The future of care is not confined by walls; it thrives in the heart of homes, where compassion meets innovation, and healing becomes a daily experience. Home-based primary care with full-risk Medicare Advantage is a transformative model that not only brings health care to the doorstep of our seniors but also places the responsibility for their well-being squarely in the hands of dedicated providers, creating a proactive and patient-centered approach to aging with dignity and comprehensive care. By making primary care easier to access for our nation’s seniors, we can deliver personalized care that meets their needs; help them stay healthy and feel better; and live well with existing conditions so they can prepare for what’s ahead. This week we are joined by two executive leaders from WellBe Senior Medical -- the largest and fastest growing independent home-based medical group in the country. WellBe is a global risk medical group that provides longitudinal geriatric care to underserved, frail, complex, and homebound Medicare Advantage beneficiaries. In this episode, we feature Dr. Jeffrey Kang, Chief Executive Officer and Mike Stuart, Chief Growth Officer from WellBe Senior Medical. Dr. Kang is a geriatrician with extensive experience in global risk and primary care for frail, elderly, and disabled populations.  Mike Stuart has extensive experience in fostering partnerships with health plans, health systems, and provider groups and leads commercial strategy and partnership development for WellBe Senior Medical.  In this interview you will learn about the home-based care continuum, primary care innovation, mission-driven leadership, Medicare Advantage risk, and the future of value-based primary care. Episode Bookmarks: 01:30 An overview of WellBe Senior Medical – a global risk primary care group providing longitudinal geriatric care in the home. 02:30 Introduction to Dr. Jeffrey Kang, WellBe CEO (formerly served as ChenMed President, Walgreens SVP, Cigna CMO, and CMS CMO). 03:00 Introduction to Mike Stuart, WellBe Chief Growth Officer (formerly served in executive leadership roles at Somatus and Evolent). 05:00 An overview of the home care continuum (e.g. acute, post-acute, custodial, longitudinal primary care, DME, home infusion). 08:00 How WellBe is helping patients navigate and coordinate the fragmentation of home care point solutions. 10:30 A mission to help senior patients “lead healthier meaningful lives by delivering the most complete care”. 11:30 Opportunities to make care in the home more multidisciplinary, personalized, and SDOH-responsive. 12:00 Proactive vs. Reactive Care (leveraging analytics and unique provider skillsets for population health). 13:30 The clinical persona of the “frail elderly” and why WellBe focuses on this target population. 14:30 “Everything done in a primary care office can actually be done at home.” 15:30 “Home-based primary care is the best thing to do. You get better outcomes and better patient satisfaction.” 15:45 Is it possible to deliver high quality primary care (like ChenMed or Oak Street) in the home setting? 16:30 Referencing Marcus Welby, M.D. as an example of an empathetic approach to delivering care in the home (see Season 1 Trailer) 17:00 Care Fragmentation Challenges - NEJM found that the average Medicare patient sees a median of two PCPs and five specialist physicians per year. 18:00 “Quality of Life” is more important than “Quantity of Life” (why empathy and compassion matter most in caring for frail seniors). 19:30 Patients define a good doctor by bedside manner and respect given. 20:30 How the economics of full global risk enable complete care models for seniors. 20:30 Scalable home-based primary care is a new approach in value-based care. 23:00 WellBe’s results (e.g. >50% neighborhood engagement, patient satisfaction is at 95%, and MLR improvement >40% in 3yrs). 23:30 The importance of reaching a 4 Star Rating in a Medicare Advantage plan.

Many factors impact our health beyond genetics and aging.  Collectively, these are called social determinants of health and include factors such as education, housing, income, occupation, hunger, language, literacy, where we live, and access to affordable healthcare services. However, there is a gap in the current list of social determinants of health, and that is the influence of “information” or an “information ecosystem” on patients’ behavior, engagement, and health outcomes. It is critical to consider “information” as another social determinant of health since it can be used to drive positive patient health outcomes.  How we deliver it, where we deliver it, and who delivers it is crucial to value-based health care transformation and patient-centeredness. So, how do we harness this idea that information can change health outcomes?  To answer this question, we have invited Debbie Welle-Powell back to the Race to Value!  As a 30-year healthcare executive veteran, value-based care thought leader, and educator, she is committed to the empowerment of change management principles to drive population health at the intersection of patient engagement and information sharing. In this episode, we discuss what is needed to empower the patient and clinician, technology-enablement and value-based payment to fine tune the delivery system, and the information ecosystem needed to drive healthy outcomes. As a companion to this podcast, make sure to read Debbie’s new article on this topic.  It is available for download on the Race to Value webpage for this episode! Information as a Social Determinant of Health Episode Bookmarks: 01:30 Introduction to Debbie Welle-Powell, a healthcare executive veteran whose work focuses on delivering affordable and accessible high quality care. 02:45 Reference previous R2V episode - “Climbing the Mountain: Reaching New Heights for a Transformative Future”) 03:00 Read the companion article to this interview on the Race to Value episode website! 03:45 Debbie provides a brief update on her professional work in value-based care (and her mountain climbing adventures!) 05:30 The influence of “information" or an "information ecosystem” on patients’ behavior, engagement, and health outcomes. 06:30 Should we consider information as another Social Determinant of Health (like transportation, education, housing, and food security)? 07:30 “Information only really matters if it helps patients change behaviors.  The delivery of information is crucial to empowering health outcomes.” 08:30 “The American healthcare system is not as patient-centric as it claims to be because of a failure to provide empowering information.” 09:00 The roles of clinicians and patients to improve health literacy. 10:00 Patient noncompliance – Ex: 20-30% do not pick up prescriptions, 30-40% do not follow-through on referrals. 10:45 The challenges of interpreting and addressing SDOH challenges to avoid unnecessary utilization. 12:00 The importance of the patient-provider relationship. (Eric shares insights from his healthcare trip to Cuba.) 14:30 Technology enablement and health system evolution to better address patient information needs. 15:00 Improving patient engagement through the online user journey (i.e. the digital front door). 15:45 Debbie shares a personal example from her cancer journey where the care team failed to provide adequate information. 17:00 Half of patients seeking receive misleading information when independently searching online sources. 17:30 The opportunity for clinicians to provide trusted and reliable online educational resources. 18:00 The hyper-saturation of online content (e.g. 500 hours of content uploaded to YouTube per minute!) 18:30 How the value-based care movement provides incentives for improving patient engagement. 19:30 The use of Generative AI in the clinical setting to help patients better navigate their care journey. 20:45 Merging the science of medicine with the art of informat...

A revolution is imminent in American healthcare, and “the revolution will not be televised” for passive observation.  Value-based care transformation, like any other important movement, requires the active participation of all leaders on the frontlines. However, for these leaders to make the right decisions, they need to embrace innovation in order to realize the fullest potential of generative AI and predictive analytics.  Through the reengineering of care delivery, we can achieve a more personalized, proactive, and efficient outcomes-based model that can ultimately transform population health. As we navigate this transformative journey, data will play a pivotal role in reshaping the landscape of care delivery.  And no one knows this better than Nassib Chamoun, Founder President & CEO of Health Data Analytics Institute (HDAI), our guest this week on Race to Value.  In this episode, you will hear from a leader and primary inventor of a broad-based population health data analytics platform, enabling healthcare providers to make informed decisions based on real-time information. Tune in to an informative conversation covering such topics as data aggregation, predictive analytics, digital twinning, network management, generative AI in clinical care, and future advancements in technology-enabled value-based care. Episode Bookmarks: 01:30 The Imminent “Big Data” Revolution in Value-Based Care 02:00 Introduction to Nassib Chamoun of Health Data Analytics Institute 03:00 As a teenager living in Beirut, Nassib experienced the horror of a civil war. 04:00 The inventor of Bispectral Index monitoring – a technology standard in operating rooms around the world. 05:00 Nassib discusses the pivotal moments in his life that shaped a passion for data analytics in healthcare. 07:00 80% of health information in EHRs is unstructured and entirely unusable unless converted to discrete data. 07:45 CMS provided HDAI a highly coveted Innovator’s License that allows the company access to data on 100 million Medicare beneficiaries. 09:00 How Big Data drives powerful AI algorithms and predictive models in healthcare. 10:00 “If you can’t measure something, you can’t improve it.” 11:00 Understanding the intersection between cost, outcomes, and utilization. 11:30 Making data actionable in order to effectuate change in care delivery. 11:45 Data overload can actually lead to clinical inefficiencies if it isn’t curated appropriately. 12:30 The artful curation of data to drive operational improvements at point-of-care. 14:00 The limitations of claims data in making timely clinical decisions and treatment interventions. 15:00 Interpretation of unstructured EHR data to extract potential new conditions and HCC coding opportunities. 16:00 The importance of clinical judgement in augmenting AI-based recommendations in value-based care. 17:00 Combining behavioral, psychosocial, and biometric data with the existing sciences of epidemiology and clinical medicine. 18:00 Generalized clinical use cases of AI at the point-of-care to improve costs, outcomes, and utilization. 19:00 “To be successful in value-based care, you must operationalize two separate goals: Prevention and Avoidance of Complications.” 20:30 “The goal of AI is to very simply do what a clinician does, but do it repeatedly and do it continuously for every patient in their cohort.” 21:00 How staffing limitations and an aging populations necessitates a more optimal use of technology in VBC. 22:00 In 2032, U.S. healthcare spending will reach $8 trillion (ahead of the economy of Japan) making it the third largest economy in the world! 22:45 Leveraging predictive models to drive more effective care coordination and interdisciplinary team-based care. 24:30 Patient engagement as one of the more challenging aspects of value-based care. 26:30 The integration of predictive analytics and digital twinning for individualized patient care. 28:45 Using multiple predictors to serve every comp...

Everyone needs access to quality, affordable health care regardless of health status, social need or income.  To reach this paradigm shift, healthcare leaders must evangelize within industry and communities they serve.  There is a better path forward for American health care – one that is people-centered and transformational; however, to get there we must unite the power of one at the intersection of people, policy, and politics. By listening to people’s needs, jointly developing policy solutions, and partnering with others, we can ensure our health care system works for everyone. This week on the Race to Value, we bring to you Natalie Davis and Dr. Venice Haynes at the United States of Care, a nonprofit organization focused on an ambitious goal to achieve universal access to quality and affordable healthcare for all Americans. It brings together stakeholders from various backgrounds, including healthcare experts, patients, policymakers, and advocates, to develop and implement practical, bipartisan solutions to improve the healthcare system in the United States. By fostering dialogue and collaboration, conducting research, and advocating for policies that enhance access, lower costs, and improve healthcare outcomes, the organization finds common ground and works across party lines and ideological divides to address the healthcare challenges facing the nation. As CEO and Co-Founder of the United States of Care, Natalie Davis is on a mission to reshape and implement American health care policies that improves the lives of all people.  Dr. Venice Haynes, the Director of Research & Community Engagement for United States of Care, is a social and behavioral scientist focused on an overarching research agenda to address social determinants of health and health disparities in underserved populations using qualitative and community-based participatory approaches.  In this episode we talk about the tenets of patient-first care (a.k.a. value-based care) including affordability, dependability, personalization, and understandability.  We also have an in-depth conversation on the power of storytelling in health care transformation and the imperative to overcome structural barriers in the creation of health equity. Episode Bookmarks: 01:30 United States of Care, a nonprofit organization focused on an ambitious goal to achieve universal access to quality and affordable healthcare for all Americans. 02:00 Introduction to Natalie Davis, Chief Executive Officer and Co-Founder. 02:45 Introduction to Venice Haynes, PhD, Director of Research & Community Engagement. 05:00 Natalie shares her personal story that led her towards an entrepreneurial career path in health care policy transformation. 07:30 Mentorship from Andy Slavitt and his advice to get out of Washington, D.C. to make an impact on health policy. 08:30 Venice discusses how her science and public health background inspired her to lead people-centered health care change. 11:45 Inspiration from Camara Phyllis Jones, a physician, epidemiologist, and anti-racism activist who specializes in the effects of racism and social inequalities on health. 14:30 When offered an alternative, by a 4:1 margin, people favor a model that compensates providers for improving overall health, delivering superior care, and coordinating patient care. 15:30 What it means for United States of Care to be at the intersection of people, policy, and politics in health care transformation. 16:00 Research and listening to people as a way to overcome tribalism and build an agenda of reform for the whole country! 16:45 The 4 goals and 12 solutions of United States of Care to meet the needs of people across demographics and can drive collection action to build a better health care system. 18:30 “The 4 goals of United States of Care – Affordability, Dependability, Personalization, and Understandability – comprehensively cannot be done in a fee-for-service model.”

In the Race to Value, we must recognize that quality of life is the ultimate currency of healthcare, and this aim is all the more important in senior living facilities.  Transforming health outcomes for skilled nursing and senior living populations is not just a goal; it's a commitment to providing the care and dignity our elders deserve.  This week, we profile a leader in the value movement who leads a company on a mission “to improve the health, happiness, and dignity of senior living residents”. We are joined by Mark Price, CEO of Curana Health – a leader who lives by the mantra that “extreme passion” is the single most important ingredient to reform the American healthcare system. Curana Health is a provider of value-based primary care services exclusively for the senior living industry, including in nursing homes, assisted/independent living facilities, CCRC/life plan communities and affordable senior housing communities. Curana Health serves more than 1,100 senior living community partners across 30 states and participates in the MSSP ACO, ACO Reach and Medicare Advantage programs with CMS. Backed by more than $300M in venture capital funding, the organization is poised to disrupt care delivery in senior living on a meaningful scale through innovative care models and applied analytics. In this episode, you will learn about how to transform health outcomes for skilled nursing and senior living populations through extreme passion.  We cover such topics as how to leverage APMs such as MSSP and ACO REACH in the senior living setting, the performance results of Curana Health across their value-based portfolio, technology innovation, palliative care, the state of the nursing home industry, and future trends in the shift to home-based care delivery. Episode Bookmarks: 01:30 Introduction to Mark Price, CEO of Curana Health. 03:45 An estimated 27M more people are aging into the 75+ cohort through 2050, resulting in rising age and higher health acuity levels of residents moving into senior living. 05:00 Curana Health has achieved a 39% reduction in 30-day hospital readmissions and a 37% reduction in total hospital admissions among Medicare Advantage I-SNP members. 06:00 “There are many subsectors in the industry where value-based care can succeed.  The important thing is ensuring that your people have an extreme amount of passion for making it work.” 07:00 Founding story of Curana Health based on how we would want our loved ones to be cared for at the end of life. 08:45 The majority of Americans will spend some time in senior living or skilled nursing in the final years of their life. 10:00 Elite Patient Care ACO performed in the top 1% of ACOs in its first year of operation, achieving PBPY savings amount of $2,235—the highest PBPY for any first-year MSSP ACO since 2012. 11:30 Curana Health also has one of the top performing ACO REACH and risk-based MA I-SNP programs in the country. 11:45 “Our core business is not a payment model. It is a clinical model that produces health outcomes which, in turn, enables affordability as well.” 13:00 Developing a population health playbook for the senior living space. 14:00 Success in developing a level of clinical integration within a senior living facility that is now owned by the company. 15:00 MA Institutional Special Needs Plans (I-SNPs) are designed to meet the needs of people living in long-term care settings such as long-term care nursing, skilled nursing facilities, and inpatient psychiatric facilities. 16:45 Facilities are taking an ownership position of MA plans for senior living and skilled nursing residents. 17:00 Mark provides perspective on I-SNPs and how the Curana Health clinical model is achieving results to improve clinical outcomes. 18:30 Performing well by recognizing the commonality between MSSP, ACO REACH, and Medicare Advantage. 20:00 How CMS and CMMI is incorporating innovation to value-based payment models (e.g.SNF 3-Day Rule Waiver).

Connecting the health and wellbeing of patients of patients directly to the bottom line isn’t just good business; it is a visionary approach that shows how healthier outcomes can actually drive healthier profitability. Continued success in demonstrating the correlation between clinical and financial outcomes will be a catalyst for generating societal wellbeing that paves the way for others to adopt value-based care.  And in doing so, we create a more sustainable and effective healthcare ecosystem. In this Race to Value, the true race isn’t about speed; it is about the journey to improved outcomes. Strategic and transformational partnerships guided by an enabling vision to improve population health will ultimately create a healthcare system that we can be proud of. In this episode, you will hear from Kyle Wailes, the Chief Executive Officer and Board Member of value-based care company, Wellvana.  Kyle Wailes is someone on a mission to demonstrate how fully-capitated models in primary care, empowered by the right partnerships to create enablement, will ultimately drive patient behavior change.  Under his leadership, Wellvana is an industry-leading example of a company that is connecting the healthy outcomes of patients directly to healthier profitability. With the tools, technologies, analytics, and resources for healthcare providers to successfully and seamlessly transition to value-based care, Wellvana is getting outstanding results and growing at an exponential rate for such a young company.  This is highlighted by the recent announcement of their partnership with AdventHealth to revolutionize primary care in the state of Florida.  Don’t miss this important interview to learn more about VBC enablement, high-touch primary care and clinical integration, the power of storytelling, patient behavior change, lifestyle medicine, and the current state of private equity investment in healthcare!   Episode Bookmarks: 01:30 Connecting healthy outcomes of patients to healthier profitability.  (A High-Touch Approach for High Performers) 02:00 Introduction to Kyle Wailes, Chief Executive Officer and Board Member at Wellvana. 04:00 Big Announcement -- AdventHealth partners with Wellvana to transition its Florida primary care network to VBC 05:00 Wellvana is the first value-based care enablement organization in the country to partner with a multi-state/national health system. 06:00 Kyle provides more details on how Wellvana’s recently announced partnership will impact the delivery of healthcare in Florida. 06:30 “Building clinically integrated primary care networks across the country requires flexibility.” 07:00 Expanding primary care impact through interdisciplinary roles (e.g. case management, care coordination, pharmacy integration, social work, coding) 07:45 Health systems across the country are extremely distressed with expenses growing 2X as fast as Medicare payments. 09:30 “The pandemic has been an accelerant overall to drive the adoption of value-based care.” 09:45 The opportunity to reposition primary care in the health system setting, taking it from loss leader to profit center, as a strategic cornerstone for transformation. 10:00 A health system focused only on fee-for-service can lose up to $200-300K per employed PCP. 10:30 “Clinically integrated primary care networks can drive better clinical outcomes, but they can also drive profit and growth as well.” 11:00 Flexibility in growing a PCP network through either an employed or affiliated model. 11:30 Kyle’s personal journey as a professional athlete, student of neuroscience, and value-based healthcare executive. 12:30 “The Story of the Chinese Farmer” – a parable that illustrates the idea that events that initially seem bad or good can lead to unexpected outcomes. 14:00 Kyle provides perspective on the highs and lows of life and how that translates to theculture at Wellvana. 15:00 Lessons learned from playing competitive sports (discipline, hard work,

Unlocking wellness and reshaping healthcare involves the profound bridge between Lifestyle Medicine and the Social Determinants of Health, a blueprint found in the wisdom of the Blue Zones. Blue Zones are regions of the world where people are known to live longer, healthier lives compared to the global average, often to 100 years of age. These areas have gained attention from researchers and health enthusiasts because they provide valuable insights into the factors that contribute to longevity and well-being.  Researchers have reverse-engineered longevity to find the common denominators and found that these Blue Zones are all places where people enjoy a diet rich in plant-based foods, regular physical activity, strong social connections and community support, and a sense of purpose or meaning in life. Given these lifestyle factors that contribute to the remarkable longevity and well-being of the people in these Blue Zones, we need to find a way to replicate them in our uniquely American society, which is often limited by modern fast-paced living, processed foods, and social structures that de-prioritize these essential elements of health and well-being. If population health success is at the intersection of Blue Zones and Lifestyle Medicine, how can drive the necessary realignment of financial incentives for value-based care? In this enlightening episode of Race to Value, we dive deep into the world of healthcare transformation with Dr. Dexter Shurney, President of the Blue Zones Well-being Institute. He is responsible for creating innovative health and well-being solutions that have broad impact. The Blue Zones Institute is a “Living Lab” to create, study, and codify best practice, including a whole-person approach to care, that can be replicated across regions and communities, including those of greatest need. In this episode, we explore the potential for wellness through the lens of Blue Zones research, discuss the impact that chronic disease has on declining U.S. life expectancy, uncover the profound connection between stress-induced inflammation and chronic disease, and address the impact of both racism and SDOH variables on health equity.  Additionally, we go deep into the tenets of lifestyle medicine and how it aligns with the broader movement value-based care. Tune in for a thought-provoking conversation that unveils the pathway to healthier lives, stronger communities, and a brighter future in healthcare!   Episode Bookmarks: 01:30 Introduction to Dr. Dexter Shurney and the wellness potential of applying Blue Zones research. 03:30 After peaking in 2014, US life expectancy has declined each subsequent year, trending far worse than peer countries. 04:00 Chronic diseases remain our nation’s greatest killer, erasing more than double the years of life as all overdoses, homicides, suicides, and car accidents combined. 04:30 The death rate gap between the rich and poor has grown almost 15x faster than the income gap since 1980. 05:30 We have the answers to address declining life expectancy…but haven’t put in place the right policies to solve the problem. 06:00 Referencing the new Netflix docuseries, “Live to 100:  Secrets of the Blue Zones” 06:30 People living in Blue Zones often live to be 100 and do not suffer from high rates of chronic disease. 07:00 “Blue Zones countries spend far less than the U.S. on healthcare, and their good health is driven by things others than genetics.” 07:45 “Drug overdoses, homicides, and suicides with our youth are all deaths of despair. It touches back to people being lonely and not connected to friends, family, and society.” 09:00 The common denominators of long life expectancy (plant-based diet, regular physical activity, strong social connections and community support, and a sense of purpose or meaning in life). 09:30 Finding ways to replicate Blue Zones in our uniquely American society, which is often limited by modern fast-paced living, processed foods,

Data interchange and interoperability are the keystones of a united ecosystem for value-based care, where information flows seamlessly, connecting patients, providers, and payers to drive better outcomes, lower costs, and improved patient experience. Overcoming siloed information is the key to breaking down the barriers that fragment care delivery, and in doing so, we unlock the potential for a healthier future for all. While health data interoperability has arguably become an industry buzzword over the past decade, the concept's importance for digital health transformation cannot be understated. The benefits of optimal interoperability in healthcare includes improved care coordination for patients and reduced administrative burden for healthcare payers and providers. Interoperability also supports public health surveillance and population health initiatives that are so critical to value-based care transformation. In this podcast episode, you will hear from two executives on a mission to unlock greater value in American healthcare by aggregating, normalizing, and unifying data.  Venkat Kavarthapu and Dr. Summerpal Kahlon are the Chief Executive Officer and Chief Medical Officer for Edifecs, a Best in KLAS interoperability platform that serves as the foundation for the solutions that eliminate stakeholder friction to overcome healthcare’s biggest challenges. We discuss how interoperability will accelerate value-based payment adoption and help providers obtain more complete and accurate care funding for alternative payment models. We cover such topics as the future of AI, the potential for automated prior authorization, how ACO REACH will drive population health management, and the collaboration that is enabled by technology. Episode Bookmarks: 01:30 Introduction to Venkat Kavarthapu and Dr. Summerpal Kahlon and their company Edifecs that provides a leading interoperability platform. 04:00 Industry struggles to implement interoperability requirements of the CMS Interoperability and Patient Access Final Rule. 04:30 The benefits of interoperability and how it serves as a foundation for value-based care. 05:30 Venkat discusses how value-based care is the only path forward in creating a sustainable healthcare system. 06:30 The need for data to improve patient experience and quality of care. 07:00  “True value-based care can only be accelerated if information is available to all entities in all three dimensions – clinical, administrative, and financial.” 08:00 Exchanging information across organizations and between systems without friction, while ensuring privacy and security. 09:00 How data siloes create healthcare dysfunction. 10:00 Extreme data siloing increases data management costs (25-30% of total cost spent to ensure data accuracy). 10:30 Payer-provider collaboration supports value-based care but is still limited by interoperability adoption. 12:00  “Driving interoperability is not a burden on the industry, but a true competitive advantage for the industry.” 12:30 How interoperability reduces administrative burden and the cost of human capital. 13:45 “An interoperability framework can drive a meaningful dialogue, and communication is key to driving good patient outcomes.” 14:30 Summer describes how an overly-fragmented healthcare system that still relies on fax machines contributes to data inaccuracy. 16:00 Emphasizing data accuracy within an interoperability framework ensures patient safety. 16:30 How Natural Language Processing and AI can provide context and improve communication at the point-of-care. 19:00 CMS Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule 20:00 The need for fully automated Prior Authorization (PA) enabled by EDI processing, FHIR-based APIs, AI/ML, and NLP. 21:45 Electronic PA will foster payer-provider collaboration and drive clinical decision support. 23:30 PA transactions are only automated 30% of the time at present (compared to 90% or more ...

Innovation and partnership are the twin engines that propel us into a new era of healthcare. The fusion of cutting-edge technology and clinical innovation, empowered by collaborative relationships, can revolutionize primary care.  This cohesion of innovation and partnership makes primary care more accessible, effective, and patient-centered than ever before. There is no better example of primary care modernization than Central Ohio Primary Care (COPC), the largest physician-owned primary care group in the United States with over 480 physicians and 83 locations in central Ohio. Rooted in a long history of clinical excellence and a commitment to the highest ethical standards, COPC is building a new holistic model for primary care that gives physicians time to build relationships with their patients and one another. Through ACO REACH, full-risk delegated capitated Medicare Advantage Plans, and direct-to-employer value-based arrangements, they are able to engage their entire team in the innovation of their primary care model.  Furthermore, through partnerships they are able to share risk and build a pathway to sustainability in the provision of value-based care for decades to come. Joining us on the Race to Value this week is Donald Deep, M.D., the CEO of Central Ohio Primary Care.  In this episode, we discuss the modernization of primary care that is underway at COPC – including technology-enabled care efficiency, 24/7 access, care management, and post-discharge follow-up. We explore the successes of their Extensive Care Center and Comprehensive Home and Palliative Care programs.  There is also in-depth discussion on low value care, the importance of payer partnerships, direct-to-employer strategies for commercial populations, accessing capital partnerships in full-risk MA, and collaborative leadership for success in VBC. This episode is sponsored by Agilon Health, a company that partners with independent primary care practices that are leaders in their markets and helps them transition to value-based care success in the Medicare program. https://vimeo.com/870324462?share=copy Episode bookmarks: 01:30 Introduction to Donald Deep, M.D., the CEO of Central Ohio Primary Care (the largest physician-owned primary care group in the U.S.) 02:45 Referencing prior episode featuring Dr. Bill Wulf (“The Value Game”: Achieving Success with Capitated Risk and Patient-Centered Primary Care) 03:00 This week’s episode is brought to you by Agilon Health 04:30 COPC has directing 2,200 employees across 90 locations covering six counties and has been on a value journey since 2010. 05:30 The modernization of primary care at COPC. 06:30 Patient care coordination that includes technology-enabled care efficiency, 24/7 access, care management, and post-discharge follow-up. 07:30 “We are responsible for the care of our patient population, even outside of the exam room.” 07:45 Empowering PCPs to spend more time with patients and engage patients and families in the care process. 08:00 Addressing prevention and SDOH requires a modernized primary care model. 08:45 Extensive Care Center (ECC): A Novel Approach to Reducing Emergency Department Visits and Observation Unit Utilization 10:00 The Extensive Care Center at COPC returns 95% of patients to the home (ER Avoidance) and prevents 2-3 hospital admissions each week. 11:00 Scaling the ECC model in co-location with Same Day Centers at COPC to provide immediate access for emergent primary care needs. 12:00 Addressing chronic disease in the extensive care center avoids unnecessary ER visits and hospitalizations. 13:30 Payer recognition of the ECC model, with high levels of patient satisfaction. 14:45 The Comprehensive Home and Palliative Care (CHPC) program at COPC provides primary and palliative care in the home setting. 15:30 Palliative care in ACOs have demonstrated reductions in 30-day readmissions, avoidable hospital admissions,

Fourteen years ago, surgeon, writer, and public health researcher, Atul Gawande wrote his landmark article, The Cost Conundrum, about the healthcare challenges of the Rio Grande Valley (RGV) of South Texas. Gawande showcased the challenges that health systems confront when dealing with public and private insurers and the paradox between high-cost treatment options and low-quality outcomes. His careful assessment of McAllen, Texas, a small city on the border, found that it had the most expensive healthcare system in the nation.  This “cost conundrum” in the Rio Grande Valley inspired President Obama to pass the Affordable Care Act and begin a national movement to value-based care. Now that ACOs have reached a critical mass in the Rio Grande Valley we must now ask ourselves “to what degree can value-based care accelerate health equity?” Value-based care is the seed from which health equity transformation can bloom, nurturing a system that values every life, cultivates well-being, and harvests a future where health disparities are but a distant memory. Health equity transformation in underserved regions (like the RGV) is not just a matter of providing medical care; it's a testament to our commitment to justice, compassion, and the recognition that the well-being of every individual, regardless of their circumstances, is a reflection of our shared humanity. Equity transformation is currently underway in the Rio Grande Valley, one of the most underserved regions in the entire United States. The RGV – a 50-mile stretch of towns that span the border of Texas and Mexico – is home to 1.4 million people (almost twice the population of El Paso), nearly 90% Hispanic, and has some of the poorest counties in the country. Issues like poverty and lack of access to healthcare burden the Valley. These factors are the leading cause of health problems like diabetes, obesity, and cervical cancer. Our guest this week is Dr. Edwin Estevez, a nationally-recognized value-based care leader and champion for health equity in the RGV.  His vision is to activate the local health ecosystem to expand access and promote inclusivity through the power of co-opetition. It involves competing organizations in the same market, working together on something that is mutually beneficial while simultaneously competing in other areas. Coopetition in healthcare is the catalyst for transformative change, where the pursuit of collective well-being transcends individual interests, and collaboration becomes the cornerstone of a healthier local ecosystem. If you want to be a part of the health equity transformation in the Rio Grande Valley, register today for Accelerator2023 on October 17th!  (Attendees can attend in-person in Mission, Texas or virtually).  More information at www.equity-accelerator.org https://vimeo.com/decibelrocks/accel?share=copy Additional Resources: WGU Aims to Transform Rio Grande Valley’s Healthcare A Vision of Pioneering Co-opetition for Health Equity Episode Bookmarks: 01:20 The landmark article, “The Cost Conundrum” about the healthcare cost crisis and how it inspired a national movement to value-based care. 01:45 Obama’s Favorite New Yorker Article led to the passage of the Affordable Care Act and the development of ACOs. 02:00 Edwin Estevez returns to the Race to Value!  (Episode #1 with Edwin) 02:30 The underserved region of the Rio Grande Valley (RGV) as a focal point to create a replicable convening model of equity-based co-opetition. 04:30 Advancing health equity through a community-based ecosystem – Eric and Edwin discuss their upcoming collaboration in the RGV. 05:45 “Value-based care is a platform to shape policy, redirect programs, and understand services better through the lens of health equity.” 06:00 Edwin’s prior VBC success with RGV ACO, one of the earliest (and most successful) physician-led MSSP ACOs in the country. 06:30 Edwin discusses AltaCair,

The plasticity of primary care, in the new value-based era, embodies remarkable adaptability, innovation, and responsiveness to evolving community health needs. As our understanding of health and well-being expands, primary care stands as the first line of defense, ready to transform and customize its services to address the unique challenges faced by diverse populations. This flexibility allows primary care providers to pivot swiftly, whether it's in responding to public health crises, addressing disparities in healthcare access, or integrating innovative technologies into daily practice. In embracing this plasticity, primary care not only becomes a cornerstone of community health but also a powerful catalyst for positive change, driving us closer to the goal of a healthier, more equitable society. In this week’s episode of the Race to Value, we are joined by R. Shawn Martin, Executive Vice President and Chief Executive Officer for the American Academy of Family Physicians. The AAFP is the medical specialty organization representing 129,600 family physicians and medical students nationwide. Shawn Martin works with the AAFP Board of Directors on the mission, strategy and vision for the AAFP and provides representation to other organizations, including medical, public, and private sectors. He is nationally recognized for his thoughtful leadership on a range of healthcare and workforce issues. While his career portfolio has focused on numerous health care and public-policy issues, he is best known for his extensive work on the development and implementation of primary care delivery and payment models. In this episode, we discuss such things as payment reforms in primary care, the industry impact of primary care consolidation, physician-led ACOs, the new Making Care Primary (MCP) payment model and the need for multipayer collaboration, health equity, rural healthcare transformation, physician workforce challenges, and the future implications of AI on the medical profession. With leadership from Shawn and his constituents throughout the primary care ecosystem, we are well-positioned for transformation in the race to value! Episode bookmarks: 01:30 The plasticity of primary care and how it can evolve to meet community health needs in the new value era. 02:30 Introduction to R. Shawn Martin, the Executive Vice President and Chief Executive Officer for the American Academy of Family Physicians. 04:45 People who have access to advanced primary care tend to have better health, receive timelier diagnoses, and get more prompt treatment when it is needed. 05:30 The U.S. spends only 5-7% of its healthcare dollars on primary care — less than half of the 14% average in Western European countries. 06:00 AAFP Advocacy Priorities:  Fighting for Family Medicine! 07:00 Shawn discusses the need for additional investment in primary care at a national level. 08:30 The misalignment of fee-for-service in the primary care setting. 09:00 “Appropriate investment in primary care, coupled with a prospective payment model, will transform both patient experience and care team performance.”   09:45 PCP Infrastructure Investments + Rapid Transition to Value-Based Care = Primary Care Transformation 10:45 Vertical integration of primary care can lead to higher prices and costs, including insurance premiums, without improving care quality or patient outcomes. 11:30 Site-of-service payment differentials create uneven playing field between independent practices and hospital-owned primary care. 12:00 Shawn’s congressional testimony to the Senate Finance Committee on the “Consolidation and Corporate Ownership in Health Care” 13:00 The Medicare program created siloed benefits between hospitals and physicians, and these design flaws created incongruencies in system economics and patient health outcomes. 14:30 The inability of independent physician practices to survive on the regulatory framework of the modern healthcare system.

Democratizing access to value in healthcare through primary care enablement is the compass guiding us toward a future where health is a universal right, not a privilege, and where the promise of value-based care is accessible to all. It represents a fundamental shift in our approach to healthcare delivery. By prioritizing primary care and leveraging technology, we can extend the reach of healthcare services, making them more affordable and accessible to diverse populations. This approach emphasizes preventive care, early intervention, and patient education, reducing the burden on emergency rooms and hospital admissions. Ultimately, primary care enablement has the potential to transform the healthcare landscape, promoting healthier communities and improving the overall well-being of individuals while also making healthcare a more equitable and sustainable system for everyone. Joining us this week on the Race to Value is Michael Kopko, the CEO of Pearl Health – a company that is on a mission to democratize access to value in healthcare. More than 800 primary care providers across the country partnered with Pearl to align payments with patient health and leverage emerging data and technology to achieve better outcomes more efficiently. And earlier this year, they closed on a $75M Series B funding round to bring even more capability to the health value economy, by empowering providers to transition to a more proactive care model, enabling them with a technology solution that surfaces urgent cases before they become emergent, and rewarding them for outcomes aligned with value. This is a company that you need to know about, and it is my pleasure to have Mike on the podcast this week to discuss the challenges facing our industry and how Pearl Health is accelerating the development of innovative solutions that place providers at the center of healthcare delivery and cost management. Episode Bookmarks: 01:30 Introduction to Michael Kopko and Pearl Health -- a company that is on a mission to democratize access to value in healthcare. 03:30 After more than a decade of value-based care efforts, the U.S. still pays about twice as much for healthcare than any other country, despite underperforming in quality and outcomes. 04:00 How do we reach a critical mass with ACOs and other APMs to save the Medicare Trust Fund from insolvency by catalyzing care delivery transformation? 05:45 There is reason for optimism for healthcare in the long-term, e.g. R&D in the health sector, the steady march to value since Michael Porter coined the term in 2006. 07:00 The increasing adoption of Medicare APMs and value-based Medicare Advantage (see HCP-LAN APM Measurement Effort). 07:30 “The underlying infrastructure and operating system for healthcare is positioned well for value.” 07:45 More work needs to be done, e.g. Medicare negotiations with pharma companies to lower drug costs, further realignment of incentives. 08:00 Medicare cost growth has abated.  (See recent NYT article: “A Huge Threat to the U.S. Budget Has Receded. And No One is Sure Why.”) 08:30 The need to balance ACO Shared Savings performance over time with the democratization of data to improve population health outcomes. 09:00 “We are starting to get the highways and freeways established for data interoperability to be very proactive in creating health value.” 09:30 “Our healthcare system has so much money that with the right capability sets and incentives, we will solve any problem as long as we have the will to do so.” 10:00 Pearl has seen 10X year-over-year growth, expanding from 10 to 29 states, since its founding in November 2020. 11:00 Technology enablement requires the harmonization of the platform with the wisdom of experienced healthcare professionals. 12:30 Michael shares key learnings in his healthcare leadership journey and how that led to the founding of Pearl Health. 14:45 The realization that the missing piece of value transformation was the enablement of PC...

In the ever-evolving landscape of healthcare technology, humility is the compass that guides successful change management. It reminds us that the journey towards seamless adoption of health information technology is a collaborative one, where the wisdom of many outweighs the knowledge of one.  The humility to acknowledge one's limitations fosters an environment where collaboration and learning thrive. In the context of clinical informatics, allyship and teamwork are indispensable. Effective clinical informatics demands a diverse skill set, often spanning healthcare providers, IT specialists, and administrative personnel. Allyship within this multidisciplinary team is essential, and applied clinical informatics can be the linchpin in the transition to value-based care.  Through successful HIT implementation, leaders can illuminate the path to better outcomes, reduced costs, and patient-centered excellence. A new era for Clinical Informatics is upon us and will empower healthcare with data-driven insights, AI capabilities, virtual care at scale, and precision medicine to ensure that quality triumphs over quantity in our pursuit of healthier communities. On the Race to Value this week, we are joined by Brittany Partridge, a national thought leader on health data management and informatics.  Brittany is passionate about implementing technology that impacts clinical workflow in a positive way and increases patients' access to care. Join us for an informative discussion on Clinical Informatics, the importance of allyship to mitigate medical technology risk, the impact of Generative AI and virtual care on health system transformation, and change management best practices to lead your organization to successful healthcare innovation. Episode Bookmarks: 01:30 Introduction to Brittany Partridge, an industry leader in Virtual Care Technical Architecture and Informatics Implementations. 03:00 Recent book collaboration with Ed Marx – “Voices of Innovation:  Fulfilling the Promise of Information Technology in Healthcare” 04:30 The sub-disciplines of Health Informatics (e.g. Nursing, Pharmacy, Public Health, Biomedical, Medical, and Clinical Informatics). 06:00 AMIA: Why Informatics? -  “Informatics is the overarching field of study that pulls all these subdomains into one discipline focused on improving health and healthcare.” 06:30 Applied Clinical Informatics – the frontline of healthcare innovation with direct clinician interaction. 07:00 Early experiences in e-prescribing implementations that led to other care delivery innovations such as virtual care and remote patient monitoring. 08:00 The intersection of Clinical Informatics and VBC (ensuring tech usability to optimize care workflows for clinical quality improvement). 09:00 Best Practice Advisories (BPAs) – pop-up alerts to empower clinicians to make the best informed decisions at the point-of-care. 09:45 Leveraging technology innovations to improve patient access and affordability. 11:30 The importance of shadowing and workflow analysis as a catalyst for innovation. 13:00 How shadowing is incorporated into user validation, user design, and Lean (“Go to the Gemba”) 14:00 Simply asking clinicians to describe a workflow is insufficient in understanding the entire process. 15:00 “Get a robust current state workflow before you implement any innovation project because you need to know what you're going to be replacing.” 15:45 How virtual interactions with providers can complement provider shadowing in an embedded CI model. 16:30 Non-judgement in applied clinical informatics is required to build trust. 17:30 “The most important part of rolling out any technology project is clinician trust. They need to know that you have their best interests at heart.” 19:45 Allyship is key to reducing medical technology risk because the inclusion of diverse perspectives yields the greatest rewards. 21:30 “Fail fast and iterate” and “Perfect being the enemy of good” philosophies don’...

Crossing the Value-Based Healthcare Rubicon isn't just a journey, it's a revolution in care, where the currency is quality, and the compass is compassion. This transformation is both an economic and moral imperative, and in the alchemy of healthcare, transforming economics isn't just about numbers; it's the catalyst for transmuting care outcomes into golden results that enrich both lives and ledgers. This week you have access to two of the leading minds in value transformation. We are joined by Dr. Edward McEachern (Executive Vice President and Chief Medical Officer for PacificSource) and Jenni Gudapati (Value-Based Healthcare Program Director and Clinical Associate Professor at Boise State University). In this illuminating episode, we delve into the transformative realm of value-based healthcare with a diverse range of topics. Our insightful interview explores the value movement and its profound impact on economics and care outcomes. We unravel the intricate dynamics of care management, particularly in the context of chronic diseases, while shedding light on the crucial aspects of risk adjustment, Annual Wellness Visits, and Quality Improvement. We also investigate the concept of "Gold Carding" and the role it plays in healthcare transformation. Furthermore, we delve into higher education's pivotal role in shaping the future of healthcare value, emphasizing the essential skills that healthcare leaders of tomorrow must possess. Tune in for an enlightening discussion that navigates the evolving landscape of healthcare, economics, and leadership! This week’s episode is brought to you by Edifecs – an EMR-agnostic, interoperable, and AI-enabled technology helps providers unify and utilize data for a more complete digital portrait of patient populations. The result: better clinical, financial, and compliance outcomes.  To learn how Edifecs’ applications can enhance prospective risk adjustment and value-based contract performance, visit edifecs.com today. Episode Bookmarks: 01:30 Introduction Edward McEachern, M.D. and Jenni Gudapati, MBA, RN 06:50 The slow uptake of accountable care (HCP-LAN: only 20% of healthcare payments flow through Categories 3B and 4 APMs). 07:20 Provider challenges: supply chain disruptions, labor shortages, high inflation, and the end of COVID-19 relief payments. 08:20 Congressional Budget Office projects insolvency of the Medicare Trust Fund by 2026. 08:50 The economic necessity of value-based health care to reduce unnecessary spending. 09:35 “In the shadow of COVID we have crossed this Rubicon where there is a push on the current paradigms of care delivery and payment.” 10:15 Stressor #1: The retirement of the Boomer workforce will create a 14% structural deficit in accessible labor. 10:30 Stressor #2: FFS infrastructure collides with APM adoption strategies and cannot support value transformation. 11:20 Stressor #3: Shift of hospital care delivery to the outpatient and home setting. (“It is never coming back.”) 11:50 “This chronic complex system of care that takes care of people in the post-acute setting is not adequately available in most communities.” 12:20 “LAN 3B and 4 payments will only help in the context of the operational reshaping of the health delivery system.” 12:50 Value-based consumer perspective needed: 46% cannot afford out-of-pocket healthcare expenses! 13:20 Low value services that do not track to best patient outcomes. 13:50 Revenue dependency on a sick-care model of fee-for-service medicine. 14:35 “Too many health inequities exist. We need to financially incentivize providers to take care of underserved populations.” 15:20 “Healthcare is the only industry that is Yelp proof.” (the dislocation between costs and consumerism) 16:20 What if we created a well-financed and integrated SDOH health system to work alongside the sick care health system? 17:50 The power of the Annual Wellness Visit (AWV) in patient-centered care.

Now is the time to embark on a journey towards a brighter and more resilient future. As the U.S. healthcare system grapples with the aftermath of a global pandemic, we find ourselves at a pivotal crossroads. This episode delves deep into the profound changes brought about by the pandemic, examining how it has exposed vulnerabilities in our existing systems and ignited conversations about the need for transformative change. Join us as we navigate this critical juncture, exploring the shifts in healthcare, economy, and societal values that could ultimately lead us to a high-value system that prioritizes well-being and sustainability for all. Get ready to be inspired and informed as we embark on this enlightening exploration of the post-pandemic world. Joining us in the Race to Value this week is David B. Nash -- an American physician, world renowned scholar and public health expert, and Founding Dean Emeritus of the Jefferson College of Population Health. His accolades and achievements in healthcare transformation are innumerable. (The week before this interview was recorded he had received the Lifetime Achievement Award from the American Association for Physician Leadership.) Dr. Nash is also a bestselling author with his new book, “How COVID Crashed This System: A Guide to Fixing American Health Care.”  In this episode, we discuss insights from Dr. Nash’s research on COVID-19’s impact on the healthcare system and how this post-pandemic era can help us transition to a high value health care system.   Episode Bookmarks: 01:30 Introduction to Dr. David Nash, an American physician, world renowned scholar and public health expert, and Founding Dean Emeritus of the Jefferson College of Population Health. 03:30 Have we learned our lessons from the COVID disaster? 05:00 Dr. Nash reflects on his recent experience with Dr. Ashish Jha on the last day of service to our country as the White House COVID-19 Response Coordinator. 05:30 “The office of the presidential response to COVID is now a janitorial closet somewhere in the West Wing of the White House…it is sad.” 06:00 “1.2 million dead from COVID-19 is more than the total of all combat casualties of every war since the Revolutionary War of the United States!” 06:30 “Sadly in the history of our country, when the dying stops, the forgetting begins.” 07:00 PTSD from the pandemic with physicians and healthcare professionals, coupled with societal apathy towards COVID-19 and surging cases in China. 08:00 Medicaid Redetermination as the consequence of the end of the Public Health Emergency and how lost coverage will impact marginalized populations. 09:00 3,000+ people died from 9/11, and we are still taking our shoes off at the airport.  1.2M died from COVID-19, and it is back to business as usual. 09:30 Societal issues (e.g. structural racism, inequality) persist in our country. 10:00 What is the True North for American Healthcare really?  ($4 Trillion in spend with significant amount of low value care, declining life expectancy, low ranking in world health rankings) 10:30 Additional societal measures of a poor performing health system (alcoholism, depression, suicide, opioid abuse). 11:30 How Philadelphia is suffering an exacerbation of  pre-pandemic problems (lack of access, redlining, crime, homelessness, educational disparities). 11:45 There is a 20-year disparity in life expectancy between rich and poor communities in Philadelphia. 13:00 The persistence of health inequities and social injustice since the transatlantic slave trade. 13:30 COVID-19 blasted a searing light on social determinants of health! 14:30 “You can’t have value-based care without equity.” – the costs of health inequities are in the hundreds of billions (see recent JAMA article). 15:00 Employer engagement in health equity transformation. 15:30 “The emergence of the payvider model has given value-based care additional energy.” 17:00 The evolution of medical and nursing education to improve heal...

In value-based care, true leadership emerges from the depths of the heart, where empathy, compassion, and authenticity converge to illuminate the path of positive change. Purpose-driven leadership can not only revolutionize community health but also create a ripple effect that reaches every corner of society. At the intersection of purpose, compassion, and community lies a transformation of our healthcare system with a tangible impact on the well-being of individuals, families, and neighborhoods. Now is the time for healthcare leaders to harness the power of the heart to shape a healthier and more harmonious world for all.  The heart’s power of purpose knows no boundaries, for it holds the strength to heal, inspire, and connect the threads of humanity. Joining us this week on the Race to Value is Mikelle Moore, a nationally recognized health executive with more than 25 years of experience impacting communities through forward-thinking, collaboration, and leadership. Mikelle has payer, provider, business and start-up experience in healthcare having served in executive leadership at Intermountain Health, an integrated system serving an 8-state region. During her tenure at Intermountain, she served as Chief Community Health Officer and as the first female CEO of the system’s flagship hospital. In addition, Mikelle has worked in contracting for a provider-owned health plan and in strategy for Mayo Clinic Arizona. As a thought leader in the space, Mikelle knows the value in moving from healthcare to health. In this week’s episode, prepare to be inspired and enlightened by Mikelle’s heartfelt exploration of “The Power of Purpose:  Transforming Community Health Through Leadership of the Heart.”   Episode Bookmarks: 01:30 Introduction to Mikelle Moore, a nationally-recognized VBC executive leading system change to improve population health outcomes. 03:15 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:00 Broadening the scope of care delivery in health systems to address the determinants of health through equity, impact investments, and ESG factors. 06:00 Mikelle discusses her leadership journey as an expression of authenticity and purpose to right the wrongs of a broken system. 08:00 Intermountain Health as a leading health system that is designed for a consumer-provider approach to improving health care. 09:00 Advocating for improvements in the variability of care and the reduction of wasteful healthcare utilization. 09:30 Listening to the community in the strategic planning of a hospital. 10:00 Pivoting from “sick care” to “health care.” 10:45 The realization that health disparities were far reaching beyond just the care delivered, e.g. poverty, homelessness. 11:00 “If we want to be health leaders that are making healthcare better, we have to be champions for addressing disparities in underserved and marginalized communities.” 13:00 Finding common ground with Community Benefit Organizations (CBOs). 14:00 Mikelle shares his insights on the importance of relationship-building in community partnerships. 16:00 How the principles of collective impact forged new community partnerships to address behavior health and SDOH. 17:00 Defining success by really understanding the problem and what issues get in the way (e.g. how nonmedical issues such as homeless and social isolation impact health outcomes) 19:00 Developing a system of communication and data sharing between the CBO and health system that is centered on patient needs. 20:00 The Alliance for the Determinants of Health as a vehicle to address social needs to improve health. 21:00 The impact of institutional racism on health equity. 24:00 Viewing social factors in society as a lens to view and understand racism. 25:00 “Inequities are often delivered at a subconscious level. It is our accountability to identify those disparities and build systems of care to prevent them from occurring.”

Peering into the horizon of healthcare, we unveil the vanguard of value-based care research and innovation, where data-driven insights and daring ideas converge to shape a healthier tomorrow. In the ever-evolving landscape of healthcare, trailblazing research serves as the guiding light that illuminates the path toward a value-based care revolution. By delving into the intricate dynamics of accountable care, dissecting payment models, and exploring innovative strategies, research on healthcare transformation provides the foundation upon which healthcare stakeholders can build a more equitable, efficient, and patient-centered future. This work not only dismantles traditional barriers but also empowers policymakers, providers, and patients to collectively navigate the complex journey toward a value-driven healthcare paradigm. Our guest this week on the Race to Value is none other than the esteemed David Muhlestein, PhD, JD a true trailblazer in the field of value-based care research and innovation! With a passion for accelerating the adoption of accountable care and driving meaningful change, David has dedicated his career to unraveling the complexities of the value movement by telling a story with data.  As the chief research and innovation officer at Health Management Associates (HMA), David Muhlestein’s research and expertise centers on health care payment and delivery transformation, understanding health care markets, and evaluating how the broader health care system is changing. In this interview, we cover topics such as the value-based care movement and the goal of speeding the uptake of accountable care; the current growth trajectory of ACOs; payment model reforms that are taking place to advance health equity; the positioning of Medicare Advantage in the accountable care landscape; the inclusion of specialists in value-based care; multi-payer alignment to reduce administrative burdens and increase the impact of accountable care reforms; hospital and health insurer price transparency; and the new Primary Care Alternative Payment Model ("Making Care Primary").   Episode Bookmarks: 01:30 Introduction to David Muhlestein, PhD, JD – one of the nation's leading value-based care research executives. 03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:30 The glacial pace of scaling payment model transformation and CMS’ goal of speeding the uptake of accountable care. 05:30 Industry challenges (e.g. supply chain disruptions, labor shortages, inflation, financial distress) that complicate value-focused investments. 07:30 The plateau of accountable care growth over the last three years in terms of total number of participating ACOs and lives covered. 08:30 The business model for value is supported by payment mechanisms, unique population health capabilities, and playbook approaches. 09:30 Who is really the customer of a health system?  (Is it the patient, the health plan, or physician practices that drive referrals?) 10:30 The capacity-focused world view of a FFS model – creating capacity for well-reimbursed services and then driving transactional patient volume. 11:00 The population health focus of VBC and how that creates conflicts within health systems optimized for fee-for-service capacity. 14:00 Changing the reality of an organizational culture dominated by FFS is increasingly more difficult in a post-pandemic economy. 15:30 Has anyone else noticed that the VBC solutions vendors at healthcare conferences are less predominant in recent years? 16:00 “When times are tough, organizations revert to the lowest common denominator that is their underlying business model.  That is the current challenge for value transformation.” 17:00 Recent stats on the growth trajectory and overall savings of Medicare ACOs over the last few years. 19:00 Average savings in the MSSP (after bonus payments) is about 1% relative to the projected benchmark.

In this thought-provoking episode, we delve into the transformative world of value-based care, exploring the multifaceted facets that are reshaping the future of healthcare. Join us as we dissect the vital components of this paradigm shift, from tackling social determinants of health and championing health equity, to seamlessly integrating behavioral health into patient care.  Discover how population health enablement is empowering communities, while bundled payments revolutionize the healthcare landscape. We'll also uncover the incredible role of technology and patient outreach, enabling unprecedented levels of personalized care and accessibility. And lastly, we navigate the critical importance of physician engagement, a driving force behind the success of value-based care. As we peer into the crystal ball, we envision the future role of hospitals, embracing change and embracing innovation. Joining us in the discussion this week are three important thought leaders in value-based care transformation: Dr. Caroline Goldzweig, Chief Medical Officer – Cedars-Sinai Medical Care Foundation Cynthia Deculus, Vice President and Chief Population Health Officer, Cedars-Sinai Dr. Michael Conseulos, Vice President Strategy, Growth, and Innovation Consulting at OptumInsight Get ready to be inspired as we illuminate the path toward a healthier, fairer, and more compassionate healthcare system. The journey starts now! This week’s episode is brought to you by Edifecs – an EMR-agnostic, interoperable, and AI-enabled technology helps providers unify and utilize data for a more complete digital portrait of patient populations. The result: better clinical, financial, and compliance outcomes.  To learn how Edifecs’ applications can enhance prospective risk adjustment and value-based contract performance, visit edifecs.com today.   This audio was re-purposed from a discussion that took place at the Pinnacle Value Based Care Symposium on April 24th, 2023.     Episode Bookmarks: 01:30 To learn how Edifecs’ applications can enhance prospective risk adjustment and value-based contract performance, visit www.edifecs.com  today! 02:30 This we ek’s episode is all about the VBC paradigm shift –from tackling SDOH and championing health equity, to seamlessly integrating behavioral health into patient care. 03:30 This week’s guests are Dr. Caroline Goldzweig (Cedars Sinai Medical Foundation), Cynthia Deculus (Cedars Sinai) and Dr. Michael Consuelos (OptumInsight) 04:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:15 “The true measure of any society can be found in how it treats its most vulnerable members.”  - Mahatma Ghandi 06:45 “We are finally seeing major movement in the direction of healthcare providers addressing social determinants of health.” 09:00 “There is so much more to making people healthy than just writing a prescription.  We must begin to impact how patients are living.” 11:00 Cynthia discusses how Cedars Sinai is helping patients navigate the totality of health and social needs, especially dual eligible Medicare patients. 14:00 Patients who have a chronic disease have a three to four times higher frequency of behavioral health comorbidities. 14:30 Cedars Sinai Collaborative Care Model – an overview of how Cedars Sinai is integrating behavioral health in the primary care setting. 16:45 How Care Teams at Cedars Sinai coordinate transitions of care and prevent ED overuse for patients dealing with a behavioral health condition. 18:00 Behavioral health provider workforce challenges and the role of technology and education to fill the void in providing whole-person care. 20:00 Depression screenings in primary care and the need for more inpatient psychiatry beds in the acute care setting. 22:00 34% of all deaths from cancer could be prevented if disparities in access to care were eliminated!

There is a dynamic interplay between health economics, patient-centricity, and value assessment—an intersection that holds the key to unlocking better health outcomes, improved access to care, and sustainable healthcare systems.  With the principles of health economics guiding our decision-making processes in healthcare, we can allocate resources effectively and maximize the value delivered to patients. Patient-centricity lies at the heart of this convergence, emphasizing the importance of putting patients and their unique needs at the forefront of healthcare delivery. Despite decades of investment in patient-centered health care, decisions about access and value are typically made in the context of financial risk management, and often without the input of those who should benefit from care. In addition to a myriad of payment reform strategies, rising interest in cost-effectiveness evaluation commands a central place in the debate about how to measure and pay for high-quality, efficient, and equitable health care. This week on the Race to Value we are joined by Dr. Jason Spangler, the Chief Executive Officer for The Innovation and Value Initiative (IVI).  The IVI is a collaboration of scientists, patient organizations, payers, life sciences companies, providers and delivery systems dedicated to finding scientifically credible approaches to measuring value in healthcare.  The IVI provides the technical knowledge, resources, and collaborative learning platform that facilitate exploration and application of value-based care. In this podcast episode, you learn how partnership with patients, researchers, and industry and purchaser stakeholders can build consensus on the scope and inputs  needed for value assessment models.  Only by assessing true value in health care will we win the Race to Value!   Episode Bookmarks: 01:30 Podcast Introduction with background on Dr. Jason Spangler, the Chief Executive Officer for The Innovation and Value Initiative (IVI). 03:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:30 Creating open-source models that allow researchers and decision-makers to explore, apply, and test scientifically credible approaches to measuring value in health care. 05:30 “The IVI is a nonprofit research organization that focuses on the science and the methodology for determining value, new medical technologies, and innovations.” 06:00 Health technology assessments (HTA) typically have only included payer perspectives (not the patient perspective!) 07:30 Going beyond the academic research understanding of value assessment to reflect real world patient experience. 08:00 How is patient-informed value assessment and comparative effectiveness research used to impact health policy at a national level? 11:00 Defining “value” from a health economist perspective provides the standard equation. 11:45 What is important to patients beyond the clinical outcomes – these must be measured too! 12:30 The costs of healthcare beyond the financial domain (e.g. time, future prospects, family) forces us to deviate from the simple value equation. 12:45 The “Value Flower” – the elements of value that are important to all stakeholders (e.g. QALYs Gained, Net Cost, Productivity, Equity, Hope, Knowing, etc.) 14:00 Asking patients what is important to them in the formation of specific patient-reported outcome measures. 15:00 “We typically look at cost effectiveness in terms of patient populations and averages. This must be balanced with individual patients or smaller patient communities.” 15:45 How good are we…really…in actually listening to patients?  Fee-for-service care complexity gets in the way of meaningful connection. 17:00 Using both qualitative and quantitative data to advance patient-centered innovation. 17:30 The IVI is driving innovation in value assessment through the Open-Source Value Projectwhich is a laboratory for advancing the science and im...

In this week’s episode, we embark on a journey into the realm of transforming rheumatology care with tech-driven value-based care. Autoimmune conditions affect millions of people worldwide, causing chronic inflammation, pain, and a host of complex challenges.  These patients often receive substandard care, as it takes almost 2.5 years to receive a diagnosis and patients often wait six months to receive an appointment with a rheumatologist!  This is often a neglected patient population in the movement to value-based care, but what if there was a new frontier of care that leveraged technology and a value-based approach to transform the lives of those living with autoimmune conditions? This podcast explores how a virtual specialty practice, centered on improving patient outcomes and reducing healthcare costs, is driving the transformation of rheumatology care.  We are joined today by Anuj Patel (Founder) and Dr. Elizabeth Ortiz, the CEO (Chief Medical Officer) from a new startup company called Motto Health. Anuj is a seasoned digital health innovator and operator with over 15 years of experience in the healthcare industry. And Dr. Elizabeth Ortiz is a board-certified rheumatologist with patient care experience ranging from large public medical centers to concierge practices.   Episode Bookmarks: 01:30 Where does rheumatology care intersect with the world of value transformation? 02:45 Introduction to Anuj Patel and Dr. Elizabeth Ortiz, the Founder and Chief Medical Officer respectively for Motto Health. 03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:00 The rheumatology workforce faces a deficit of physicians trained to provide high-quality care to patients with rheumatic diseases (only 0.5 rheumatologists per 100,000 people). 06:00 Chronic inflammatory conditions are very expensive to treat (e.g. the average healthcare cost for a patient with Rheumatoid Arthritis is $32k per year). 06:30 Why aren’t ACOs and other Risk Bearing Entities actively addressing this patient segment like they do patients with diabetes, CHF, COPD, or even kidney disease? 06:45 The epidemiological fragmentation of chronic diseases across the care delivery landscape. 07:30 Lack of overall marketplace adaptation in rheumatology care and treatment (e.g. specialty pharmacy injectables) to the shift in value-based care. 09:00 The wide breadth of conditions in the specialty of rheumatology and how that creates a “black box” for other physicians to understand. 10:15 Patients waiting so long to see a rheumatologist that it takes, on average, 2.5 years for a patient to receive a confirmatory diagnosis! 10:30 Rheumatology provider shortage worsening (50% of adult and 32% of pediatric rheumatologists projected to retire over the next 10 years). 11:30 The window of opportunity for clinical outcomes improvement if chronic autoimmune and inflammatory diseases are diagnosed early. 12:30 Limited capacity for rheumatologists to see new patients due to long persistence of disease and the shortage of providers. 13:00 How virtual care can increase access by offloading the maintenance burden of managing a large patient panel. 13:30 Enablement of expanded geographic access through a virtual care model. 13:45 “Virtual care delivery can democratize access for patients in need of rheumatological care.” 14:00 In Texas, 213 of 254 counties in the state do not have a practicing rheumatologist leading to 5M people without access to care. 14:45 A huge opportunity in value-based rheumatological care is to tackle the exorbitant specialty drug costs for drugs like Remicaid or Humira that have an annual cost of $70k. 15:00 Mark Cuban’s online pharmacy announced that it will be selling a biosimiliar of Humira for a steep discount. 15:30 Since 2016, AbbVie has raised the price of Humira 30X from $522 per syringe to $2,984 per syringe. 17:30 Biosimiliar adoption should not be over-indexed in valu...