthcare transformation on our #podcast. #healthcarepodcast #healthcaretransformation #payer #pophealth

Glen Roebuck has served as a leader in senior health care and post-acute care for over 32 years. His career has spanned a wide range of positions with growing responsibility. He holds an MBA and Certificate in Leadership from the University of Iowa, and undergraduate degree from The College of Wooster. Mr. Roebuck has been a licensed Nursing Home Administrator in three states, and served as a regional director of senior care operations in numerous states throughout the Midwest and Mountain West. He has also served in strategic leadership roles, including operational guidance, business development and consultation, in environments ranging from single ownership models to large, statewide and national health care systems.In his current role, Mr. Roebuck serves as Executive Director Home, Outpatient and Senior Services for Genesis Health System, based in the Quad Cities region of Iowa and Illinois. He has operational responsibility for community and inpatient hospice services, a large home health care agency, palliative care services, 18 physical therapy clinics, specialty clinics, occupational health, home medical equipment and retail pharmacy. In addition, Mr. Roebuck has implemented an outreach program placing Genesis Nurse Practitioners within high volume post-acute care sites, dramatically affecting quality metrics and readmissions. He also maintains regular communication with senior health care facilities throughout the Genesis service area, addressing health system throughput, interoperability of EMR systems, and opportunities for improved collaboration to achieve Triple Aim performance within the community. In addition, he is actively engaged in the oversight and post-acute engagement of the Genesis ACO.Through community partnerships and collaborations, Mr. Roebuck has developed the Genesis Senior Services partnership, a collaborative between Genesis and community service partners, providing access to trusted, proven providers committed to excellence and a shared vision to serve the Quad Cities older adult community.Mr. Roebuck has published numerous professional articles on topics such as the successful leadership of skilled centers during challenging economic conditions, as well as preparation for health care reform and participation in Accountable Care Organizations. Mr. Roebuck speaks locally and nationally on a variety of topics on post-acute care and health system integration. Glen resides in Davenport, IA with his wife Diane. They have two adult children.Topics Discussed:Can you provide us an update on the state of the virus in your area and its impact on the senior living industry over the past months?What makes the current state of long-term care so tenuous?What are some things owners and operators need to do to keep the lights on and survive in the future, in a post-COVID world?What changes need to be made to make long-term care services viable in the future?For older adults in general, how has the pandemic changed what they need and want out of the various care models?Can you share about what this is and how it’s making an impact on our seniors?What is the importance of strong leadership in the senior living industry?Do you think there’s anything different about the importance of leadership in senior living vs. leadership in other sectors?Glen's Links:LinkedIn: https://www.linkedin.com/in/glenroebuck/Genesis Health System: https://www.genesishealth.com/Twitter: https://twitter.com/GlenatHDG

Three transparency rules have come out of CMS in the past months. My guest in this health care podcast, Jeff Leibach, calls these three rules three steps on a ladder. They build on each other. The first rule was announced last year, and it was for hospitals to post their chargemasters. You could consider this a baseline step. It’s not really all that useful in practice as many discovered. The next step on the ladder (which is coming out on 1/1/21): Providers (hospitals) for all services have to post a machine-readable file—all of their negotiated rates for all service categories. They also have to post a shoppable service file and/or some kind of patient estimator tool so patients can estimate the cost of the most shopped services. Then there’s the payer rule. This is more comprehensive than the provider rule, and the payers have some extra time—actually, they have an extra year (till 1/1/22). But basically, payers have to comply at a higher level. They have to allow price shopping across all sites of care. My guest in this health care podcast, Jeff Leibach, is a director with Guidehouse in the Healthcare Practice. He focuses on how health care services are priced and paid for, working with a lot of payers and providers. Thus, he is the perfect person to discuss these transparency rules with because of his deep knowledge of payers and provider contracting and also how pricing impacts patients, employers, and stakeholders across the industry. Jeff and I get into these three transparency rules and their likely impact and also kind of their philosophical underpinnings. We also talk about what might happen with them under a Biden administration. After our conversation, I started to think about these transparency rules in the broader context of what’s going on in the health care marketplace. There’s kind of a constellation of market factors, and these market factors increasingly seem to be necessitating hospitals and ambulatory practices to really differentiate themselves in ways that employers and patients/consumers care about. I mean, these CMS transparency rules for payers and hospitals are but one thing that is going on. But these rules ultimately mean that it’s easier for patients and employers to price shop. It also makes it easier for employers to narrow their networks and exclude providers. Consider this impact and then think about how that fits with the ONC TEFCA (Office of the National Coordinator for Health Information Technology Trusted Exchange Framework and Common Agreement) rule. So, that ONC TEFCA rule means that it’s gonna be a less effective tactic to prevent network leakage by hoarding patient data. So, if patient data is portable, patients can seek out the best care provider without the friction of some kind of PHI (protected health information) transfer. Okay … so now prices are available because of the transparency rule, and patients can walk more easily because of the TEFCA rule. So, these two together could be a forceful combination. We also have the rise of consumerism. I just saw a study the other day kind of validating that consumers are voting with their feet if a provider does not meet the quality of care, the supportive patient experience that they believe could be found elsewhere. And add to that the at-risk PCPs (primary care providers) cropping up in various concentrations across the country. But then also, you’ve got payers buying PCPs. And what that means is that you get these PCPs who control the referral flow, and they’re taking an active interest in the downstream costs and population outcomes of specialists in their referral networks. So, you’ve got specialists who maybe lack processes to minimize inappropriate care or who do not deliver consistently high patient experiences and outcomes. They could easily get excluded from those referral flows. So, you take all these things together—the transparency, the ONC TEFCA rule, consumerism, and the disruption of certain referral flows—and, if you ask me, I think all of this together means that providers who are more commodity and less brand may need to consider ramping up their Triple Aim endeavors. You can contact Jeff at jeff.leibach@guidehouse.com. You can also connect with him on LinkedIn and Twitter.   Jeff Leibach, MBA, is a director with Guidehouse’s Healthcare Practice. Over the last decade, Jeff’s main area of expertise has been in developing and implementing managed care solutions for payers and providers. These solutions include development of several analytic solutions, alignment of clinical and financial models, and negotiation training and preparation. Jeff has significant experience building and leading teams to deliver complex analytical tools to quantify opportunities into business strategies for clients. Jeff currently leads Navigant’s Strategic Pricing and Revenue Rebalancing Solutions for Navigant. Prior to his consulting career, Jeff led national nonprofit Camp Kesem, a summer camp for children affected by a parent’s cancer. Additional information: Price Transparency White Paper and 2019 Massachusetts Attorney General Report 05:31 What are the two pieces to the new transparency rule going into effect on January 1, 2021? 06:58 “Any negotiated rate … is required to be disclosed.” 07:43 What’s the payer rule, and how does it differ from the hospital rules? 10:24 Where are direct comparisons going to come in most useful with transparency rules? 11:16 How does CMS intend these rules to be used? 14:34 “I anticipate employers having a newfound power here.” 17:27 Why is there opposition to transparency in health care? 18:27 “The administrative burden is real.” 21:03 “I think commoditized is a word we’re going to hear a lot more.” 22:55 Where is CMS headed under a Biden administration? 26:22 What barriers can tech help break down, and what other opportunities are there for tech right now? 28:49 What should payers be preparing for right now? You can contact Jeff at jeff.leibach@guidehouse.com. You can also connect with him on LinkedIn and Twitter. @jeffleibach of @GuidehouseHC discusses #hospital and #payer #transparencyrules in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcaretransparency #healthtransparency What are the two pieces to the new transparency rule going into effect on January 1, 2021? @jeffleibach of @GuidehouseHC discusses #hospital and #payer #transparencyrules. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcaretransparency #healthtransparency “Any negotiated rate … is required to be disclosed.” @jeffleibach of @GuidehouseHC discusses #hospital and #payer #transparencyrules. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcaretransparency #healthtransparency How does CMS intend these rules to be used? @jeffleibach of @GuidehouseHC discusses #hospital and #payer #transparencyrules. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcaretransparency #healthtransparency “I anticipate employers having a newfound power here.” @jeffleibach of @GuidehouseHC discusses #hospital and #payer #transparencyrules. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcaretransparency #healthtransparency “The administrative burden is real.” @jeffleibach of @GuidehouseHC discusses #hospital and #payer #transparencyrules. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcaretransparency #healthtransparency “I think commoditized is a word we’re going to hear a lot more.” @jeffleibach of @GuidehouseHC discusses #hospital and #payer #transparencyrules. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcaretransparency #healthtransparency Where is CMS headed under a Biden administration? @jeffleibach of @GuidehouseHC discusses #hospital and #payer #transparencyrules. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcaretransparency #healthtransparency

Today, we have the incredible Kelly Ritchie, who is a CCRN (Critical Care Registered Nurse) who dropped EVERYTHING to rush to New Jersey in the peak of the pandemic outbreak. Join our discussion as we learn about how unprepared many hospitals were, common misconceptions about Covid, and what science tells us about the future of the disease. CHARITY/ NON-PROFITCenter for Improving Value in HealthcareCIVHC is a Denver, CO-based non-profit that strives to empower individuals, communities, and organizations through collaborative support services and health care information to advance the Triple Aim of better health, better care, and lower costs for all Coloradans.In 2009, CIVHC began as a convening of diverse stakeholders committed to changing the way care is paid for and delivered. Through workgroups and task forces, CIVHC cultivated relationships with like-minded partners that continue to make improvements throughout the state. Community engagement is integral to CIVHC’s philosophy and core work; they hold a broad view of what makes up a community and feel that only through partnerships and collaboration will we successfully affect change.To learn more go to civhc.org Follow us on IG & Twitter@thesospod Subscribe and review on Youtube, iTunes, Spotify, Google, and more....here’s to turning meltdowns into magic! 

PCPs (primary care providers) are really important to population health. Primary care is the foundation of any well-functioning health system, I am sure many listening to this podcast know well. For the Triple Aim to happen, patients really need access to robust primary care. This has been affirmed by almost anyone who looks into it. And yet, in this country, our system sort of anemically supports our primary care colleagues. As a general statement, poking and prodding and procedures are compensated at a far higher rate than anything requiring cognitive services. What a PCP or a pediatrician mainly does all day is really cognitive. It’s listening and thinking and counseling and coordinating. But here is maybe an underappreciated point: If we’re going to measure PCP performance, then we need the right measures to measure that performance. You might be doing this measurement as a basis for incentives or maybe for continuous improvement programs. Either way, if you don’t have the right measures, then maybe great primary care is under-rewarded or your continuous improvement process is counterproductive—you’re incenting the wrong things, you get the wrong activity. And to add to that, PCPs (ie, practices) can spend upwards of $40,000 a year of uncompensated time trying to add and subtract and tote up the difference in all these varied and potentially inapplicable measurement standards coming at them from all manner of directions. My guest in this health care podcast is Rebecca Etz, PhD. Dr. Etz and the team over at The Larry A. Green Center have worked hard to create a set of 11 performance measures for primary care. These measures went through the wringer as far as their creation and validation. These 11 measures take into account what patients want, what primary care clinicians (including pediatricians, nurse practitioners, and others) think is most important and possible to provide, and what payers want to pay for. These 11 measures are aligned across the three stakeholders, and they are actionable. Neither of these descriptors is anything to take for granted. Rebecca Etz, PhD, is associate professor of family medicine and codirector of The Larry A. Green Center, which is in Richmond, Virginia, at the Virginia Commonwealth University. You can learn more at green-center.org. Rebecca S. Etz, PhD, is an associate professor of family medicine and population health at Virginia Commonwealth University (VCU) and codirector of The Larry A. Green Center—Advancing Primary Health Care for the Public Good. Dr. Etz has deep expertise in qualitative research methods and design, primary care measures, practice transformation, and engaging stakeholders. Her career has been dedicated to learning the heart and soul of primary care through three main lines of inquiry: (1) bridging the gap between the business of medicine and the lived experience of the human condition, (2) making visible the principles and mechanisms upon which the unique strength of primary care is based, and (3) exposing the unintended, often damaging consequences of policy and transformation efforts applied to primary care but not informed by primary care concepts. As a member of the VCU Department of Family Medicine and Population Health and previous codirector of the ACORN practice-based research network, Dr. Etz has been the principal investigator of several federal and foundation grants, contracts, and pilots, all directed toward making the pursuit of health a humane experience. Recent research activities have included studies in primary care measures, behavioral health, simulation modeling, care team models, and adaptive use of health technologies. Dr. Etz currently leads the fielding of a weekly survey regarding the response to and impact of COVID-19 on US primary care practices. She also serves on the National Academies of Medicine consensus study, “Implementing High-Quality Primary Care.” 03:41 Why is primary care one of the “best-kept secrets” of better health outcomes? 08:38 “Measures are a form of communication.” 08:51 “If the way that you are assessed does not actually match up with the work you do or what you find to be important, it’s pretty demoralizing.” 11:41 “It is the outcome of health care, but it is not the same thing as quality.” 16:31 “It creates a financial incentive to hit a target by any means necessary.” 18:06 “We incentivize people to have good outcomes, and what that means is that electronic medical records are no longer simply databases that tell us what the health of the population is. They are databases that tell us what is the optimal picture that a clinician is able to paint of their patients.” 21:07 “Primary care is a relational field.” 22:14 “How does this relate to cost and utilization?” 26:43 “I think we all know that fee for service is death.” 27:11 How has the measure of PCPs in the time of COVID held up? 27:32 What measure performs worse in the time of COVID? 28:17 “Primary care is the place that everybody goes.” 31:16 EP270 with Dave Chase and EP272 with Guy Culpepper, MD.  You can learn more at green-center.org. Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp “Measures are a form of communication.” Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp “If the way that you are assessed does not actually match up with the work you do or what you find to be important, it’s pretty demoralizing.” Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp “It is the outcome of health care, but it is not the same thing as quality.” Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp “It creates a financial incentive to hit a target by any means necessary.” Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp “Primary care is a relational field.” Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp “I think we all know that fee for service is death.” Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp How has the measure of PCPs in the time of COVID held up? Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp

Stella Safo and Saranya Loehrer discuss the role of physicians and other healthcare providers in helping shape policy by taking a more active role in the voting process AND by having those discussions with their patients. Topics of disparities in healthcare and the exacerbation of those disparities in COVID are also discussed. See bios below: https://www.votehealth2020.com Dr. Stella Safo is a HIV primary care physician with experience in clinical transformation and healthcare redesign within Mount Sinai Health System and Premier Inc, where she respectively serves as an Assistant Professor and Strategic Advisor. Dr. Safo received her medical education from Harvard Medical School and a masters degree in public health with a focus on global health at the Harvard School of Public Health; she completed a residency in Primary Care and Social Medicine at Montefiore Medical Center in the Bronx, New York followed by an HIV fellowship from the HIV Medical Association. Her research areas focus on qualitative analyses of healthcare delivery to vulnerable populations around the world. Saranya Loehrer is the founder of VoteHealth 2020, a growing non-partisan coalition of health professionals collaborating to increase the number of our peers and patients registered – and voting safely – this November. In addition, Saranya serves as the Head of Innovation at the Institute for Healthcare Improvement and a leader of IHI’s Leadership Alliance, a group of 50+ leading US health care executives working courageously and collaboratively to deliver on the full promise of the Triple Aim. Prior to joining IHI, Saranya worked for Physicians for Human Rights, leading global and domestic grassroots advocacy efforts to create more just and scientifically sound HIV/AIDS policies. She received her MD from Loyola University Chicago Stritch School of Medicine, where she was an Albert Schweitzer Fellow, and her MPH from the Harvard School of Public Health, where she was a Zuckerman Fellow.

Primary care is especially compromised in the ongoing pandemic crisis. PCPs are uniquely vulnerable to the deleterious economic effects of COVID-19, since most of their revenue still comes from in-person visits which have plummeted since March amid widespread stay-at-home orders and fears about in-office virus transmission. The pain has been particularly acute for PCPs who are not backed financially by health systems, private equity or other entities. Roughly half of U.S. doctors still own their own practices, and those independents were already operating on razor-thin margins after years of reimbursement cuts, unfavorable payment structures, and expensive EHR and tech implementations. Add a pandemic to the mix, and it's a recipe for disaster. We are pleased to welcome Dr. Jed Constantz as our guest this week. As a primary care finance and delivery reform strategy consultant, he has worked with payers, employers, and providers, all the way from independent primary care physicians to large health systems. Over his 30 plus years in healthcare, he has developed tools and resources for primary care providers and employers seeking to reduce costs, drive greater efficiency and quality outcomes, and thereby create a “featured-and-favored” network in their regions and community. This process includes a deep focus on the selection of the right community of primary care physicians and specialists, a thorough audit of existing patient and population data, commitment to accountable care standards, and improved compensation for the physician. Jed comes with wisdom and critical counsel for sustaining PCPs as the foundation of our health care system. Bookmarks: 5:50 The lack of a payment strategy for primary care prevents trusting relationships. 6:50 COVID-19 has provided a deeper understanding of why primary care needs to be purchased differently. 8:00 Payment reform will allow primary care to live up to the expectations of true patient-centered care and population health. 10:30 Primary Care must retain the agency to care for patients when underlying financial arrangements and equity positions change. 11:30 Terms and conditions of primary care business arrangements must allow physicians to continue to have a high level of accountability to the patient. 14:30 Primary care physicians must pursue business models that allow them to practice independent clinical decision-making. 16:00 The VillageMD and Walgreens partnership is a perfect example of a corporate model that retains primary care independence. 16:45 Blue Cross North Carolina as an example of how to calculate the future value of primary care so money in health care can be spent more intelligently. 21:55 Innovation must be focused on meeting the needs of the patients, and F2F encounters are not as important as we once thought. 22:40 Dr. Constantz explains how the FFS economic model makes it impossible to spend quality time with patients. 23:17 The innovation of telemedicine is a great example of how primary care was able to make a pivot towards improved population health during COVID-19. 24:00 The Primary Care Innovators Network (PCIN) and its contribution to innovating care delivery through payment reform. 24:42 The Triple Aim as a foundation for patient activation to improve health outcomes (Dr. Constantz cites the research of Judith Hibbard.) 25:08 Payment reform in primary care gives you the opportunity to imagine a different relationship between the primary care team and the patient. 26:50 The disruption of the employer-sponsored health insurance marketplace 27:52 Rosen Hotels as an example of what employers can do to take charge of healthcare costs and funnel savings back into the community. 31:15 Dr. Constantz shares his perspective on how self-funded employers are planning their health benefits strategy for 2021. 33:54 Partnership between The National Alliance of Healthcare Purchaser Coalitions (National Alliance) an...

Palliative care, and the role it plays in health value, is difficult for many people to understand because it runs so contra to the linear algorithm that is allopathic medicine. Curative care – played out in the form of surgeries, procedures, therapies, and various other medical interventions – is focused on doing something TO the patient. This becomes problematic when the patient has a terminal illness - eventually the illness will win. Nature always wins. Palliative care shifts the caregiver's paradigm from one of asking, “How can I help prevent death?” to the more appropriate question, “How do you want to live?”   When caregivers ask the right question, treatment activities naturally move away from an escalation of clinical interventions that can shorten life and worsen quality of life, and move toward supportive medicine and therapy in the form of symptom-controlling medication, rehabilitation, and counseling that focuses on a patient's quality of life, symptoms, and emotional wellbeing. – things they do FOR the patient. That's not to say that curative treatments aren't appropriate or indicated – palliative care works in partnership with other specialists – but the palliative care provider plays an important role in truly helping the patient understand the nature of the disease, the treatment options, and the patient's physical ability to respond to the treatments. Inevitably, patients choose less treatment: costs decrease while quality of life increases.   In this episode we speak with Dr. Tim Ihrig, Chief Medical Officer at Crossroads Hospice and Palliative Care. Dr. Ihrig is a nationally recognized thought leader in palliative care, with 1.5 million hits on his Ted Talk “What We Can Do To Die Well” and author of the important book, Palliative Care and Symptom Management. His work in multiple organizations has proven that effective palliative care aligns with the objectives of the Triple-Aim – it is a key organizational and individual competency required to make value-based care a reality.   5:50 Dr. Ihrig explaining his early involvement in the ACLC and his journey in health value 8:00 Reverse engineering the individualized care of a patient into programs, training, policy, and reimbursement 10:45 The linear algorithmic model of treatment that leads to an escalation of clinical interventions 11:05 The need to reform medical education so that death is not always viewed as a failure of the physician 12:30 Asking the question, ‘how do I want to live?' shifts the narrative to loving, learning, and growing through every breath 13:00 Informed Consent as one of the core tenets of true palliative care 14:10 Physicians must ask the question: what is sacred to you as an individual? That doesn't change over time, cancer or not. 14:45 Understanding the appropriateness of treatment against the backdrop of where somebody's at on their physiologic journey 14:53 True palliative care going beyond the limits of allopathic reductionism and looking at the whole human being 16:04 Aligning therapies with the clinical reality of where patients are physiologically and what their goals of care are 16:45 Palliative care needs a concise, unified definition of what it is to overcome current misperceptions 18:31 The present medical paradigm sets up fighting to beat Mother Nature, which means we all fail. 19:56 The inflection period - the moment in our health journey when our bodies no longer have the capacity to recover or restore 22:50 Using the inflection period as a tool to prevent iatrogenic causality which potentiates decline secondary to physiologic stress. 23:45 The diminishing ROI of medical interventions at the inflection period 24:18 Dr. Ihrig describes a personal example of iatrogenic causality that brought about death 25:07 Patients becoming victims when we don't understand the reality of death and the limitations of medicine

By Michael Tetreault, Editor-In-Chief, Concierge Medicine Today/The DPC Journal and Host, The DocPreneur Leadership Podcast The Society of Actuaries (SOA) commissioned Milliman to develop this report to provide health care stakeholders (patients, payers, policymakers and actuaries) with a comprehensive description of Direct Primary Care (DPC) as well as an objective actuarial evaluation of certain claims made about the DPC model of care. Today we sit down with one of the authors of the study, Fritz Busch, a consulting actuary at Milliman. Fritz's experience includes 27 years as an actuary and business leader in the insurance industry. Prior to starting at Milliman, he was with one of the larger Blue plans and had several consulting roles with McKinsey & Co. His commercial carrier experience includes a wide range of actuarial plan management functions that include reserving and annual statement work, trend analysis, commercial large group pricing, ACA individual and small group pricing, Medicare Supplement pricing, benefit plan design and product development. At Milliman, he has successfully worked with a variety of clients including regulators, insurance company executives, and others. He is a frequent speaker at industry and public policy meetings. Primary care is a vital and even foundational component of any health care system. Primary care physicians (PCPs) are the front line of health care and are often the entry point for patients needing care. How often a patient accesses primary care, and the quality of that care, can have significant impacts on downstream costs and patient health outcomes. However, while PCPs are almost universally acknowledged as essential to achieving the health care Triple Aim of providing high-quality care, at lower cost, with improved patient experience, many health care experts describe the current state of primary care as being in crisis. This crisis is characterized by physician burnout, large PCP patient panels, low pay for PCPs relative to other physician specialties, increased administrative burden, longer work hours without increased reimbursement, an increased risk of mental health conditions and suicide, and ultimately a PCP shortage relative to market demand. RESOURCES MENTIONED www.milliman.com https://www.soa.org/resources/research-reports/2020/direct-primary-care-eval-model/ www.DirectPrimaryCare.com https://www.dpcare.org/ www.ConciergeMedicineFORUM.com www.ConciergeMedicineToday.com

Guest: Jeffrey Brenner, MD, Senior Vice President of Integrated Health and Human Services, UnitedHealthcare. Community & State, Founder and Former Executive Director, Camden Coalition of Healthcare Providers, and MacArthur Genius Award Winner, Camden, NJ joins Fred Goldstein and Gregg Master on PopHealth Week. Dr. Brenner responds to the recent results published in the New England Journal of Medicine, 'Health Care Hotspotting — A Randomized, Controlled Trial' and previews his keynote at the 20th Anniversary of the Population Health Colloquium (#PHC20). About Dr. Brenner: Jeffrey Brenner is the Senior Vice President of Integrated Health and Human Services at UnitedHealthcare Community & State. In this role, Dr. Brenner leads myConnections™, UnitedHealthcare’s program to help low-income individuals and families access essential social services that are the gateway to better health. UnitedHealthcare Community & State proudly serves nearly six million Medicaid members in 24 states, plus Washington D.C. UnitedHealthcare is a division of UnitedHealth Group (NYSE: UNH) which is a diversified health and well-being company with a mission to help people live healthier lives and make the health system work better for everyone. About United Healthcare UnitedHealth Group Incorporated is an American for-profit managed health care company based in Minnetonka, Minnesota. It offers health care products and insurance services. It is the largest healthcare company in the world by revenue, with 2018 revenue of $226.2 billion and 115 million customers. ==##==        

On PopHealth Week our guest is Rushika Fernandopulle MD co-founder & CEO Iora Health. Dr. Rushika Fernandopulle is a physician who has spent decades improving the quality of healthcare delivered to patients. He was the first Executive Director of the Harvard Interfaculty Program for Health Systems Improvement, and served as a Managing Director of the Advisory Board Company. He serves on the faculty and earned his AB, MD, and MPP from Harvard University. He completed his clinical training at the Massachusetts General Hospital. Iora Health changes primary care as we know it. Iora's care team, includes a dedicated advocate for each patient, works together to treat the whole person. ==##==      

On PopHealth Week our guest is Rushika Fernandopulle MD co-founder & CEO Iora Health. Dr. Rushika Fernandopulle is a physician who has spent decades improving the quality of healthcare delivered to patients. He was the first Executive Director of the Harvard Interfaculty Program for Health Systems Improvement, and served as a Managing Director of the Advisory Board Company. He serves on the faculty and earned his AB, MD, and MPP from Harvard University. He completed his clinical training at the Massachusetts General Hospital. Iora Health changes primary care as we know it. Iora's care team, includes a dedicated advocate for each patient, works together to treat the whole person. ==##==      

Robotic surgery expert Dr. Herb Coussons explores the keys to achieving the Triple Aim in robotic surgery and discusses the critical elements to achieving a best practice robotic program.  Dr. Coussons also serves as Medical Director of CAVA Robotics.

Kathy Watkins talks about her history as a midwife, her view of mindful birth in a family birth center in her community, her philosophy as a provider, and how she and her OB partner, Dr Megan Kasper deliver respectful, mindful care for the pregnant woman and her family in the Treasure Valley. She explains the process of a successful implementation of a family friendly cesarean practice in the hospital where she works and how she and her physician partners work so well together. BIO Kathy Watkins Certified Nurse Midwife.  Bachelor of Science in Nursing from University of Saskatchewan, in Saskatoon, Saskatchewan, Canada – Masters of Science in Nursing –Midwifery from the University of Utah – Transformational Nurse Leadership Fellowship from Duke University 26 years practicing as a Certified Nurse Midwife with certifications in Midwifery Sonography, First Assist at C Section, Centering Pregnancy, Evidence Based Birth Instructor, WaterBirth International Currently, Full Scope CNM care with Saltzer OBGYN offering all pregnancy care inclusive of attendance at birth at St Luke’s Nampa Family Birth Center, well woman care, gynecology, contraception, menopause Interests include a fit clean healthy lifestyle, commitment to the Triple Aim initiative, team member of the family friendly c section movement

RCGP Vice Chair for Membership, Professor Mike Holmes talks to RCGP Clinical Support Fellow for Collaborative General Practice, Dr Alka Patel about motivations in general practice, Don Berwick’s Triple Aim (https://www.healthaffairs.org/doi/full/10.1377/hlthaff.27.3.759) , which includes, improving the experience of care for patients, improve healthcare outcomes and reducing costs. They also support the need for a fourth aim, the Quadruple Aim, which focuses on improving the experience of delivery of care.

Today's special guest is Dr. Andrey Ostrovsky of Care at Hand. As Co-Founder of Care at Hand, he and his team are committed to achieving the Triple Aim and eliminating health disparities for vulnerable populations by creating disruptive technology. What does that mean? Well listen in to see what he has to say and how he plans to achieve the triple aim.

On the Wednesday July 10th, 2013 broadcast at 10:00AM Pacific/1PM Eastern our special guest in This Week in Health Innovation is Jonathon Dreyer of Nuance Healthcare. Dreyer's background is a follows: For over 2 years, Jonathon Dreyer – the director of mobile solutions marketing at Nuance – has committed himself to the growth of a healthcare development community that's reached more than 700 global partners. Dreyer is a firm believer in the idea that complex problems require simple solutions. As the leader in the mobile solutions marketing team at Nuance, Dreyer is the driving force behind helping healthcare providers solve complex problems by bringing virtual assistants – like Siri but even smarter – to healthcare.    During the broadcast Dreyer will discuss the digital health space, telemedicine in particular, and its role in supporting the triple aim (including available data on reported outcomes) and the platforms, apps and tools in his line of sight.   For more information on 'Florence' a virtual assistant for healthcare, see: Healthcare Virtual Assistant: Project "Florence"  PROGRAM NOTE: during the interview, the Nuance Healthcare website was erroneously noted. The correct URL is Nuance.com.   Join us for an informative chat with Jonathon Dreyer!