Clinical Integration – The Race to Value Podcast™

In caring for our communities, a carefully designed Care Continuum Blueprint becomes the roadmap to enhanced population health outcomes—a testament to the profound impact of integrated care and strategic coordination.  There has never been a more compelling time to adopt a system of care based on population health management. The COVID-19 pandemic revealed substantial health disparities and compels us to take action. The population is aging, and the Medicare insolvency crisis is looming. Now is the time to move away from fee-for-service care and toward an approach that prioritizes quality, outcomes, and affordability for all populations.

In this week’s episode, we interview Dr. Mark Angelo, a senior administrator of a large accountable care organization and a leader in population health and palliative medicine.  He is the author of the new book Caring for Our Communities: A Blueprint for Better Outcomes in Population Health, that provides tactical guidance for developing effective population health programs and explores value-based care models. Dr. Angelo is an inspirational leader to the health value movement, providing a road map for creating an equitable, outcomes-focused system, using the right resources to nurture the health of our communities.

Dr. Mark Angelo currently serves as CEO and President for the Delaware Valley ACO (DVACO). In this role, he oversees clinical strategy and operations, including quality, population health pharmacy, clinical integration, care coordination, post-acute networks and practice transformation. In addition to serving patient communities as an executive with the ACO, he is a practicing palliative care doctor who continues to see patients.  DVACO has participated in the MSSP since 2014 and also works with commercial and Medicare Advantage payers in an effort to grow and expand the mission of value-based care in the Greater Philadelphia area.

Episode Bookmarks:

01:30 Introduction to Delaware Valley ACO and Mark Angelo, MD, MHA, FACP.

04:30 Referencing Dr. Angelo’s new book Caring for Our Communities:  A Blueprint for Better Outcomes in Population Health.

05:00 “Never doubt that a small group of thoughtful committed citizens can change the world; indeed, it is the only thing that ever has.”  — Margaret Mead

06:00 Dr. Angelo provides his perspective on population health underpinned by his clinical practice of palliative care.

07:30 A care continuum strategy that ensures care continuity, collaborative planning, and case management for complex patients.

09:30 The post-acute care journey at DVACO that began in 2014.

10:30 The Skilled Nursing component of DVACO’s post-acute care strategy.

11:30 Using claims data and real-time readmission tracing to monitor performance of SNF partners.

12:30 Graduating from a post-acute care focus to an overall care continuum strategy.

13:45 Optimizing home health to prevent avoidable hospitalizations.

14:30 How to identify suboptimal hospice care (e.g. length of stay greater than 180 days).

16:30 Home-based therapy as part of the care continuum to reduce TCOC in a frail elderly population.

18:00 An optimal zone of therapy between 12 and 32 therapy units over the course of a year.

19:00 Medicare reimbursement differentials across the different settings in a post-acute care continuum.

20:30 Building a population health playbook in post-acute care begins with SNFs.

22:00 Assessing performance data in developing a small SNF network to guide steerage decisions.

23:30 Applying the SNF assessment strategy in the vetting of preferred providers in home health and hospice.

26:00 Are partnering PAC facilities communicating with you in a meaningful way?

26:45 “Discharge planning shouldn’t happen in the last 24 hours of discharge. It should be happening all along. This is an important factor when it comes to creating partnerships across the care continuum.”

28:00 DVACO (in partnership with Main Line Health) developed a palliative care program that reduced hospitalizations by 50%!

28:45 “If you are an ACO and you are not focusing on your seriously illness population, you are missing a big opportunity.”

29:30 Developing an analytics methodology to identify patients with serious illness.

31:00 Guidance from Dr. Diane Meier, a nationally-recognized geriatrician and palliative care expert.

31:30 Improving lives of patients while decreasing costs at end-of-life through a home-based palliative care program.

34:00 Population health data that confirms the superiority of home-based palliative care (e.g. decreased hospitalizations and ED visits, increased hospice utilization).

37:30 Dr. Angelo provides leadership insights on how best to engage providers in population health approaches to care.

38:45 An example of supporting providers in VBC (a dedicated call center that connects resources to patients most in need).

41:00 SDOH and behavioral health resources for patients (e.g. addressing food insecurity to improve population health).

42:00 Another example in supporting providers in VBC (a successful aging program).

43:00 In-home wellness assessments for patient (e.g. medication reconciliation, dietician and care coordinator consults).

44:45 “We help our providers to better care for patients at the point of care. That is a great way to get providers to want to be part of your ACO.”

46:00 Health equity as a societal flashpoint and the challenges of inequality in the Greater Philadelphia area.

47:30 How DVACO provides a health equity lens in the design and implementation of all population health programs.

48:45 The need to compare QM results between population segments (e.g. an overall mammogram completion rate of 88%).

49:30 How the pandemic highlighted health inequities and reframed opportunities for improving population health.

50:00 “In an Accountable Care Organization, you’re responsible for managing the care of your community, not the care of a fraction of your community.”

52:00 The impact of social isolation on frail and elderly populations.

52:45 People experiencing social isolation have a higher risk of heart disease, stroke, depression, and anxiety.

53:45 Surgeon General Dr. Vivek Murthy’s call to action to address “the epidemic of loneliness” as a public health crisis.

54:00 The correlation between excess utilization of healthcare services and social isolation.

55:00 Building bridges with Community Benefit Organizations to address social isolation.

57:00 The emerging “payvider” trend and how Humana became a valued partner in Delaware Valley ACO.

58:45 The benefits of a strong payer relationship within an ACO.

60:00 “Payvider relationships say to the market that we are laser-focused on the success in value-based programs.”

61:00 The Infinite Game: “Infinite-minded leaders don’t ask their people to fixate on finite goals; they ask their people to help them figure out a way to advance toward a more infinite vision of the future that benefits everyone.”

63:00 Parting thoughts on balancing fee-for-service with the “infinite game” of value-based care.

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).

22:00 Building a technology enablement ecosystem within a high-touch, integrated care model for senior living communities.

23:00 Value-based care technology adoption starts with the input from the clinical care teams.

24:00 Seeking technology enablement for both common and specialized challenges.

26:00 Developing technology partnerships with intentionality. Augmenting those partnerships with internally-developed customized analytical and educational solutions.

28:45 A survey by Leavitt Partners and NAACOs shows that only a 10% of ACOs selected palliative care as a top priority for improving efficiency and lowering costs.

30:00 Mark provides perspective on the importance of palliative care and advanced  care planning in their senior-focused care model.

33:00 Many nursing home providers operate on thin margins and have been squeezed tighter as they’ve struggled with occupancy.

34:00 Chapter 11 bankruptcies among nursing homes and senior living operators continue to increase and show no signs of abating going into next year.

35:30 The impact of the pandemic on the senior living industry.

36:30 The workforce challenges faced by nursing homes.

37:00 Financial impact of rising variable interest rates on nursing homes attempting to service their facility debt.

38:00 CMS-imposed staffing mandates on Skilled Nursing Facilities.

38:45 The impact of aging baby boomers on distressed SNFs and senior living facilities.

40:45 Collegiality and information sharing is important to advance value-based care transformation across the country.

41:30 Skilled Nursing and Senior Living communities traditionally ignored value-based care (and how they are now waking up!)

43:30 Success in the future requires us to think differently than we did in the past.

44:30 Up to $265 billion worth of care currently delivered in traditional facilities for Medicare FFS and MA beneficiaries could shift to the home by 2025.

46:45 Post-acute skilled care will increasingly move to the home in the future.

48:00 The significant demand for senior resident models in the future.

49:30 Mark discusses why technology won’t disrupt the senior living space like it will other sectors in care delivery.

52:00 CMS’s goal of having every Medicare beneficiary in an ACO or ACO-like model by 2030.

53:00 Americans aged 65 and older will more than double over the next 40 years —  reaching 80 million in 2040.

53:45 Parting thoughts of optimism on the imperative for value-based care transformation in the country.

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, and preparation in winning…while also overcoming losses).

16:00 Wellvana has raised $140 million in capital since 2021 and is now in 22 states, reaching more than 100K lives through multiple payers, Medicare Advantage and ACO REACH.

17:30 Building large high-touch primary care networks at scale requires behavior change.

18:15 Aligning a high-quality specialty network with tech-enabled primary care to achieve appropriate procedural utilization and lower costs.

19:00 Merging High-Touch with High-Tech (“Technology as a standalone solution doesn’t work well in healthcare today. You have to wrap services around it to drive behavior change.”)

19:45 Building Capabilities to Improve Care for High-Risk Patients (“The ability to transition into fully-capitated risk is impossible for a doctor to do on their own.”)

20:30 The connection between improved patient outcomes and higher profitability — a patient success story showing how high-touch care management reduced avoidable ED utilization.

22:00 The power of effective storytelling in value-based care transformation.

24:00 Kyle discusses how Wellvana utilizes storytelling to revitalize care teams and provider partners in creating positive change.

26:00 The Challenging Politics of Value-Based Care (differing ideologies, debates about government involvement, conflicting interests and lobbyists, uncertainty about implementation, economic concerns, partisan politics).

27:30 Kyle shares insights from his involvement in advocating for value-based care on Capitol Hill.

28:30 The evidence that fully-capitated models work despite low market penetration in Medicare (e.g. MA <10% full-risk, ACO REACH).

29:00 How Wellvana educates legislators on the importance of frontloading savings payouts and provider aggregation in networks to drive success in fully-capitated risk.

30:00 Advocacy in patient communities is just as important as political advocacy.

31:00 How Wellvana engages and educates patients on the purpose of value-based care and care planning.

32:00 “To win long-term in this industry, you’re going to have manage medical spend more effectively. We do this by engaging patients in way that can drive behavior change.”

33:30 Wellvana co-founder, Charlie Martin:  “Building a Sustainable Economic Model for Lifestyle Medicine”

34:45 Kyle discusses the importance of Lifestyle Medicine in creating a holistic, patient-centered wellness model.

35:45 Wellvana is conducting a clinical trial study on LM with the goal of applying broader findings that drive behavior change at scale.

37:30 Are investors placing more bets on value-based care enablement?

38:30     The runway for value-based care companies in the current investment landscape and why PCPs relationships are so critical to success.

39:30 Digital health and AI solutions will support primary care value transformation.

40:00 Nashville as the epicenter of healthcare investment.

41:00 ACO REACH as an inflection point for adoption of fully-capitated risk in the primary care setting?

42:00 How fully-capitated models will strengthen the connection between improved SDOH interventions and Health Equity outcomes.

43:45 Kyle discusses the future of Wellvana in terms of continued growth and sustained high performance.

46:00 “Success in value-based care is not about the speed; it is about overall outcomes and finding the right partners to take risk.”

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.”

25:30 The need to include minority populations in clinical research trials.

26:00 The importance of literacy in the messaging of prevention strategies.

26:45 Conscious vs. Subconscious Racial Bias and the accountability for health leaders to address both.

29:00 The critical need to have a well-trained, qualified, and more culturally-competent health workforce that mirrors the diverse population it serves.

30:45 An opportunity for health systems to overcome division in communities through staffing and training models.

31:30 How Circles USA gathers middle-income and high-income volunteers to support families in poverty.

32:30 Health leader participation on nonprofit CBO boards can enhance understanding of lived experiences in a community to advance health equity.

33:30 Empowering the clinical workforce to understand why outcomes are different in minority cultures.

35:00 “Listening to others without judgement improves our ability to be a colleague, parent, healthcare worker, or problem solver when we realize a disparity exists.”

36:00 The epidemic of behavioral health and Substance Use Disorder.

37:00 “ As healthcare leaders, our goal is to make behavioral healthcare a convenient, routine, everyday part of one’s life so that people can reach their fullest potential and, more importantly, find — hope.”

38:00 Solving complex problems in community health through multi-level thinking.

39:00 How COVID-19 made mental health challenges more visible.

39:45 Social connection, health and wellness, and access to support services as an access point for improved societal wellbeing.

41:00 The failures of the criminal justice system in recognizing mental health issues.

41:45 Increasing access to outpatient therapy and acute response to behavioral health conditions.

42:15 Creating a continuum of access to behavioral health services by normalizing conversations in the workplace.

43:30 How the flawed economics of fee-for-service create inequities in maternal health outcomes.

45:30 The implications for improved maternity services and patient engagement in a community health model.

47:30 Creating the right incentives for improved maternal health with value-based payment.

48:45 The need for employees to emphasize person-centered maternal health care.

49:30 Innovative employers as a template for redesigning Medicaid within a state.

50:30 The potential for hospitals and health systems to become an anchor institution for community health.

52:30 How an anchor institution can contribute to both economic and community health.

54:45 Investment allocations and staffing decisions that can support a “do both mindset” as an anchor institution.

57:00 The impact of consumerism on the improvement of community health.

58:00 Looking to other industries for a consumer-centric view of what healthcare could be.

59:00 Transforming to a more consumer-centric definition that values “health” and “wellness” over “healthcare.”

59:45 Partnerships and listening to what people need as a catalyst to system transformation.

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 value-based care. We must first prioritize site of care and treatment plan adherence.

18:30 Inpatient hospital settings cost much more for drug infusions. (VBC opportunity to shift infusions to the practice setting.)

19:15 The importance of an integrated Lifestyle Medicine model in managing chronic inflammatory conditions.

20:00 Dr. Ortiz explains how biologics have changed the landscape of rheumatology care.

21:00 The factors to consider when safely titrating a patient off of an expensive biologic drug.

22:00 Sleep and stress management are more important than diet when controlling an autoimmune condition.

23:00 The prevalence of Rheumatoid Arthritis among employees can lead to a substantial burden on employers in terms of productivity loss, absenteeism, and healthcare costs.

25:00 Providing better access to rheumatology care for employers providing health benefits to their workers.

26:30 Treating patients sooner leads to lower healthcare costs and improved workforce productivity for employers.

27:00 Rheumatological care requires more than just the specialist – the need for physical therapy and diet and health coaching.

28:00 Allostatic load (the cumulative physiological wear and tear on the body that occurs in response to chronic stressors) impacts inflammation.

28:30 The connection between allostatic load and inflammation as a contributing factor to health inequities in underserved populations.

29:30 Dr. Ortiz discusses the relationship between stress and autoimmune conditions; however, stress management is underutilized as a treatment tool.

30:00 Allostatic load over time can actually lead to the development of an overactive immune system which then, in turn, leads to an autoimmune disease.

30:30 Adverse childhood events, PTSD, and the stress of discrimination leading to more severe chronic diseases in African American population.

31:00 How do stressful social structures lead to devastating outcomes with Lupus in African American populations?

33:00 “The data shows that diet, stress management, sleep, exercise, and a sense of community all favorably impact clinical outcomes with Rheumatoid Arthritis.”

34:00 The benefits of an anti-inflammatory Mediterranean diet and exercise in managing inflammatory conditions.

34:45 The importance of health coaching in implementing lifestyle programs to improve patient engagement and accountability.

36:00 Longer life expectancy in Blue Zone regions due to improve connection with community.

36:45 The psychological impact of social isolation during COVID-19.

37:00 Research shows how chronic inflammation can significantly impact mental health and increase the risk of developing depression and anxiety disorders.

38:30 Dr. Ortiz discusses the bidirectional relationship between inflammation and mental health and how mental health issues complicate patient outcomes.

40:30 How Motto Health’s virtual care platform brings additional benefits of team-based care and scalability in rheumatology care and mental health support.

41:30 Combining collaborative and longitudinal care to reach an inflection point in the virtual delivery of behavioral health care.

43:00 Dr. Ortiz on the essential role of rheumatology care and other specialties in understanding and addressing Long COVID.

45:00 Challenges to expand rheumatological capacity – no increases in fellowships in practice and over half of the rheumatologists in practice are experiencing burnout.

45:30 Enhanced partnership between rheumatology and primary care to alleviate lack of rheumatological capacity.

46:00 The need for more integrated services that are reimbursable to improve care of autoimmune patients.

47:00 Medical education costs and high student loan debt burden causes a shortage of rheumatologists.

47:45 Anuj shares his vision for the value-based future for rheumatology care.

48:45 How capitation arrangements and incentives alignment creates a long-lasting, longitudinal care model in rheumatology.

50:45 What is Motto Health and how does it bring VBC and consumerism to rheumatological specialty care?

We have Dr. Omolara Thomas Uwemedimo as a guest on this week’s Race to Value! She is a healthcare social entrepreneur, board-certified pediatrician, community health equity consultant, career transition and business coach, public health researcher, and health justice advocate. She is currently the CEO and Co-Founder of Strong Children Wellness, a multi-award winning healthcare practice in New York City, providing integrated, physical, mental, and social health services for low-income communities of color.

Back in 2019, Omolara lost her ability to walk. She was diagnosed with Multiple Sclerosis, a chronic autoimmune condition. During her recovery, she became a staunch wellness advocate for women of color who in healthcare often experience disproportionally higher rates of chronic disease due to weathering – the deterioration of one’s health due to medical racism and toxic environmental stress in the workplace and in society.  In response, she founded “Melanin and Medicine”, a community health equity consulting and social entrepreneurship company that helps women of color thrive by building purposeful careers within healthcare enterprises.  She also has a weekly podcast called “Funding Your Healthcare Vision” that helps visionary leaders of health centers & practices to secure grants, contracts and other funding to strengthen, scale & sustain their vision, mission & impact to support under-resourced communities of color.

With her leadership insights, you too can break the barriers to health justice by building a healthcare social enterprise built on CBO partnerships and social impact innovation!

Episode Bookmarks:

01:30 Introduction to Dr. Omolara Thomas Uwemedimo (CEO and Co-Founder of Strong Children Wellness, founder of Melanin and Medicine, and host of Funding Your Healthcare Vision).

04:00 The intersection of Social Entrepreneurialism and Value-Based Care, where private profit creates public good.

06:30 The difference between “health equity” and “health justice”.

07:00 Creating health justice for a psychosocially complex Medicaid patient population dealing with social and mental health challenges.

07:30 Working with grant partners and Community Benefit Organizations (CBOs).

08:30 Closing the loop between physical health and social determinants of health (SDOH).

09:00 Overcoming a flawed business model by moving physical health care delivery into the CBO setting.

09:30 Aligning the public health interest in patient outcomes with economic incentives.

09:45 How healthcare capitation (PMPM reimbursement) merges with philanthropy dollars to drive holistic care delivery.

10:00 “The collective impact of capitation and philanthropy is the precipice of an integration model that makes an impact with payers and patients.”

11:00 The majority of healthcare organizations are not conducting place-based interventions to improve health equity and create health justice.

12:30 The fatigue of healthcare providers dealing with under-resourced communities.

13:30 Starting with the patient first by addressing the referral process in addressing social health needs.

14:00 Developing a social navigation workforce as a baseline to deliver primary care to Medicaid populations.

15:00 Funding a healthcare social enterprise through embedded CBO partnerships (“reverse integration”).

16:00 “We thought we were dealing with psychosocially complex patients until we integrated our care model with CBOs.  This in where the impact can be made in VBC.”

16:30 Identifying the right community organizations (e.g. homeless shelters) in creating a holistic care model.

17:30 Securing over $2 million in grant funding within a community health network and working with other BIPOC, women-led healthcare practices to create sustainable health justice.

19:45 “Human social organizations are an essential leader in health.  We must think beyond the delivery of care when building a mission-driven healthcare social enterprise.”

20:00 What is in your arsenal beyond just clinical care? (e.g. community health education, training staff in patient counseling).

21:30 Making the math “work” with your targeted patient population (e.g. underserved youth, undocumented immigrants).

22:30 Using your innovative advance primary care model to pitch potential funders.

24:00 An example of the largest Medicaid payer in New York offering a PMPM for patient navigation services.

26:30 The “interrogation phase” of a healthcare business model to identify strengths, values, virtues, vulnerabilities, and threats.

27:45 Finding operational gaps in the social and cultural responsiveness of staffing to address community needs.

28:45 Evaluation of profit margin and financial burn rate to best understand scale and impact in population health.

29:00 Leveraging technology for virtual care efficiency.

29:30 Progression to the “innovation phase” with verifiable frameworks developed in due diligence.

30:00 Focusing on optimizing one service line at a time (e.g. outsourced clinical delivery, consulting, provider training, decentralizing information).

31:00 The importance of an evidence-basis in developing a fundable community vision.

31:30 The “identification phase” within a community needs assessment to identify the right partners.

32:00 The Five M’s:  Market Buy-in, Mission Alignment, Money, Management focused on justice, and Missing services?.

33:00 Connecting with key stakeholders to make an elevator pitch for funding.

33:45 Co-creating a collaborative partnership and implementation of an integrated model.

34:00 Setting up a legal structure and the necessary agreements for a successful CBO partnership.

36:30 Conducting pre-visit screenings and risk assessments for social and behavioral needs to help families navigate the services enrollment process.

38:00 The ethical balance of conducting comprehensive screenings with the capability to actually implement the necessary SDOH interventions.

38:45 Supporting nurse educators and patient navigators in seeing SDOH in the same way as they see vitals.

39:30 “Knowing a BP is just as important as knowing that a patient is positive for a Food Insecurity screen. The navigators are the linchpin, and the care coordinators are the glue.”

41:00 Not a single CBO partner can handle everything for a patient. (The importance of having both a referral and a follow-up process.)

43:00 The Medicaid Health Home program in New York as a laboratory to pursue social impact innovation.

45:00 Negotiating a Medicaid PMPM model to deliver population health and subsidize navigation in FFS.

46:30 The New York 1115 Medicaid Waiver to provide subsidies to Regional Health Information Organizations (RHIOs).

47:00 An inflection point in VBC:  The people in clinical care are not always the ones to ensure population health justice.

48:45 Cultural competence as the bedrock of a great patient-provider relationship.

50:00 Referencing a recent study that shows that black patients receiving care from black residents had lower all-cause mortality rates and longer life expectancy.

51:00 How can white-owned or white-led healthcare organizations become more culturally responsive?

52:00 Diversity, Equity, and Inclusion (DEI) to best support patients and families in medical decision-making.

53:00 Preventing burnout with BIPOC Founders as a key to save Primary Care and build Health Justice.

54:00 The recent suicide of Dr. Nakita Mortimer, a black female Anesthesiologist, as a cautionary tale for BIPOC physician burnout.

55:45 A personal patient story that illustrates how social impact funding transformed the life of a child and his family.

60:00 How to reach out to Dr. Omolara to learn more about how to build a healthcare social enterprise.

In rural communities, the transformation towards value-based care is an ongoing journey rather than a fixed destination. Rural healthcare faces unique challenges such as geographic barriers, limited resources, and reduced access to specialized care. The value journey in these communities involves adapting care models to meet the specific needs of rural populations. It requires innovative solutions to overcome barriers which can bridge the distance between patients and healthcare providers.  It represents a fundamental shift in healthcare delivery, focusing on improving patient outcomes, enhancing the patient experience, and controlling costs. Ultimately, this journey involves continuous adaptation, collaboration, and innovation that is fostered by a mission-driven culture to improve community health and wellbeing.

One of this nation’s leading examples of value-based rural health transformation is the Bassett Healthcare Network, and we are joined this week Leonard Lindenmuth, their Vice President of Strategy and Population Health.  Since 2014, he has been leading value-based care transformation throughout Central New York. In this episode you will learn about what it takes to lead a successful value journey through a cultural evolution that increasingly seeks innovation to improve rural health outcomes.  We discuss such topics as risk progression, the use of commercial ACOs as a learning laboratory in value-based care, population health playbook success that focuses on pharmacy optimization and interdisciplinary team-based care, deploying remote patient monitoring to rural populations, how workforce burnout is related to fee-for-service payment, and the importance of SDOH innovation to better serve vulnerable patients in underserved communities.

Episode Bookmarks

01:30 Introduction to Leonard Lindenmuth, DHA – Vice President, Strategy & Population Health, Bassett Healthcare Network

02:00 Bassett Accountable Care Partners, LLC – BHN’s Accountable Care Organization founded in 2014

03:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.

05:30 How a data-enabled value-based care journey changed the culture of the health system.

05:45 “The value journey helped us understand much more about ourselves so we can better care for our rural communities. It has evolved our culture.”

06:00 A calculated progression to downside risk as a rural healthcare provider.

09:00 An increase in Medicare Advantage penetration in the marketplace and how that is impacting value-based care strategy.

10:00 Developing a co-branded regional MA product and the intention to take aggregated risk with a national MA plan.

12:00 Leveraging brand equity of the health system to develop a MA plan in the future.

12:30 Approaching MA risk-readiness of providers through coding education.

13:00 “MA Risk is clearly on the horizon.”

14:45 Leonard describes BHN’s commercial value-based playbook strategy that includes focus on pharmacy spend.

15:30 The Ambulatory Intensive Pharmacotherapeutics (AIP) program to reduce pharmacy costs through lower medication-related adverse events, avoidable hospital admissions and ED visits.

16:00 How the AIP program reduced BHN’s commercial spend on pharmacy through comprehensive medication management.

16:30 1% of the population drives 55% of specialty drug costs.

17:00 Risk progression in a two-sided risk arrangement with Excellus Health Plan (a local Blue Cross affiliate).

18:00 What being in a Commercial ACO has taught BHN about value-based care transformation.

18:30 How a rural health system balances the “two canoes” – volume vs. value.

19:00 “We have to get to a point where value drives the equation, but it is not an overnight transformation.”

19:30 How a healthcare organization performs better – both financially and clinically – under a fully-capitated environment.

21:30 An alarming divergence of health outcomes and life expectancy between urban and rural populations.

22:00 The challenges of improving population health in rural communities that are highly agricultural and farm-based.

23:00 Leveraging remote patient monitoring and other digital devices to better serve rural populations in upstate New York.

24:00 Bridging the digital divide in rural communities where access to broadband access is limited.

24:45 The Bassett Research Institute conducts research to understand and improve the health and well-being of rural populations.

25:00 Leonard describes the rural community of Cooperstown, New York and how their patient population is challenged by SDOH (lack of transportation, housing instability, food insecurity).

26:00 Medicaid expansion in New York fostered partnership and innovation with Community Benefit Organizations (ex: partnership with a local food bank).

28:00 Creating an anchor institution in a community where the health system is an enabler of improvement in social determinants of health.

29:00 Moving the needle on value by moving closer to the premium dollar and building infrastructural capability to manage delegated premiums from payers.

30:00 The maldistribution of premium dollars that disproportionately benefits insurers through excess profits (at the expense of health system investment to improve patient outcomes).

31:30 The imperative to adopt a payment system that supports lower costs and improved population health outcomes.

32:00 The importance of knowing trends in medical claims costs and utilization.

33:00 Being conscious of what you are getting into when it comes to assumption of risk-based payment.

33:45 Lessons learned from building a vertically integrated system and how that informed perspective on opportunities in a risk-based world.

34:45 Referencing prior podcast — Ep 141 – Cultivation of Physician Wellbeing in the Value Journey, with Dr. Dike Drummond, Dr. Moshe Cohn, Dr. Amadeo Cabral

35:00 How capitation can alleviate workforce burnout and moral injury.

36:00 The unsustainable pharmaceutical cost trajectory, with Americans spending an average of over $1,500 per person on prescription drugs, paying much more than comparable nations.

37:00 Leonard discusses the challenges of pharmacy spend and how Comprehensive Medication Management (CMM) has become an important area of focus in their population health playbook.

39:30 Understanding disease-specific use cases for pharmacy optimization and the340B Drug Pricing Program.

40:30 “Increased pharmacy spend is only acceptable if it crowds out medical spending on the inpatient side.”

41:30 The role of pharmacists in interdisciplinary team-based care and how they can meaningfully collaborate with physicians.

43:30 Value-added pharmacy programs that create a win-win-win for patients, providers, and payers.

45:00 The ticking timebomb of the healthcare workforce!

46:30 Alarming rates of nursing turnover resulting in higher costs due to increased reliance on agency nursing.

48:00 “At any given shift, we are down anywhere from 6-16 nurses. We have the demand to fill our beds, but we can’t get them in because of the nursing shortage.”

49:00 How nursing burnout is ultimately related to the dependence on a fee-for-service payment model.

50:45 New York is one of a number of states that is attempting to address the social needs of Medicaid enrollees through Section 1115 waivers with SDOH-related provisions.

53:00 Economic development zones and SDOH networks in New York supported by Section 1115 demonstration projects.

55:00 Examples of innovative SDOH programs (ex: giving patients free air conditioners to prevent acute exacerbations of chronic asthma).

56:30 Tackling disparities in care through VBC will drive community health outcomes (more so than philanthropic support of CBOs).

58:00 Parting comments on the challenges of health equity transformation.

Medication adherence remains an important yet vexing issue in American health care. According to the World Health Organization, medication adherence can have a more direct impact on patient outcomes than a specific treatment itself. Still, it is estimated that a staggering 50% of Americans don’t take their chronic long-term therapy medications as prescribed. Statistics show that each year, poor adherence contributes to more than $500 billion in avoidable health care costs, around 125,000 potentially preventable deaths, and up to 25% of hospitalizations in the United States.  This issue of medication adherence is so important, yet so vexing to solve for because it is so multi-faceted and entrenched into the business economics of healthcare.  In this Race to Value, we must find a better way to ensure affordability and promote adherence to medication therapies.  This is a life or death situation – both from an economic and a clinical perspective.  If we don’t find solutions to improve medication adherence as part of value-based care, patients will die.  And eventually, the weight of the entire healthcare system will collapse upon itself due to the unsustainable costs that are incurred due to avoidable healthcare utilization that medication adherence would have prevented!

Our guest this week is Jason Rose, a leading expert on the trillion dollar impact of the medication adherence issues in our country and what can be done to address them. Since 2018, Jason Rose has been spearheading value-based care as CEO of AdhereHealth. The innovative technology company is focused on transforming healthcare by leveraging intelligent data analytics, promoting medication adherence and working with patients to resolve social determinants of health. Customers are managed care companies and employers looking to improve quality of care and reduce costs for their patients and employees, respectively. After one year in his role, AdhereHealth experienced its fastest-ever year of growth and has grown from about 100 employees to nearly 1,000 employees over the past three years.  This is a leader in the value-based care movement that you should be listening to, as medication adherence is one of the most critical challenges to overcome in the transformation of our industry.

Episode Bookmarks:

01:30 According to the World Health Organization, medication adherence can have a more direct impact on patient outcomes than a specific treatment itself.

01:45 50% of Americans don’t take their chronic long-term therapy medications as prescribed.

02:00 Poor adherence contributes to more than $500 billion in avoidable health care costs, causes 125,000 potentially preventable deaths, and up to 25% of hospitalizations.

03:00 Introduction to Jason Rose, a leading expert on medication adherence and CEO ofAdhereHealth.

04:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.

06:30 If unabated, medication non-adherence will soon be a trillion-dollar problem with no end in sight.

07:00 Jason discusses the financial impact of non-adherence and the criticality of addressing this issue in healthcare.

08:00 “Medication non-adherence should be one of the top issues in all of healthcare, given the size of the actual problem.”

08:30 How value-based care programs can improve adherence outcomes in both senior and commercial populations.

10:00 A series of factors, rather than a single one, determine patients’ ability to follow treatment recommendations correctly.

11:00 Jason discusses the impact of social determinants of health (SDOH) on medication adherence.

12:00 How SDOH symbolize the “Maslow Hierarchy of Needs for Health Care” (e.g. safe drinking water, transportation, health literacy).

13:00 A critical decision point – paying for the food of a beloved pet instead of purchasing lifesaving medication!

14:00 Referencing Jason’s recent AJMC article: “Medication Adherence is a Force Multiplier for Medicare Advantage Profitability, Enrollment, and Star Ratings”

15:00 70% of MA prescription drug plans earned a rating of 4.0 Stars or higher in the 2022 Star Ratings compared with 49% for 2023.

16:00 Medication-related measures make up 52 percent of the overall Stars Ratings weighting, and adherence measures for cardiovascular, hypertension, and diabetes are all triple-weighted.

16:30 The exacerbation of chronic diseases during the COVID-19 pandemic and implications on value-based adherence programs.

18:30 Jason explains the reason for the year-over-year MA Star Ratings adjustment due to lower health plan investment and more competitive ratings.

19:30 How Hemoglobin A1c quality measures for diabetics relates to medication adherence.

20:30 33% of Star Ratings relate to patient experience, and these CAHPS measures will suffer if plans to perform well in medication adherence measures.

21:00 “It is quite obvious and logical that medication adherence outcomes is exactly what CMS is focusing on with quality measurement.”

21:45 How CMS will be “tripling down” on medication adherence outcomes related to MA Star Ratings.

22:30 The importance of achieving the 4 Stars (or above) to unlock needed health plan profit margin to compete in the open MA marketplace. (“Darwinism in Healthcare”)

24:30 More than a quarter of 30-day hospital readmissions are directly tied to medication adherence reconciliation issues.

25:00 AdhereHealth Survey: 62% of discharged patients would have had at least one drug therapy problem that would have gone unaddressed without telepharmacy outreach.

26:00 Jason discusses why CMS will soon be retiring Medication Reconciliation Post Discharge (MRP) measures for higher-weighted Transitions of Care (TRC) measures.

26:30 How TRC measures will emphasize PCP admissions and post-discharge notifications along with increased emphasis on medication reconciliation.

28:00 25-40% of medication issues related to lack of reconciliation (referencing a personal story of a patient that almost died because of taking two different statins).

29:00 The need for automated clinical workflows to drive provider notifications and data-analytics to identify drug therapy problems.

30:30 For every 100 prescriptions written, just 50 to 70 are ever picked up at the pharmacy. Once a patient leaves the pharmacy, a mere 25% of the medications are taken as directed at home. And then just a fraction—15% to 20%—are refilled.

31:00 A typical Medicare beneficiary saw a median of 7 physicians per year, highlighting the need for more coordinated, multifaceted strategies in medication management.

32:00 Home care is expected to increase nearly 4-fold by 2025, comprising up to $265 billion in care services (a quarter of the total cost of care for Medicare fee-for-service and MA members).

33:00 Lack of clinical integration and interoperability contributes to poor medication reconciliation in the healthcare industry.

34:00 Fee-for-service incentives do not align with improving medication adherence outcomes.

35:00 The need for health plans to reconcile drug utilization data with a targeted list of patients for which medication adherence outcomes could improve.

36:00 “Seventy-percent of medication adherence problems are related to patients not taking the drug they were prescribed. It’s not even low adherence; it is no adherence.”

36:30 How a value-based care environment provides an incentives platform for collaboration and co-development of tools to address non-adherence.

38:00 Public-private partnerships (like Medicare Advantage) as the best opportunity to drive value-based care.

38:30 The lack of chronic care management and focus on medication adherence in the home health environment.

40:00 How the lack of care management analytics for home health providers causes them to “fly blind” in their clinical workflows for medication-related issues.

41:00 The opportunity for medication adherence analytics and real-time data to improve clinical outcomes for home-based patients!

42:30 Collaborative care models that include a clinical pharmacist have been shown to alleviate some of the demand for physician-provided care and facilitate access to primary care services.

44:00 Jason discusses the need for more integrative models of care that utilize a team-based, multidisciplinary approach.

44:30 How Walgreens and CVS are freeing up the dispensing time of pharmacists so they can spend more time counseling patients.

45:30 The opportunity for ACOs to enable pharmacy-led interventions with targeted high risk patients.

46:30 Polypharmacy (the use of 5 or more prescription medications) is present in nearly 20% of the U.S. population and 40% of the population over 65 years or age.

47:00 Nearly 20% of seniors take 10 drugs or more, which can lead to a higher risk for adverse reactions and drug interactions!

48:30 How AdhereHealth is accessing reference databases to drive real-time analytics that identify potential over-prescribing of drugs.

51:00 The importance of capturing patient-reported data in a medication management program.

52:00 Over 75% of all ambulatory communications are over facsimile (fax machines) – not EHRs!

54:00 The moral imperative of ensuring that diabetics can afford life-saving insulin.

54:45 Price gouging by the pharmaceutical industry – a vial of insulin now costs about $300 — roughly 30,000% more than the original cost of the patent!

55:00 Eli Lilly’s recent announcement that it will slash its high list prices for some of its insulins and will immediately offer programs to limit out-of-pocket costs to $35 per month.

56:00 Jason explains why the Eli Lilly change was not voluntary and is more related to regulation by the Inflation Reduction Act.

57:00 According to IQVIA Institute for Human Data Science’s 2020 report, prescription abandonment rates are less than 5% when the prescription carries no out-of-pocket cost; it rises to 45% when the cost is over $125 and to 60% when the cost is more than $500.

58:00 Optimism for the future in the lowering of prescription drug prices.

59:00 Real-time benefit checking of formularies at the point-of-care.

60:00 The future of medication adherence to be addressed in value-based care through partnerships and collaboration.

61:00 Medical cost inflation as a continued challenge for those taking risk.

62:00 How AdhereHealth is bringing patient-centered solutions to the marketplace to guide clinical outcomes and improve patient relationship management.

In value-based care, we have both an economic and a moral imperative.  What’s at stake is so much more than saving our healthcare system. It is about ensuring the continued prosperity of our nation to ensure that we leave it better for future generations. The best indicator of whether our country is on the right path is the assurance that healthy mothers can give birth to healthy children. And those children, in turn, must be assured of good care and a sound education that will enable them to face the challenges of a changing world. If we could have but one generation of properly born, educated, and healthy children, many of the insurmountable problems in our country would vanish in our lifetimes.

This week on the Race to Value, you are going to hear from a value-based care leader who is boldly moving beyond with a call to action to serve our nation’s youth. Karen Wilding, the Chief Value Officer at Nemours, is on a passionate pursuit of the Quadruple Aim, and her health system is redefining children’s health in our country. Nemours Children’s Health is truly “leaning in” to the promise of population health by transforming the very definition of what it means for children to be healthy. And their value journey reflects a bold vision to create the healthiest generations of children that will take us beyond medicine by ultimately impacting the world. If you are looking for an example of inspirational leadership in value-based care, look no further than Karen Wilding and the Nemours Children’s Health System!

Episode Bookmarks:

01:30 “If we could have but one generation of properly born, educated, and healthy children, many of the insurmountable problems in our country would vanish in our lifetimes.”

02:30 Introduction to Karen Wilding, the Chief Value Officer at Nemours Children’s Health

03:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.

05:45 Karen describes the whole-person care orientation at Nemours and how the mission of “Well Beyond Medicine” guides their value-based care journey.

06:45 Social Determinants of Health (SDOH) screening in underserved populations to expand care network and create community partnerships.

07:45 Driving “macro-system impact” as an anchor institution (e.g. best practice clinical research, cross-sector partnerships, health equity investments)

08:30 Health Equity opportunities in pediatric whole-person care (e.g. teen birth rates, preventative care access, infant mortality rates…and even household income).

09:00 “Well Beyond Medicine is a commitment to not just care for the medical aspects of children – we also care for the larger health ecosystem to create whole-child health and healthier generations.”

11:45 “Payment transformation is foundational to being able to create sustainability in value-based care.”

12:30 Karen explains how the fee-for-service infrastructure does not align incentives for healthy outcomes (e.g. asthma exacerbations with children in Delaware).

13:30 “Investing in children’s health is the single most important thing we can do as a society.” (balancing present-day economics vs. future economics).

14:45 Partnering with payers to pursue health equity transformation and the importance of community-based investments.

16:45 Nemours has been utilizing Community Health Workers to conduct SDOH screenings and individualized interventions through a culturally competent care model.

17:45 Karen explains how the interdisciplinary care team at Nemours works together to capture, assess, and address SDOH barriers.

18:45 The importance of enterprise-level buy-in when launching a SDOH population health strategy.

20:30 Overcoming fears and concerns of families in sharing personal information about their social barriers.

21:00 The creation of a national toolkit on whole-child population health and how Nemours is collaborating with policy stakeholders at the federal level.

23:30 “We want to be where children live, learn, play, and grow.  In order to address health in communities, you need partnerships.”

24:00 The role of virtual care and home health in a community-based ecosystem.

25:00 Karen describes how Nemours provides physical and behavioral health services in partnership with elementary schools.

26:00 Working with CBOs and faith-based organizations to address SDOH barriers in communities.

27:00 Partnering with government agencies (e.g. juvenile justice, CPS) to elevate the health of vulnerable children.

28:30 The focus of Nemours leadership in technology innovation to develop the system’s EHR infrastructure and digital, consumer-centric strategy.

30:45 Karen discusses the importance of technology enablement to drive population health through an omni-channel patient experience.

32:00 EHR optimization to drive clinical decision support at the point-of-care.

32:30 Leveraging analytics to bridge the clinical and claims data experience.

33:00 How the MSSP empowered healthcare organizations through the provision of claims data. (Medicaid data in children’s health is not the same.)

34:00 The need for national data standards to have consistency with all payers in the country.

35:45 1 of 6 children between the ages of 6 and 17 has a treatable mental health disorder, yet only around half ever receive treatment.

36:45 The pandemic created an increase in childhood Emergency Department utilization (25% increase in children 5-11, 30% increase in adolescents 12-17).

37:00 40% of children are living with anxiety and 45% are living with behavioral health disorders.

37:45 How Nemours is handling the pediatric behavioral health crisis through clinical integration, telepsychiatry, and digital mental health tools.

38:45 Behavioral health diagnoses is 17% more prevalent in a Medicaid population.

40:00 Referencing Daniel Dawes (“The Political Determinants of Health”): We would save over $300 billion per year if we were to eliminate American racial health disparities in our healthcare system.

40:30 Black children are 3X more likely to die in infancy than white children, 7X more likely to die from asthma attacks, and more than 3X more likely to die after elective outpatient surgery than white children.

41:00 Disparities in household income based on race and how that contributes to teen birth rates and health inequities.

42:00 Nemours commitment to equity through program development to ensure education and access.

43:00 The Chief Health Equity Officer role supports health equity transformation, community partnerships, and workflow process changes.

45:00 How payment disparities and demographical attributes between Medicaid and commercially-insured pediatric populations may contribute to health disparities (ex: asthma).

45:45 Designing a whole-person care model to ensure every child is given optimal treatment regardless of their health insurance status.

47:00 Integrated behavioral health in the primary care setting needed to make timely interventions.

49:30 Parting thoughts on the meaningful and impactful work of value-based care transformation and how that provides the passion for service-oriented leadership.

The healthcare industry is facing immense financial pressure. Staffing shortages, skyrocketing labor costs, continuing supply chain disruptions, inflation, rising interest rates, and volatile markets are pressuring both revenue and expenses for provider organizations. These economic challenges, however, are an opportunity to catalyze value-based care.  The promise of value in health can lift up communities through improved clinical outcomes, reduced disparities, financial rewards associated with population health, and emerging opportunities for upskilling the workforce.  Now is the time to prioritize value-based care as a key strategic priority for long-term success and sustainability. There are few other health systems in the country that have demonstrated more of a longstanding commitment to transformation than Ochsner Health through its population health enterprise.

A leader in innovative healthcare delivery, Ochsner Health Network (OHN) is the accountable care network of the massive Ochsner Health system – the largest nonprofit, academic healthcare system in Louisiana (and one of the largest health systems in the Southeastern region of the US). Ochsner has 47 hospitals and more than 370 health and urgent care centers across Louisiana, Mississippi, Alabama, and the Gulf South. Ochsner Health Network – the value-based care arm of the health system –has 277 affiliated physician practices with nearly 3,500+ physicians spanning 625 locations. They are responsible for managing 406,000 lives across six risk-based, accountable care contracts in their value-based care portfolio. Through its collaborative efforts, OHN is making a difference for the nearly 1 million patients throughout Gulf South communities each year.

In this week’s episode of the Race to Value, we are engaging two incredible leaders from Ochsner Health Network (OHN). As Chief Executive Officer for OHN, Eric Gallagher is responsible for directing network and population health strategy and operations, including oversight of value-based performance management operations, population health services and care management programs, post-acute and home care strategies, value-based analytics, and OHN network development and administration.  Joining him is Dr. Sidney “Beau” Raymond, the Chief Medical Officer for OHN who is board-certified by the American Board of Internal Medicine and has been on staff at Ochsner since 2016 and practicing medicine since 2000.  These two leaders discuss what it takes to transform a health system in the “race to value” and how to ultimately improve the health for an entire state in the process!

Episode Bookmarks:

01:30 Ochsner Health Network (OHN) is the value-based care arm of the Ochsner Health system – the largest nonprofit, academic healthcare system in Louisiana.

02:30 Through its collaborative efforts with patients, communities and employers, OHN is caring for nearly 1 million patients in Gulf South communities.

04:00 Introduction to Eric Gallagher (CEO, OHN) and Dr. Sidney “Beau”Raymond (Chief Medical Officer, OHN)

05:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts!

06:00 A recent Kaufman Hall report on the mounting pressures facing providers (e.g. staffing shortages, labor costs, supply chain disruptions, inflation, rising interest rates, volatile markets).

07:30 Eric Gallagher discusses the critical challenges of staffing shortages and the skyrocketing cost of labor.

08:30 “Staffing shortages and rising costs of labor is a critical challenge. It serves as a catalyzing environment for value-based care.”

09:30 Investments in value-based infrastructure has forged collaborative relationships within the entire system.

11:00 Dr. Raymond on how post-pandemic workforce pressures have impacted primary care access and care delivery innovation.

13:00 The number of Americans ages 65 and older is expected to more than double over the next 40 years.

14:00 Approximately 10,000 Americans are aging into Medicare each day.

15:00 The Ochsner value journey in caring for seniors — from global capitation risk in Medicare Advantage to the Ochsner Accountable Care Network (OACN) ACO.

15:30 OCN/OACN have saved CMS over $100 million in the last 5 years! (recent press release on OACN Shared Savings Results)

16:30 Ochsner Health Plan – the only Medicare Advantage plan sponsored by and fully integrated with Ochsner Health.

17:30 Oschsner 65 Plus – a new initiative consisting of freestanding, PCP value-focused clinics delivering high touch, team-based primary care for seniors.

20:00 In the last three years, OACN MSSP ACO has doubled in size to 63,000 attributed beneficiaries.

21:30 How Ochsner has improved quality results performance in the ACO and is scaling it through continued growth.

23:00 The importance of value-focused leadership in building infrastructure and culture to drive performance outcomes.

23:45 “You can’t undervalue the importance of having the talent, leadership-buy-in, and investment to drive value-based outcomes.”

26:00 How senior-level engagement and alignment creates an environment for care delivery innovation.

27:45 The elevation of value-based care to one of four pillars of success for Ochsner Health.

28:00 Hardwiring VBC success into the compensation model for both system executives and physicians in the Ochsner Health enterprise.

28:30 How primary care engagement has led to next-level partnerships with specialists in the network.

30:00 How compensation plans and bonus incentives have driven provider engagement in value-based performance.

33:00 Ochsner’s partnership with Walmart to provide integrated, coordinated, high value care for employees across Louisiana.

34:30 The importance of employer-provider partnerships in improving the health and wellness of a workforce.

35:30 Sharing of financial-risk with self-funded employer-sponsored health plans.

37:00 Negotiating PMPM prospective payment with employers for a care management team model that improves clinical outcomes.

40:00 How Ochsner has been very intentional in building a population health data infrastructure to support its partner physicians.

41:00 Using claims groupers and population-based analytics to evaluate the totality of care spend for specific patient populations.

41:45 Collaborating with partner hospitals and community physicians to democratize population health data analytics at the point-of-care.

43:00 “HIT infrastructure capability and democratization of data at the point-of-care are the dual challenges in reaching greater depths of analytical precision.”

43:45 Ochsner’s patient population: 14-percent have diabetes and 40-percent have hypertension.

44:00 Improving outcomes for patients through enrollment in the Ochsner Digital Medicine program.

46:30 The use of algorithms for personalized care interventions to better engage chronically ill patients.

47:00 Overcoming physician concerns that the use of digital medicine is competitive to in-person E&M encounters.

47:30 The digital medicine program has improved outcomes (e.g. screenings, care gap closures, patient engagement) without diminishing office-based RVUs.

48:30 Piloting digital medicine for Medicaid populations and how that has increased care access and engagement.

50:00 Digital Health as a core component of Ochsner Health’s strategy (along with value-based payment).

51:00 The role of innovationOchsner (iO) as an important think tank and lab for digital health innovation.

52:00 Piloting the Ochsner Connected Stability Fall Prevention digital health program for MA members who are the highest risk of falls.

56:30 How the Ochsner population health enterprise delivers integrated behavioral health in the primary care setting.

58:00 Virtual behavioral health integration as the next big opportunity for care delivery innovation.

59:00 The Office of Professional Well-Being at Ochsner that has been established to improve the well-being of the workforce.

60:00 The growing concern of burnout and moral injury with physicians, APPs, and other clinicians.

61:30 A conscious effort to minimize inbox messaging for providers as a way to eliminate administrative burdens that contribute to provider burnout.

62:30 Integration of pharmacists in primary care setting to help manage prescription refills.

63:30 Team-based care (e.g. social workers, nurses, care coordinators, dieticians, patient engagement specialists) as an opportunity to improve overall workforce outcomes.

66:30 Partnering with Higher Education for interprofessional upskilling opportunities (e.g. Delgado Community College partnership in training nurses and CHWs).

69:00 The Healthy State by 2030 initiative as a catalyst to improve health equity in marginalized and underserved communities in Louisiana.

71:00 Community partnerships that recognize the impact of education as an opportunity equalizer.

74:00 Parting comments on the importance of health equity as a societal priority that is a shared responsibility in communities.