Relentless Health Value

Everybody's been talking about the surge in telehealth usage—how it would have taken, like, ten years to get as far as we've gotten in the past ten days. I wanted to talk to somebody who has been ramping up their telehealth capabilities for a while to get a sense of what it takes to do it well. As has been said by many, doing telehealth isn't just about technology. It's about training—clinicians and patients and accounts receivable and other staff. It's about rearranging workflows and processes. So, super pleased to have had the opportunity to talk with Jonathan Thierman, MD, PhD. Dr. Thierman is an ER doc. He's also the chief medical information officer for LifeBridge Health systems and the medical director of the LifeBridge virtual hospital. So, this show has two parts: episode 273 that you're listening to; but the second part, episode 274, is where we're going to get into some of the operational aspects of telehealth, like what EHR integration actually means and what it looks like. In this health care podcast (episode 273), however, Dr. Thierman and I discuss what telehealth can accomplish, maybe better than a face-to-face patient encounter, and what it's not so good at. One thing that dawned on me as we were talking is that the technology isn't just, you know, a video system. There's apps, there's AI, there's minivans full of lab equipment … there are other innovations that expand the capability of a remote patient visit. Here's another point to ponder that Dr. Thierman and I explore a little bit. What is the impact of telehealth in a value-based care environment but also in an FFS (fee-for-service) reimbursement model? It's likely, if you think about it, there will be more patient visits because the barrier to getting care has diminished. And that might be a good thing if we're talking about chronic care, if we're talking about ensuring follow-up after a surgical procedure. There's any number of examples where patients getting help prior to some sort of acute event would be considered a good thing by most. But does improving access to care increase a patient's chances of getting inappropriate care? You know, 25+% of care is some variation of waste, fraud, and abuse; and additional services rendered always have the risk of negative consequences. Or do we figure that bad actors are doing a pretty good job behaving badly anyway, so the net positive for the rest of us is worth it? You can learn more at lifebridgehealth.org. You can also follow Dr. Thierman on Twitter at @techie_doc or connect with him on LinkedIn. Jonathan Thierman, MD, PhD, is physician executive in the LifeBridge Health system and president of the medical staff at Northwest Hospital. He started his career as an engineer and inventor, earning his PhD at MIT and then training in emergency medicine at Harvard Medical School and Johns Hopkins Hospital. In the past, he has worked to bring real-world clinical experience to the engineering and design of medical devices. Currently, he is the chief medical information officer for the LifeBridge Health system in Baltimore, where he leads a team of physician informaticists to interface between the 180+-person IT department and the 3000+ affiliated physicians across five hospitals and in community practices on matters of the EMR, CPOE, and other health IT systems. Dr. Thierman is passionate about applying technology to improve health and outcomes. To this end, he helped to establish the LifeBridge Health Virtual Hospital, with affiliated clinical call centers in Jerusalem and the Philippines, to provide telemedicine services across the continuum. He also created the LifeBridge Techbar to offer in-person IS assistance to LifeBridge providers. In addition, he developed a patient "Digital Front Door" to help direct patients to the right care center with the least wait time, improving patient experience and load-balancing the emergency departments and urgent care centers in the LifeBridge Health system. 03:26 What was happening with telehealth pre-COVID-19. 04:50 What's happened to telehealth and primary care practices post-COVID-19. 06:28 How quickly telehealth medicine appointments are growing. 07:30 What percentage of patients are doctors able to see via telemedicine? 08:24 Are patients getting adequately cared for? 10:20 "The vast majority of medicine, except for surgical services, really is a mental game." 14:15 "If you have a window into the home, you probably have a better view of the social determinants of health." 14:25 How AI plays into telemedicine right now. 16:52 Where telehealth visits will land after the pandemic. 18:40 "When you improve access, you also improve demand." 19:22 Is telehealth consumer driven? 20:48 "For the most part, patients are most connected to their actual physician." 21:37 Why more frequent touch points via telehealth will benefit health care quality and costs in the future. 28:20 "It's about the patient, and it's about really keeping them well."

A lot of people are wondering why independent PCPs are furloughing nurses and talking about shuttering their practices in the middle of a pandemic. Conventional wisdom would assume that PCPs would be just fine if they stand up telehealth and can take some sort of majority of their patient visits virtually. After all, it would make a lot of sense that a lot of patients are calling their doctor right now. In this health care podcast, I interview Guy Culpepper, MD. Dr. Culpepper sets us straight about what is actually going on day to day for PCPs right now. He also suggests that, right now, this pandemic is a flash point. It's a game changer. It's the trigger for an abrupt and transformational change in the business of providing patients with primary care. Just a couple of vocab words to keep us straight here: DPC stands for direct primary care. This is when a doctor bills a patient directly—no insurance in the picture. So, the doctor sends a bill for, say, $70 a month to the patient and the doctor will then take care of that patient no matter how many questions they ask or texts they send or office visits they require or don't require. Direct to employer means that the doctor contracts directly with an employer—usually a self-insured employer, again without insurance. So, the employer pays the doctor usually some capitated lump sum per month or per year for primary care. Goodbye, fee for service (FFS). Dr. Culpepper is a founder and CEO of an independent physician group in North Texas with 550 providers. He served in that role for 25 years, but as he says, his day job is being a board-certified family doctor. You can learn more at benttreemd.com. You can also connect with Dr. Culpepper on Twitter at @DrCulpepper. Guy L. Culpepper, MD, founded Bent Tree Family Physicians in 1987. His enthusiasm for health care and his focus on each patient as an individual has been rewarded by numerous recognitions as one of America's premier family physicians. Disease prevention is the primary goal of his work. He has expertise in diabetes, cholesterol management, and osteoporosis; however, caring for children is his greatest joy. Dr. Culpepper's leadership has been seen at every stage of his career. During training, he served as both chief resident in family medicine and as the president of the medical/surgical house staff of St. Paul Medical Center. He was the founding chairman of the department of family medicine at Texas Health Resources Presbyterian Hospital of Plano, where he was honored to serve as the president of the medical staff. His dedication to primary care continues to be seen in his leadership of the Jefferson Physician Group, an organization of more than 230 internists, pediatricians, and family physicians improving North Texas health care since 1995. A Dallas native, Dr. Culpepper lives in Frisco with his three sons, whose support has made his work possible and his leisure time joyful. He enjoys reading, writing, movies, sports, and collecting medical antiques and is a lifelong fan of the Dallas Cowboys. 02:22 What a PCP's average day looks like during the pandemic. 03:48 How likely is it that PCPs can transition easily to telehealth? 06:00 Why the pandemic is a flash point game changer for telehealth and PCP reimbursement. 08:54 "It's like a perfect storm of multiple tragedies coming together." 10:47 How primary care is going to alter after this. 13:24 "We need to totally change the way that our country pays us." 14:29 What is the incentive for health plans and hospitals to change financial models in all of this? 16:26 "The ones who are going to change are the ones who need to change." 18:13 Why the employers will be demanding this change in financial model. 19:12 Why being independent vs being part of an accountable care organization matters during this pandemic. 21:07 "If we don't save the independent doctors, there's nothing to break this chain of abuse." 24:34 "Higher income doesn't always mean more happiness; it often means less sense of freedom." 25:53 "There's a point where a little bit more money and a loss of freedom are no longer properly balanced." 27:53 Untangling the FFS reimbursement. 30:00 Why right now is a flash point for PCP reimbursement. 30:38 "No one else can do what we can do in effective primary care. No one … in this market." 31:49 What payers should be doing right now. 33:27 EP270 with Dave Chase of Health Rosetta.33:39 Dr. Culpepper's message to Medicare. You can learn more at benttreemd.com. You can also connect with Dr. Culpepper on Twitter at @DrCulpepper. Check out our #healthcarepodcast with @DrCulpepper as he discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcare #podcast #digitalhealth #reimbursement #ffs What does a #primarycarephysician's typical day look like during this #pandemic? @DrCulpepper discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcarepodcast #healthcare #podcast #digitalhealth #reimbursement #ffs How li

In this health care podcast, I'm talking to Al Lewis from Quizzify. This episode also guest stars Rachel Miner from Thrive Benefits, David Contorno from E Powered Benefits, and Doug Aldeen, a health care attorney in Texas. This episode started out being about surprise billing in the emergency room (ER) and a potential defense strategy that patients and employees can use to protect themselves from egregious billing practices. Surprise bills are when a patient gets "balance billed" for a sum above what their insurance carrier will pay. Usually this transpires when an out-of-network provider somehow or another gets involved in their care. Usually the patient has no idea this happens until after the bill comes—the big bill, in many cases, thus the surprise. But here's where surprise billing and COVID-19 connect. You might not have thought of this because you might know that patients who present in the ER with COVID-19 and then test positive are protected from surprise bills, for the most part, by the CARES Act. But there's a couple of wrinkles. What if the patient does not actually have COVID-19? Then whatever treatment they wind up getting in the notoriously expensive ER is business as usual. Here's another wrinkle: The cost of treatment for COVID-19 is not like it's capped. So even if an employee doesn't get a surprise bill, the self-insured employer or health plan might. And the CARES Act explicitly states that the employer or plan is on the hook to pay for it. And one last wrinkle: Dealing with this pandemic among other things leaves about 0.0 chance that the national surprise billing legislation is gonna happen this year. But it's not like kids have stopped running into the side of the pull-out couch and needing stitches, or drug overdoses or heart attacks have suddenly vanished. There was a news article just the other day about a private equity–run ER in the Midwest continuing to dish out nasty surprise bills to their community of taxpayers at the exact same time that they were lobbying to get a piece of the federal bailout paid by taxpayers. Al Lewis and his team over at Quizzify created this handy wallet card that patients or employees can use when they have the unfortunate experience of going to the ER themselves or with a loved one. It protects them from egregious surprise bills, thus its moniker, the surprise billing defense strategy. But nothing for nothing, this wallet card, this surprise billing defense strategy, also protects employers and health plans from these large bills in the age of COVID-19. Al Lewis and I start our conversation talking about a New York Times article (also available here for those who don't subscribe to the New York Times) that came out recently featuring Al as well as myself and chronicles my visit to an emergency room wherein I deployed the surprise billing defense strategy/wallet card. You can learn more at quizzify.com or connect with Al on LinkedIn. You can also connect with Al on Twitter at @quizzify and @whynobodybeliev. You can also connect with Rachel and David on LinkedIn and with Doug on Twitter at @AldeenDoug and on LinkedIn. Al Lewis wears multiple hats, both professionally and also to cover his bald spot. Hat #1: Employee Health Literacy. He is the founder and "quizmeister-in-chief" of Quizzify, whose mission is to help companies teach their employees to utilize health care services appropriately, using a format best described as "Jeopardy meets health benefit education meets Comedy Central." Quizzify is the only vendor authorized to display the Harvard Medical School "Veritas" shield and has received excellent reviews from users. Quizzify is best known today for its employee coronaquizzes (now exceeding 100,000 plays!) and its surprise billing "Prevent Consent" solution, which was recently featured in the New York Times. It can be taped to an insurance card, used as a stand-alone card, or downloaded into your Apple Wallet. His quiz-specific background includes authorship of the best-selling Newsweek Presents the Ultimate Trivia Game, which Games magazine lauded as having the best questions of any trivia game; hosting two quiz shows on Boston network affiliates; and appearing on Jeopardy. Hat #2: Outcomes Measurement. 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 digital health book of the year in Forbes. Cracking Health Costs, written in conjunction with Walmart alum Tom Emerick, was also a trade best seller. Surviving Workplace Wellness has also received great accolades, and excerpts appeared in Harvard Business Review and elsewhere. He was the cofounder of the World Health Care Congress's Validation Institute. His expertise in outcomes measurement got him named one of the unsung heroes changing health care forever. He graduated Phi Beta Kappa with honors from Harvard, where he taught economics as we

Let's talk today specifically about primary care physicians (PCPs) and family medicine doctors. Data was reported in USA Today, saying that an estimated 60,000 family practices will close and 800,000 of their employees will lose their jobs by the end of June. It's hard for any practice to just snap its fingers and transfer patients over to telemedicine regardless of the reimbursement rate and/or how many payers are actually paying any reimbursement for telemedicine or remote patient monitoring. It's a thing to go virtual. It requires new processes, different staffing training, different workflows. Plus, a lot of what a PCP does (ie, fielding phone calls with quick questions, for example) aren't reimbursable; and if they were, no one's gonna, like, spend half an hour trying to send a bill for $12. What are the consequences of all, let's just say, independent PCPs going out of business? Well … first, logically, all patients served by these doctors and their teams now no longer have a place to go to get care, right in the middle of a pandemic. Second, let's just say in a thought experiment that a lot of independent physicians do go out of business and do wind up going to work in an employed model. That might very well happen. Private equity and payers like Humana and Optum have been buying up PCP practices all over the place. Why? So they can have captive populations. Patients come in the door at their PCP, and everywhere they go from there can be controlled by the vertically integrated entity. This has been stated openly. It's also pretty clear at this point that that model increases costs for any ultimate purchaser of health care like, for example, an employer. There's also other, let's just say, more unseemly motivations if you start to think about what a company who owns patient relationships with their PCPs can manage to perpetuate. It's great if you're a shareholder. It might be less great if you're a citizen of this country. In this health care podcast, I speak with Dave Chase, cofounder and CEO of Health Rosetta. Health Rosetta empowers community-owned health plans like, for example, employers and states' and town governments. Dave talks about Health Rosetta's Marshall Plan, which is an action plan right now to minimize the negative impact of COVID-19 by ensuring that family and primary care practices can stay in business. The Marshall Plan is a call to action for self-insured employers and commercial health plans. You can learn more about the Marshall Plan at healthrosetta.org/marshallplan. You can also connect with Dave on Twitter at @chasedave and follow Health Rosetta at @HealthRosetta. Dave Chase leads the vision for Health Rosetta, which is to empower community-owned health plans. Health Rosetta's blueprint and platform power the health plans of your dreams: high-quality, trustworthy, local, affordable care—that you thought had disappeared forever—from caregivers we know and trust. They free up compassionate, well-trained, community-based caregivers to rediscover love in medicine so they can do what they have always been called to do: serve their patients not just in disease but toward their fullest health. A trusted and sacred caregiver-patient bond is built through transparency and openness that equips and empowers patients wherever they can best achieve their unique health goals—at home or any setting best optimizing their well-being. By avoiding the 50% wasted health care spending, we can ensure our caregivers have the independence and resources to address the psychosocial and medical issues their patients face. Human-centered health plans restore health, hope, and well-being. Through best-selling books and The Resident (on FOX), where Dave serves as a consultant, collateral damage from the Extractive Era of health care is highlighted as well as the tremendous successes and opportunities with Health Rosetta–type health plans. The books, writing for various media outlets, TED Talk, and TV/film have reached over 10 million people, with the goal of informing, enraging, empowering, and activating a broad grassroots movement designed to restore hope, health, and well-being to our communities. Dave proudly received the Health Value Awards' Lifetime Achievement for Health Benefits Innovation at the 2020 World Health Care Congress. Dave cofounded Avado, which was acquired by and integrated into WebMD/Medscape, and founded Microsoft's $2 billion, 28,000-partner health care ecosystem. Outside of work, Dave Chase is an oxygen-fueled mountain athlete and volunteer high school track and cross-country coach. Once upon a time, Dave was a PAC-12 800 meter and 4x400 competitor. Most importantly, his devotion to faith, family, and friends underpins a desire to be a servant leader to the four million lives (and growing) stewarded through the Health Rosetta community. 03:15 The state of independent fee-for-service PCPs during COVID-19. 03:57 CMS and telehealth, and why these aren't really aiding PCP revenue. 05:

The first wave of this COVID-19 pandemic has been totally reactionary. Don't get me wrong: That does not detract from the Herculean effort made by hospitals and clinicians who have thrown everything they have at this—and more. But I don't think that anyone would disagree that if we had enough PPE (personal protective equipment) and ventilators—you know, like, proactively—we'd be in better shape. So let's stay ahead of the second wave of this pandemic, which is going to happen when, as Marty Makary put it in episode 267, the backlog of patients who were scared to or unable to get care for a few months creep out of their homes. What happens when patients who should have gotten a tumor removed or had a colonoscopy because of GI bleeding or felt the symptoms of a heart attack but did not get timely care? In this health care podcast, I am speaking with Eric Bricker, MD, from AHealthcareZ; and we're talking about how the post-COVID-19 new normal may shape up. One way to conceive of what health care will be moving forward is to look at how stakeholders are impacted by the pandemic right now and what action steps they're taking right now, because to a nontrivial degree, the moves made now will have an outsized impact on their success trajectory in the near term and long term in the months and years to come. I was super thrilled to have the chance to speak with Dr. Bricker. If you haven't watched his videos on LinkedIn or at AHealthcareZ.com, you should definitely go and check them out. You can connect with Dr. Bricker on Twitter at @DrEricB and on LinkedIn. Eric Bricker, MD, is an internal medicine physician and former cofounder and chief medical officer of Compass Professional Health Services. Compass is a health care navigation service that grew to 2000+ clients, including T-Mobile, Southwest Airlines, and Chili's/Maggiano's restaurants. Compass was acquired by Alight Solutions in July 2018. Alight is a 10,000-person employee benefits and HR outsourcing company that separated from Aon in 2017. Dr. Bricker has since started AHealthcareZ.com, with 170+ health care finance videos with approximately 90,000 views per month across all platforms. He is also the author of Healthcare Money Campfire Stories. 02:48 How COVID-19 is impacting insurance carriers and payers. 06:16 How COVID-19 is going to affect payers with self-insured employers. 07:59 "The carrier's revenue is going to go down because of layoffs." 09:05 Other helpful or harmful COVID-19 factors to insurance carriers. 12:37 The risk to pharmacy benefit manager (PBM) revenue. 13:14 The financial stability of recent health system mergers. 14:03 The potential "cash crunch" for health systems because of COVID-19. 17:01 The issue with telehealth revenue right now. 20:57 EP251 with Dr. Kimberly Noel. 21:32 "In health care, you add technology and the price tends to go up."—Stacey 22:02 "Telemedicine allows for geographic competition." 22:19 How COVID-19 will affect specialty from a revenue perspective. 24:31 "An economic truism … one person's spending is another person's income." 27:06 "Pain causes change." 28:01 Do population health outcomes go up or down after COVID-19? 29:15 The high number of moves from high-deductible plans to Medicaid and how that will affect patient outcomes. 32:38 EP267 and EP268 with Dr. Marty Makary.33:02 Coming out of this peak, what hospitals need to be thinking about. You can connect with Dr. Bricker on Twitter at @DrEricB and on LinkedIn. Check out our newest #healthcarepodcast with @DrEricB. #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19 #covid19billing #covid19healthcare How is #covid19 impacting #insurancecarriers and #healthpayers? @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19billing #covid19healthcare How will #covid19 affect #healthpayers with #selfinsured #employers? @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19billing #covid19healthcare "The carrier's revenue is going to go down because of layoffs." @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19 #covid19billing #covid19healthcare What's the risk to #PBM revenue? @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19 #covid19billing #covid19healthcare What's the issue with #telehealth revenue right now? @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19 #covid19billing #covid19healthcare "In health care, you add technology and the price tends to go up." @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19 #covid19billing #covid19healthcare "Telemedicine allows for geographic competition." @DrEricB discuss

On Friday, March 27, President Trump signed into law the Coronavirus Aid, Relief, and Economic Security Act—otherwise known as CARES. This CARES Act covers the whole $2 trillion megillah stimulus package, but in this health care podcast episode, we're talking quickly about a provision in that Act. I speak first with Doug Aldeen, an attorney specializing in helping employers settle hospital bills. Doug works with clients across the country. And then at the end of the episode, you will also hear from Al Lewis, who is a founder over at Quizzify. Al Lewis, as many of you may or may not know—but if you don't know, you should—created a "surprise billing wallet card" that is actually super relevant to this discussion as you will see. There's actually going to be a whole surprise billing episode coming up soon where we discuss this wallet card, so you can consider Al's short commentary today as kind of a coming attraction. The provision that we're going to talk about in this episode is the No Cost Sharing for COVID-19 Testing and Vaccines provision. This is where insurers are required to cover testing for COVID-19 without cost sharing to their enrollees, and they must pay for the tests based on contracts or the posted pricing of labs. So, the thing is, hospitals and diagnostic testing companies can essentially basically name their price on COVID-19 tests; and employers and insurers will be required to pay for it. This is in Section 3202, the Price of Diagnostic Testing, in that CARES Act. The plot thickens this week as health insurers—including Aetna, Cigna, and Humana—are now waiving patient cost sharing on all treatment for coronavirus, not just the testing, including hospitalizations and ambulance transfers. And they're doing this for their insured members and employer plans at their in-network health systems—emphasis intended on the "in-network" part. So, you might be thinking, "Great … no costs to anybody!" But I did emphasize that last part for a reason. If you think for a minute about this, just because patients are not paying co-pays for COVID treatments first of all doesn't mean that while they're in the hospital that their diabetes won't flare up … or their MS or their RA. COVID-19 is just one thing, and the US has a patient population that has, let's just say, no shortage of chronic conditions—otherwise known as underlying conditions, otherwise known as the people most likely to be in the ICU. My concern is that there's nothing to say that co-pays and coinsurance for treatment of other things while being treated for COVID are going to suddenly vanish, too, even if it's an in-network health system. Furthermore, there is that problem of a patient going to a hospital that's not contracted with the employer plan or the patient's insurance carrier. At that point, I'm not seeing anything that would suggest that patients with COVID-19 are going to get any different treatment billing-wise than patients with anything else. We've seen COVID-19 bills that are, for uninsured patients, $34,000 and $73,000 in the press. What if the patient doesn't have out-of-network coverage, for example? What if the patient's out-of-network deductible is tens of thousands of dollars like some of them are? I don't see anything in this bill to suggest that those are suddenly going to go away. And, oh, by the way, exactly as the bill pretty much states explicitly, regardless of what the patient pays, the employer's on the hook to pay for whatever the hospital chooses to charge—at least as far as testing goes. You can connect with Doug on Twitter at @AldeenDoug and on LinkedIn. You can learn more at quizzify.com or connect with Al on LinkedIn. You can also connect with Al on Twitter at @quizzify and @whynobodybeliev. Doug Aldeen is an Austin, Texas–based health care and Employee Retirement Income Security Act (ERISA) attorney who recently served as ERISA counsel on behalf of the Berkeley Research Group in New York City to the $7.7 billion May 2016 acquisition of Multiplan and its medical bill repricing product Data iSight by the private equity firm Hellman and Friedman. Since 1997, he has represented reference base pricing organizations, a bundled payment software platform, PPO networks, medium to small self-funded plans, third-party administrators, and provider-sponsored health maintenance organizations in various capacities, including Herdrich v. Pegram, which was argued before the US Supreme Court in 2001. Moreover, he serves as a resource to national news organizations regarding issues on health care and as a consultant with the Governmental Relations Committee at the Self-Insurance Institute of America in Washington, DC, and as an adviser to RIP Medical Debt, which has abolished over $1.2 billion in medical debt. Doug received his JD from the University of Illinois. Al Lewis wears multiple hats, both professionally and also to cover his bald spot. Hat #1: Employee Health Literacy. He is the founder and "quizmeister-in-chief" of Qui

The reaction of some hospitals and health care systems to the COVID-19 pandemic has been truly breathtaking. Doctors, nurses, first responders, other staff at hospitals and elsewhere have worked hard—so hard—to support the national effort. The same can be said to some tech entrepreneurs and other businesses who have snapped into action in order to provide PPE (personal protective equipment) and artificial intelligence to the frontline health care workers. In this health care podcast, I'm talking again with Marty Makary, MD, MPH. Dr. Makary is a surgeon at Johns Hopkins, professor of surgery and health policy and management at Johns Hopkins University, and the author of The Price We Pay and Unaccountable. So, this is episode 268. In this particular episode, Dr. Makary and I discuss the situation that will likely play out after the "reactive" phase of this COVID-19 pandemic (ie, March, April, May). After about June, the pandemic, according to Dr. Makary, will start to wind down a bit; and at that juncture, there's going to be a backlog of patients who had their elective surgeries postponed and their care journeys potentially interrupted if they required an in-person visit or a lab test or an imaging study that did not happen. There will be a need to prioritize them, something that we have never really done in this country before. This is what we're going to talk about in this episode: this second phase. Potential point of interest: Episode 267 (the one right before this episode) is about the here and now, prior to the peak, if you want to go back and listen to that when you have time. You can learn more at martymd.com or connect with Dr. Makary on Twitter at @MartyMakary. Martin "Marty" Makary, MD, MPH, 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 recently released 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 Web site 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. 02:23 What "normal" will look like in June. 03:46 Why people who need basic medical care right now aren't getting that care. 06:13 "For the first time, we've got to think now about prioritizing which patients need to get in line first." 07:51 "We see gaming of the system." 08:05 "We don't do a good job of prioritizing." 10:07 Why teamwork and team building are a problem in medicine. 12:57 The incredible heritage of the medical profession. 13:52 Will there be a decrease in outcomes? 14:33 Why lowering insurance deductibles will be key in making successful strides on the other side of this pandemic. 17:23 The great things to come out of the pandemic. 21:41 "Everybody's right … [they're just] looking at it from their point of view." 21:56 What's in store for pharmacies coming out of this pandemic. 24:53 What hospital executives should be doing, looking and planning months out from now. 25:48 "We've never asked ourselves, 'What would take priority?'" You can learn more at martymd.com or connect with Dr. Makary on Twitter at @MartyMakary. Keeping up with #covid19 news, check out our second-part episode with @MartyMakary as he talks #healthcare, #hospitals, and #coronavirus in the u

Marty Makary, MD, MPH, is a surgeon at Johns Hopkins. He's a professor of surgery and health policy and management at Johns Hopkins University. And he's also the author of The Price We Pay and Unaccountable. I had the honor of speaking with Dr. Makary last week, and I learned a lot. For one, the worst is between now and June. For two, it's all about ramping up capacity as fast as possible in our hospitals. We talk a lot, Dr. Makary and I, about what that looks like and what other stakeholders like employers and Pharma can be doing right now in this very, very reactionary phase. Spoiler alert: On Thursday this week, a second episode with Dr. Makary will be out. In this second show, Dr. Makary discusses the next phase of this pandemic when all of the pent-up demand becomes a backlog of patients who need care for everything else besides COVID over the summer. You can learn more at martymd.com or connect with Dr. Makary on Twitter at @MartyMakary. Martin "Marty" Makary, MD, MPH, 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 recently released 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 Web site 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. 01:38 What happened that made Marty Makary sound the alarm bells on COVID-19. 03:12 Paul Kennedy's The Rise and Fall of the Great Powers.04:21 "Everyone has an opinion, but no one's listening." 06:00 What the next 4-6 weeks will look like. 08:22 What we should do to support our highest-risk patients: health care workers. 09:16 How long will this initial phase last? 13:10 What business leaders should be doing right now. 16:11 "Critical care generally pays very well." 17:15 Marty's concern for rural hospitals. 17:30 "If we're going to overfund [something], I'd like it to be our hospitals." 20:54 "I think the pharma industry has also gotten a wake-up call … Maybe we should start working on viruses." 24:04 "We're at war with COVID-19 right now." 25:32 "We need to help researchers that are working specifically on lowering deaths from COVID-19." 28:23 "Anything that can wait 3 months must wait 3 months." 30:37 "We need everybody." 31:38 "Hospitals need to be focused on building capacity, number one." You can learn more at martymd.com or connect with Dr. Makary on Twitter at @MartyMakary. In light of COVID-19 news, check out our specially released episode with @MartyMakary, as he talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 What made @MartyMakary sound the alarm on COVID-19? Listen to our episode where he talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 "Everyone has an opinion, but no one's listening." @MartyMakary talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 What will the next 4-6 weeks look like? @MartyMakary talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 How can we support #healthcareworkers, who are at hi

This episode was recorded prior to COVID-19 hitting our shores. Irrespectively, it is incredibly relevant. Right now, more than ever, we need physician leadership and we need partnership across organizations and within organizations so that good decisions can be made as fast as possible. Look, we don't have time to mess around right now. We need to be making good decisions—and fast. And these decisions on digital health solutions and other technologies and processes and workflows need to really be made by those who are participating in the care of patients directly. Or by the patients themselves. Or, best case, by both together working as partners, if you will. It doesn't go well for all kinds of reasons when decisions about what patient care is going to look like at a macro level are made by the suits and people or departments or companies who are "over there" as opposed to here in the exam rooms. In this health care podcast, I speak with Matt Anderson, MD, MBA. Matt is the innovation lead over at Banner Health. He talks about the importance of physician leadership a lot. And, by that, he means doctors and nurses and other clinicians demanding to be heard and demanding that their point of view be a decision-making criterion in how a care delivery system operates. But as we dug deeper, Dr. Anderson and I, a theme emerged. Along with multiple mentions of the Shkreli Awards and my conversation with Shannon Brownlee and Vikas Saini (which is episode 260 if you want to look back and listen to that), the theme that emerged in the conversation you're going to hear was the importance not just of physicians in leadership roles but of the scrubs partnering with the suits in almost every leadership decision. Doctors and nurses and administrators really have to work together so that the business is sustainable, for sure, but while patients continue to get the best care—also for sure. One cannot sacrifice the other without consequence. You can learn more at bannerhealth.com and drmatthewanderson.com. You can also connect with Dr. Anderson on Twitter at @DrAnderson19 and on LinkedIn. Matthew Anderson, MD, MBA, is a father, husband, and family physician living in Arizona. He serves as innovation lead and division medical director for Banner Health. Since joining Banner Health in 2018, Matthew has been an active member of the AZBio Government Affairs Committee. By providing primary care medical services to his patients in Arizona, Matthew has seen many of the inefficiencies and difficulties within their health care system. His training at Mayo Clinic taught him what it means to put the patient first, and that focus has stayed with him for every patient encounter. Recently, Matthew completed an MBA program at Arizona State University's WP Carey School of Business. His goal is to take the foundation he has in good-quality medical care and combine that with an understanding of the economics of health care to use technology to create a better, safer, and healthier medical system. 02:30 Distinguishing between billing technology and technology improving bonds between clinicians. 04:03 "The scribe is literally just there to take the burden of the EMR off the physician." 04:41 "If all of your goals begin and end with patients, you're not gonna go wrong." 06:07 "We gotta get a little bit tribal in medicine." 06:27 "Physicians have to be leaders in this space." 07:21 Suits vs scrubs. 08:47 Why low-revenue care is sometimes better than high-revenue care. 13:49 EP260 with Shannon Brownlee and Vikas Saini, MD, from the Lown Institute.16:11 "There's a role to play for all of our clinical partners in the leadership of our health care systems." 16:38 "You have to be able to be curious." 18:35 The movement to humanize medicine with technology, led by Eric Topol. 20:45 Creating a culture where it's okay to fail. 22:31 Starting the educational process on the business of health care earlier. 25:48 Technology as top-down vs physicians as bottom-up. You can learn more at bannerhealth.com and drmatthewanderson.com. You can also connect with Dr. Anderson on Twitter at @DrAnderson19 and on LinkedIn. Check out our #healthcarepodcast with @DrAnderson19. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals Billing #technology vs technology that improves clinician work. @DrAnderson19 discusses in our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals "The scribe is literally just there to take the burden of the EMR off the physician." @DrAnderson19 discusses in our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals "If all of your goals begin and end with patients, you're not gonna go wrong." @DrAnderson19 discusses in our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals "We gotta get a little bit tribal in

There is a lot going on with digital health tools these days. Which ones are the good ones and which ones are nothing burgers packaged up in beautiful marketing? That's a good question, and it would be nice to have a go-to source for such information. Some parties — mainly PBMs [pharmacy benefit managers] and to some extent payers and providers — recognize that this actually would be nice, and they see that creating digital formularies could be an opportunity to grow revenue for their shareholders by meeting a market need potentially and offering additional services to the marketplace. But the term formulary implies more than just some kind of health technology assessment. It implies, at least at some level, the promise of reimbursement. But given how local health care tends to be, especially when considering patient populations and the "bottom-up" nature of the doctor-patient relationship, here's the question I have for you: Is it even possible for a third party, disconnected from the care setting and the patient, to "top-down" select the technology which will be used and reimbursed … especially in the age of consumerism? For more on the intersection of patients and provider digital tool selections, listen to episode 250 with Vicky Tiase from NewYork-Presbyterian. In this health care podcast, I am speaking with Randy Vogenberg, PhD. Randy suggests that a more crowdsourced approach to digital health tool selection might be in order here. He says that those who are using the tools really need to have a seat at the table. He says that possibly the "formulary" within any given organization should be more of a consensus among stakeholders and less of a mandate from on high. But there are a lot of wrinkles … like, lots of wrinkles. Randy Vogenberg is board chairperson at the Employer-Provider Interface Council. He is principal over at the Institute for Integrated Healthcare. You can learn more at iih-online.com, epicouncil.org, and hope.rutgers.edu. Randy Vogenberg, PhD, is principal at the Institute for Integrated Healthcare, co-leader for the National Employer Initiative on Specialty Pharmacy, and cofounder of the National Institute of Collaborative Healthcare (NICH). He is a health care expert on health system delivery and economics as well as health-related solution innovation research. Most recently he partnered with the Hospital Quality Foundation in developing the Employer-Provider Interface Council (EPIC). His broad hospital and managed care expertise includes current or future trends around financing, market excellence, and benefit management or design. A leader and highly requested speaker on applied health systems research, he has authored programs or books on self-funded health benefits, managed markets, hospitals, and integrated medical-pharmacy benefit management. His academic relationships include Rutgers HOPE Center and former senior fellow at the Jefferson School of Population Health. Currently, he is an adjunct professor at the University of Rhode Island College of Pharmacy and Presbyterian College School of Pharmacy as well as the University of Illinois College of Pharmacy. 02:51 What a digital formulary is. 03:52 PBMs and digital formularies. 04:41 The changing landscape of PBMs and digital health. 06:00 The intersection of PBMs and digital health tools. 10:18 "Arbitrage, full on."—Mark Blum, from America's Agenda. 12:21 The inherent differences between a health plan and a PBM. 15:58 The original purpose of a pharmacy/therapeutics committee. 16:58 "There's a lot of change happening, is the bottom line." 18:18 The risk assessment behind medical software. 18:29 Harm vs digital therapeutics and digital medicine. 18:52 Cybersecurity in digital therapeutics. 19:08 Reimbursement in digital therapeutics. 19:43 The question of "how" in reimbursement. 20:37 "How do we reset health care in just one state, let alone the whole country?" 22:13 Taxpayers, patients, and employers vs the health care industry. 22:56 The slow move away from fee for service, and why. 24:13 The timeline for incorporating digital tools into the health care system. 24:33 "It's a real problem for the consumer side." 25:09 "What's really going to be worthy of reimbursement?" 25:50 "There's only two major payers in the health care system … that's the government, and it's the private sector employers and state programs or unions." You can learn more at iih-online.com, epicouncil.org, and hope.rutgers.edu.

It's kind of a vicious cycle. Payers don't trust providers to do the right thing and provide appropriate care. And OK, there's some logic there considering that 25-ish% of health care delivered is low-value or unnecessary. On the other hand, some patients actually need the care and now it's painstaking for them to get it—and that painstaking part of the sentence is borne by providers, at least logistically. So then the providers learn how to expedite getting their patients care by copying and pasting, and now they're gaming the system. Then more arduous processes get put in place, and now good physicians get caught in the same net as the less good ones and they begin to spiral toward moral injury and burnout. Let's get to the bottom of this. In this health care podcast, I speak with Ron Wince, CEO of Myndshft. You can learn more at myndshft.com or follow Ron on Twitter at @RWince. Ron Wince is founder and CEO of Myndshft Technologies in Mesa, Arizona. An engineer by training, he has two decades of experience automating and optimizing time-consuming health care administrative tasks and has held executive positions at leading financial, manufacturing, outsourcing, and customer experience companies. Ron created Myndshft with a singular but ambitious goal: to fix the "administrative plumbing" that keeps health care stuck in the past. They are working at the intersection of blockchain and artificial intelligence (AI). Through CognitiveBus, a first-of-its-kind cognitive blockchain platform, Myndshft Technologies is simplifying enterprise-grade AI and unlocking the insights hidden in the massive and growing data universe. 01:29 What is a prior authorization? 02:45 The three reasons payers put prior authorization in place. 02:49 Cost, medical necessity, and compliance. 04:24 EP200 with Stacey Worthy.05:15 "Clinicians are really managing clinicians in a lot of ways." 05:41 Why the prior authorizations system sometimes fails patients and payers. 08:13 Surprise care—can it be avoided? 09:53 The impact on providers. 14:52 The impact on patients. 16:46 Specialty pharmacy and prior authorizations. 18:43 Shkreli Awards (EP260).19:25 The most complex prior authorizations. 21:03 E-prior authorizations. 24:19 Gold carding and what that is within prior authorizations. 28:08 The "chasm of trust." 29:11 Myndshft and its goal to solve prior authorization issues. You can learn more at myndshft.com or follow Ron on Twitter at @RWince.

Here's the thing: All the top-performing Medicare Advantage plans are using, today, right now, some form of advanced analytics and artificial intelligence (AI) to risk-stratify their populations and predict which members will, without intervention, become high cost in the near term. The idea is then to intervene to mitigate risk and stop bad things from happening—bad things that stink if you're the patient and also cost a lot if you're the plan. That's what population health management is all about, after all. Others using AI, right now, to do the kind of predictive analytics that you need to excel at pop health include PCP groups and other providers, mainly those at risk to manage populations or readmissions. In this health care podcast, I talk with Andrew Eye about AI. Andrew is CEO over at ClosedLoop. I get to ask Andrew some of the hard questions that have been bothering me about all the AI hype, and he set me straight a couple of times. Love it when that happens. You can learn more at closedloop.ai or by following Andrew (@andreweye) on Twitter. Andrew Eye's executive and entrepreneurial experience spans over 20 years in business to consumer and business to business for start-ups and Fortune 500 companies. Andrew founded and sold three technology companies and today is the CEO and founder of ClosedLoop.ai. In 2017, Andrew founded his fourth technology company, ClosedLoop.ai. ClosedLoop.ai is a next-generation predictive analytics platform provider leveraging the latest in artificial intelligence and machine learning technologies to rapidly create predictive models from diverse sources of raw, messy, real-world health care data. Prior to founding ClosedLoop, Andrew cofounded the mobile software company Boxer. Boxer developed mobile productivity software for individuals and large corporations. Boxer's flagship email product was downloaded by millions of users and received significant industry praise for its exceptional user interface, including a 2015 Webby nomination as one of the top 5 productivity applications in the world. Boxer was purchased by VMWare (one of the top 10 largest software companies in the world) in 2015. Prior to Boxer, Andrew cofounded the cybersecurity firm Ciphent in 2007. Ciphent grew to nearly 100 employees with 1000 customers by 2010 before being acquired by Accuvant (now Optiv). With a three-year growth rate of 8900%, Ciphent was recognized by Inc. magazine as the 16th fastest-growing private company in the United States. During his tenure as SVP of services at Accuvant, Andrew oversaw a $50-million, 200-person organization and was responsible for doubling revenues in 18 months. Andrew also served as CEO of Bodkin Consulting Group, where he worked with Fortune 500 brands and technology companies to define their interactive marketing strategies. Andrew began his career as a software architect working with NASA, i2 technologies, and the US Marine Corps. Andrew graduated summa cum laude from Virginia Tech with a degree in management information technology. Andrew lives in Austin, Texas, with his two daughters and champion "Dock Dog" Sophie. 01:50 Artificial intelligence in health care, and the different things that this means to the health care community. 02:06 Image analysis, also known as replacing doctors with robots. 02:25 Chatbots for health care. 02:43 Predictive analytics. 04:39 "What they really care about is, How can this impact our business? How can this improve patient lives?" 04:51 "For us, this is all just better math." 08:13 What exactly predictive analytics is. 08:40 The use cases of predictive analytics value. 11:33 The oversimplification of how people think about risk. 13:13 "Did you have an impact or not?" 13:27 The public scorecard for predictive analytics. 18:16 "Explainability is a real hot topic in artificial intelligence, specifically in health care." 19:46 Data shaming—what's wrong with it, and why incomplete data are still important. 21:53 The possibilities that machine learning allows for in patient care in health care. 28:08 "Our health care system can't afford for that level of inefficiency." 29:21 "It's not a question of if; it's a question of when." 30:37 The diminishing returns of interoperability and more data for machine learning. 33:54 "You're running your business today, and whatever data you're using to run your business … you can use it to provide better patient care." 34:34 Andrew's advice: Get started now. You can learn more at closedloop.ai or by following Andrew (@andreweye) on Twitter.

The World Bank had a revelation a few years back. Some very smart people working there realized that countries that were easy to do business with thrived. Within these countries' business ecosystem, the best and the brightest entrepreneurs and investors grew not only their own businesses but also positively influenced other businesses and the community around them. Brian Van Winkle and Rishab Shah, both executives at Johns Hopkins, had their own revelation: Health systems who are easy to do business with attract and enable the best and the brightest start-ups or other entrepreneurs who are able to do great work within their walls, with their patients, and with their clinicians. It's becoming fairly axiomatic at this juncture that provider organizations—along with payers, by the way—cannot be good at inventing and innovating absolutely everything that's possible to conceive of and develop. It is impossible for any group, no matter how dynamic and forward thinking and awesome, to be better than everybody else at everything. For this reason, the idea of health systems and payers becoming great aggregators of amazing tech and services is definitely gaining traction. This would include internally developed as well as externally sourced technology and services. Listen to Rahul Dubey in episode 259 for more info on this evolution in the payer space. But back to Brian and Rishab. They spotted this trend in its early days and also saw the issues that health systems face and will face as the ease of doing business becomes more and more of a rate critical of success. Thus was born the Ease of Doing Business Initiative, health care–style, based on the World Bank's Ease of Doing Business model. In a nutshell, what the World Bank did in their Ease of Doing Business Initiative is they came up with a set of measures and hived those measures into categories and then they ranked countries against those measures. Brian and Rishab decided to do the same thing. They created a list of questions for health systems to self-rank (at least initially) themselves on how well they did within these seven categories of measures. Twelve to fifteen of the leading health systems agreed to participate. Most are members of NODE.Health, where Brian is the former executive director. And this Ease of Doing Business Initiative is under the NODE.Health umbrella. In this health care podcast, Brian and Rishab speak only for themselves during this interview. They do not speak for their employer or anybody else. (Note: I also interviewed Brian and Rishab at the NODE.Health Digital Medicine Conference.) You can learn more at the Sibley Innovation Hub (@SibleyHub) on Twitter or by connecting with Brian and Rishab on LinkedIn. Brian Van Winkle, MBA, is the executive director of innovation at the Sibley Innovation Hub. His focus is on transforming the health care system by being a conduit between passionate clinicians and some of the most advanced solutions emerging around the world. Brian brings more than 10 years of experience helping some of the most complex health care systems in the world with transformation, process improvement, and strategy design. Brian has a dual degree in economics and English from the University of Virginia and earned his MBA at Fuqua School of Business at Duke University. Rishab Shah, MHS, is the head of digital innovation and strategic partnerships at the Sibley Innovation Hub. He leads the Hub's charge in development, implementation, and oversight on driving innovation through strategic partnerships with emerging technologies around the world as senior manager of tech innovations. Rishab is a strategist inspired to innovate while empowered to create. He has helped companies around the world with corporate strategy, business operations optimizations, and large-scale technology transformations—primarily within the health care and life sciences industries. Rishab has a bachelor's degree in biomedical engineering from Virginia Commonwealth University and a Master of Health Science from Johns Hopkins University. 03:46 Focusing on "outside-in" innovation. 04:09 The downside to hospitals and health systems not being easy to work with. 05:17 "You have to acknowledge that we're in a crisis state."—Brian 06:56 "Are we putting ourselves at a disadvantage by not … being easy to interface with?"—Rishab 08:25 Why hospitals might not be so easy to work with right now. 09:11 The correlation between a partnership strategy and health outcomes and metrics that matter. 09:42 The gap between health care players' workload and collaboration. 12:04 "Who is putting the focus on the requirements?"—Rishab 12:44 What the Ease of Doing Business Initiative is. 14:56 The opportunity for entrepreneurs to be involved in this process. 16:07 Ecosystem-based work groups. 17:22 "What box do you exist in?"—Brian 18:29 The seven success factors an organization needs to be good at to improve their ease of business. 18:53 Customer support and governance. 19:02 Cont

Today I speak with Fred Goldstein. Fred knows a lot about population health. His credentials, in fact, are about as long as my arm, so I'm just going to call him president and founder of Accountable Health, LLC and also co-founder and lead co-host at PopHealth Week—a podcast you should check out. Today Fred and I get into not just what 'good' looks like when it comes to population health, but also the six steps to achieve it. If you are looking to deploy some population health or if you are currently engaged in pop health and are looking to evaluate or benchmark what was done and how it was done, then, yeah, you might find this conversation helpful. You can learn more by contacting Fred at Accountable Health LLC, via email, or on Twitter. Fred Goldstein is the president and founder of Accountable Health, LLC, a health care consulting firm focused on population health, health system redesign, new technologies, and analytics. He has over 30 years of experience in population health, disease management, health maintenance organization (HMO) and hospital operations. Fred is considered an expert in population health, care management, behavioral health, risk management, health information technology (HIT), and health system design and development. During his career, he founded a disease management company that provided services to employer groups and ten state Medicaid programs, operated a Medicaid/commercial HMO that was ranked the highest-quality Medicaid health plan in Florida, developed an award-winning mobile health app, and worked with employers, health systems, and vendors to develop population health programs, services, and platforms. He was also directly responsible for the inclusion of the Medicare Annual Wellness Visit in the Affordable Care Act. Fred is an instructor at the John D. Bower School of Population Health at the University of Mississippi Medical Center and an adviser to the Validation Institute. He serves on the editorial board of the journal Population Health Management and the founding advisory board of Population Health News and is past chair of the board of directors of the Population Health Alliance. Fred has testified before the legislature in the states of Alaska, Florida, Kentucky, and Texas on disease and population health management and their application to state employees and Medicaid. He is also the co-founder and lead co-host of PopHealth Week, a weekly podcast featuring thought leaders and companies working in population health. Fred received his master's degree in health care administration from Trinity University and a BA in zoology from the University of California, Berkeley. 01:20 Population health vs precision medicine. 02:46 "What precision medicine allows us to do in population health is to get an even more precise and better intervention." 03:16 Pop health as precision medicine. 03:30 "We need to first note who our population is... and we take that group and we then assess them." 04:57 The variation in care, and how this effects outcomes and care. 05:46 How assessing individuals has improved over the years. 06:28 What the goal of assessment is. 06:46 "What does 'good' look like?" 09:18 The purpose of stratifying individuals. 10:50 The impact of social determinants and how this is being incorporated into individual assessment. 11:15 How the use of behavioral economics has helped. 11:37 "It's really about changing the culture." 12:57 Interventions and what these look like in population health. 17:03 Measurement in population health. 18:45 Population health outcomes, and what these might look like to patients. 19:38 Promising population health outcomes. 21:10 The importance of patient-reported outcomes. 24:47 How providers can tell if they're doing population health well. 26:15 Fred's advice to payers. 27:29 "Forget pilots, build something scalable." You can learn more by contacting Fred at Accountable Health LLC, via email, or on Twitter.

In this health care podcast, Josh LaRosa from the Wynne Health Group is back to give us an update on the snowball of drug pricing initiatives zigzagging their way around Washington right now. For the details, listen to episode 243. That's where we really drill into the details. This conversation is more of a status report. (Note: This episode was recorded on February 6.) You can learn more at wynnehealth.com or reach out to Josh at [email protected]. Josh LaRosa, MPP, is a policy director at Wynne Health Group, focusing primarily on regulatory affairs with a focus on the US Food & Drug Administration (FDA) and Centers for Medicare & Medicaid Services (CMS). His interests lie in delivery reform and innovations in payment and care delivery models. Josh also supports the firm's Public Option Institute, which studies the emergence of public option programs at the state level. Prior to Wynne Health Group, Josh consulted for the CMS Innovation Center, where he 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 holds a Master of Public Policy from the University of Virginia's Frank Batten School of Leadership and Public Policy. He also completed his undergraduate studies at the University of Virginia, graduating cum laude with a BA in political philosophy, policy, and law. 01:01 Updates on the drug pricing front on the national level. 01:44 The three major updates on national drug pricing. 01:48 Part D redesign legislation. 02:54 Giving private industry more stake in the game of keeping costs lower. 03:01 Check out EP243 for more info on drug pricing deals.05:18 The legislative deadline for any of these drug pricing bills to take place. 06:39 The International Pricing Index Model. 08:49 The administration's importation plan. 10:13 The end of the comment period and how long stakeholders have to give their input on the importation plan. 12:29 Updates on 340B hospitals and Health & Human Services (HHS). You can learn more at wynnehealth.com or reach out to Josh at [email protected].

Rahul Dubey is the founder of Percynal Health Innovations. He's also the former chief innovation officer at AHIP—that's America's Health Insurance Plans. AHIP is a trade group for insurance carriers, health systems, best-in-breed solution providers, and others. Rahul has created what he calls strategic working groups, in which he gets together essential stakeholders within a regional geography to collaborate and figure out innovative best-in-class emerging solutions and approaches. The first thing they do in these strategic working groups is to identify common problems. Since the best solutions solve the best problems for the most stakeholders, this seems like a pretty decent way to start. What are some of the challenges that Rahul has identified with payers and providers and other stakeholders to solve for? Here's your listicle: Really get to population health management and just population health Operational inefficiencies Information trafficking without getting anything out of it is not gonna work anymore Level up health literacy Here's a point Rahul makes that I'm continuing to think about. He says that payers should be grade aggregators—aggregators of data, aggregators of solutions that they should be able to distribute to other essential stakeholders. I heard somebody else say the other day that the new payer is more like an entity that provides comprehensive services. You can learn more by connecting with Rahul via email or LinkedIn. Rahul Dubey is CEO of Percynal Health Innovations and the Founder of America's Health Insurance Plans (AHIP) Innovation Lab. Rahul is currently responsible for collaborating with C-level executives at his health plan. Prior to joining AHIP and launching Percynal Health Innovations, Rahul held a leadership role as a founding employee of a successful digital health care start-up based in Washington, DC. Along with the company's cofounders, Rahul was instrumental in developing a multifaceted consumer tool as well as leading the company's "go-to-market strategy," resulting in successful market penetration and revenue growth for the industry's first consumer-led shared decision making and treatment selection platform. Rahul was recognized with the Smart Health's 2018 Excellence in Healthcare Transformation award, was named the American Journal of Health Promotion's 2017 Innovators and Game Changers, and is featured in Accenture Perspectives: Minds Driving the Future of Business. In 2017, Frost & Sullivan presented Rahul with one of their highest honors, their Global Visionary Innovation Leadership Award. He is a graduate of the University of Michigan–Ross School of Business and lives in Washington, DC, with his son. He invites you to contact him directly—that is, if you're willing to roll up your sleeves and drive transformation through inflective collaborative. 02:08 The stated needs of payers. 03:24 "Where are the inefficiencies that we can actually cut out of the system?" 05:14 A reverse approach to meeting the needs of payers. 06:35 Information transfer—what this means. 09:42 "Innovation is a team sport." 13:12 The "optimal solution." 18:49 "The lines of communication and business model creation … it's getting very creative right now." 20:10 Data play and finding key insights. 20:49 "A more definitive risk." 21:24 Vendors as "solution providers." 21:33 "The great aggregators"—collaborating optimally. 22:39 Brian Van Winkle and Rishab Shah on NODE.Health's "Ease of Doing Business." 25:16 "It's more relationship innovation and business model innovation than technology." 27:02 Rahul's advice to health plan collaborators, like insurance carriers. 29:44 Rahul's advice on how providers can collaborate better. 30:37 What's essential to payer success. 30:56 "Who are we trying to serve?" You can learn more by connecting with Rahul via email or LinkedIn.

In this health care podcast, seven thought leaders talk about the areas of promise they see in health care in 2020. Seven thought leaders include: Kimberly Noel, MD, from Stony Brook Medicine Eric Weaver, from Innovista Health Solutions Suzanne Delbanco, from Catalyst for Payment Reform Sue Schade, from StarBridge Advisors Naomi Fried, from Health Innovation Strategies Joe Grundy, from Grundy Consulting Adrian Rubstein, from Merck Just a couple of comments up front here. I don't want to further my reputation for dropping major spoilers, however, so I'll keep this short. Many of the thought leaders today talk about AI in various contexts. Are you rolling your eyes right now? If so, let me remind everyone about the Gartner Hype Cycle. The first step is wild-eyed enthusiasm. The next step in the hype cycle is anger, the old trough of disillusionment. I'd suggest that as far as AI is concerned, we are coming out of that trough and AI—be it artificial intelligence or augmented intelligence or machine learning or deep learning or whatever you choose to call it—it is being used, for reals, for various applications. Other corroborations among our thought leaders include the importance of exalting primary care, in the form of what some may call direct primary care and Zeev Neuwirth calls complex-condition care or condition-specific care—a relationship model, if you will. Another idea that comes up in various ways is the idea of breaking down silos and getting everyone with a stake in patient health to the table and focused on achieving better patient outcomes using all the technology and wherewithal available to us in 2020. By all the stakeholders, I mean going beyond the usual suspects of providers and insurance carriers—meaning employers. Also meaning Pharma, in the sense of Pharma taking the opportunity to collaborate more deeply toward outcomes their medications can potentially confer … IRL with RWE. Today's episode features the following guests: Kimberly Noel, MD, MPH, is a board-certified, preventive medicine physician. She serves as the telehealth director and deputy chief medical information officer of Stony Brook Medicine, where she provides leadership to all telehealth activities of the health system. Dr. Noel is also the chief quality officer of the patient-centered medical home (PCMH) for the family medicine department, working on quality improvement and population health management for National Committee for Quality Assurance (NCQA) designation. She practices occupational medicine clinically and provides digital solutions for employee wellness programs. She is an appointee the New York State Department of Health Regulatory Modernization Initiative Telehealth Advisory Committee and has won many service and innovation awards for health care. In academia, her research areas are in machine learning, risk models, and remote patient monitoring. Dr. Noel has developed several educational curriculums, including a 40-hour telehealth curriculum for the School of Medicine, as well as interprofessional educational curriculums with the School of Health Technology and Management, Nursing, Dentistry, and Social Work. Dr. Noel is a graduate of Duke, George Washington, and Johns Hopkins Universities. She is a proud graduate of the Stony Brook Preventive Medicine program, whereby she is now working collaboratively with the residency program leadership on development of a telehealth preventive medicine service. Eric Weaver, DHA, MHA, is nationally recognized for his work in primary care transformation and value-based care. As a corporate vice president for Innovista Health Solutions, he oversees enterprise strategy and technology adoption for a fast-growing population health management services organization. Dr. Weaver has been recognized for his contribution to the health care industry by receiving the ACHE Robert S. Hudgens Award for Young Healthcare Executive of the Year and the Modern Healthcare "Up & Comers" Award in 2016. Prior to joining the Innovista leadership team in 2015, he was the president and CEO of Austin, Texas–based Integrated ACO—one of the more successful physician-led accountable care organizations in the country. Suzanne Delbanco, PhD, is the executive director of Catalyst for Payment Reform (CPR), an independent, nonprofit corporation working to catalyze employers, public purchasers, and others to implement strategies that produce higher-value health care and improve the functioning of the health care marketplace. In addition to her duties at CPR, Suzanne serves on the advisory board of The Source on Healthcare Price & Competition at the University of California–Hastings and the Blue Cross Blue Shield Institute. Previously, she was the founding CEO of The Leapfrog Group. Suzanne holds a PhD in public policy from the Goldman School of Public Policy and an MPH from the School of Public Health at the University of California–Berkeley. Sue Schade, MBA, is a nationally recognized health IT leader and Pri

In this health care podcast, I talk with Karl Bilimoria, MD. Dr. Bilimoria is a surgical oncologist and a VP of quality over at Northwestern Medicine. Plus, he is also a John B. Murphy professor of surgery. The second I heard that Dr. Bilimoria and his colleagues had worked on an initiative to "rate the raters" of hospital and physician quality, I reached out to get him on the show. I had just had about four conversations with various people about the difficulties of judging quality. And I had also had a confounding personal experience visiting a patient at a hospital judged a top hospital by a well-known national rating scale. And this "top" hospital had some readily apparent issues, and I am no expert. That got me wondering about the validity of some of these quality raters. Given the importance and the need for health care quality transparency, Dr. Bilimoria and his colleagues set out to fill this gap by undertaking a (as mentioned) Rating the Raters process to evaluate and compare probably the major publicly reported hospital quality rating systems in the United States. These include the CMS (Centers for Medicare and Medicaid) Hospital Compare Overall Star Ratings, Healthgrades Top Hospitals, Leapfrog Safety Grade and Top Hospitals, and the U.S. News & World Report Best Hospitals. Interestingly, that "top" hospital I was in was scored a top hospital by one of the lowest-rated raters. You can learn more at the New England Journal of Medicine Web site, thesecondtrial.org, and the NEJM Catalyst Web site. Karl Bilimoria, MD, is a surgical oncologist and a health services, quality improvement, and health policy researcher at Northwestern University's Feinberg School of Medicine. He is the vice president for quality for the Northwestern Medicine system. He is also the vice chair for quality in the Department of Surgery and the John B. Murphy professor of surgery. His clinical practice is focused on melanoma and sarcoma. Dr. Bilimoria is the director of the Surgical Outcomes and Quality Improvement Center of Northwestern University (SOQIC), a center of 50 faculty and staff focused on national, regional, and local quality improvement research and practical initiatives. He is also the director of the 56-hospital Illinois Surgical Quality Improvement Collaborative (ISQIC).

You know how in JAMA recently it said that 25% or more of health care spending is frittered away wastefully? Some of that wasteful spending comes from unnecessary care. And some of that unnecessary care happens when a patient is misdiagnosed and then, based on that misdiagnosis, gets care for the wrong thing. And "wrong thing" care obviously isn't going to fix the actual problem because its intention is to fix something else. How do some of these misdiagnoses occur? Considering all of the diagnoses that begin with an MRI or a CT scan or an ultrasound or some other kind of imaging, it's not hard to gin up thought that if a radiology report or radiology veers into the "not exactly correct" zone, then you have a treatment plan immediately zipping off on a poor-quality and likely wasteful trajectory. That's what I speak with Ron Vianu about in this health care podcast. Ron, by the way, is the founder and CEO over at Covera Health. We don't have time (Ron and I) to get into the AI (artificial intelligence) and machine learning in radiology aspect, but (spoiler alert) a follow-up on that is forthcoming. You can learn more at coverahealth.com. Ron Vianu is the CEO and co-founder of Covera Health and a serial entrepreneur and problem solver by nature. He has spent the last 20+ years founding ventures in the health care, technology, and insurance spaces. Ron studied chemistry and philosophy at NYU.

Dr. Richard Zane is the chief innovation officer at UCHealth. He's also the executive director of emergency services there. Besides that, he chairs emergency medicine at the medical school and he's a professor at the business school and at the medical school. At the recent NODE Digital Medicine Conference, I asked Dr. Zane to talk about the 2019 innovations that he is most proud to have rolled out in their hospital system. We talk about three of these innovations, and then we get into the challenges that Dr. Zane and his team faced and overcame in the pursuit of those rollouts. What struck me most is the underlying dependency on data of all three of these innovations. Optimally complete data sets are really needed to make each one of these programs work as well as they possibly could. And as a corollary to that, the necessity of collaboration with payers like insurance carriers and PBMs (pharmacy benefit managers) to even get close to that complete optimal data set. Sidebar (because I can't help myself): It's going to be really interesting to see which payers and PBMs are ultimately willing to share data with providers—and, honestly, which providers are willing to share data with other providers—to help their patients get the right treatments in pursuit of better patient outcomes, because that's kind of a proxy to which ones value better patient care more than, let's just say, other things. I think the organizations that choose to share and choose to collaborate—you know, which ones self-sort into that category—that information is going to become more and more publicly available, and I wonder when and if that transparency will influence organizational decision making. In this health care podcast, Dr. Zane uses the term ethnographic a couple of times. Call me "out of the loop" but I had not heard that term before. So, just in case you haven't either, let me reference my go-to for mostly accurate information, otherwise known as Wikipedia. Ethnographic research, says Wikipedia, is a qualitative method where researchers observe and/or interact with a study's participants in their real-life environment. You can learn more by connecting with Dr. Zane on Twitter at @richardzane. Richard Zane, MD, currently serves as the George B. Boedecker Professor and chair of the department of emergency medicine at the University of Colorado School of Medicine, professor of health administration at the University of Colorado Business School, and chief innovation officer for UCHealth. Dr. Zane completed medical school at Temple University in Philadelphia, followed by residency training in emergency medicine at the Johns Hopkins School of Medicine. Following residency, Dr. Zane joined the faculty at Johns Hopkins as assistant chief of service. In 1998, Dr. Zane joined the faculty at Harvard Medical School and Brigham and Women's Hospital in Boston.

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.