Podcasts about value based payment

With 1 out of every 3 U.S. health care dollars emanating from Washington, the federal government is the single largest payer of health services in the United States and accounts for nearly half of all national health spending. As our country ages, these forces are accelerating, with Medicare spending alone projected to increase by 7.5% annually through 2031. Healthcare companies that depend on government revenue – or are downstream from it – must begin to view policymakers as among their most important customers. Impactful organizations that will succeed in the new era of value-based care will learn how to leverage the unparalleled value of internal advocacy.  By creating extraordinarily powerful messaging for policymakers to understand what is needed for value-based innovation, we exercise our right to form a more perfect union.  While healthcare will never be perfect, we must still strive for perfection – that is at the heart of value-based care transformation in our country! On the Race to Value this week, we interview Andrew Schwab – a value-based care leader, an intentional strategist, and a master of Washington's internal game.  He brings a bold, brash, no-holds-barred approach to government affairs by coaching and mentoring forward-thinking organizations ready to invest in their internal policy teams so they can thrive in a new era of value-based care.  Prior to establishing his own firm, Platform Government Strategies, Andrew advocated in-house on behalf of both nonprofits and private sector organizations. Most recently, Andrew established Oak Street Health's first government affairs function that put them at the center of the national value-based care conversation and contributed to their recent acquisition by CVS Health. Episode Bookmarks: 01:30 The federal government is the single largest payer of health services and accounts for nearly half of all national health spending. 02:00 Healthcare companies that depend on government revenue must begin to view policymakers as among their most important customers. 02:30 Introduction to Andrew Schwab and his public affairs consulting firm, Platform Government Strategies. 05:30 The glacial pace of the value-based care movement.  Is there truly bipartisan consensus on the aims of health value? 07:00 2030 Medicare VBC Goal (“The government is putting its thumb on the scale for value-based care.”) 08:15 The 1st Amendment right to petition government for redress of grievances (“Advocacy and lobbying are quintessentially American.”) 09:00 “Elected officials and appointed regulators in Washington D.C. and in state capitals react to a different set of incentives.” 10:00 Explosive growth of the Medicare Advantage program. 11:00 Consumer-centric innovation and higher quality of care in MA plans. 11:30 Political controversy with MA (e.g. PE-backing, overpayment concerns, risk adjustment gaming, “perverse business model”) 13:00 Critics of MA ranging from physicians and hospitals protecting the “sanctity of fee-for-service" to those leery of privatization. 13:30 The incredible popularity of MA and the research showing it has superior outcomes. 14:00 Mitigating the potential for upcoding with the new V28 risk adjustment methodology being implemented over next 3 years. 15:00 MA is paid more than Traditional Medicare, but it offers more in terms of benefits (e.g. hearing, dental, vision, population health interventions). 16:00 Private equity investment and payvider innovation (e.g. Oak Street Health, VillageMD, Centerwell, Archwell). 17:00 The importance of Patient-Reported Outcome Measures since process measures alone don't achieve patient-centeredness. 19:00 “Outcomes should be the most important metric by which we judge the health of our healthcare system.” 20:00 “We need to put providers that participate in value-based relationships at the center of advocacy pushes in Washington and in state capitals.” 21:00 If we are incentivized to keep patients healthy and out ...

Sign up for FREE Health Affairs newsletters.Health Affairs Editor-in-Chief Alan Weil interviews Chip Kahn from the Federation of American Hospitals on his recent paper where he and co-authors argue that CMS hospital value-based programs should be refined to reduce health disparities and improve outcomes.Order the August 2023 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone. Sign up for FREE Health Affairs newsletters.

In this episode, I sat down with Dawn Alley, President of Decision Support at Carebridge, a company that works with health plans and states to care for individuals receiving long-term support services. Prior to joining Carebridge, Dawn spent about a decade working in the federal government as Chief Strategy Officer at the Centers for Medicare and Medicaid Innovation (CMMI), and before that as Deputy Senior Advisor for Value-based Transformation at HHS. Dawn and I discuss: The main initiatives she worked on at CMMI including the Accountable Health Communities Model and Medicare Diabetes Prevention Program Lessons learned during her tenure about implementing and delivering healthcare models at scale Why Dawn is excited about the future of long-term care services and why she believes in Carebridge's model

JoAnne McClure, ASTHO Senior Analyst for State Health Policy, details a new report written to help public health leaders address rising rates of congenital syphilis; Alex Kearly, ASTHO's Director of Medicaid and Value-Based Payment, breaks down recent direction from the Centers for Medicare and Medicaid Services regarding social services and Medicaid dollars; an ASTHO blog article highlights the importance of proper leadership strategies when building a high-performing team; and a virtual edition of ASTHO's Public Health TechXpo and Futures Forum is set for June 15th. ASTHO Report: Policy Considerations for Reducing Congenital Syphilis ASTHO Blog Article: Addressing Health-Related Social Needs through 1115 Demonstrations ASTHO Blog Article: Three Key Leadership Strategies for Building a High-Performing Team ASTHO Webpage: TechXpo and Futures Forum Registration

On this episode of Managed Care Cast, we feature several leaders in diversity, equity, and inclusion advancing health equity in their respective organization's policy and practice initiatives.

Lesley Weir, senior director, customer and product success at Veradigm, and Kate Wormington director, product management, analytics at Veradigm Payer Analytics, join us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Medicare Member Acquisition & Experience; and Social Determinants of Health.In this 31-minute podcast, they discuss the risk adjustment and quality changes in the final rules and their recommendations and strategies for organizations going forward. About Lesley WeirLesley Weir, senior director of customer and product success at Veradigm, has over 30 years' experience in the Medicare Managed Care industry, with specific expertise in operations, risk adjustment, and quality improvement. She has a demonstrated track record of assisting health plans in meeting operational and revenue goals, as well as developing innovative strategies to improve member's health and experience. Prior to her role at Veradigm, she held various leadership positions at multiple provider-owned Medicare Managed Care Health Plans and a large national plan.  She also spent six years working in the vendor space supporting Medicare Advantage plans across the country with their risk adjustment and quality programs.About Kate WormingtonKate Wormington, director, product management, joined Veradigm in January of 2023 leading theQuality Analytics solutions. For the past 20 years, Kate has focused on HEDIS® and quality reporting for both payers and providers.  Kate spent close to 10 years managing complex operations of a quality analytics program supporting HEDIS, CMS Star, IHA AMP, QARR, QRS, and Medicaid State measurement sets for innovative health care organizations.  She has deep experience leading a multi-state Client Success Support and Implementation team, supporting 27 clients across three products.  Additionally, Kate has led an NCQA Data Aggregator Validation (DAV) project team through Cohort 2, and was in the middle of Cohort 4, providing targeted HEDIS standard supplemental data using C-CDA files. She began as a software engineer specializing in software quality, with a Masters degree in IT.   She embraced the business side, utilizing product, project and client management skills. Wormington lives in Denver, Colo., originally from the UK, starting her career in health care working for the National Health Service.  About Veradigm Veradigm Payer Analytics (formerly Pulse8) is health care analytics and technology solution delivering complete visibility into the efficacy of your Risk Adjustment, Quality, and Pharmacy Benefit Management programs. Veradigm empowers health plans and providers to eliminate waste and achieve the greatest financial impact in the Medicare Advantage, Medicaid, and ACA Commercial markets as well as with Value-Based Payment models for Medicare. Advanced analytic methodologies and flexible business intelligence tools offer real-time visibility into member behavior and provider performance while also improving efficiency for payers and at-risk providers through high-speed clinical data exchange. Veradigm's patented Dynamic Intervention Planning offers a suite of uniquely pragmatic solutions that identify the most cost-effective and appropriate interventions for closing gaps in documentation, coding, and quality. For more company information or to schedule a demo, please email payersolutions@veradigm.com

Dr. Marcus Plescia, ASTHO Chief Medical Officer, says public health agencies are increasing the focus on COVID-19 boosters for those living in nursing homes and other care settings; Alex Kearly, ASTHO's Director of Medicaid and Value Based Payment, explains Medicaid policies will emphasize equity; recent graduates of ASTHO's Diverse Executives Leading in Public Health weigh in with their thoughts on leadership; and public health leaders can learn how to navigate personal conflict in the executive space during a webinar set for Jan. 18th. ASTHO Webpage: Impacting Social Determinants of Health Through Managed Care Contracts Centers for Medicare & Medicaid Services News Release: HHS Approves Groundbreaking Medicaid Initiatives in Massachusetts and Oregon ASTHO Blog Article: Elevating Community Voices Through Health Equity Leadership ASTHO Webpage: Navigating Personal Conflict in the Executive Space

Kim Martin, ASTHO's Director of Immunization, reminds us that vaccines this winter are more important than ever as we recognize National Influenza Vaccination Week; Mike Fraser, ASTHO CEO, discusses the announcement that ASTHO is one of three to win CDC grant funding that aims to help jurisdictions build public health infrastructure over the next five years; and Alex Kearly, ASTHO Director of Medicaid and Value Based Payment, says members can learn how to align their state Medicaid agencies with the goal to end the HIV epidemic in a new webinar scheduled for December 13th. CDC Webpage: 2022 NIVW Digital Media Toolkit ASTHO News Release: Three National Public Health Associations Will Support Historic Opportunity to Build Public Health Infrastructure ASTHO Webpage: Medicaid and Public Health Partnerships in Virginia

Equitable and accessible care must ensure appropriate and optimal use of medications since nearly 70 percent of clinician visits involve drug therapies. However, each year there are an estimated 275,000 deaths and $528.4 billion wasted in the US due to suboptimal medication use through inaccurate prescribing, medication errors, adverse drug reactions, skipped doses, or treatment failures. Given that most therapeutic options for the treatment of illness involve pharmaceutical interventions, we must find a way to maximize medication benefits and mitigate harm.  That promise for a more patient-centered approach to optimize medication use can be found through Comprehensive Medication Management (CMM).  The GTMRx Institute defines CMM as: “The standard of care that ensures each patient's medications (whether they are prescription, nonprescription, alternative, traditional, vitamins, or nutritional supplements) are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the comorbidities and other medications being taken, and able to be taken by the patient as intended.” Joining us this week on Race to Value are three amazing thought leaders who recently wrote a Health Affairs article on how CMM should be integrated within value-based care delivery: Katie Capps, is co-founder, executive director and board member of the Washington-based Get the Medications Right Institute (GTMRx) and founder and president of Health2 Resources, a national health care project management and consulting firm practicing in the Washington area for nearly 23 years.  At GTMRx, Capps collaborates with fellow board members to develop and execute the Institute's strategy, bringing together critical stakeholders to focus on appropriate use of medications and gene therapies. Michael Barr, MD, MBA, MACP, FRCP – Dr. Michael Barr is a mission-driven physician executive with 35+ years of clinical and leadership experience is founder and president of MEDIS, a health care consulting company which provides customized, client-driven services and support for health care organizations and the dedicated professionals who deliver care to people. In addition, he is the executive physician advisor at GTMRx. M. Shawn McFarland, Pharm.D., FCCP, BCACP -- Dr. McFarland is the National Program Manager VA Clinical Pharmacy  at Veterans Health Administration in Washington D.C. In the past, Dr. McFarland was responsible for the direction of clinical pharmacy services within the Tennessee Valley Health Care System. In this episode, we discuss the role of CMM in value-based care, the importance of interprofessional collaboration, CMM implementation strategies, CMM use cases, HIT infrastructure requirements, pharmacoequity, and value-based payment reforms needed for CMM adoption growth and sustainability. Episode Bookmarks: 01:30 Nearly 70 percent of clinician visits involve drug therapies; however, there are an estimated 275,000 deaths and $528.4 billion wasted due to suboptimal medication use. 04:00 Introduction to Dr. Michael Barr, M. Shawn McFarland, Pharm D., and Katie Capps (and their recent Health Article on CMM and VBC) 07:00 Katie defines Comprehensive Medication Management (CMM). 07:45 Dr. Barr further explains that CMM helps provide “better care for people” and the work GTMRx Institute is doing to bring much-needed attention to it. 09:00 Katie outlines the multitude of problems in care delivery associated with the inappropriate use of medications (e.g. polypharmacy issues, adverse events, high costs) 10:00 The important role of a clinical pharmacist working in close collaboration with physicians. 10:30 Shawn discusses the success of CMM in the Veterans Affairs system. 13:45 Shawn describes the confusion about the role of the pharmacist and how CMM can expand the profession. 15:00 The role of the pharmacist in interprofessional,

In this episode of Tuning In to the C-Suite, Managing Editor of Managed Healthcare Executive, Peter Wehrwein, speaks with President of Value Evolutions and MHE Editorial Advisory Board Member, Doug Chaet, FACHE, about value-based care's current standing, the status of various payment models and more. 

Value-based pay expert Fred Bentley says long-term care providers have great opportunities to start diversifying services and entering in more risk-based payment schemes. He shares what's working and what the consequences are if providers sit on the sidelines in this podcast moderated by McKnight's Executive Editor James M. Berklan. www.mcknights.comFollow us on twitter:  @mcknightsltcn Connect with Fred on LinkedIn here, and ATI on LinkedIn here. 

Francois de Brantes is a pioneer in measuring and improving healthcare outcomes. Francois began his career at GE Healthcare which provided him with a solid background in measuring what matters. While at GE, Francois helped create The Leapfrog Group focused on improving quality and safety. From there, Francois spent almost 11 years as the Executive Director of the Healthcare Incentives Improvement Institute before moving to Altarum and now Signify where he continues his focus on payment innovation. On this episode you'll hear Francois' perspective on value-based payment models and what we might expect to see moving forward.  Show notes: To Err is Human: Building A Safer Health System by Institute of Medicine and Committee on Quality of Health Care in America and Crossing The Quality Chasm: A New Health System For The 21st Century by Institute of Medicine and Committee On Quality of Health Care in America

Dr. Rishi Wadhera is a cardiologist at Beth Israel Deaconess Medical Center and an assistant professor at Harvard Medical School. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. S. Gondi, K. Joynt Maddox, and R.K. Wadhera. “REACHing” for Equity — Moving from Regressive toward Progressive Value-Based Payment. N Engl J Med 2022;387:97-99. D. Jacobs and Others. Expanding Accountable Care's Reach among Medicare Beneficiaries. N Engl J Med 2022;387:99-102.

I wanted to remind everyone about this show from last year because it's becoming increasingly relevant. We have this weird thing going on where everybody seems to be talking about physician incentives and payments and financial implications but so often disregards patient incentives and payments and financial implications. Consider that we're at a place in the time-space continuum where it is inarguable that financial toxicity has become clinical toxicity. Patients are increasingly in huge numbers abandoning care, splitting pills, doing all kinds of things to save money that are clinically toxic. And these are patients with “good insurance” that we are talking about here. So, here's a role play: Provider organization is actually paying doctors for outcomes. In wanders a patient with a huge deductible. Doc says, “Wow, Patient … so important that you take your insulin or med as directed or get a follow-up on that scary colonoscopy finding.” Patient says, “Sorry, Doc. Can't afford it.” And the doc gets dinged because the patient outcomes are avoidably poor. That's what this show with Dr. Mark Fendrick digs into: aligning patient incentives (aka benefit designs etc) with value-based payments on the provider side. And with that, here's your encore: And here I thought I knew a lot about value-based care. In this healthcare podcast, I am speaking with Mark Fendrick, MD, who is the director over at the University of Michigan Center for Value-Based Insurance Design. This conversation is for those of you who already know pretty much about value-based care concepts. If you do not, I'd go back and listen to, say, Encore! EP206, with Ashok Subramanian, before this one.   Dr. Fendrick talks in this healthcare podcast about what it takes for value-based care to happen in the real world. No kidding, it's about making sure that reimbursement is aligned with good things (no great surprise there). But two light bulb moments I had in this conversation with Dr. Fendrick: At the beginning of the year, how many doctors and nurses, inspired to do the right thing, have told their patients with diabetes, say, to go get an eye exam to check for diabetic retinopathy? No one would disagree that this is definitely a good idea. Diabetic retinopathy causes blindness. But here's the reality of that conversation. Doc says, “Go get an eye exam.” And patient says, “I can't. My deductible is huge, and I can't afford it.” So, the patient doesn't get the follow-up care and winds up in the hospital or blind. And the doctor gets dinged on his or her quality scores. Suboptimal outcomes all around, I'd say. This also happens on the pharmacy side of the equation, but I think a lot of us are a little bit more familiar with that scenario—like type 1 diabetics who can't afford to pick up their insulin because of a Medicare Part D or commercial deductible that they haven't met yet. I just never really connected the dots back to the provider getting black marks because their patient has a benefit design that's not aligned with the quality measures. In a majority of benefit designs, consumer price sharing is based not on the value of the service but on how expensive the service just happens to be. Wow! So, we're trying to get our plan members to be consumers and use the power of their wallets to make good healthcare choices. And what we're really doing is driving them toward cheap things or no care and discouraging them from indulging—and I say that sarcastically—in expensive things. But the expensive things might be the high-value care, and the relatively cheap things might be crap that's fully unnecessary or harmful and, over a whole population, adds up to a lot of zeros. Healthcare is not like a consumer market where the expensive things are usually a better version of the cheap things. For all you economists out there, you don't want the demand curve to be elastic when what's cheap and what's expensive has no correlation to quality or necessity. Nobody should be super flabbergasted when a $35 cure-all supplement peddled on YouTube makes some random influencer a millionaire. That's how supply and demand works. Much to ponder in this episode. You can learn more at vbidcenter.org. There's also a great newsletter you can sign up for there.   A. Mark Fendrick, MD, is a professor of internal medicine in the School of Medicine and a professor of health management and policy in the School of Public Health at the University of Michigan. Dr. Fendrick received a bachelor's degree in economics and chemistry from the University of Pennsylvania and his medical degree from Harvard Medical School. He completed his residency in internal medicine at the University of Pennsylvania, where he was a fellow in the Robert Wood Johnson Foundation Clinical Scholars Program. Dr. Fendrick conceptualized and coined the term Value-Based Insurance Design (V-BID) and currently directs the V-BID Center at the University of Michigan (vbidcenter.org), the leading advocate for development, implementation, and evaluation of innovative health benefit plans. His research focuses on how clinician payment and consumer engagement initiatives impact access to care, quality of care, and healthcare costs. Dr. Fendrick has authored over 250 articles and book chapters and has received numerous awards for the creation and implementation of value-based insurance design. His perspective and understanding of clinical and economic issues have fostered collaborations with numerous government agencies, health plans, professional societies, and healthcare companies.   Dr. Fendrick is an elected member of the National Academy of Medicine (formerly IOM), serves on the Medicare Coverage Advisory Committee, and has been invited to present testimony before the US Senate Committee on Health, Education, Labor and Pensions; the US House of Representatives Ways and Means Subcommittee on Health; and the US Senate Committee on Armed Services Subcommittee on Personnel. 05:00 Is back surgery high-value care? 05:51 If care is patient to patient, how is high-value care decided upon? 06:40 “Flintstones delivery: We have to move from the sledgehammer to the scalpel.” 11:14 “Almost all of the services that we recommend to reduce cost sharing … do not save money.” 12:30 “I didn't go to medical school to learn how to save people money.” 17:03 “When a patient and their clinician agree … the patient should be able to get that [service] easily, and the clinician should be paid generously.” 18:01 “When patients and providers are aligned, they do much better.” 19:59 What services are deemed high value, and what services should be pre-deductible? 21:50 “Are primary care visits high value? … The answer is, it depends.” 25:55 What are V-BID's core pillars to address value-based care? 28:04 How does Dr. Fendrick's method of value-based care and reimbursement actually enable better consumerism? 29:51 What do providers think about changing reimbursement on low-value and high-value care? 30:58 “We have incentives that are run amok.” 32:12 EP176 with Dr. Robert Pearl. 32:49 “It's all about incentives.” 33:43 “You do have the funding; you just have to have the courage.” You can learn more at vbidcenter.org. There's also a great newsletter you can sign up for there. Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth If care is patient to patient, how is high-value care decided upon? Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth “Flintstones delivery: We have to move from the sledgehammer to the scalpel.” Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth “Almost all of the services that we recommend to reduce cost sharing … do not save money.” Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth “I didn't go to medical school to learn how to save people money.” Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth “When patients and providers are aligned, they do much better.” Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth “Are primary care visits high value? … The answer is, it depends.” Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth “We have incentives that are run amok.” Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth “You do have the funding; you just have to have the courage.” Mark Fendrick, MD, of @UM_VBID discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #vbc #digitalhealth   Recent past interviews: Click a guest's name for their latest RHV episode! 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, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble  

HFMA President and CEO Joe Fifer interviews Jonathan Blum, principal deputy administrator and COO at CMS. In this interview, Blum discusses how CMS plans to phase out the public health emergency, how price transparency and surprise billing legislation are being received by provider organizations, and the effect the pandemic will have on CMS's value-based care strategy.

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

Dr. Sanjay Doddamani, the CEO of UpStream HealthcareModerator: Brian Zimmerman, Senior Director, Client Content + Strategy with Becker's Hospital ReviewThis episode is sponsored by UpStream.

Before I get into the show today, let me just remind everybody about our mailing list, which you can sign up for on our Web site, relentlesshealthvalue.com. You might follow Relentless Health Value on LinkedIn or Twitter, which is a great option, for sure; but I wanted to point out that what you see there is abridged at some level. Meanwhile, if you subscribe to our mailing list directly (again, by going to our Web site, relentlesshealthvalue.com—it's over on the right sidebar where you can sign up for the mailing list), if you subscribe that way, each week you'll get an email with a full transcription of the whole introduction of the show with timed show notes. Also, we don't send out literally anything else beyond what I just described on a weekly basis. Also, you can unsubscribe easily and anytime you want. You just hit the unsubscribe in the email. Also, we don't share our list with anybody. We barely have time to look at it ourselves, so if you have any concerns there in that regard, please don't.  Last week's show (EP359) was with Dan O'Neill, and he talked about the four gradations of value-based payments, from paying purely for volume on one end of the continuum to paying purely for value on the other. When you have a moment (not now, but when you can), go back and listen to that show, as it adds some color to what we talk about in this healthcare podcast.  But in the meantime, one of the points that Dan O'Neill makes is that patients in this country won't gain the benefits of value-based care unless commercial insurers pay for value, for reals. After all, value-based payments are payments that incentivize value-based care. Without value-based payments, how does anyone expect to get value-based care? To belabor this point momentarily, a provider is not gonna switch up their FFS business model when insurers, especially commercial insurers, pay whatever for whatever with no reward going to providers who spend time and effort to create value and/or better outcomes for patients. I'm being super cynical here, I will grant you. But in this day and age of private equity and record profits by a consolidated healthcare industry, if I'm in charge of a provider organization just realistically here, Pramod John, PhD, says this really well in EP352. He's talking about drug development in that episode, but same thing here is true for medical care. If you indiscriminately pay Ferrari prices for Hyundais, you're gonna get a Hyundai for the price of a Ferrari.   To add insult to injury—and this is just one important reason why providers aren't really willing to invest in lifting outcomes—any value that they would manage to create is gonna be realized by the insurers. It's gonna go right back into insurers' pockets. Steve Schutzer, MD, talks about this in his episode (Encore! EP294) about the why and how to create a center of excellence. If, as a provider in a pure volume contract which is FFS, I work really hard to save downstream costs and complications for patients, some carrier is gonna bank the difference.   It's go time, all you self-insured employers out there. Pay for high quality. Make the carrot an orange-colored stick, as they say. Patients will benefit. Probably doctors and other clinicians, too, honestly: less moral injury and crappy workflows. In this healthcare podcast, I am talking with Jeb Dunkelberger. Jeb Dunkelberger is the CEO of Sutter Health | Aetna, which is a payvider. Payviders, by Jeb's definition, take on full risk. They have a full-risk insurance product, meaning they must switch up their business model and how they deliver care so that it works in a total capitation payment situation. We go deep on payviders the last time Jeb was on the show (EP348). But in this relatively short conversation, I wanted to talk to Jeb about the operational imperatives of moving to value-based care, moving to a care model that is aligned with value-based payments—what needs to switch up in the day-to-day to ensure that patients don't have care gaps that cause expensive trouble downstream, or patients at rising risk get taken care of promptly before something avoidable and/or acute (ie, expensive) happens.   There are three main things that Jeb talks about: Fixing up the clinical workflow Having care navigators Aligning physician comp to organizational goals Let me dig into each one of them briefly. 1. Fixing up the clinical workflow. There's basically five aspects to that: Ensuring that the right data is in the clinical workflow. Let's talk about this data for just one sec and we'll find actually one more reason that payers and purchasers need to get kinda engaged in this making sure members get care thing. Because data—data that payers have that is needed at the point of care. Like claims data. Please provide it to providers and actually insist that it gets used by clinicians making clinical decisions at the point of care. Ensuring that there are pick lists of drugs, with generic drugs first Making sure it's easy to get to pended orders that close care gaps right within the clinical workflow Empowering medical assistants and holding them responsible to create value for members Building referral management into the clinical workflow in pursuit of a nonfragmented patient journey 2. Having care navigators. I just want to remind everyone: This is even more important if the EHR doesn't support referral navigation. Also, Liliana Petrova talks about this extensively, the need for care navigators, in EP357. She's talking about it relative to telehealth, and she makes a really important point: If you want to ensure that the right patients are getting telehealth and also taking advantage of it to streamline their longitudinal care and make it less fragmented, you have to have navigators involved in scheduling. Otherwise, how's a patient supposed to know whether to go in person or telehealth or even that telehealth is available?  3. Aligning physician comp to organizational goals. We definitely get into this in some detail. We cover these three top-line operational must-haves in this episode, and you'll hear about them right from a CEO who is doing them right now. Besides this conversation, another resource I would highly recommend checking out is a recent article in Nature entitled “Deploying Digital Health Tools Within Large, Complex Health Systems.” While this article is about digital health tools (obviously by its title), 80% of the article is pertinent to deploying pretty much anything in a big provider organization, including an upgrade to value-based care delivery—and/or probably digital health tools are pretty requisite in any attempt to effectively remodel the clinical workflow in this way in 2022, so there's that, too.   For additional Relentless Health Value episodes on this topic of how to build an operational model that fulfills value-based care objectives, I'd listen to the show with Shawn Rhodes on the essentials for clinical integration (EP354)—also the show with Lisa Trumble (EP349) on what that clinical integration looks like from a care perspective. I am also going to refer you to the episode next week (EP361) with Carly Eckert, MD, MPH. So, check that out for sure. We talk about care gaps.  You can learn more at sutterhealthaetna.com.   You can also connect with Jeb on LinkedIn and follow him on Twitter.   Jeb Dunkelberger, MSc, MHCI, currently serves as CEO of Sutter Health | Aetna (SH|A), a commercial insurance plan serving Northern California. The health plan aims to combine the value of retail, provider, and payer via its partnerships with CVS, Sutter Health, and Aetna. Prior to SH|A, Jeb led growth for two bay-area healthcare start-ups: Cricket Health and Notable Health. Jeb has also held executive roles at Highmark, McKesson, and EY. Jeb holds healthcare-related degrees from Virginia Tech, The London School of Economics, Cornell University, and University of Pennsylvania. 08:36 What must a provider organization consider operationally when incorporating value-based care and value-based payments? 09:44 How can you use perverse incentives to encourage people to do the right thing? 12:25 How should clinical workflows operate to incorporate value-based care? 14:10 “How do you align patients?” 15:52 How should the EHR operate to maximize value-based workflow? 16:52 Why is taking action on claims data and clinical data together important? 20:26 “Have they actually solved the last mile of integrations?” 21:15 “Changing the behavior of a provider is an absolute art and science.” 22:57 “We have to do more.” 27:09 “That administrative headache … doesn't just end with the insurer.” You can learn more at sutterhealthaetna.com.   You can also connect with Jeb on LinkedIn and follow him on Twitter.   @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs What must a provider organization consider operationally when incorporating value-based care and value-based payments? @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs How can you use perverse incentives to encourage people to do the right thing? @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs How should clinical workflows operate to incorporate value-based care? @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs “How do you align patients?” @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs How should the EHR operate to maximize value-based workflow? @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs Why is taking action on claims data and clinical data together important? @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs “Have they actually solved the last mile of integrations?” @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs “Changing the behavior of a provider is an absolute art and science.” @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs “We have to do more.” @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs “That administrative headache … doesn't just end with the insurer.” @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs Recent past interviews: Click a guest's name for their latest RHV episode! Dan O'Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb  

What is going on with Value-based payment models in healthcare? We've been talking about it for years and despite all the chatter and investment, uptake has been slow. Now, the CMS Innovation Center (CMMI) has put many of its models on hold including the Direct Contracting Geo model that we covered earlier this year. Does this mean we are moving away from value-based payment models? Absolutely not! In fact, things are going to start moving much more quickly towards value in 2022. The #HCBiz Show has partnered with Value-based Contracting expert, Gail Zahtz to bring you a 5-episode series that will tell you everything you need to know about value-based payment models to prepare for 2022. Get all the details here: https://thehcbiz.com/174-vbp-2022-series-preview-gail-zahtz/

Analytics are key to success in value-based care. That's because analytics deliver data-driven insight into exactly what it takes to achieve desired patient outcomes for any given episode of care. With that insight, payers and providers can collaborate to move more smoothly from fee-for-service to fee-for-value, to create logically bundled payment programs, and to  produce insight-driven results. So learning more about VBC analytics will help you reap more of VBC's potential benefits. Presenters: Summerpal Kahlon, MD, VP Value-Based Payment at Change Healthcare Kyle Kroening, Product Manager, NetworX Product Suite at Cognizant Jennifer Mann, Senior Manager, NetworX Product Management Team at Cognizant

This is one of the most health challenging times in modern history. Healthcare systems and practitioners face dire circumstances in delivery of care to scores of citizens. A reverential ethic in healthcare leadership that promotes an informed and respectful approach towards life is key to health system success in population health. This core value is how Trinity Health, one of the largest integrated care delivery systems in the nation that serves more than 30 million people across 22 states, approaches their transition to value-based payment.  They believe the “race to value” is a moral imperative to improve community outcomes and ensure health equity, instead of just a business opportunity. Our guest this week is Akil McClay, System Director of APM Operations at Trinity Health. Akil is responsible for the implementation, deployment and operational CIN/ACO/APM activities across four states (Delaware, Pennsylvania, Indiana and New York) with approximately 290,000 covered lives. Additionally, Akil serves as the Executive Director for the Trinity Health Integrated Care MSSP Enhanced ACO and successfully led Trinity Health Integrated Care to achieve $45M in shared savings for performance years 2017−2019. Most importantly, Akil lives the value of reverence, and his insights spark a similar passion in each of us.   Episode Bookmarks: 04:00 Akil's formative years that led him to understand the need for minority health and health equity 05:30 How charity care hospitals impact the health of vulnerable communities 06:30 How an educational path in neurosciences led to a healthcare administrative career 07:45 “When you are a healthcare leader, you have the opportunity to impact millions of lives across the country.” 10:00 “It starts with us.  You need to have leaders that are reflective of the communities that we serve.” 10:30 Akil reflects on the presence of institutional racism in our country's healthcare system and how Mike Slubowski is committed to DEI in leadership 11:15 Akil discusses the inequitable distribution of vaccines in the Philadelphia market and how Trinity was able to operationalize equity through a rapid-cycle innovation approach 15:35 How the VA system is an exemplar of value-based care innovation and why the private sector should learn from them as it moves to fully-capitated payment 17:40 A fully-capitated, total cost of care model gives us the best ability to care for our patients.” 18:05 How Trinity is moving to a fully-integrated EHR system across all of its markets 19:20 Engaging patients in healthcare by creating a community-based center (a lesson learned from the VA) 21:40 Akil discusses how Trinity Health has been able to navigate the COVID-19 pandemic 24:00 Trinity Health's deployment of a unified telehealth platform 25:00 High-speed internet access as a social determinant of health 27:40 Trinity Health's early beginnings in value-based care led by Rick Gilfillan and the aspirational goal of having 75% of revenue derived from the APM portfolio 29:00 The future of VBC is in risk-based payment and how early adoption of CMMI programs allowed for innovation 30:00 “We want to have the majority of our revenues come from value-based contracts because we believe that is what's best for the patient.” 31:20 Do we need as many hospitals as we currently have in the United States?  What is the impact of COVID-19 on the movement to VBC? 33:00 Akil discusses how Trinity Health is building out capabilities for risk coding and documentation to better reflect burden of illness in their patient population 37:40 Trinity Health's approach to building an integrated EHR and digital health platform for patient engagement 42:00 EHR optimization through provider-led workgroups and use of internal teams to build a homegrown analytics platform 44:35 Overcoming the limitations of digital tools by listening to patients

Dr. Timothy E. Dudley, an MGMA consultant, reflects on his work as a founding medical director and chief medical officers for a clinically integrated network (CIN) serving 80 primary care practices in the Denver metro area, which had eight value-based contracts covering more than 130,000 patients. For more Executive Session episodes, visit www.mgma.com/execsession. Producer: Chris Harrop, MGMA senior editorial manager Intro/outro audio: "Street Walk," Paolo Pavan (CC BY-NC-SA 4.0)

Today’s episode looks at the long-awaited companion final rules advancing value-based care published by the Centers for Medicare & Medicaid Services and the Office of Inspector General of the Department of Health and Human Services. Epstein Becker Green attorneys Anjali Downs, Jennifer Michael, Lesley Yeung, and Paulina Grabczak give an overview of the final rules and point out key issues health care companies should carefully consider as they take advantage of these value-based care safe harbors and exceptions. Visit our site for more information and related resources: https://www.ebglaw.com/dhc21 Subscribe for email notifications: https://www.ebglaw.com/subscribe Visit: http://diagnosinghealthcare.com The EMPLOYMENT LAW THIS WEEK® and DIAGNOSING HEALTH CARE podcasts are presented by Epstein Becker & Green, P.C. All rights are reserved. This audio recording includes information about legal issues and legal developments. Such materials are for informational purposes only and may not reflect the most current legal developments. These informational materials are not intended, and should not be taken, as legal advice on any particular set of facts or circumstances, and these materials are not a substitute for the advice of competent counsel. The content reflects the personal views and opinions of the participants. No attorney-client relationship has been created by this audio recording. This audio recording may be considered attorney advertising in some jurisdictions under the applicable law and ethical rules. The determination of the need for legal services and the choice of a lawyer are extremely important decisions and should not be based solely upon advertisements or self-proclaimed expertise. No representation is made that the quality of the legal services to be performed is greater than the quality of legal services performed by other lawyers.

Kristen McGovern, a partner at healthcare consulting firm Sirona Strategies, discusses the next evolution of value-based payment: Medicare’s Direct Contracting model. The first group of participating organizations starts the demonstration this week.  

Host Nigel Ohrenstein talks to Dana Safran, Senior Vice President, Value Based Care & Population Health at WELL Health. She formerly held leadership roles at Haven and Blue Cross Blue Shield of Massachusetts and served in advisory roles to numerous local, national and international organizations and government agencies. Dana shares key insights from his payer and healthcare retail experience, and where he expects the industry to move in the future. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

This episode of Tuning Healthcare features Dana Safran, Senior Vice President, Value Based Care & Population Health at WELL Health. She formerly held leadership roles at Haven and Blue Cross Blue Shield of Massachusetts and served in advisory roles to numerous local, national and international organizations and government agencies. Dana shares key insights from his payer and healthcare retail experience, and where he expects the industry to move in the future.

Tim and Nicole discuss GBUACO's Value Based Payment contracts and how their performance is measured.

Vanessa Guzman is the CEO of Smartrise Health, which specializes in all Value-based Payment and Accountable Care organization matters. She helps us make sense of the alphabet soup of acronyms like ACO, MIPS and why the Center for Medicare and Medicaid Services is CMS and not CMMS. She defines value by CMS’ three aims: better care for individuals, better health for populations and lower cost. She attempts to shorten the chasm between what we see as useless clicking and how it actually helps our patients. We discuss how this can help our bottom line and help our patients to thrive and how we can use the data we collect for CMS and commercial payers to help our own organizations. We also discuss the impact of COVID and where she sees these payment models going in the future. With almost 15 years of experience, Vanessa has helped organizations gain over millions of dollars in value-based payment related revenue - through her unique integrated strategy that creates a collaborate space among health systems, payors, technology solutions and community-based organizations. Vanessa graduated from Columbia University’s Fu Foundation School of Engineering and Applied Science with a BS and MS in Biomedical Engineering, specializing in Diagnostic Imaging. She is also certified in Quality Engineering and Quality Management and Organizational Excellence by the American Society for Quality. For her outstanding contributions, Vanessa has been awarded the 2018 Becker’s Hospital Review “Rising Stars Under 40” and 2017 Modern Healthcare’s “Up and Comers” Awards. Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com Please be sure to leave a five-star review, a nice comment and SHARE!!! A proud member of the Doctor Podcast Network!

Health care is considered a high stakes issue in the 2020 presidential election in terms of both health insurance coverage and affordability of care. In Part 2 of Sg2 Perspectives' 2-part election series, Vizient Senior Government Relations and Policy Director Steve Rixen once again joins Sg2’s Bill Woodson and Valinda Rutledge to discuss the potential fate of the Affordable Care Act as well as the path forward for value-based care.

Rich Daly interviews Rep. Suzan Delbene about the Value in Health Care Act, proposed legislation that would make a series of hospital-supported changes to value-based programs operated by Medicare. Andrew Renda of Humana talks about how the company improved Healthy Days in Medicare Advantage markets. In a sponsored segment, MedAssist Senior Vice President Nate Allen and Carilion Clinic's Vice President of Revenue Cycle Brett Tracy discuss Medicaid expansion in Virginia.   Sponsored by MedAssist

In this week’s episode, Limo Cherian, Carla Dewberry and Steven Pine discuss recent changes to value-based health care payment arrangements triggered by the current COVID-19 emergency. In particular, the presenters discuss changes implemented by CMS to the Quality Payment Program (QPP), the Merit-based Incentive Payment System (MIPS), and the Medicare Shared Savings Program (MSSP), as well as additional considerations for commercial value-based arrangements.

In response to COVID-19, the GBUIPA Triage line has become a critical tool that allows individuals to speak to their doctor or nurse without risking further exposure to COVID-19 or spreading it deeper in the community. Steve Nelson, Millennium Director of Value Based Payment and Performance spoke with Dr. Vazquez, CEO of G-Health Enterprises and Chelsea Adamski, MPA, Assistant Director, VBP, G-Health.

In response to COVID-19, the GBUIPA Triage line has become a critical tool that allows individuals to speak to their doctor or nurse without risking further exposure to COVID-19 or spreading it deeper in the community. Steve Nelson, Millennium Director of Value Based Payment and Performance spoke with Dr. Vazquez, CEO of G-Health Enterprises and Chelsea Adamski, MPA, Assistant Director, VBP, G-Health.

In response to COVID-19, the GBUIPA Triage line has become a critical tool that allows individuals to speak to their doctor or nurse without risking further exposure to COVID-19 or spreading it deeper in the community. Steve Nelson, Millennium Director of Value Based Payment and Performance spoke with Dr. Vazquez, CEO of G-Health Enterprises and Chelsea Adamski, MPA, Assistant Director, VBP, G-Health.

In response to COVID-19, the GBUIPA Triage line has become a critical tool that allows individuals to speak to their doctor or nurse without risking further exposure to COVID-19 or spreading it deeper in the community. Steve Nelson, Millennium Director of Value Based Payment and Performance spoke with Dr. Vazquez, CEO of G-Health Enterprises and Chelsea Adamski, MPA, Assistant Director, VBP, G-Health.

Robert Nielsen of Pinnacle Health - Preparing for Value Based Payment

Health systems have been working hard to lay the foundation for taking on a larger case mix of value-based contracts. 75% of health systems surveyed said they are ready to accept downside risk in the next two years, up from 42% in 2015. As health systems are discovering, value-based care reimbursement is more complicated and requires a new level of specificity in documentation. The question is, are health systems really ready to take on downside risk while continuing to manage FFS contracts? Today we have Kyle Swarts, Chief Growth Officer, and Matt Lambert, MD, Chief Medical Officer from TrustHealthcare to help us answer that question. We discuss challenges and opportunities facing health systems as they embrace the shift to value. Enjoy! Highlights from Headwinds Impacting the Shift to Value-Based Care It's time for providers to take on risk. Everyone has a population health department but fee-for-service is still driving your overall strategy. The threshold for making the jump to VBP. Why it's so difficult to get doctors on board with VBP. "It's not how sick your patients are, it's how well you document how sick your patients are." The risk of moving slowly to VBP. The promise of 60 minute home visits with a physician finally has a reimbursement model. Where we will see new consolidation in response to VBP. The two big reasons specificity in documentation is key to successful downside risk contracts. Reimagining EHR design to foster VBP. AI success is all about physician adoption. Kyle Swarts, Chief Revenue Officer Kyle is a growth-minded leader who has overseen sales, marketing, and business development at healthcare consulting, revenue cycle management and information technology companies for the past 12 years. Matt Lambert, MD, Chief Medical Officer Matt brings over twenty years of experience as a clinician, CMIO, and change leader to value-based care, ensuring that patients receive more comprehensive care and that payers and providers better capture the value of their services. TrustHealthcare Founded in 2018 by a team of healthcare veterans and clinicians with private equity funding from Windrose Health Investors, TrustHealthcare's mission is to empower healthcare provider organizations and health plans to successfully navigate from fee-for-service to value-based care. The TrustHealthcare platform seamlessly integrates with the electronic health record and leverages more than 500 proven clinical rules – while also connecting CDI specialists, clinicians, and coders in one simplified workflow. With TrustHealthcare, providers and health plans can rest assured that they are capturing the full value of patient care in real-time. Links and Resources TrustHealthcare Website TrustHealthcare Linkedin Unrest Insured by Matt Lambert, MD A Primer on HCC codes and Risk Adjustment Related Episodes: Top 10 Things to Ensure Success in a Value-based Healthcare World Value-based Payment: Progress, Trends and Direction w/ Jason Helgerson The Future of Value-Based Payment w/ François de Brantes of Remedy

Medicine Grand Rounds July 26, 2019 Barbara Vickrey, MD, MPH Professor and Chair of Neurology Icahn School of Medicine at Mount Sinai

Addressing the Complexities of Value-Based Payment Models by Managed Care Cast

Pathologists could lose, or gain, $2.1 billion over seven years in Medicare’s new quality payment programs. This represents the difference between pathologists gaining the full possible Medicare payment bonuses or receiving the payment penalties. Pathologists need to understand Medicare’s merit-based incentive payment system (MIPS) program as it relates to reducing the burden of participating, understanding and maximizing scoring, and seeking measures and improvement activities with maximum scoring and bonus point potential, explain Drs. Emily Volk and Diana Cardona in this CAPcast. Drs. Volk and Cardona are leading a CAP19 session on Monday, September 23 at 9:30am. Register now for CAP19: www.capannualmeeting.org.

Join Dave Ballenberger, MSW and Kristin Walker as they discuss what's going on in Arizona and the challenges one mental health organization has faced. Michael Boylan, LCSW – Chief Executive Officer of Crisis Prep is one of the few successfully managing Value Based Payment in Behavioral Health. Mr. Boylan has a Masters Degree in Social Work from Arizona State University and has his certification with the Arizona Board of Behavioral Health Examiners. Michael has been providing crisis intervention services in a multitude of capacities for the past 16 years. He started his career as a crisis counselor serving a diverse population in New York City in a public elementary school. He moved to Arizona in 1994 and began providing services in the County-wide Mental Health Crisis System and later served as Director of Crisis and Referral Services under ValueOptions in 1998 until 2001. He began his work with Crisis Preparation and Recovery in 2001 as a crisis counselor and currently provides operational direction and program development to CPR.www.crisisprepandrecovery.com

Don helps organizations launch new health IT products and services. He’s a product and business development consultant and accomplished health IT expert with a 20-year track record of driving value with technology. Don began his career as a custom software developer and eventually built and led a team of more than 30 engineers. Later, he was the subject matter expert, product manager, and head of sales and marketing for a digital health start-up that launched a software as a service (SaaS) platform focused on administrative simplification in health care. Today, Don is president of Glide Health IT, LLC, a consulting firm that helps forward-looking organizations align their health IT and business strategies. The firm specializes in business and product development with a focus on data aggregation, interop, analytics, and quality measurement. Don is also the host of The #HCBiz Show!, a podcast dedicated to unraveling the business of health care, as well as a partner at VBP Forward, a new conference focused on value-based payment for complex and special needs populations. 01:09 What problems the VBP Forward Conference aims to solve. 01:45 “Providers are being asked to take on risk.” 03:13 “The health systems have to engage with these existing resources.” 03:27 Bridging gaps in order to solve a common goal. 03:45 Finding the shared priority. 04:03 Value-based care conference vs a value-based payment conference. 05:44 Care = perspective; payment = retrospective. 05:58 National conference vs regional conference.

On this episode, we talk with Jason Helgerson, founder of Helgerson Solutions Group and Former Medicaid Director for New York and Wisconsin. Jason shares his perspective on Value-based payment progress and direction tells us who needs to get involved and how, and we discuss how to measure success. That is, how will we know if value-based payment has been adequately deployed, and more importantly, how will we know if it's working?   This episode is sponsored by VBP Forward: VBP Forward will host its inaugural conference February 20-21, 2019 in Buffalo, NY at the Hyatt Regency Buffalo. The conference will bring together over 200 professionals who serve Medicaid and Medicare special needs or complex populations or have an interest in that value chain. Participants will gain insight into the next generation of value-based payment and will be provided with a roadmap for their path towards effective value payment for special needs populations. In addition to clinical providers, VBP Forward will have a track and focus on guiding community-based organizations down the right path for the collection of social determinants of health and how they can become not only an integral part of care delivery but also the revenue cycle associated with that delivery.   2:09 Engaging providers who feel left behind by the Value-Based Payments conversations. 3:18 In New York, 80% of all reimbursement for Medicaid must be under VBP contract by 2020. 5:36 Community Based Organizations are treating the same issues health systems are struggling with. What do CBOs and Health systems need to learn about each other to create new sustainable business models? 9:10 Breaking down the language barriers. 12:49 What has made early pioneers successful? Green and Healthy Homes Initiative God's Love We Deliver  15:11 How do CBOs explain to plans and health systems what the expected ROI will be? "Walk before you run." 18:07 Begin the dialog with payors early. You can see this as an opportunity or a threat, but the train has left the station. 21:40 When taking on risk, you're responsible for more than you were in a FFS model. This necessitates partnerships with CBOs. If you wait, you're going to have to take what's left. 22:45 What's happening outside NY? Examples nationally and abroad. England and NHS 28:15 What about Medicare and commercial payors? 31:15 Measuring success in a VBP future. What does success look like for the state, for CBOs, for doctors, and for patients? “I think at some point in the not too distant future, we will look back on how we treat people who are sick and with flu-like symptoms almost as bloodletting. Requiring them to leave their homes and go to a clinic to be treated when the technology exists to do bloodwork and other tests in the home; with new telehealth tools to be able to almost do a complete exam on those individuals without them having to leave the comfort of their home, which is in the best interest of the patient and the public's health, those models are not possible in the traditional FFS system. They are much more possible in a value-based world." "Consumers having more choices will be the real power of Value-Based Payments." 37:00 How close are we to knowing which clinical outcomes to measure? HEDIS measures taken from claims data measure process and not the true outcome. Patient-reported outcomes are needed to say if patients are getting high-quality services. Beyond healthcare measures, how do we measure the health and wellbeing of a community? 42:00 Helgerson Solutions – What do you do and who do you do it for?   About Jason Helgerson Jason Helgerson is an entrepreneur, investor, consultant and social change agent.  After more than 20 years of public service he has embraced the “gig economy” and launched a multifaceted private sector career.  Helgerson Solutions Group LLC (HSG) is focused on helping companies, providers, payers and governments make the move to value in health care.  Jason also advises Private Equity firms and Venture Capital funds that share his commitment to value-based health care.  Jason also works around the world as a Senior Advisor to a global management consulting firm. Before his move to the private sector, Jason was a nationally recognized leader in public sector health care.  Most recently he was New York's Medicaid Director, a role he held for over seven years.  New York's Medicaid program provides vital health care services to over 6.6 million New Yorkers and has an annual budget in excess of $68 billion.  Jason also served as the Executive Director for New York's Medicaid Redesign Team, nationally recognized as a 2015 Innovation in American Government Finalist by the Harvard Kennedy School of Government.  In this capacity he directed Governor Cuomo's effort to fundamentally reshape the state's Medicaid program in order to both lower costs and improve health care quality.  In 2015, Jason was also recognized as a Public Official of the Year by Governing Magazine. Twitter: @policywonk1   About Helgerson Solutions Group HSG was founded to make the world a better place.  Its founder, Jason Helgerson, has made that his mission his entire professional life.  He has been a positive and successful change agent in every position he has held.  Most recently he was New York's Medicaid Director.  In that role he led the state's historic Medicaid redesign efforts which not only bent the cost curve but improved outcomes for Medicaid members. A 2018 Commonwealth Fund study found New York to be the most improved state in the nation relative to its overall health system performance and suggested that further improvement was likely thanks to reforms launched by Jason and his team. Prior to moving to New York, Jason was Wisconsin's Medicaid Director.  In this role he led the effort to expand access to health care to virtually all state residents.  He also helped lead a major cost-cutting exercise that brought down spending without taking benefits away from a single Medicaid member.  Prior to his Medicaid work, Jason held a series of positions in state and local government leading efforts to reform education, child care, public finance and, of course, health care. https://www.helgersonsolutions.com   Related and/or Mentioned on the Show:  DSRIP and VBP reform Green and Healthy Homes Initiative God's Love We Deliver Adam Boehler and CMMI MVP Healthcare   Join our Community!  Trying to drive change within your healthcare organization? Launching a new product? Having trouble getting decision makers attention and buy-in? We'll help you understand the whole picture so that you can align your innovation with the things decision makers care about. And then we'll help you execute It's not easy, but it's possible and we'll help you get there.  Sign up here and we'll keep you up to date on healthcare industry news with podcasts, blog posts, conference announcements and more. No fluff. No hype. Just the valuable (and often not-so-obvious) information you need to get things done. Sign up here   The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media. Music by StudioEtar

On this episode, we talk with François de Brantes, Senior Vice President of Commercial Business Development at Remedy, about the future of value-based payment. François shares with us the importance of transparency, measurement, and responsibility and tells us why payment reform is such an effective lever to drive change. You'll hear about models that have been successful, how employers are driving change, and what you can expect from the next generation of value-based payment. In addition, François shares his insights on how we can account for the social determinants of health (SDOH) in our program design.  This section led to a significant "aha" moment for me and underscores the importance of incorporating community-based organizations (CBOs) more tightly with our traditional healthcare delivery system.   View full post and show notes on the web   François de Brantes will be a keynote speaker at the inaugural VBP Forward Conference in Buffalo, NY on February 20th and 21st, 2019.   This episode is sponsored by VBP Forward: VBP Forward will host its inaugural conference February 20-21, 2019 in Buffalo, NY at the Hyatt Regency Buffalo. The conference will bring together over 200 professionals who serve Medicaid and Medicare special needs or complex populations or have an interest in that value chain. Participants will gain insight into the next generation of value-based payment and will be provided with a roadmap for their path towards effective value payment for special needs populations. In addition to clinical providers, VBP Forward will have a track and focus on guiding community-based organizations down the right path for the collection of social determinants of health and how they can become not only an integral part of care delivery but also the revenue cycle associated with that delivery.   About François de Brantes:  François de Brantes serves as Senior Vice President of Commercial Business Development at Remedy Partners. He leads customer development of the Medicare Advantage, Self-Insured Employer, and Commercial Payer markets. He has spent close to two decades working to transform the U.S. healthcare system by improving incentives for providers and consumers in order to encourage value-based decisions. Prior to joining Remedy Partners, he served as Vice President of Altarum, a national nonprofit. From 2006 to 2016, he was Executive Director of the Health Care Incentives Improvement Institute (HCI3), a not-for-profit company that designed programs to motivate physicians and hospitals to improve the quality and affordability of healthcare delivery. The organization, which merged with Altarum in December 2017, was responsible for the Bridges to Excellence® (BTE) and PROMETHEUS Payment® programs, which compensate and reward clinicians that focus on episodes of care and performance measures. Prior to HCI3, François was Chief Operating Officer of the eHealth Initiative (eHI), which promotes adoption of health information technology in the U.S. He led the development of eHI's HIE Value and Sustainability Model, a method to value services offered by Health Information Exchanges. Early in his career working in General Electric's corporate health care department, he was involved in many strategic programs that created, connected and supported Active Consumers, and defined market mechanisms to reward providers for better performance. François holds a master's degree in Economics and Finance from the University of Paris IX-Dauphine and a master's degree in Business Administration from the Tuck School of Business Administration at Dartmouth College. LinkedIn Twitter   About Remedy:  Remedy operates the nation's largest bundled payment network. Remedy is not only an operator of bundled payment programs, but actively manages and assumes financial risk with providers that are contracted for at-risk bundles. Remedy works hand in hand with the payer and the providers to deliver bankable savings by implementing double-sided risk programs. We believe that it's only by sharing financial risk that bundled payment operators can truly become partners with the payer and the providers in the transformation of the delivery system and achieve better quality and cost outcomes. All of the bundled payment programs that Remedy has participated in and implements are risk-based. https://www.remedypartners.com/   Related and/or Mentioned on the Show:  Quality of Healthcare in America Report   Join our Community!  Trying to drive change within your healthcare organization? Launching a new product? Having trouble getting decision makers attention and buy-in? We'll help you understand the whole picture so that you can align your innovation with the things decision makers care about. And then we'll help you execute It's not easy, but it's possible and we'll help you get there.  Sign up here and we'll keep you up to date on healthcare industry news with podcasts, blog posts, conference announcements and more. No fluff. No hype. Just the valuable (and often not-so-obvious) information you need to get things done. Sign up here   The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media. Music by StudioEtar

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care news included a CMS plan for changes in drug coverage that brought a wave of criticism; a government task force recommended more people at risk for HIV take pre-exposure prophylaxis, known as PrEP; the American College of Cardiology issued an Expert Consensus Pathway on treatment of patients with type 2 diabetes and atherosclerotic cardiovascular disease. Read more about the stories in this podcast: CMS Aims at Drug Prices Through Part D, MA Step Therapy, Pharmacy Rebates: https://www.ajmc.com/newsroom/cms-aims-at-drug-prices-through-part-d-ma-step-therapy-pharmacy-rebates CMS Finalizes New Structure to Move Home Health to Value-Based Payment: https://www.ajmc.com/newsroom/cms-finalizes-new-structure-to-move-home-health-to-valuebased-payment USPSTF Recommends Clinicians Prescribe HIV PrEP to All High-Risk Patients: https://www.ajmc.com/newsroom/uspstf-recommends-clinicians-prescribe-hiv-prep-to-all-highrisk-patients ACC Pathway Finds Empagliflozin "Preferred" SGLT2 Therapy for Patients With Type 2 Diabetes, ASCVD: https://www.ajmc.com/newsroom/acc-pathway-finds-empagliflozin-preferred-sglt2-therapy-for-patients-with-type-2-diabetes-ascvd American Society of Hematology Annual Meeting & Exposition: https://www.ajmc.com/conferences/ash-2018 Twitter: @EBOncology: https://twitter.com/eboncology

Value-based Payment (VBP) seeks to tie healthcare payment compensation to measurable improvements in the quality of care in an effort to achieve the Triple Aim: an improved care experience, and better health, at an affordable price. Here, DST Health Solutions’ Adele Allison discusses VBP, explaining what it is, what it means for health plans, why it is a good thing, and most importantly what plans can do to build a transition strategy.

Muir Gray’s paper of the week: Time for Value-Based Payment Models to Adopt a Disparities-Sensitive Frame Shift Reference: Chaiyachati KH, Bhatt J, Zhu JM. Time for Value-Based Payment Models to Adopt a Disparities-Sensitive Frame Shift. Ann Intern Med. 2018;168:509–510. doi: 10.7326/M17-2590 https://bettervaluehealthcare.net/paper-of-the-week-22-08-18/

Tuesday, October 3rd our special guest on This Week in Accountable Care Leavitt Partners, Chief Research Officer David Muhlestein, PhD, JD joins Andre Berger, MD and Alex Foxman, MD for a 'pulse check' on the accountable care industry including key insights from a recent publication: Medicare Alternative Payment Models: Not Every Provider Has a Path Forward. More about David: David Muhlestein, PhD, JD, is Chief Research Officer based in Washington, DC.  He directs the study of accountable care organizations through the LP Center for Accountable Care Intelligence and leads the firm’s quantitative evaluation of health care markets. He is an expert in using policy analysis, predictive modeling, and applied analytics to understand the evolving health care landscape. David also serves as Adjunct Assistant Professor of The Dartmouth Institute (TDI) at the Geisel School of Medicine at Dartmouth College, is a Visiting Policy Fellow at the Margolis Center for Health Policy at Duke University, and is a Visiting Fellow at the Accountable Care Learning Collaborative.  In these roles he conducts research to translate learnings of high-performing organizations for the benefit of the broader health care system. Join National ACO co-founders Drs. Andre Berger and Alex Foxman for an informative exploration!

A value-based contract between Advocate Physician Partners (APP) and Blue Cross Blue Shield of Illinois (BCBSIL) has reduced inpatient admissions and emergency room visits and has bent the cost curve after its first year. In this interview, Dr. Carrie Nelson, APP's medical director for special projects, describes how APP's eight-year clinical integration of 4,000 physicians and 10 hospitals has laid the groundwork for this value-based contract. Dr. Carrie Nelson presented during "Bending the Cost Curve with a Commercial Value-Based Payment Contract: A Case Study from Advocate Physician Partners," a 45-minute webinar on July 18, 2012, now available for replay, during which she shared lessons learned from the first year of implementing the value-based contract between APP and BCBSIL.