Relentless Health Value

Everybody knows about evidence-based medicine, especially evidence-based medicine around the use of pharmaceuticals—and especially in oncology. Provider and payer organizations, many of them, strive to standardize care pathways around that evidence-based medicine. Here is the thing: I've heard it said that doctors and patients at the point of care are not particularly interested in evidence-based medicine. What they want right then is medicine-based evidence: If this patient takes this medicine, what will the outcome be? Is there a name for this medicine-based evidence? Why, yes there is! It's otherwise known as patient-reported outcomes, or PROs. And the high demand for meaningful PRO data has been clear across the spectrum of stakeholders but especially when it comes to patients and doctors who are actually making treatment decisions. This demand is really acute for oncology patients and their doctors, where the stakes are high and adverse events are definitely not trivial. PROs can be collected for drugs that are already FDA approved but also for drugs in development. It's been said that a Pharma these days who skips collecting PROs in cancer drug development does so at its own peril. Here's something that Dr. Ethan Basch said. He said, "When I sit down with a patient to think about starting a new treatment, almost invariably the first question that they ask is how they will feel with this product." Dr. Ethan Basch, by the way, I interviewed in EP157. He's the director of the Cancer Outcomes Research program at the University of North Carolina. In that interview, you can hear about how Dr. Basch and his colleagues found that by collecting patient-reported outcomes and acting on them, patient survival time improved something like 5 months. So put this in perspective: Those drugs that cost hundreds of thousands of dollars that are coming out … they don't increase survival time that long. Let's bring this full circle. How is all of this relevant to evidence-based medicine? It's relevant because all of those evidence-based pathways that we're working on these days should lead to not "better patient outcomes." They should lead to the outcomes that matter for this patient. And what matters is not some kind of universal truth. Patients at different points in their lives with different goals are going to have different ideas of what good looks like to them. We all know that what gets measured gets managed. So, if achieving patient outcomes or being patient-centric is the goal here and we're not measuring PROs, then we're not managing them either. In this health care podcast, I speak with Nadine Jackson McCleary, MD, MPH, BSN. Dr. McCleary is an oncologist at Dana-Farber Institute and an assistant professor in medicine at Harvard Medical School. She is currently working on a project to collect patient-reported outcomes and make them actionable. I interviewed Dr. McCleary at the NODE Digital Medicine Conference in New York City recently. You can learn more by connecting with Dr. McCleary on Twitter at @DrNJMcCleary. Nadine Jackson McCleary, MD, MPH, BSN, is an assistant professor of medicine at Harvard Medical School, senior physician of the Dana-Farber Cancer Institute (DFCI), and medical director for the DFCI Patient-Reported Data Program in the department of informatics and analytics. As an active member of the Gastrointestinal Cancer Center, she specializes in gastrointestinal oncology with a unique clinical focus on those at the extremes of age (younger than 20 and older than 80). She serves as the liaison for the Gastrointestinal Cancer Center to the DFCI satellite and collaborative members.

I was asked by a group of students from Michigan University's Ross School of Business to identify what I would consider companies or areas of promise in health care. It's a good question. I'm going to take a stab at the answer in this health care podcast, but let me foreshadow coming up next month, there'll be a second episode of Relentless Health Value dedicated to this same exact topic. I have asked a panel of people from across the industry to weigh in on this same exact question. So, here's what I have to say about it, but you can balance my views with theirs upcoming and decide for yourself what advice you wish to take. For more information, go to aventriahealth.com. When not hosting the show, Stacey is co-president of Aventria Health Group, a marketing agency and consultancy. Aventria specializes in helping pharmaceutical, employer, pharmacy, and health system clients improve patient outcomes by creating and leveraging collaborations with other health care organizations. For more than 20 years, Stacey has innovated better-coordinated health solutions benefiting all stakeholders and, most of all, the patient. 01:47 Promise doesn't mean piling up bills at the expense of patients and taxpayers. 02:47 "These companies won't change unless there are people working from within to get them on track." 03:53 Stacey's three-prong plan to find promising companies within health care. 04:08 "Follow the money." 05:29 Three things to look for in a health care company or health care area. 06:12 "It's really hard to integrate with an unknown entity." 06:50 "Doctors … like to create their own solutions." 07:34 "The realities [are], people buy what they … create." 09:48 "The hype cycle is real." 10:45 All promising areas and companies have one thing in common: They're innovative. 11:07 Disruptive innovation vs sustaining innovation. 11:45 Clayton Christensen's The Innovator's Dilemma.12:23 Zeev Neuwirth's Reframing Healthcare. 14:48 EP202 with Frazer Buntin. 15:41 "Look for first movers." 15:56 "Look for disruptive companies that have gotten investments from entrenched players." 16:23 Who excels at incremental innovation vs disruptive innovation. 17:10 Stacey's note of caution about transparency and health care businesses. For more information, go to aventriahealth.com. Check out our #healthcarepodcast #inbetweenisode with our host, Stacey Richter, as she talks areas of promise in #healthcare. #podcast #digitalhealth #healthtech #healthcarebusiness What it really means to have promise within #healthcare. Our host, Stacey Richter, discusses. #healthcarepodcast #podcast #digitalhealth #healthtech #healthcarebusiness "These companies won't change unless there are people working from within to get them on track." Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness What's our host Stacey Richter's three-prong plan for finding promise within #healthcare? Find out in our latest #inbetweenisode #healthcarepodcast #podcast #digitalhealth #healthtech #healthcarebusiness "Follow the money." Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness "It's really hard to integrate with an unknown entity." Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness "Doctors … like to create their own solutions." Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness "The realities [are], people buy what they … create." Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness "The hype cycle is real." Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness All promising areas and companies have one thing in common: They're innovative. Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness Disruptive innovation vs sustaining innovation. Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness "Look for first movers." Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness "Look for disruptive companies that have gotten investments from entrenched players." Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness Who excels at incremental innovation vs disruptive innovation? Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness

Right now, I am in the middle of rereading The Innovator's Dilemma—that seminal work by Clayton Christensen. I'm at the chapter right now where he talks about resources (human and otherwise), processes, and values. These three things are the trifecta that determines what any organization can manage to achieve—or not achieve, as the case may be with disruptive technologies. Here's where this is relevant to health IT. You can have the most dedicated team who has built out and proven a digital tool that meaningfully improves patient outcomes and that patients embrace. But if the organization surrounding that team does not have the processes and the values that support this team, the effort will, at best, be suboptimal. In this health care podcast, I speak with George Mathew, MD, MBA, FACP, and Chief Medical Officer, Americas, over at DXC Technology. We talk about the why and the how of patient/provider collaborations when it comes to digital tools. We spend some time on the process prong of Clayton Christensen's trifecta. From there, there's news you can use, like what's going on with the FDA pre-cert program. And then we also get into how digital tools are being inserted into clinical workflows to greater or lesser effect. I can probably also claim that we freewheel our way through some resources and some values advice, but at a minimum, we touch on a number of adjacencies to the process of creating and deploying digital tools effectively, including the why of it all. You can learn more at dxc.technology. George Mathew, MD, MBA, FACP, is the Chief Medical Officer for the North American health care organization for DXC Technology, the entity created by the merger between Hewlett Packard Enterprise Services and Computer Sciences Corporation (CSC). In this role, Dr. Mathew serves as the clinical expert and health care thought leader to our health care clients in the transforming health care marketplace in payer, provider, life sciences, and state and local Medicaid business. His experience includes consulting, technology development, and business development work at GE; Goldman, Sachs and Co.; WebMD; Pfizer; and Aetna. Dr. Mathew brings a strong technology innovation focus to this role, having founded a health care technology start-up earlier in his career, and advises several health care IT start-ups.

Musculoskeletal issues, otherwise known as MSK issues, account for something like 20% of the cost to any given health plan or employer or anyone else who is paying the bill for health care. That's like one in every five dollars, which is meaningful when you consider million-dollar drugs and diabetes and all the other things that a purchaser of health care can write checks for. MSK is a big cost kahuna. In this health care podcast, I talk with Chad Gray, who is the CEO of IMC, Integrated Musculoskeletal Care. Interestingly, Chad says that the problem with MSK in this country isn't a cost problem usually. It's a quality problem. It's a problem of patients getting a whole lot of care that doesn't actually relieve their symptoms or underlying condition. This is what MSK care and the 4-minute mile have in common besides the blindingly obvious necessity of healthy bones to run fast. Everybody thought it was impossible for a human to run a 4-minute mile—until somebody did. And once that happened, it was like a dam opened and lots of people began breaking that previously impossible time. It's conventional wisdom that MSK problems are mostly going to turn into intractable chronic conditions that ultimately result in surgery, which still doesn't, in many cases, cure the symptoms or underlying problem. Chad Gray and his team over at IMC may have broken the 4-minute mile when it comes to inventing a systemic approach to MSK care that actually works. Prepare for the dam to burst. You can learn more at imcpt.com. Chad Gray, MS, PT, Cert MDT, is cofounder and CEO of Integrated Musculoskeletal Care, Inc (IMC), providing outcomes-accountable musculoskeletal care programs that improve overall health care quality, reduce costs, and improve patient and employee safety. He has over two decades of experience as a clinical practitioner and is a widely recognized entrepreneur, health-benefit design consultant, and concierge practitioner focused on innovations in musculoskeletal triage, health care, and self-care.

I was listening to The #HCBiz Show!, featuring hosts Don Lee and Shahid Shah, earlier this year—specifically, their two-part series entitled "Selling Into Health Systems" [part 1 and part 2]. Besides being co-hosts of The #HCBiz Show!, Don Lee is the founder of Glide Health and VBP Forward [which stands for value-based payments], and Shahid is a serial entrepreneur; one of his companies is Netspective. Shahid can be found doing HIT keynotes all over the country, too. Both of these guys, Don and Shahid, know a whole lot about selling into health systems from both sides of the table. So it is not a surprise that they did a couple of shows on this theme. A lot of what Don and Shahid were talking about in that "Selling Into Health Systems" series dovetailed superiorly with some work that we do over here at Aventria and that we know a lot about. So pretend there's a drum roll here because I'd like to announce that this is not just an inbetweenisode. We have just driven right off the Relentless Health Value podcast format reservation. With Don and Shahid's permission, of course, we are going to play some clips that I find particularly relevant from that #HCBiz Show! "Selling Into Health Systems" series. Then Dave Dierk, my co-president over here at Aventria Health Group, and I will discuss said clips. Dave and I are going to talk about how exactly a—let's just call them—seller needs to prepare its account management team to go into a health system and successfully do all of the things that Shahid and Don talk about. As foreshadowing, a lot of what Dave and I recommend to prepare an account management team for successful selling centers on five links in a chain … and here they are: Account managers need a really firm grasp of (1) market knowledge and (2) customer knowledge. They need (3) collaborative selling skills (the ability to listen and dialog), (4) consultative skills (which should be additive), and lastly, there is a great requirement for (5) strategic ability to think critically around how to make all of the other links in the chain actionable. And you'll hear these five things woven throughout the conversation I have with Dave in this health care podcast. One last note: I need to mention Brian Van Winkle. This podcast conversation that Shahid and Don had references an article [part 1 and part 2 on The Health Care Blog] that Shahid coauthored with Brian, who is executive director of innovation over at Johns Hopkins. You can learn more at aventriahealth.com/perspectives. Listen to "Selling Into Health Systems" (part 1 and part 2). Dave and Stacey are co-presidents of Aventria Health Group. Stacey specializes in helping employer, pharmaceutical, device, and pharmacy clients by creating partnerships with other health care organizations. For 20 years, Stacey has innovated better-coordinated health solutions benefiting all stakeholders and, most of all, the patient. Dave is a 30-year veteran of managed-markets marketing. After working in consumer marketing with AT&T and health care publishing with Elsevier, Dave made the move to medical advertising and communications at KI Lipton, Inc. Subsequently, he became a cofounder of Pinnacle Health Communications. Dave is an accomplished strategist, providing innovative customer marketing, access, quality, and health intervention solutions for large clients and has directed the development of numerous industry-leading campaigns in primary care and specialty markets. He has supported clients in disease areas that include oncology (Bristol Myers Squibb [BMS], Novartis, Eisai), virology (BMS, Merck & Co.), pharmacy (American Pharmacists Association, Merck, Novartis), and blood disorders (Novo Nordisk), to name a few. Dave has helped more than 15 clients achieve top rankings in their respective categories. He is also an active member of the Pharmacy Quality Alliance. 03:37 Don Lee on understanding problems in health care on a micro level rather than on the whole. 03:55 Focusing on larger entities that are looking to collaborate with a health system rather than innovators and start-ups in health care. 04:52 Looking at innovation and affecting behavioral change more broadly. 05:42 Helping manifest potential value. 06:06 Don Lee on being a proactive innovation guide rather than telling a health system how their system works. 07:39 Learning new skills and putting new infrastructure in place to support new approaches. 09:24 "The value that you bring is the incremental between where they are now and what they could attain."—Stacey 10:42 "It's more about you than it is about your customer."—Stacey 12:41 "All of that is predicated on, 'What's your strategy? What's your plan?'"—Dave 14:54 Don on doing the consulting work. 15:16 Shahid on building business cases for everything you bring into the health system environment. 15:48 Don on the number of perspectives at the table and needing to understand and align your product to this multitude of needs. 17:24 "Once you get to yes, your

In this podcast originally published early last year, Alex Akers and I had a chance to speak with Dr. Robert Pearl about his book Mistreated: Why We Think We're Getting Good Health Care—And Why We're Usually Wrong. Besides being an author, Dr. Pearl is former CEO of the Permanente Medical Group; he's a frequent keynote speaker; and he is also the host of a podcast called Fixing Healthcare. Here's what Dr. Pearl said at the recent HLTH conference in Vegas, and I'm editorializing a little bit here. Dr. Pearl said day after day, patients and their families experience the unnecessary frustrations and heartaches that are so rife in American health care. Mistreatment is certainly a continuum, but in all of its manifestations, it's pretty much nothing less than rampant. I mean, how else do Americans manage to pay more than twice as much per patient for a health system that ranks 37th in the world? There are definitely bright spots, and there are definitely great men and women working within health care. So, I do not—and I'm certain Dr. Pearl does not—mean to be all doom and gloom. But we've got some realities to deal with here. There's a simple answer to the question, "What happens if we fail to change?" Disruption will happen. While the pace of health care disruption in many sectors hasn't exactly set world speed records, it's inevitable. And, according to Dr. Pearl, status quo health care providers will lament their decision not to have embraced change sooner. To wrap our heads around this, Dr. Pearl suggests that there are four must-haves, four pillars to get the American health care industry back on track. Spoiler alert: Those four pillars are (1) integration, (2) pay-for-value, (3) modernize our approach to technology, and (4) clinician- and physician-led organizations. You can learn more by connecting with Dr. Pearl on Twitter at @RobertPearlMD.

There are four pillars that contribute to readmissions: ensuring patients are equipped to self-manage and properly take their medications; follow-up (usually by PCPs); managing transitions of care and care coordination, which might be known as interoperability; plus avoiding medical errors. Dr. Kim Noel and I discuss each of these pillars and how telehealth and other digital tools can close gaps and help patients do what they need to do to stay out of the hospital. Dr. Noel is a clinical researcher, physician, and telehealth specialist. She is an appointee to the New York State Department of Health Regulatory Modernization Initiative Telehealth Advisory Committee and serves as the director of Stony Brook Medicine Telehealth and the deputy chief medical information officer there as well. Kimberly Noel, MD, MPH, is a board-certified, preventive medicine physician. She serves as the telehealth director and deputy chief medical information officer of Stony Brook Medicine, where she provides leadership to all telehealth activities of the health system. Dr. Noel is also the chief quality officer of the patient-centered medical home (PCMH) for the family medicine department, working on quality improvement and population health management for National Committee for Quality Assurance (NCQA) designation. She practices occupational medicine clinically and provides digital solutions for employee wellness programs. She is an appointee the New York State Department of Health Regulatory Modernization Initiative Telehealth Advisory Committee and has won many service and innovation awards for health care. In academia, her research areas are in machine learning, risk models, and remote patient monitoring. Dr. Noel has developed several educational curriculums, including a 40-hour telehealth curriculum for the School of Medicine, as well as interprofessional educational curriculums with the School of Health Technology and Management, Nursing, Dentistry, and Social Work. Dr. Noel is a graduate of Duke, George Washington, and Johns Hopkins Universities. She is a proud graduate of the Stony Brook Preventive Medicine program, whereby she is now working collaboratively with the residency program leadership on development of a telehealth preventive medicine service. You can learn more by connecting with Dr. Noel on Twitter at @DrKimNoel

Patients, families, caregivers are generating data outside of the health care setting. They are tracking exercise, symptoms, blood pressure. And they're coming in for their appointments bearing stacks of printouts or their username and password on a little piece of paper and asking their clinicians to log in to their accounts and check out the goings on. Clinicians, meanwhile, struggle to understand how to bring these data elements into provider environments so that the data can improve engagement and can improve care and outcomes. How can all this data be used to help patients better self-manage? In this health care podcast, I speak with Vicky Tiase, a nurse informaticist and director of informatics strategy over at NewYork-Presbyterian Hospital. We talk about the opportunities to use patient-collected data, but mostly we discuss the barriers and how to overcome them. We also consider the flip side to this: a new CMS (Centers for Medicare and Medicaid Services) rule that mandates that providers must make provider-collected data available back to patients in a form of the patient's choosing. How does that fit into this picture? It's interesting to observe that there's at least two schools of thought emerging relative to which apps patients use. Or maybe a better way to put it: It's less about two schools of thought and maybe more like two phases to a larger goal. One might come before the other. One school of thought concludes that provider organizations should prescribe apps, since it makes it easier on the back end to assimilate the data into clinical workflows and also hearkening back to the patriarchal origins of medicine—Doctor knows best and should tell the patient what to do. The other school of thought concludes that patients should be able to pick their own apps that appeal to them. The place that these two priorities merge is if apps are part of a trusted framework so that no one winds up with anything developed by Russian hackers, but yet the choice can still be left up to patients but within, like I said, this trusted framework. Vicky will be speaking at the Digital Medicine Conference sponsored by NODE.Health. That event is coming up on December 9 in New York City. NODE.Health, by the way, stands for the Network of Digital Evidence. Look it up on the Web if you have questions. I will be at the Digital Health Conference. If you're going to be there, too, let me know! You can learn more by connecting with Vicky on Twitter at @vtiase, or join her at the NODE.Health Digital Medicine Conference on December 9, 2019. Victoria (Vicky) Tiase, MSN, RN, is the director of research science at NewYork-Presbyterian (NYP) Hospital. She has over 13 years of experience of giving clinical input to technology projects in all areas, especially regarding the implementation of the NYP electronic medical record. Vicky is responsible for supporting a range of clinical information technology projects related to patient engagement, alarm management, and care coordination. She was the nursing lead for the design, implementation, and rollout of an institution-developed personal health record (PHR), myNYP.org. She is passionate about finding data-driven, information technology (IT) solutions for increased patient and provider engagement in health care and leads research efforts to ensure the capture and presentation of data for the use and benefit of clinicians. Vicky serves on the steering committee for the Alliance for Nursing Informatics (ANI) and recently completed a fellowship in the ANI Emerging Leaders Program assessing nurse readiness to use health IT tools for patient engagement. She completed her master's in nursing informatics at Columbia University and is currently pursuing a PhD from the University of Utah with a focus on the integration of patient-generated health data into clinical workflows.

The North Carolina State Employees Health Plan (SEHP) crafted a proposal called the Clear Pricing Project. The Clear Pricing Project proposed to pay network hospitals based on a transparent price schedule. Considering that SEHP purchases benefits for something like 720,000 people in North Carolina at a cost to taxpayers of billions of dollars, this seems reasonable. When you're the fiduciary for thousands of dollars, let alone add six more zeros, it would seem to be non-negotiable to actually see the numbers and not write a check to a black box. Nonetheless, a few of North Carolina's largest hospital chains disagreed. They want to bill whatever they want and to do so shrouded by a cloak of secrecy. I don't want to put words in anyone's mouth, but it appears that the CFOs and CEOs of these hospital systems don't believe that the treasurer of the state has a right to see what he's spending taxpayer money on. And these CFOs and CEOs have expressed their position with a brutal onslaught of personal attacks against the North Carolina Treasurer's office. I feel like this episode needs a trigger warning. As David Contorno, also from North Carolina, has said on this podcast (EP186), the only way to pay less for health care is to pay less for health care. It's hard to do that if you don't know how much you're paying. It just blows my mind when all across this country, financial toxicity is reducing health outcomes while nonprofit health systems—excluding some of the rural ones—are yanking in record profits, and employers and public entities are not messing around when they say that health care prices are an existential threat. Let's all get on the same side of this issue, please. Ultimately, it's everyone's responsibility to do the right thing right now. In this health care podcast, I am speaking with North Carolina State Treasurer Dale Folwell. You can learn more at nctreasurer.com. You can also connect with Treasurer Folwell on Twitter at @DaleFolwell or on Facebook at Dale Folwell. Dale R. Folwell, CPA, was sworn in as State Treasurer of North Carolina in January 2017. As the keeper of the public purse, Treasurer Folwell is responsible for a $100 billion state pension fund that provides retirement benefits for more than 900,000 teachers, law enforcement officers, and other public workers.

In this health care podcast, I speak with Mark Blum from America's Agenda. When I was talking with Mark, I kind of pictured him bearing a flag with a peace sign on it. His point for unions and employers alike is this: Instead of ripping each other into shreds at the bargaining table over health care, maybe work together proactively. Clip the reasons for rising health care costs in the first place. These reasons include, but certainly are not limited to, excess middleman profits that do not contribute to patient value, private equity earning profits on the backs of patients and payers, a health care system that rewards volume over value … I could go on and on. But here's a way out of this tangled web we've been forced into: Instead of bowing and scraping at the boots of special interests driving up the costs of health care for Americans—and when I say Americans, I mean bosses or labor alike—instead of flailing at the mercy of these forces, change the game. Gang up together and proactively demand to get what you pay for. Mark and I talk about two very concrete examples on how to do this. Mark and the team at America's Agenda, for example, saved New Jersey $1.6 billion (that's billion with a B) over the past three years on pharmacy benefits alone. That's a whole lot more shekel than could have been generated by haggling over who pays for what of a pharmacy bill that is $1.6 billion too high. We also talk about direct primary care and how much direct primary care—not owned by a private equity, by the way—how much direct primary care can improve patient outcomes while, at the same time, reducing costs. Mark has some learnings here, too. You can learn more at americasagenda.org and solidaritus.net. Mark Blum is executive director of America's Agenda, an alliance of labor unions, businesses, health care providers, and government leaders with a common mission of guaranteeing access to affordable, high-quality health care for every American. Under Mark's direction, America's Agenda has defined widely adopted principles of high-value care delivery design and achieved an unrivaled record of success in building winning statewide health care reform campaigns. Managed Care magazine recently featured an America's Agenda–designed strategy that netted more than $1 billion in prescription drug savings for New Jersey's public workers during 2018 and 2019 and is projected to save the state nearly $2.5 billion over five years without cutting public employee prescription benefits. Mark serves also as president and CEO of SolidaritUS Health, a leading-edge, labor-owned direct primary care provider whose innovative approaches to relationship-based care delivery were featured recently in Modern Healthcare magazine. SolidaritUS Health has revolutionized patient experience and improved quality of care while reducing employer health costs substantially and helping save thousands of US industrial jobs from being offshored. Mark, who has served as a special adviser on hospital finances to leadership of the California legislature, serves currently as an appointee of Governor Phil Murphy to the New Jersey State Health Benefits Value and Quality Task Force. Mark was the first male ever elected to the board of directors of the American Medical Women's Association. Internationally, he has served as adviser to Cambodian textile workers organizing the first labor unions in their country's history.

In this health care podcast, I speak with John Gorman, who is a government-sponsored health programs guru. He's also the founder of a newly minted organization called Nightingale that (spoiler alert) we discuss toward the end of our conversation. I just want to interject right here that I, for one—but I'm sure John would agree—do not believe that Medicare Advantage (MA) is, as is, perfectly terrific and devoid of problems. There are, of course, well-known issues with coding, the whole exaggerated diagnoses for higher reimbursements thing … then there's the whole potentially wasteful quotas payments and the restrictive networks of doctors cited issues. We don't get into these during our conversation, focusing instead on comparing MA to FFS (fee-for-service) Medicare. From there, we get into advice for independent physicians in rural hospitals and then we wind up at price gouging by nonprofit hospitals. John's points are insightful as always, and I guarantee he will give you a lot to think about. You can learn more and connect with John on LinkedIn. John Gorman is the founder and former executive chairman at Gorman Health Group (GHG). For 22 years he led the development of the industry's leading consulting practice and several entrepreneurial ventures in government health programs. John's work focuses on Medicare Advantage, Medicaid, and Accountable Care Act strategy, governance, and social determinants of health. John considers himself a defender and fixer of health insurance coverage, especially Medicare, Medicaid, and subsidized individuals served by health plans. He has strong opinions and relies on evidence and sound policy. Prior to founding GHG in 1996, he was appointed by President Clinton as the first assistant to the director of the Health Care Financing Administration's (now Centers for Medicare and Medicaid Services) Office of Managed Care.

In this health care podcast, Pam Arora, SVP and CIO at Children's Health in Dallas, talks about the work she and her team are doing. Spoiler alert: It's pretty visionary. They have integrated telemedicine solutions in schools and in patients' homes. They've also been monitoring adherence to vital transplant meds by putting chips on the capsules. They have initiatives happening with voice and GPS technology. I asked Pam what it takes to get all of this done while, at the same time, balancing the usual suspects—the EHR upgrades, the security patches, the virtual desktops, the inevitable panic of the month. Pam explains her answer far more eloquently than I'm going to be able to recap here, but in a nutshell, she says it's all about getting the fundamentals right. A hospital, a health system, needs a capable, robust EHR infrastructure that really works. She further adds that attaining that infrastructure takes a lot of things, but one of them is a relentless attention to the details, particularly the details around what exactly and specifically patients and their families want and need. I met Pam at the NODE.Health conference earlier this year in New York City. You can learn more at childrens.com or onTwitter at @ChildrensTheOne. You can also connect with Pam on Twitter at @pkarora. Pamela Arora serves as senior vice president, information services, and chief information officer (CIO) and is responsible for directing all efforts of the information services groups in the organization. Her oversight encompasses systems and technology, health information management, and health care technology management and support.

I want to talk about the wellness industry today. In the parlance of the famous (or infamous, depending on where your revenue is coming from) Al Lewis, traditional "to employee" types of wellness programs are health care done to employees, not for employees. They're like forced health care. Generally, these programs tout cost savings to the employer. And also generally, these programs aren't optional; they may include sticks as well as carrots and sometimes sticks that are dressed up as carrots but are actually still sticks. The wellness industry is big business—like, regulated by the SEC big in some cases. That's why this Clay Christensen quote is so apropos. Despite the fact that your average wellness program is often, let's just say, heartily suboptimal from a cost, quality, and satisfaction standpoint, most employers continue to basically force employees into them. Many brokers continue to offer these ineffective programs as well. I mean, why wouldn't they? Everybody in the supply chain is making money. Besides, it's time consuming and maybe even risky to try to re-educate an employer organization who might not know any better. It's one of those great examples where doing the right thing isn't as profitable or safe as exploiting outdated thinking as long as the market will bear. Employers are getting wise to a lot of things right now. I'd suggest a fast follow-on is going to be their view of these wellness programs. It will be interesting to see if current vendors are able to compete with the newer solutions that actually work and which employees actually appreciate. It will also be interesting to see if there's any backlash against the supply chain that continues to offer up these solutions, especially given some of the lawsuits that are currently under way and all the research which is eminently available. After about ten people wrote in looking to hear an interview with him, in this health care podcast I'm honored and pleased to speak with the one and only Al Lewis. Al is basically synonymous with wellness programs' analysis and evaluation. One of my favorite things about Al is that he is as controversial as he is respected. He's been called both "the founding father" of disease management, and he's also been called the "troublemaker-in-chief" of the wellness industry. Regardless of your opinion of Al's views, his integrity and commitment and rigorous analytical approach is open and shut. Al is the author of two books, which you can find in the show notes. He's also the CEO of Quizzify. Quizzify is a company and an approach that teaches employees how to get the care they need while avoiding the "care" they don't. Quizzify's claims have been validated, by the way, by the Validation Institute. You can learn more at quizzify.com. Al Lewis wears multiple professional hats. As an author, his critically acclaimed category-best-selling book on outcomes measurement, Why Nobody Believes the Numbers, chronicling and exposing the innumeracy of the health management field, was named 2012 health care book of the year in Forbes. Cracking Health Costs: How to Cut Your Company's Health Costs and Provide Employees Better Care, released in 2013, was also a trade bestseller. His 2014 book Surviving Workplace Wellness has also received great accolades, and excerpts appeared in Harvard Business Review and elsewhere.

In this health care podcast, I speak with Lee Lewis, who is the newly minted chief strategy officer at the Health Transformation Alliance, otherwise known as the HTA. The HTA is a group of 50 major corporations that have come together in an alliance to do one thing: fix our broken health care system. Anyone who knows Lee knows he knows a lot about how to improve health care benefits for large employers. He's pretty much the perfect guy to be the chief strategic officer at the HTA. The most amazing thing that I always find about improving health care, the structure of health care benefits, and health care benefits for an employer is that it's like having your cake and eating it, too. On one hand, both the employer and the employee save money. On the other hand, employees get better care and they spend less time away from work struggling to navigate the health care jungle all by themselves. Lee has a playbook for improving the structure of health care benefits or health care benefits for large employers, and this playbook consists of three chapters, which we get into in this podcast. The first chapter covers the "how" of health benefits, including what Lee calls the "administrative superstructure." The second chapter in Lee's playbook is the "what," which usually comprises drug spend and then, on the medical side, how care is delivered for specific clinical conditions like musculoskeletal, cardiometabolic, etc. There are a few conditions that tend to rack up the most costs categorically, and those are the ones that Lee focuses on. The last chapter in Lee's playbook is the "who," meaning where employees are steered to for care—and that also includes an emphasis on PCPs (primary care providers). You can learn more by visiting htahealth.com and by connecting with Lee on LinkedIn. Lee Lewis is an innovator and strategist helping large, national, self-funded employers save millions on health care through leading practices, vendor partnerships, and member engagement. He pioneers methods around the convergence of digital health, medical consumerism, biomedical supercomputing, and system reengineering.

Here's one fact of life that's always true: It will always be the desire of big vested interests to maintain and stick with the status quo. This applies to all of the various parties in the drug supply chain as much as it does to any other industry. So, here's the $106-billion-a-year question: In 2019 or 2020, will all of the drug pricing proposals and legislature popping up all over the place in Washington and in some states right now—will they all just simply blow over? Is it the case that Big Pharma and pharmacy benefit managers (PBMs) and insurance carriers are well girded enough to withstand these various efforts to undermine their revenue streams—at least at some level? But let's start at the beginning. You may be wondering what exactly is going on right now legislatively and with various proposals. It's very difficult to keep track of it all. And what are pharma companies and PBMs and insurers mulling over as they contemplate their strategies to maintain their current level of control and keep their shareholders happy? Never fear. In this health care podcast, I speak with Josh LaRosa from Wynne Health Group. He sets us straight and gets us up to speed. You can learn more at wynnehealth.com. Josh LaRosa, MPP, joined the Wynne Health Group in November 2018, bringing with him over three years of federal health care policy consulting experience. The majority of his experience in the federal consulting space has been with the Centers for Medicare and Medicaid Services (CMS), and he in particular has worked heavily with the agency's Center for Medicare and Medicaid Innovation (CMMI). With CMMI, Josh worked to implement, monitor, and spread learning garnered from the center's high-profile demonstration projects, most recently including the national primary care redesign effort, Comprehensive Primary Care Plus (CPC+). Josh has also assisted a multitude of provider organizations participating in CMMI's Health Care Innovation Awards Round One and Two to implement their innovative health care delivery and payment models. Through such experiences, Josh has been exposed to a wide array of innovations in health care delivery and is deeply interested in how changing provider, patient, and payer incentives can result in a higher-quality and more cost-effective health care delivery system. Josh holds a Master of Public Policy from the University of Virginia's Frank Batten School of Leadership and Public Policy, where he had the opportunity to work with a DC-based nonprofit and explore policy options for addressing the behavioral health needs of military and veteran families. Josh also completed his undergraduate studies at the University of Virginia, graduating cum laude with a BA degree in political philosophy, policy, and law. 01:48 This conversation happened at the end of August 2019. 02:32 Are we at an inflection point with health care legislation? 05:10 What obstacles stand in the way of seeing any legislation passed by Congress? 05:51 EP231 with AJ Loicano.06:14 Most likely to happen and most disruptive among the health care measures being proposed. 09:03 The catastrophic benefit and how it works. 16:34 International Pricing Index Model. 20:12 The two areas that would have the greatest impact on the industry, if they transpire. 21:07 Federal Trade Commission (FTC), PBMs, and drug pricing. 21:46 Mandating PBM contracts, and what it would take at the FTC. 22:27 Bringing transparency to the forefront of PBM contracting. 27:10 Brand manufacturers vs generic manufacturers. 28:05 Breaking down barriers in generic reform. You can learn more at wynnehealth.com.

In this health care podcast, I speak with Dr. Marty Makary about his new book, which is entitled The Price We Pay: What Broke American Health Care—and How to Fix It. I could not recommend this book more highly. It's a page turner for hospital execs trying to do the right thing, employers trying to do right by their employees, insurance carriers looking for better ways to actually drive health care value, and doctors and nurses who are feeling burnout because they see their organizations demanding them to do things misaligned with their mission to do the best they can by patients. Dr. Makary tells me in this interview that his intent with this book was to shine light on some of the issues, mainly around the price we—as patients, taxpayers, employers, basically all of us—pay. Dr. Makary says that understanding the situation is the first step toward navigating and redressing it. The Price We Pay gives multiple examples of egregious pricing. I'm going to split these examples into two categories: First, your basic price gouging, including surprise billing and what amounts to predatory pricing done at scale. The second category are high total prices because the services rendered were some shade of unnecessary. So high prices based on the price of the unit, and then high prices based on the number of units delivered. Dr. Makary and I talk about both challenges in this health care podcast. We also talk about the multiple instances where doctors and nurses and others are doing the right thing and really working hard to correct issues. Their efforts are glimmers of hope for all of us working hard to do right by patients. You can learn more at martymd.com or connect with Dr. Makary on Twitter at @MartyMakary. Martin "Marty" Makary, MD, is an American surgeon, New York Times best-selling author, and Johns Hopkins health policy expert. He has written for The Wall Street Journal, USA Today, Time, Newsweek, and CNN and appears on NBC and Fox News. He has written extensively on organizational culture, the science of measuring quality in medicine, and health care reform. Dr. Makary is the author of two best-selling books: Mama Maggie, a book about a Nobel Prize nominee, and Unaccountable, a book about health care transparency. He also just released a new book, The Price We Pay: What Broke American Health Care—and How to Fix It. This book offers a road map for everyday Americans and business leaders to get a better deal on their health care and profiles the disruptors who are innovating medical care. Dr. Makary is principal investigator of a Robert Wood Foundation grant to lower health care costs in the United States by creating physician-endorsed measures of appropriate medical care and directs the national "Improving Wisely" project to reduce waste in medicine. He speaks nationally on disruptive innovation in health care. Dr. Makary is a frequent medical commentator of NBC and Fox News, commenting on the health care cost crisis, the impact of new technology, and interpreting the latest medical research for everyday consumers. Dr. Makary is director of the Center for Opioid Research and Education and founder of solvethecrisis.org, a website that shares expert opioid prescribing recommendations for common medical procedures for clinicians and patients. At Johns Hopkins, he has served as the endowed chair of gastrointestinal surgery, director of surgical quality and safety, and founding director of the Johns Hopkins Center for Surgical Outcomes Research and Clinical Trials. Dr. Makary is a surgical oncologist specializing in minimally invasive surgery and teaches health policy and management at the Johns Hopkins University School of Medicine. He currently serves as the chief of the Johns Hopkins Center for Islet Transplantation and director of the appropriateness in medicine project. 02:11 Marty's new book and its multiple examples of egregious pricing in health care. 02:41 The reason why hospital bills are often overinflated. 03:31 "Are Americans responsible for paying these marked-up, sticker-priced bills?" 04:58 Explaining the complexities of medicine, simplistically. 07:27 Balancing stories of price gouging with responsible billing. 07:59 "Hospitals were created in America as a safe haven for the sick and injured." 09:29 How everyone can work toward changing this at the individual level. 11:23 "Have a conversation with your hospital." 12:59 Marty's advice to hospital administrators and board members. 16:56 "We can restore honesty in health care." 17:01 How billing practices happen unbeknownst to hospital leaders. 17:35 Bad debt and mischaracterizing bad billing practices. 19:12 "Why don't we call it 'predatory billing'?" 22:12 "People are hungry for honesty in health care right now." 22:55 A code of ethics pledge for hospitals on restoringmedicine.org. 23:25 "Large hospitals are on track for the largest profit margin in their history." 24:50 Marty's advice for how employers can help address these egregious prices. 25:47 "

There are 65,000 community pharmacies in the United States today, and the total cost to locate, staff, and operate these pharmacies is about 9% of our total national drug spending. That's less than 1% of our national health expenditure—and falling. This is despite the fact that about 85% of our nation's something like 6 billion prescription fills are unbranded generics, and unbranded generics are a staple of community pharmacy business. These stats are courtesy of Troy Trygstad, by the way. Bottom line, and pharmacy benefit managers pushing mail order may beg to differ, but many patients rely on walk-in pharmacies to get their meds filled timely (same day). They rely on the pharmacist for advice. They rely on the pharmacist to be an extension of the care team. This is even more stark in rural settings where there may be a pharmacist nearby but potentially not a doctor. It would kind of stink for a lot of patients if these pharmacies were pushed out of business by the elephants of the supply chain or, more accurately, on the demand chain. I'm referring to traditional PBMs (pharmacy benefit managers) and the pressures that they are increasingly putting on pharmacies, resulting in what's beginning to amount to an existential threat for these community pharmacies. In this health care podcast I speak with Vinay Patel, who is the founder of Self Insured Pharmacy Networks. He's also a pharmacist, and he's also an expert in these matters. To clarify a couple things before we dive in, PBM stands for pharmacy benefit manager. There are three main pharmacy benefit managers that process the vast majority of prescriptions in this country today. These three traditional PBMs are ESI (Express Scripts), CVS Caremark, and OptumRx. Who hires and pays these PBMs? Employers, for one. And also some insurance carriers and sometimes the government, as in Medicare Part D. These PBMs, by the way … these three are vast, and they're powerful. You can learn more at sipharmacynetwork.com. Vinay Patel, PharmD, is a pharmacist executive with a 12-year career focused on population health and community pharmacy operations. His background includes integrating pharmacy programs within multifaceted health care teams, engineering effective clinical operations to meet HEDIS program measures, and initiating a pharmacist-led hospital discharge medication reconciliation program.

Are patients consumers? Defining the terms patient and consumer will get us started here and also provide the insight and common understanding that we need to tackle this seemingly elusive question. Patient (adjective): able to accept or tolerate delays, problems, or suffering without becoming annoyed or anxious. Synonyms: forbearing, uncomplaining, tolerant, long-suffering, resigned, and stoical. Definition two (noun): a person receiving or registered to receive medical treatment. I'll get to the number one adjective definition of patient soon enough—don't you worry—but to start, let's consider number two (noun) for about T minus 5 seconds. You'll notice "a person receiving or registered to receive medical treatment" could mean pretty much any adult or child human with an appointment at any health care facility. Moving on. Consumer (noun): a person who purchases goods and services for personal use; a person or thing that eats or uses something. Similar to the term patient, a consumer could be anyone anywhere at any time who purchases anything or uses anything. The definition doesn't separate informed consumers from ill-informed consumers and then postulate that ill-informed consumers are actually not consumers, and I can see why: This path would get dark really fast. If we're looking at the literal answer here and I wanted to be obtuse, I could correctly say that the literal answer to the question, "Are patients consumers?" is yes. Consumers are people who use something, and they pay for something. Patients use health care and sometimes they pay for it, so literally patients are consumers as per Webster's dictionary definitions. But let's look at the not-literal answer. When not hosting the show, Stacey is co-president of Aventria Health Group, a marketing agency and consultancy. Aventria specializes in helping pharmaceutical, employer, pharmacy, and health system clients improve patient outcomes by creating and leveraging collaborations with other health care organizations. For more than 20 years, Stacey has innovated better-coordinated health solutions benefiting all stakeholders and, most of all, the patient. 02:32 Why patients are not consumers. 02:41 A better way to define consumer. 03:15 When "patients are not consumers" is even more correct. 03:40 Where the definition of consumer starts to devolve or evolve. 04:17 The definition of consumer according to an article by The Hastings Center.05:01 The "consumer metaphor" and eroding physician professionalism. 05:26 The problematic points at demonizing the consumer patient. 06:36 EP205 with Maya Dusenbery.08:59 How "patient" may not be the best way to define our goals for the patient experience. 10:34 "It is tough to be a consumer when you don't have the information that you need to be one." 13:08 The paradox: Patients are not, and also are, consumers. 13:31 "The question itself is the answer." 13:41 "Patients … are basically incapable of achieving health care consumer status in this country today." 13:57 Things to consider for those who don't think patients should try to be consumers. 15:21 "If you're a patient … do the best you can to be a good health care consumer." 15:59 Tips for being a good health care consumer. 16:30 Articles on how to be a good consumer online.17:00 "It pays to be suspicious." 17:15 Get second, third, and fourth opinions from subspecialists.

"If operating on the wrong leg is called a 'medical error,' what do we call operating on someone who doesn't need surgery?" That is a quote I have heard attributed to Jack Wennberg. It also crystalizes a theme I have been hearing a lot lately—the idea that quality metrics in this country today assess care from basically a patient safety standpoint but they don't consider whether the patient actually needed the surgery or whatever in the first place. Or whether the outcome of the treatment matched an outcome the patient understood and had hoped for. I get into this in depth, by the way, with Dr. Suzanne Clough (EP235); and I'm going to get into it again in my upcoming interview with Dr. Marty Makary (EP242). In this health care podcast, I speak with Olivia Ross. Olivia has a reputation as a "rock star in the employer coalition world," and I say this because it was a direct quote from an email I received after I mentioned that she was coming on the show. Olivia earned her rock star chops at the Pacific Business Group on Health (PBGH). Olivia is the associate director of the Employers Centers of Excellence Network, otherwise known as ECEN. What Olivia has worked on at ECEN is to put together a network of centers of excellence (COEs), meaning provider organizations that have committed to prospective bundled care payments for services like orthopedic surgeries, oncology, and bariatric surgery. Not only do these organizations … well, not only have they demonstrated excellence, but they also have demonstrated that they only treat patients who are appropriate to treat. Employers including Walmart, Lowes, and McKesson use this network. In my interview with her, Olivia discusses how the COEs are selected and exactly how employers intercept employees at the right waypoint along their patient journey, fly them or get them to travel to the COE, and then repatriate them back home with their local PCP (primary care provider) for follow-up care. I'm not sure if repatriate is the right word to use there, but I'm going to go with it. You can learn more at Pacific Business Group on Health. Olivia Ross, MBA, MPH, is associate director of the Employers Centers of Excellence Network (ECEN) at the Pacific Business Group on Health (PBGH). Olivia oversees the ECEN program, a national, multi-employer initiative developed as part of PBGH's commitment to value-based purchasing.

I am working on a collaborative endeavor right now where the BAA (business associate agreement) signing has literally taken a year. The whole project will likely take 2 weeks. I know I'm likely not going to shock anyone listening, but the legal side of any sale or install or collaboration or proposed interoperability can be a serious impediment when every venture takes literally months or even years. That's kind of the opposite of a fluid marketplace or fluid collaborative environment and one of the reasons why organizations can't innovate, even incrementally, if that innovation involves any outside partners or alliances. This whole legal jumble can also be a big reason why organizations might stick with substandard vendors, even vendors who are clearly overcharging them in some cases—just because the hassle factor and expense of switching to a better option is real. So, what's some practical advice to minimize the amount of time spent in BAA or contracting purgatory so that we can move forward with improving patient care and outcomes and being disciplined and efficient in the process in doing so? In this health care podcast, I speak with Bill Tanenbaum from Polsinelli. Bill is Polsinelli's practice co-chair of health care technology and innovation. You can learn more by contacting Bill on LinkedIn and by visiting polsinelli.com. William A. Tanenbaum works closely with clients to provide actionable, industry-informed solutions for their business needs. Recognized as one of the Who's Who Legal "Thought Leaders Global Elite," Bill is also ranked in top tiers by Chambers: America's Leading Lawyers for Business, Legal500, and Best Lawyers in technology, outsourcing, intellectual property (IP), and data law and as one of the Top 30 IT lawyers in the US (Who's Who Legal). Chambers says Bill "brings extremely high integrity, a deep intellect, fearlessness and a practical, real-world mindset to every problem."

We have gotten ourselves into this pickle: Americans—all of us as taxpayers, as patients, as employees, as employers—spend exorbitantly for highly variable results. Great work, great health care in some areas by some great physicians and their teams, and then voluminous other areas rife with overtreatment, errors, abysmal chronic care management, predatory pricing by entities owned by private equity or with billing departments gone wild. Who will be our knight in shining armor when it comes to fixing health care in the United States today? Will it be legislators? Will it be our current crop of large health care stakeholders? Will it be a self-proclaimed disrupter like Amazon or Haven Healthcare, that Amazon, Chase, and Berkshire Hathaway collaboration? In this health care podcast I speak with Brian Klepper, PhD. Brian has opinions on these questions. Spoiler alert: Some of the entities that Brian points to as intrinsic to the mission of fixing American health care are brokers who are not compensated in secret by insurance carriers. He also calls out primary care physicians and new primary care models as crucial. If you're looking for brokers of this kind, go to healthrosetta.org for a list of them. You could also listen to my podcast with David Contorno (EP186). On the primary care side of the equation, listen to my chat with Jed Constantz (EP209) and also the one with Alex Lickerman (EP184). In case you haven't heard of him, Brian is a health care analyst, commentator, and also an entrepreneur. He's executive vice president at the Validation Institute, executive analyst and editor at the Health Value Institute, and principal of Healthcare Performance, Inc, a health care strategy and business development practice. He's also principal of Worksite Health Advisors, a benefits consultancy. Formerly, Brian served as the CEO of the National Business Coalition on Health. You can learn more at careandcost.com, by emailing [email protected], and by visiting validationinstitute.com. Brian Klepper, PhD, is executive vice president of the Validation Institute, principal of Worksite Health Advisors, and a nationally prominent health care analyst and commentator. He speaks, writes, and advises extensively on high-performance health care, primary care clinics, and the management of clinical and financial risk.

Bad things have a propensity to occur in health care when patients are placed on a trajectory and then simply follow the yellow brick road—to an Oz potentially filled with unnecessary surgeries, MRIs that cost 10 times what they should, low-quality providers chasing RVUs (relative value units) like their paychecks depended on it … I could go on. Today I speak with Derek Winn, cofounder at Distilled Concepts and consultant at the Business Benefits Group. His distilled advice is to recognize that every transaction with the health care system is a waypoint on a larger journey—and also an opportunity to pause and ask questions. Payers of health care have a profound opportunity and perhaps growing obligation to help employees/members/patients, first of all, to recognize that a "look both ways before you cross the street" modus operandi is safer from both a monetary as well as an actual patient safety standpoint. Derek and I discuss the ways to make this happen, when/if it will become standard operating procedure, and the likely impact on providers and insurance carriers and Pharma if employers choose to take this route. By the way, BUCA stands for Blue Cross, United, Cigna, Aetna, and Anthem. We use this acronym in the interview. You can learn more by contacting Derek on LinkedIn atDerekWinn or by visiting distilled-concepts.com. Derek Winn is a lead consultant at the Business Benefits Group, where he has consulted clients regarding employer-sponsored benefit programs for nearly the past decade.

In this podcast, Liliana Petrova, CEO/Founder at The Petrova Experience, translates her experience as director of customer experience at JetBlue to the health care industry. Her advice is practical and designed to actually work in environments as complex and regulated and driven by safety concerns as the airline industry—and also, coincidentally, health care. In the past in health care, some have perhaps underestimated the impact of customer experience. But it's hard to continue to do so in the face of Forrester research showing customer experience drives revenue growth by double digits compared to laggards in markets where there's competition. Actually, this growth difference is true even in some markets where there's not much competition. Why? Because when the customer experience is really bad, customers might choose to abandon the service/care altogether and just not return at all, anywhere. And Gartner touting facts such as 89% of companies these days are competing on a customer experience battleground. But back to today's conversation. Somewhere in the middle of our chat, Liliana says, "When building to simplicity, it has to be perfect." I loved it! This is a really simple, if you will, maxim with a lot packed into it that we spend some time unraveling. One spoiler: Good customer experience makes it easy for customers, makes it simple for customers. And second, perfect means perfect from the patient's or customer's point of view, not ours. One of the parts of the conversation I loved was Liliana's dissection of just the physical space of a typical waiting room from a customer standpoint. I never thought about it before, but that desk that the front office staff usually is sequestered behind? That tall desk with the glass window? It resembles a payday loan place in a bad neighborhood. What's the subliminal message there? Liliana wrote a few articles about lobby design, among other topics, by the way; and the links are in the show notes. I met Liliana at the Pharma CX conference hosted by PanAgora. Learn more at thepetrovaexperience.com. Liliana Petrova, CCXP, is a proven leader in the field of customer experience (CX) and innovation. She pioneered a new customer-centric culture, energizing the more than 15,000 JetBlue employees with her vision. She has been recognized for her JFK Lobby redesign and facial recognition program with awards from Future Travel Experience and Popular Science.

Here's a vital question, "How do you make sure that the physicians your employees or members are seeing are high quality in a given area of focus?" Getting to the right doctor matters when you consider that something like 70% of back surgeries are unnecessary and medical errors are the third leading cause of death in this country. And also because, as Suzanne DelBanco put it in EP224, if a payer simply cuts out the bottom performing 10% of practices, the returns are outsized from a cost and quality perspective. The challenge is how to actually accomplish this. How to measure quality in a sea of dirty data and noise and whatever the opposite of interoperability and aggregated data sets is. With the confounding factor also that outcomes are rarely if ever included in data sets, especially when you consider that the outcomes that matter to patients are really the outcomes that count. Today I speak with Suzanne Clough, MD. In a former life, Suzanne was a co-founder of Welldoc, the first FDA-approved digital health platform and also featured on EP102 of this podcast. Now, Suzanne is the chief-medical officer over at ArmadaHealth, a company that aims to become a GPS for health care helping to get patients to the right doctor quicker. You can learn more at www.armadahealth.com Dr. Suzanne Sysko Clough, MD, is Chief Medical Officer of ArmadaHealth, a health and data science company that navigates consumers to quality health care providers using big data, AI, and proprietary quality algorithms that together produce 360-degree profiles of physicians. The platform enables precision matching of physicians with patients based on diagnosis/condition and nonclinical attributes. Before ArmadaHealth, Suzanne was a co-Founder and Chief Medical Officer of WellDoc, the first FDA-approved digital health platform. Dr. Clough completed her medical training in internal medicine and a fellowship in endocrinology at the University of Maryland Medical Systems and served as an assistant professor in the Division of Endocrinology as well as Medical Director and as the Founder and Medical Director of the Center for Weight Management and Wellness.

Today I speak with Claire Sporton. Claire is SVP of customer experience innovation over at Confirmit. Since we did this interview, the 2019 Edelman Trust Barometer came out. And it showed that trust in US hospitals has nose-dived 8 points. Pharma and biotech held steady since last year, or slight increases, but the bar is pretty low. Same with insurance. In this conversation, Claire and I discuss why this matters—why it matters to hospitals, to Pharma, to insurance carriers, and anyone else who is desirous of customers who come in once … and then they also return. And how do you get customers to come back? It's by having an amazing customer experience that meets customer expectations, exceeds customer expectations, and at the same time creates a measure of trust. And trust breeds loyal customers. Here's one maxim from Seth Godin that I particularly like. He said, "We all know someone who is transactional, and it makes us feel icky. What we strive for is to feel relational and to feel that we have a relationship with someone. We all know when we're being manipulated." The point is this: If we don't have trust, we won't have the right relationships within the health care industry involved in getting the right outcomes for patients. Entities won't be able to work together (for example, Pharma and health systems, or insurance carriers and health systems, or health systems and patients … or any combination of the aforementioned). I saw a stat the other day that said if there's an increase of customer retention of 5%, then business returns go up 25%. That wasn't a health care reference, per se, so there was no contemplation of patient outcomes and how much they may improve as a result of trusted health care relationships and the interoperability that results from them and care coordination … all of the above. I think even at the transactional level there's room for improvement. And I see this as an opportunity to differentiate. "Who will be the next—or the—JetBlue of the health care industry?" is my question. JetBlue did very well in relation to its competitors in the airline industry, and they did so by creating amazing customer experiences, which trust was derived from. For more information on the customer experience and the trust fronts, the following Relentless Health Value episodes might be of interest: INBW23, EP228, EP232, EP148, and EP188. Claire Sporton is senior vice president of customer experience (CX) innovation at Confirmit. Claire has a passion for building truly customer-centric cultures that inspire change and deliver measurable business improvement. In her role, she focuses on driving forward the discipline of CX management and ensuring that Confirmit provides the technology and expertise that organizations need to empower and inspire everyone across the organization to do the right thing. Claire was a winner of the 2018 CX Impact Award, a prestigious award issued on CX Day by the Customer Experience Professionals Association. With a background in psychology and systemic management, Claire has over 20 years' experience as a consultant and CX practitioner, leading companies to empower everyone to be accountable for improvement, motivate individuals to work differently, and predict and monitor real business impact.

Last week I was invited to attend and present at a Rare Disease Roundtable hosted by Health Catalyst and McDermott Will & Emery in Boston. A colleague from Aventria Health Group and I were there to talk about ways to enlist stakeholder collaboration throughout the rare disease patient journey. When not hosting the show, Stacey is co-president of Aventria Health Group, a marketing agency and consultancy. Aventria specializes in helping pharmaceutical, employer, pharmacy, and health system clients improve patient outcomes by creating and leveraging collaborations with other health care organizations. For more than 20 years, Stacey has innovated better-coordinated health solutions benefiting all stakeholders and, most of all, the patient. 00:43 The rare disease patient journey. 02:03 The burden to stay on top of clinical developments falls on patients. 02:14 The major problem with patients tracking clinical developments in rare disease. 03:42 Stacey's personal journey with a rare disease. 06:19 These stories aren't unique; there's a hard reality around rare disease management and treatment. 06:37 "Rare disease management takes stakeholder collaboration." 07:00 "Payers … need to pay for evidence-based approaches." 08:04 Rare disease management requires coordination between points of care. 08:57 The tough ask behind improving rare disease management. 09:41 Why Pharma is primed to affect organizational change. 10:50 "It is less about an individual patient … and more about a population of patients." 11:34 The effort required to collaborate to treat rare diseases has to be less than or equal to the perceived reward. 12:06 "What Pharma needs to offer up is more than a molecule." 12:47 Account managers, go to aventriahealth.com for blog posts on helping account managers develop the skill set to create collaborative relationships. 13:28 It is best to include clinical trial endpoints in the package insert that reflect institutional and/or payer needs.

The Society for Integrative Oncology recently completed a systematic evaluation of peer-reviewed randomized clinical trials for patients with breast cancer. The researchers assigned letter grades to therapies based on the strength of the evidence. Meditation got an A; it had the strongest evidence supporting its use. Music therapy, yoga, and massage received a B grade. Hypnosis got a C. By the way, the letter grade varied depending on the symptoms that were involved. You can go on the website of the Society for Integrative Oncology if you want to look up the trial itself. So, here's my question: Are insurance carriers paying for music therapy, meditation, and yoga? How about cooking classes? Some are, generally if it's part of the services provided by the cancer center. It's striking, though, that every single insurance carrier will pay for the downstream costs of unfettered anxiety, stress, poor nutrition … you get the idea—things that an integrative oncology focus would aim to attenuate. Do employers know about integrative oncology? I think I'd rather have an employee on a cocktail of music therapy and yoga than a cocktail of pretty much anything else. I'm thinking about this because if these therapies are not covered benefits, then I'm going to doubt that the middle-of-the-bell-curve employees or patients can afford them. Who's going to "splurge" on meditation classes when GoFundMe has a whole section to help people pay for their traditional cancer care? Today I speak with Glenn Sabin, an integrative oncology consultant at FON Consulting. Glenn is a nationally recognized thought leader with a reputation for successfully positioning integrative health organizations for sustainable growth. You can learn more at fonconsulting.com and glennsabin.com. Glenn Sabin is director of FON Consulting, a leading strategy and business development consultancy specializing in the integrative health and medicine sector. FON's clients span from medical practices, hospitals, and health systems to nutraceutical, pharmaceutical, and media companies. Glenn brings economic and moral clarity to the misnomer that health creation and promotion cannot align with profitability.

It is pretty much inarguable that happy customers are a prerequisite for business success. And that's true in health care as much as it's true in every other industry—although in health care, sometimes the customer is also called a patient. Provider organizations like Cleveland Clinic are really walking the walk when it comes to creating amazing patient/customer experiences; so are other leading provider organizations. But in other segments of the health care industry, maybe they haven't quite connected the dots between the idea of satisfying customer needs in the abstract and then what that actually looks like relative to a strategic approach. Let me give you an example—certainly not all pharmaceutical manufacturers: Here's where key performance indicators, or KPIs, come in. Everything we do should really be derived from what customers need and expect. This could be considered our North Star. And that's why creating KPIs that focus on how well we are doing delivering on great customer experiences over the long run delivers superior market returns and patient outcomes and patient satisfaction. My guest today on the podcast is Jon Skinner, who is an executive vice president at The Verde Group. Jon's message is that your KPIs—if they are done right, in any case—should tell you if you are delivering on a set of customer expectations that are going to lead you to your vision of what success looks like. The Verde Group is a market research firm that specializes in quantifying the customer experience, in case you have not heard of them. I met Jon, by the way, at the PanAgora Pharma CX conference this past spring. You can learn more at verdegroup.com. Jon Skinner is executive vice president with The Verde Group, a customer experience (CX) research consultancy focusing on the financial quantification of customer experiences. Jon works with market leaders across the pharmaceutical and health care space to help them identify the specific customer experiences most consequential to revenue and share growth, and then to develop CX improvements that sustainably grow customer value, build brand equity, and develop customer-centric cultures.

Will the Health and Human Services (HHS) proposal materially impact Pharma's ability to "pay to play" on pharmacy benefit manager (PBM) formularies? We have that HHS proposal that is now at the stage where they're trying to figure out how to implement it. What's at stake right now is that implementation flowchart and who exactly is involved in adjudicating the something like $186 billion in potential charge-backs. Since any middleman who gets himself involved in any flowchart of this sort takes a buck, there is a massive land-grab opportunity that all these heretofore hidden players are battling over. My guest today, AJ Loiacono, CEO at Capital Rx, can shed light on the hidden complexity of what goes on in the dark middle of a pharma drug transaction and contracting—and that is very relevant right now. Anthony J. "AJ" Loiacono is a successful entrepreneur, with over 20 years of experience in pharmacy benefits, finance, and software development. As the CEO of Capital Rx, his mission is to change the way pharmacy benefits are priced and administrated in the United States. Prior to Capital Rx, AJ was a co-founder of Truveris, where he served for 8 years as CEO, chief innovation officer, and board member, leading the company to record growth.

Today I'm talking with John Lynn, founder of Healthcare Scene as well as two conferences, Expo.Health and HITMC. If I was going to frame out an overarching theme, I would suggest that it is this: Organizational culture eats strategy for breakfast, lunch, and dinner. Let's consider the scope of this statement: Ambulatory patients spend about 84 minutes on average in clinic. Of those, 7-12 minutes are with a physician. Inpatient, I imagine, has probably an even greater ratio. So those 7-12 minutes are hypercritical, of course. I would never suggest anything that minimized the doctor-patient relationship. But how many times has a doctor's patient grade gone down because of someone nasty at the front desk? All of the other individuals that a patient meets in the non-doctor portion of their visit, all of the moments that happen in that time frame, all of the care coordination that does or does not happen ... all these things have a significant and meaningful impact on not only the patient experience but also patient outcomes. So, how do you get the front desk and the back office and the middle office and anyone on the phone to recognize the importance to the mission of attaining the quadruple aim of health care? How do you get the janitorial staff to see their role as crucial in the prevention of health care–associated infections (HAIs)? The IT team to feel proud that they have helped with physician burnout by making the tech help doctors instead of slow them down? Or the finance team to consider the financial toxicity of their actions? Or the medical assistants to enter the correct blood pressure or whatever data so our predictive analytics actually work? The answer to all of these questions points back to strong leadership. It's building a culture of love, as John Lynn puts it. He means aligning around a mission to do right by patients and give them the best care and outcomes that we can. Consider this, though: A culture of love can be within one organization, but it can also be cross-organizations. Peers come together and share their experiences and their best practices for the purpose of improving patient care. Then they can take their enthusiasm and passion back to their own organizations. Doing this disperses a culture; it promotes a way of thinking that connects day-to-day drudgery with an endpoint that we all can be proud of. I don't think it's controversial to say that establishing a real culture of love is the best way to achieve patient health in health care, a better patient experience, fewer burned out doctors and nurses, as well as other business results. If you're interested in how all this connects to patient experience, by the way, listen to EP228 with Julie Rish. John Lynn is the founder of the HealthcareScene.com network, which currently consists of 10 blogs containing over 11,000 articles, with John having written over half of the articles himself. These electronic medical record– and health care IT–related articles have been viewed over 18 million times. John also manages HealthcareITCentral.com and HealthcareITToday.com, the leading career health IT job board and blog. He also organized the first-of-its-kind conference and community focused on marketing to health care: HealthITMarketingConference.com. Plus, he launched Health IT Expo, a conference focused on practical health care IT innovation. John is an adviser to multiple health care IT companies and a highly sought-after keynote speaker. John is deeply involved in social media and, in addition to his blogs, can be found on Twitter at @techguy and @ehrandhit.

No one denies that it's a tough world out there for health start-ups. Finding a customer is tough, financial models are tough to figure out, operationalizing is tough. But the same is true for those other health care stakeholders attempting to purchase and implement the innovations start-ups are creating. Here's another unassailable truth: Everything is just easier within a supportive community. You gain feedback, mentorship, networking opportunities, and maybe just a venue to sob into your beers together. Today I speak with Alex Fair, managing partner at MedStartr Ventures and CEO of MedStartr. MedStartr is a community for health tech entrepreneurs that also provides venture capital to crowdsourced contest winners. And spoiler alert, the one core skill all successful start-up teams possess is listening. The ability to listen. You can learn more at medstartr.vc, medstartr.com, and medstartr.nyc, or call Medstartr at 530-MedStartr. Alex Fair is the founder and CEO of MedStartr. He originally trained as a scientist, working in physics, then cancer, and finally in heart disease research. In the 1990s he had an idea for a company that took off, so he finished off his last paper and came into the world of business. MedStartr is his seventh start-up.

Let's talk about the opioid crisis for a moment. When we say the words "opioids crisis," as a general broad stroke, many people immediately picture somebody who lives under a bridge. But that actually wouldn't be your average profile of someone with a substance misuse/opioid problem. The average profile of someone with an opioid/substance misuse profile looks exactly like an employee. In fact, 75% of adults up to the age of 64 with a misuse issue are in the workforce. And the cost to an employer of someone addicted to a long-acting opioid such as oxycontin is $117,000, on average, if you count the medical spend and loss of productivity. My name is Stacey Richter. I am the host of the Relentless Health Value podcast and co-president of a cause-driven organization called QC-Health®. We started QC-Health® to do what we can to improve the state of health care in this country today, which is, by the way, the mission of this podcast as well. You can learn more at QC-MyMeds.org. When not hosting the show, Stacey is co-president of Aventria Health Group, a marketing agency and consultancy. Aventria specializes in helping pharmaceutical, employer, pharmacy, and health system clients improve patient outcomes by creating and leveraging collaborations with other health care organizations. For more than 20 years, Stacey has innovated better-coordinated health solutions benefiting all stakeholders, and, most of all, the patient. 01:46 One of the programs QC-Health® is sponsoring—QC-MyMeds™. 02:10 SinfoníaRx—one of the most well-respected medication therapy management (MTM) providers in the country. 02:23 What QC-MyMeds™ essentially is. 02:55 Why QC-Health® thought it was important to take a proven program to even the smallest employer. 03:57 How QC-Health® aims to helper smaller employers. 04:08 The QC-MyMeds™ approach. 05:51 "This program does not aim to boil the ocean." 06:02 "The problem with opioids is that they change your brain chemistry." 06:29 Connecting the dots between service programs and employees who need them. 07:01 Eliminating barriers for small employers. 08:49 Stacey presented QC-MyMeds™ at the World Health Care Conference. You can learn more at QC-MyMeds.org.

There's a great video of Steve Jobs responding to an audience question that is, at a minimum, let's just say strident. Jobs kind of ignores the aggressive nature of the query and offers a thoughtful response which is super relevant to health care. He says, "One of the things I've always found is that you've got to start with the customer experience and work backwards to the technology. You can't start with the technology and try to figure out where you're going to try to sell it." I don't know about you, but I find this quote over-the-top relevant in health care. In health care, when we contemplate changing the workflow or integrating some technology or building some technology or whatever else we're up to, how many times are we starting from the perspective of the patient or member? How often is the patient the "why" behind "why are we prioritizing this?" I wonder, in the health care industry, how many meetings go on about what patients want with no patients in the meetings and no real consideration to that end. As a data point, probably twice a week I hear of a new program, product, service, device, digital something or other that has zero or only a few patients using it because only after development did anyone check with patients what they think about the thing. And then sometimes the patient gets blamed and labeled nonadherent to something they didn't want in the first place. I met Julie, by the way, at the PanAgora CX conference this past March. You can connect with Julie on Twitter at @julie_rish. Julie Rish, PhD, is a clinical psychologist for the Bariatric and Metabolic Institute at the Cleveland Clinic.

If you don't know the nuts and bolts of the current Health and Human Services (HHS) proposal to nix Pharma's ability to pay pharmacy benefit manager (PBM) rebates, then it's possible you might want to listen to EP216 with Chris Sloan first. In this episode, we don't talk much about the impact of the HHS proposal on patient premiums or drug costs. That's EP216. What we do talk about today is the impact on pharmaceutical companies. We also discuss the drug-buying transaction. Kuo Tong is my guest today. Kuo is a managing director in the life sciences practice of Navigant, focusing on how pharma companies interact with insurance companies and get reimbursement for their drugs. And that's actually the burning question we aim to answer today: Will Pharma's interactions with and reimbursement from insurance companies change after this proposed HHS rule goes into effect, assuming it goes into effect? We also talk about what Pharma could and should be doing right now to improve the odds of a smooth transition into a new contracting model. You can learn more at navigant.com, connect with Kuo on Twitter at @NavigantHealth, or email him at [email protected]. Kuo Tong is a managing director in the life sciences practice of Navigant and oversees its US Market Access Center of Excellence. He joined the firm in November 2017 to lead a team focused on health economics, pricing, and market access engagements.

Today I speak with Devon Herrick, PhD, who is an expert in surprise billing. Devon is a health care economist and public policy analyst who has authored many articles on surprise billing. You'll find some links in the show notes. Devon is also an adviser to the Heartland Institute, which is a free-market think tank. I find it incredibly thought provoking that a free-market think tank, for reasons we discuss in this podcast, finds unfettered market-driven surprise billing as egregious as the most progressive socialists do. Handshaking across aisles everywhere. If you're a hospital or insurance carrier executive, what are you doing right now in light of all this public attention and legislation? I hope your response includes actions to protect your patients—and not just an industry-centric lobbying effort. You can learn more and connect with Devon on Twitter at @DevonHerrick or on Facebook at Devon Herrick. Devon M. Herrick, PhD, is a health economist and former hospital accountant. He is currently a health policy adviser for the Chicago-based Heartland Institute. Dr. Herrick worked for the Dallas-based National Center for Policy Analysis (NCPA) for 21 years until it ceased operations in 2017. He also served two terms as chair of the Health Economics Roundtable of the National Association for Business Economics (NABE). Dr. Herrick focuses on health insurance issues, including state health care regulations, federal health reform, managed care, Medicare, Medicaid, and the uninsured. He also researches issues such as consumer-driven health care, telemedicine, medical tourism, pharmaceutical economics, and emerging trends in retail medicine.

It turns out, patient-centric care that produces outcomes patients care about is usually less expensive than care that is not. The Patient-Centered Outcomes Research Institute (PCORI), an independent nonprofit, nongovernmental organization in Washington, DC, was authorized by Congress in 2010. PCORI was established to fund research that can help patients make better-informed decisions, guided by clinicians, payers, and others. In other words, help nudge health care into a patient-centric place, for the good of everyone involved in a quadruple aim sort of way. Since December 2012, PCORI has funded hundreds of studies that compare health care options to learn which work best, given patients' circumstances and preferences. Today I speak with Dr. Joe Selby, executive director of PCORI. You can learn more at PCORI.org. Joe V. Selby, MD, MPH, is the executive director of the Patient-Centered Outcomes Research Institute (PCORI). A family physician, clinical epidemiologist, and health services researcher, Dr. Selby has more than 35 years of experience in patient care, research, and administration. He is responsible for identifying strategic issues and opportunities for PCORI and implementing and administering programs authorized by the PCORI Board of Governors.

"Those who say it cannot be done are usually interrupted by others doing it." That's a James Baldwin quote to keep in mind while considering employers ginning up real change in the health care industry. Generally speaking, employers who still don't believe they could have an impact helping their employees get better health care at lower prices, don't listen to this podcast. But if they did, I'd suggest this James Baldwin quote is apropos. It's probably also apropos for providers, carriers, Pharma … anyone who isn't paying a whole lot of attention to the success of organizations like Catalyst for Payment Reform. Americans, meaning employees, can no longer afford their health care. Deductibles are higher than savings, basically meaning that employees have health plans they can't even afford to use; and it costs as much as a midsize sedan—a new one every single year. Furthermore, we have employer health care spend chewing up raises. Employers and their CFOs are increasingly in a position where they have to act. It's no longer an option. I speak today with Suzanne Delbanco, PhD, executive director of Catalyst for Payment Reform. In one of her past lives, Suzanne was the founding CEO of The Leapfrog Group. You can learn more at catalyze.org. In addition, for a curriculum of podcasts to get you up to speed on what's happening in the employer space, check out this blog post. Suzanne Delbanco, PhD, is the executive director of Catalyst for Payment Reform (CPR), an independent, nonprofit corporation working to catalyze employers, public purchasers, and others to implement strategies that produce higher-value health care and improve the functioning of the health care marketplace. In addition to her duties at CPR, Suzanne serves on the advisory board of The Source on Healthcare Price & Competition at the University of California–Hastings and the Blue Cross Blue Shield Institute. Previously, she was the founding CEO of The Leapfrog Group. Suzanne holds a PhD in public policy from the Goldman School of Public Policy and an MPH from the School of Public Health at the University of California–Berkeley.

Last time I looked this up online, there were more than 5000 companies offering digital medicine tools. Which ones worked? Which ones are less good than others? Which ones have not been tested? How were they tested: apples to apples or a whole fruit basket of standards? If you're a clinician or the head of population health or an insurance carrier and you're trying to figure out whether a digital tool could help solve a problem your patients are having … at this juncture, may the force be with you and I hope you know how to use Excel. The Digital Therapeutics Alliance (DTA) aims to put definitions and standards around what can be legitimately called a digital therapeutic and how these tools are best deployed so that patients are best equipped to get the best possible outcomes. Today I speak with Megan Coder, executive director of the Digital Therapeutics Alliance. You can learn more at dtxalliance.org. Megan Coder, PharmD, MBA, is executive director of the Digital Therapeutics Alliance (DTA), whose mission is to broaden the understanding, adoption, and integration of clinically validated digital therapeutic solutions into mainstream health care through education, advocacy, and research. With more than a decade of experience in the health care industry, Megan's expertise extends from strategic growth and partnership development within the digital health sector to the direct delivery of patient care.

Say you're a provider, an insurance carrier, a pharma company … and you've realized that you need to innovate to reduce costs and deliver better care. Or hedge against an upstart showing up on the scene and disrupting your good thing. Or ensure that your risk-based contracts go well. It's one thing to cerebrally decide to be innovative and another thing to get your organization to actually do innovation and, arguably just as importantly, cross the "o-gap" or the "operationalization gap," as my guest today, Naomi Fried, puts it. Naomi is the CEO of Health Innovation Strategies, which she founded after a storied career with innovative greats such as Kaiser Permanente, Boston Children's Hospital, and Biogen. You can learn more at healthinnovationstrategies.com. Naomi Fried, PhD, is an innovative and digital health thought leader and founder and CEO of the boutique advisory firm, Health Innovation Strategies, which focuses on innovation program design and digital health strategy. Naomi was the first vice president of innovation and external partnerships at Biogen, the first chief innovation officer at Boston Children's Hospital, and vice president of innovation and advanced technology at Kaiser Permanente. She served on the board of directors of the American Telemedicine Association and the Governor of Massachusetts' Innovation Council.

"Dr. Google" has a bad rap in some health care circles. If you doubt my words, go on Instagram and do a search for "Doing battle with Dr. Google." But let me give you a tip: Pretending Dr. Google doesn't exist or telling patients to quit it with the internet—these are tactics that are always followed by #doomed. The best way to help your health care brand, organization, and clinicians and patients is to ensure that patients can find credible, accurate content on the internet, which they will be searching whether you like it or not. Another way to help your health care brand, organization, and clinicians and patients is to help patients and their families better process and use the information that they do find on the internet. Today I speak with Chris Cullmann, head of innovation and engagement at Guidemark Health. Chris offers up some key insights and practical advice to help you help patients and clinicians. Chris also curates a great Twitter and LinkedIn feed. You can learn more at guidemarkhealth.com, or find Chris on Twitter at @cullmann and LinkedIn at Cullmann. Chris Cullmann is the head of innovation and engagement at Guidemark Health, a leading marketing agency. Chris is a veteran in digital marketing with more than 2 decades of experience. Health care has been a focus of his career, technology a passion, and strategy a craft. A career in professional communication has allowed Chris to explore emerging platforms, channels, and data to create industry-leading customer experiences. Chris is actively involved in the health care innovation space and is an evangelist for the adoption of digital in health care.

Today we're talking episodes of care payment models, otherwise known as bundled payments. Just to catch you up if you're unfamiliar, this type of payment model means that a health care provider packaging together all the services needed during an episode and charges a guaranteed price for guaranteed quality of care. If we're talking about government payments, about 50% of, for example, knee surgeries are paid for right now in an episode of care fashion. In the private pay landscape, that number is lower but growing. Bundles have advantages to purchasers (ie, employers or taxpayers who are the ultimate payers) because it's possible to predict and compare the target price they'll pay. But it's also important for consumers who are partial payers in most cases. Bundles make health care prices transparent in a way that fee for service (FFS) can never manage. Today I speak with François de Brantes, senior vice president at Remedy Partners and a noted expert in episodes of care and bundled payment initiatives. François also actively supported the launch of the Leapfrog Group, created Bridges to Excellence, and led the development and implementation of PROMETHEUS Payment. You can learn more at remedypartners.com. François de Brantes is senior vice president of commercial business development at Remedy Partners. He has spent nearly 20 years advocating for, and working to transform, the US health care system by improving incentives for providers and consumers to encourage value-based decisions. Prior to joining Remedy Partners, 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 health care delivery. Early in his career at General Electric, he was involved in many strategic programs that rewarded providers for better performance. He has written extensively about the topic, including his 2013 book, The Incentive Cure: The Real Relief for Health Care.

Arshad Rahim, MD, MBA, FACP, is a practicing physician and a health economist at his core. He enjoys a track record of building innovative health care businesses, including Mount Sinai Health Partners, Healthgrades, and Sg2. As the senior medical director for population health at Mount Sinai Health System, Dr. Rahim is responsible for driving physician performance for 3000 physicians within the Mount Sinai Clinically Integrated Network, focusing on key utilization, cost, and quality metrics. Dr. Rahim has a bachelor's degree in economics from Duke University, an MD from the University of North Carolina, and an MBA from Emory University. He completed his internal medicine residency at Yale University and Northwestern University and is an actively practicing hospitalist at the Mount Sinai Hospital.

Ram Raju, MD, brings vast executive leadership experience and a keen understanding of New York's health care delivery system to Northwell Health. As senior vice president and community health investment officer, he evaluates the needs of Northwell's most vulnerable communities and provides solutions for them by collaborating with community-based organizations. He's responsible for promoting, sustaining, and advancing an environment that supports equity and diversity, and helping the health system eliminate health disparities. Prior to Northwell, Dr. Raju served as president and CEO of NYC Health + Hospitals from January 2014 to November 2016. Dr. Raju also served as CEO for the Cook County Health and Hospitals System in Chicago, the nation's third-largest public health system, where he improved cash flow by more than $100 million and changed the system's financial health during his tenure from 2011 to 2014. Dr. Raju served as vice-chair of the Greater New York Hospital Association and currently sits on the boards of numerous city, state, and national health care organizations, including the American Hospital Association, the New York Academy of Medicine, and the Asian Health Care Leaders Association. Dr. Raju earned a medical diploma and Master of Surgery from Madras Medical College in India. He underwent further training in England, where he was elected as a Fellow of the Royal College of Surgeons. He later received an MBA from the University of Tennessee and CPE from the American College of Physician Executives.

Steve Watson, CPA, SHRM-SCPAs a CFO/CHRO, Steve was frustrated each year with rising health care costs for his employer and employees. In 2012, he decided to make a change. First, he decided to fix the misaligned incentive that he had with his broker. Then he and his broker moved on to fixing the way his insurance was purchased from the insurance carriers. Now Steve is sharing this process with other employers through his consulting company Summit Path Group, whose mission is to lower employee benefit costs by sharing best practices from around the country with local employers and advisers. For more information on direct primary care, listen to EP184 with Alex Lickerman, EP198 with Eric Parmenter, and EP215 with Caroline Znaniec.

Chris Sloan is an associate principal at Avalere Health, a Washington, DC–based nonpartisan consulting firm. He advises a number of clients—including pharmaceutical manufacturers, health plans, providers, and patient groups—on key policy issues facing the health care industry. His particular areas of expertise include drug pricing, the Affordable Care Act, generics, and biosimilars. Additionally, Chris is a recognized expert in the health care policy issues facing people living with HIV/AIDS and multiple sclerosis. Chris's economic analyses of key policy proposals and issues, including drug pricing and the repeal and replace efforts around the Affordable Care Act, have been featured in a wide range of publications such as the Wall Street Journal, the New York Times, Politico, Vox, and others. He has a BBA degree in economics and marketing from the College of William and Mary.

Tom Kottler is co-founder and chief executive officer of HealthPrize Technologies, the leading cloud-based patient experience and adherence platform for life science companies. In collaboration with CEEK Enterprises, HealthPrize recently released a new report, "The Pharmaceutical Triple Aim," showing how 21 of the world's top pharmaceutical companies can increase revenue and boost earnings per share with improved adherence. Tom has led multiple high-growth organizations during his career, including Advanced BioHealing, which was acquired by Shire for $750 million, and MedAptus, an innovative health care IT company based in Boston. 01:10 A new study on medication nonadherence. 02:36 The pharmaceutical triple aim. 02:47 The 4 ways Pharma can make money. 03:04 The pressure on the key elements of the pharma business model. 03:45 The big revenue opportunities for Pharma and how they're really difficult things to solve for. 05:39 "Adherent patients get better outcomes, and they cost less … all the way around."

Caroline Znaniec, MBA, MS-HCA, is the founder and principal of Luna Healthcare Advisors LLC. Her boutique consulting group provides revenue integrity advisory services to other consultancies and large advisory firms, software companies and developers, and health system and physician providers. Caroline writes and speaks regularly on topics of revenue integrity for many nationally recognized professional associations, including the Association of Healthcare Internal Auditors (AHIA), American Health Information Management Association (AHIMA), Health Care Compliance Association (HCCA), Healthcare Financial Management Association (HFMA), and National Association of Healthcare Revenue Integrity (NAHRI). She has more than 20 years of industry experience, having worked with the nation's top health systems and health care talent.

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.

Katie D. McMillan, MPH, has dedicated her career to imagining and building technology to improve health care for patients and providers. Her experience spans multinational global health organizations, lean software start-up companies, and large academic medical centers. Katie's latest venture is the creation of the Mobile App Gateway (MAG) at Duke University Health System. The MAG serves as the hub for digital health at Duke and provides product consulting services to clinicians and researchers, monthly events and workshops, and content exploring the many facets of the health tech industry. Roylyn Fernandez, RN, has more than 15 years of combined experience in clinical and informatics roles integrating technologies such as electronic health records (EHRs), virtual desktop infrastructure (VDIs), and mobile applications into system processes. Her passion for nursing and health care enable her to leverage her clinical, operational, and informatics knowledge to design and execute technology adoption strategies that support organizational goals related to quality, patient safety, and revenue capture initiatives. In 2016, Roylyn joined DeLappe Consulting after leading enterprise-wide technology implementation and optimization projects for Kaiser Permanente, Sutter Health, and Cottage Health Systems.

Louis Morrow is regional director of sales for Intelligent Retinal Imaging Systems (IRIS), the leading comprehensive solution provider of diagnostic telemedicine services committed to ending preventable blindness due to diabetic eye disease. Louis was one of the earliest builders at IRIS and has played a major role in saving the eyesight of over 55,000 patients (so far) through the partnerships built with major health systems and integrated delivery networks across the country. He's an award-winning consultative sales team leader with more than 20 years of successful experience in the eye care space and has held senior sales leadership positions across multiple companies. Tiffany Wandy is executive director of the Clinically Integrated Network for LifeBridge Health, a regional health care organization based in northwest Baltimore and its surrounding counties. LifeBridge Health consists of Sinai Hospital of Baltimore, Northwest Hospital, Carroll Hospital, Levindale Hebrew Geriatric Center and Hospital, LifeBridge Health & Fitness, hundreds of primary care and specialty physicians throughout the region, and many affiliated health-related partners. Prior to joining LifeBridge, Tiffany was a senior data analyst and lead program consultant for the CareFirst Patient-Centered Medical (PCMH) Program, where she served as an adviser to primary care providers on best practices relating to the implementation of coordinated care delivery models. Tiffany has both payer and provider experience and leverages this knowledge to drive increased use of analytics, business development, and practice transformation for rural, suburban, and urban organizations.