Health Policy – The Race to Value Podcast™

With 1 out of every 3 U.S. health care dollars emanating from Washington, the federal government is the single largest payer of health services in the United States and accounts for nearly half of all national health spending. As our country ages, these forces are accelerating, with Medicare spending alone projected to increase by 7.5% annually through 2031. Healthcare companies that depend on government revenue – or are downstream from it – must begin to view policymakers as among their most important customers. Impactful organizations that will succeed in the new era of value-based care will learn how to leverage the unparalleled value of internal advocacy.  By creating extraordinarily powerful messaging for policymakers to understand what is needed for value-based innovation, we exercise our right to form a more perfect union.  While healthcare will never be perfect, we must still strive for perfection – that is at the heart of value-based care transformation in our country!

On the Race to Value this week, we interview Andrew Schwab – a value-based care leader, an intentional strategist, and a master of Washington’s internal game.  He brings a bold, brash, no-holds-barred approach to government affairs by coaching and mentoring forward-thinking organizations ready to invest in their internal policy teams so they can thrive in a new era of value-based care.  Prior to establishing his own firm, Platform Government Strategies, Andrew advocated in-house on behalf of both nonprofits and private sector organizations. Most recently, Andrew established Oak Street Health’s first government affairs function that put them at the center of the national value-based care conversation and contributed to their recent acquisition by CVS Health.

Episode Bookmarks:

01:30 The federal government is the single largest payer of health services and accounts for nearly half of all national health spending.

02:00 Healthcare companies that depend on government revenue must begin to view policymakers as among their most important customers.

02:30 Introduction to Andrew Schwab and his public affairs consulting firm, Platform Government Strategies.

05:30 The glacial pace of the value-based care movement.  Is there truly bipartisan consensus on the aims of health value?

07:00 2030 Medicare VBC Goal (“The government is putting its thumb on the scale for value-based care.”)

08:15 The 1st Amendment right to petition government for redress of grievances (“Advocacy and lobbying are quintessentially American.”)

09:00 “Elected officials and appointed regulators in Washington D.C. and in state capitals react to a different set of incentives.”

10:00 Explosive growth of the Medicare Advantage program.

11:00 Consumer-centric innovation and higher quality of care in MA plans.

11:30 Political controversy with MA (e.g. PE-backing, overpayment concerns, risk adjustment gaming, “perverse business model”)

13:00 Critics of MA ranging from physicians and hospitals protecting the “sanctity of fee-for-service” to those leery of privatization.

13:30 The incredible popularity of MA and the research showing it has superior outcomes.

14:00 Mitigating the potential for upcoding with the new V28 risk adjustment methodology being implemented over next 3 years.

15:00 MA is paid more than Traditional Medicare, but it offers more in terms of benefits (e.g. hearing, dental, vision, population health interventions).

16:00 Private equity investment and payvider innovation (e.g. Oak Street Health, VillageMD, Centerwell, Archwell).

17:00 The importance of Patient-Reported Outcome Measures since process measures alone don’t achieve patient-centeredness.

19:00 “Outcomes should be the most important metric by which we judge the health of our healthcare system.”

20:00 “We need to put providers that participate in value-based relationships at the center of advocacy pushes in Washington and in state capitals.”

21:00 If we are incentivized to keep patients healthy and out of the hospital, we will naturally do screenings. (Measuring number of screenings not as important as the outcome itself!)

21:30 NQF guidance on Risk Adjusting Social Risk Factors in quality measurement in order to pay for outcomes.

22:30 “Infusing SDOH, risk adjustment, and quality metrics into everything we do will shift the system to move towards outcomes.”

23:30 The role of CMMI in payment model innovation and the need for the continuation of the advanced APM bonus.

24:30 “True transformation cannot happen unless you have providers willing to take on full risk. Right now, there is not a full-risk track inside MSSP.”

25:00 The “courage of conviction” in knowing you can make people healthy.

25:30 The lack of value-based care training in medical schools and GME.

26:00 Capital requirements for full-risk.

27:00 Lack of clarity in VBC policy will perpetuate a multi-tiered system (e.g. specialists paid on FFS, primary care pushed more to capitation).

27:30 Full-risk is the only way forward to incentivize the entire system!  (Everything else is just half measures.)

28:00 How the medical establishment and generational divides in medicine are holding back the value movement.

30:00 Internal, professional government affairs expertise as an essential corporate positioning and sales function.

31:00 Positioning your views front and center to a government audience through internal advocacy.

32:00 Creating extraordinarily powerful messaging for policymakers to understand what is needed for value-based innovation.

33:30 Speaking to policymakers and elected officials is different than speaking to investors.

35:00 Figuring out the right model for advocacy (a hired gun lobbyist vs. an embedded government affairs function).

36:30 Leveraging the lobbying power of unified voice in a trade association (versus in-house government affairs that emphasizes the uniqueness of a company’s individualized and specific interests.)

38:00 Trade associations as the place where policy gets settled before it is advocated to elected officials.

39:00 Strategies for effective in-house government affairs collaboration with professional associations.

41:30 The need to teach incoming doctors about the benefits of value-based care to prepare them for success.

42:30 It is also important to teach medical students about the importance of advocacy and the effect of health policy on their career.

44:30 Medical school funding should be tied to solving a specific problem (e.g. integrating behavioral health into primary care).

45:00 “If we want to get to VBC and outcomes delivery, we have to start teaching advocacy and policy in medical schools to effectuate the future.”

47:00 Examples of effective advocacy (e.g. addressing the pediatric uninsured, the Chronic Care Act, direct billing of LSWs within Medicare, expansion of mental health workforce)

49:30 Private sector innovation in addressing health disparities in underserved communities (e.g. Oak Street Health).

50:30 “Forming a more perfect union” – always working towards perfection while knowing it will never be perfect.

51:30 How to follow and connect with Andrew!

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.”

19:00 The need to bring new health policy leaders into the value-based care movement (at the risk of the movement stalling out altogether for lack of emerging leadership).

20:00 Reframing the value-based care movement to the specific vocalized needs of constituents in the general public (instead of just payment models, quality measures, etc.)

21:00 “There is a resounding drumbeat in our community-focused value-based research — people want more whole-person care.”

22:30 Selectively using the right language when engaging communities (“using a new approach” instead of “reforming the system”).

23:00 Communities are overwhelmingly expressing their anger about the greed of the American healthcare system.

24:00 “When engaging our communities, language matters so very much. We must find the commonality in language to resonate with people.”

25:30 The storytelling project, “Voices of Real Life”, as a vehicle to galvanize healthcare experts, patients, policymakers, and advocates around a human-centered focus. 

26:00 Movements are led by effective storytelling and these stories can revitalize communities of people. (Is a social movement like civil rights or gay marriage any different than the movement for value-based care?)

27:30 The fear that people have in making large scale changes to American healthcare.

30:00 The importance of everyone feeling like they are a part of the change that is needed.  (Reframing health care failures from “individual” to “systemic.”)

31:00 Venice shares personal stories from her work with community focus groups and how people often feel alone when it comes to navigating health care challenges.

32:45 An example of poor maternal health care – a patient driving an hour for a prenatal checkup only to find that her doctor was not at that clinic on that day.

33:00 People often make life altering decisions over health care (e.g. marrying someone they don’t love, taking a second mortgage on their own).

34:00 People that are “satisfied” with their health care do not really exist! (They are just “satisfied” because they are one of the lucky ones with health insurance and access to care.)

37:00 Health Care Affordability and USofCare Poll showing 42% of voters have foregone health insurance in the past, and 41% of those under 30 have opted not to seek medical treatment in the last year.

38:00 Driving a multi-state approach to expanding coverage through public option.

39:00 “Affordability is always the #1 issue that comes up in our community conversations, regardless of the entry point where people enter the health care system.”

39:45 The breaking point of health care costs (e.g. federal deficits, employer cost shifting) and the levers that can be utilized to reign in costs through a public option.

40:30 The “hidden fees” passed on to patients by hospitals.

41:00 The different levers of change at the state level, and how they can impact change at the federal level.

41:30  The equity component to reforming health care costs at both an individual and societal level. (Check out the USofCare Health Equity Report)

42:00 Enhancing primary care access will lower overall health care costs in our country in the long-term.

43:00 Dependable healthcare coverage is an anchor in the storms of life, providing individuals and families the peace of mind that their health and well-being will be safeguarded in times of need.

43:45 More than 9 million people have been disenrolled by Medicaid redeterminationsresumed several months ago.

44:45 Common stories of people fearing lack of health care dependability (e.g. contractors, employees in the gig economy, pregnant women worried about repercussions from employers).

47:45 The challenge of health policies being written by people without the lived experiences of those directly impacted.

48:00 “Policy is nothing if not implemented well.”

49:00 The Texas Court Case (Braidwood v. Becerra) —  may cause nearly half of Americans (more than 151 million people ) the loss of access to free preventive services!

49:45 How the United States of Care is fighting to preserve the rights of Americans to retain their access to free preventive primary care. (See USofCare Preventive Services Resource Hub)

52:00 Personalized care to support to caregivers, improve mental health coverage, enhance maternal and newborn care, make care more convenient, and ensure that people can equitably access care virtually.

53:30 “We cannot reimagine health care with a one-size-fits-all approach.”

54:00 The work in Colorado to build a public option and culturally responsive networks.

55:30 How do we ensure that access to virtual care doesn’t exacerbate health inequities?

58:30 For people to get behind value-based care, we must relate to them at a personal level.

59:45 Speaking in terms of “quality over quantity” when personalizing the message of value-based care to patients.

60:00 Why “Value-Based Care” is such a poor choice of wording and causes confusion with patients.

62:00 A much-needed wave of patient consumerism is needed; however, the complexity of the system stifles innovation and creates a lack of understanding.

64:00 Natalie provides perspective on the need for community feedback on people-centered change in health care.

65:00 “We need to change the way we do change in health care.  This is not working!”

65:30 Can health care be as consumer-friendly as Uber or Chick-fil-A?

67:00 The importance of asking the right questions and engaging stakeholders before implementing a new technology innovation.

68:00 Creating trust in the system through co-creation and rightsizing of change management.

70:00 The amazing opportunity in engaging patient communities!

73:00 Support the work of United States of Care and follow Natalie on LinkedIn– “Be a part of the narrative change to follow the more systemic change that is necessary.”

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.

20:00 The spending growth of the Medicare program surpassing the net savings of the Medicare Shared Savings Program.

20:30 Health policy challenges in making ACOs more transformative in bending the cost curve for Medicare Trust Fund sustainability.

22:00 VBC Policy Lever #1: Low-risk APM design (to encourage participation) with the progression to increased risk and mandatory participation.

22:45 VBC Policy Lever #2: Expand the definition of what it means to be in a value-based arrangement in the Medicare program.

24:30 How health equity is now gaining traction in the value movement (as highlighted by ACO REACH and private payer equity-focused reforms).

25:30 A safety-net deficit in accountable care and the need for upfront investments in accountable care adoption that can address social drivers of health.

26:30 Reading between the lines to understand what CMS is really working on.

27:45 Despite other priorities, it is clear that the primary concern for CMS is to advance health equity!

29:00 Improving the measurement of health equity as a starting point for transformation.

30:30 Recent research from David Muhlestein: “Medicare Advantage is now chosen by the majority of Minority And Low-Income Beneficiaries”

32:45 How will CMS address health equity with Medicare Advantage?

33:30 Why are minorities and dual eligibles increasingly enrolling more in Medicare Advantage?

34:30 The debate that MA has better clinical and cost outcomes than Traditional Medicare.

35:30 The supplemental benefits and lower out-of-pockets costs that incentivize MA enrollment.

37:00 The lack of inclusivity for specialists in accountable care models and how bundles and COEs do not support engagement in chronic disease management.

38:00 CMS has announced a strategy to better engage specialty care in longitudinal, coordinated accountable care models, but many in industry are skeptical.

39:00 Three Categories of Specialty Care: 1) Chronic Care, 2) Urgent or Emergency Care, 3) Scheduled or Elective Care

40:00 Proceduralists that focus on elective care are the most difficult to engage in a value-based model.

41:00 How bundled payment arrangements can align incentives to engage specialists.

42:00 Improving the bridge between a diagnosis and a specialty procedure (proceduralists should not have ultimate diagnosis and referral responsibility in a VBC model).

44:00 The opportunity for Multi-Payer Alignment in Value-Based Care to reduce administrative burdens and increase the impact of accountable care reforms.

46:00 “If all of your payers are operating under different paradigms and payment models, it will be difficult to transform your business.”

46:30 The lack of common incentives to drive multi-payer alignment (full indemnity vs. TPA, limited ROI for younger populations in advanced primary care models).

48:30 The Core Quality Measures Collaborative (CQMC) as a broad-based coalition to facilitate cross-payer quality measure alignment.

49:30 Mandatory multi-payer alignment from Congress?

50:00 Competitors in the private pay sector as a driver of alignment in common patient populations?

51:00 Recent research from David Muhlestein:  “Commercial Insurer Price Transparency: A Comparison Of Four National Payers”

53:00 The lack of quality and cost improvements in healthcare due to a lack of transparency.

54:00 New regulations mandate disclosures of hospital charges, shoppable services, and insurer disclosure of negotiated rates.

55:30 Hospital And Insurer Price Transparency Rule Challenges (e.g. messy data, massive size of datasets, misalignment of providers with actual services provided).

57:30 A 1% larger market share is associated with $100 more payment on a hospital admission!

58:30 Will informed negotiations between payers and providers lead to lower prices over time?  Will transparency also drive steerage to higher quality providers?

60:00 The new Making Care Primary (MCP) Model that helps Medicare and Medicaid providers transition to value-based care.

61:00 MCP is a 10-year transformation model of participation with different tracks depending on risk tolerance.

In the universe of value-based care transformation, there has been one disease that represents a metaphorical black hole, where the gravitational pull of fee-for-service is so strong that nothing can escape. These patients experience the fullest depths of pain and despair, and this chasm is so deep and wide that there is only darkness. You may have guessed it, but we are talking about chronic kidney disease, a condition that impacts 37 million people in the U.S. The suffering of those inflicted with CKD is so immense, yet the Medicare reimbursement system is designed to fail this patient population. In fee-for-service medicine, we wait until patients succumb to end-stage kidney disease, where they crash and burn and need costly dialysis to stay alive for a little while longer. Because of this flawed reimbursement model, Medicare pays over $125 billion for people with all stages of renal disease, which is around 20% of all Medicare spending!  Unless we go upstream and start engaging patients prior to kidney failure, success in value-based kidney care will be limited.  We must “give life” to this patient population in the Race to Value!

The giving of life and that is what DaVita Kidney Care is doing.  In fact, the name DaVita is an adaptation of the Italian phrase for giving life. In value-based care, DaVita works with healthcare payers and providers to develop and implement care delivery models that focus on improving outcomes and reducing costs for CKD patients. And I am excited to share with our listeners, that our guest this week is Dr. Adam Weinstein, the Chief Medical Information Officer for DaVita. Dr. Weinstein works across numerous lanes helping bridge the intersection of IT, clinical nephrology, and healthcare policy. He is focused on delivering IT tools that take advantage of DaVita’s clinical data and help nephrologist and DaVita teammates deliver the best care possible.  A kidney doctor from Maryland, Dr. Weinstein is passionate about slowing the progression of chronic kidney disease in patients. This was such an outstanding conversation with one of the true innovators in technology and clinical care!

Episode Bookmarks:

01:30 The importance of crossing the chasm of chronic kidney disease, a condition that impacts 37 million people in the U.S.

02:30 Introduction to Dr. Adam Weinstein, the Chief Medical Information Officer for DaVita Kidney Care.

03:30 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.

05:30 Dr. Weinstein shares how his lived experiences and positive mindset have shaped his work as a nephrologist, healthcare executive, and technology innovator.

06:45 Treating kidney disease costs Medicare $130B – although CKD patients are 1% of the population, they account for over 7% of all Medicare spending!

08:30 An overview of the DaVita Integrated Kidney Care (IKC) program and how it produces solid results through data enablement and relationship building.

10:30 Integrated Kidney Care accomplished through people working in collaboration, predictive modeling, and population health management.

11:30 Facility versus At-Home Dialysis and the empowerment of patients through education and health literacy.

12:30 An overview of DaVita’s participation in value-based care payment models focused on CKD and ESKD.

14:30 Dr. Weinstein on how to bring scale to value-based payment innovation in kidney care.

16:00 The need for specialist and care team coordination that goes well beyond the office visit.

17:00 Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) Models and how they provide financial and philosophical alignment for integrated care.

18:00 The challenges of including broader specialties and building an advanced data infrastructure in value-based kidney care.

19:00 The “clinical nebulous” that requires a longer runway for value-based payment model innovation to deliver improved patient outcomes.

22:00 The Relative Value Scale Update Committee (RUC) and how it provides recommendations for setting payment amounts for different physician services.

23:30 The challenges of valuing the technical aspects of physician services that reward procedural intensity versus cognitive services that require critical thinking.

24:00 The tension that a Relative Value Unit system provides in a healthcare system evolving to value-based care.

27:00 Black Americans are 3.5X more likely than White Americans to experience kidney failure. (Black Americans are also less likely to do home dialysis or get a kidney transplant.)

28:00 “Value-based care arrangements are one step toward solving health inequities.”

29:00 The need for a culturally sensitive and contextual understanding of health determinants to address disparities in care.

32:30 “The single most important trust building issue in healthcare is the assurance that we have a caring workforce.”

33:00 How DaVita ensures that its facilities are equipped with motivated, engaged, and culturally competent care teams.

34:30 Addressing clinician burnout through the provision of robust talent pipelines.

36:00 The need to focus on early CKD detection so interventions can happen earlier to slow the progression of disease.

37:00 How lab tests to screen kidney function are not always the best diagnostic indicator for early detection of CKD.

38:30 The role of nephrologists in assuring an effective care regimen.

39:00 The use of Artificial Intelligence to help predict the progression of CKD to ESKD or the likelihood of a hospitalization.

41:00 How risk models that predict future likelihood of dialysis can drive crucial conversations with patients.

42:00 The need for clinical experts to interpret AI predictions in a way that can drive meaningful patient interventions.

43:00 Innovation Results at DaVita (e.g. survival rates for dialysis patients, cost improvement in dialysis, increase in home dialysis, lower hospitalizations).

44:30 Dr. Weinstein discusses DaVita’s innovative approach to data and how it informs an enhanced understanding of value-based care as a clinician.

46:30 The development of a CKD-specific EHR system to drive value-based care at a practice level.

47:30 How data integration and HIEs can bring about improved care delivery with independent providers on disparate EHR systems.

47:45 “Chronically ill patients are similar to projects that need their own personalized Gantt Chart to drive care delivery with enhanced outcomes.”

48:45 The importance of patient- and population-level data at the point-of-care, alongside performance benchmarking tools.

51:00 A brief update on Mozarc Medical – the new venture between DaVita and Medtronic established to develop new kidney care technologies and at-home treatments.

52:45 DaVita Venture Group (DVG) invests in companies that are aligned with DaVita’s mission of improving the quality of life for patients with kidney disease.

54:30 Impacting the kidney space at scale through capital investment in innovation.

56:30 Achieving success in value-based kidney care through people, process, and tools.

58:00 Aligning clinicians for the future of value-based care.

For all of you leaders out there on a value-based care journey, it is not lost on any of you that health value has become synonymous with health equity. We are at an inflection point in our society in the recognition that everyone needs a fair and just opportunity to attain their highest level of health. Achieving this will require ongoing societal efforts to address injustice, overcoming socioeconomic barriers to health, and eliminating preventable health disparities. But we cannot do that as a healthcare industry without the proliferation and scale of payment models that align incentives so we can realize true change for the better. On the Race to Value this week, you will hear from one of the foremost leaders on the national scene who is shaping the landscape for accountable care delivery that can advances health equity.

Dr. Dora Hughes is someone who has taken this charge to lead in service to the underserved so that we may realize the dream of a more equitable and healthy society. She is the chief medical officer at the CMS Innovation Center at the Centers for Medicare & Medicaid Services (otherwise known as CMMI). She leads the Center’s work on health equity, provides clinical leadership and input on models, serves as the Innovation Center’s primary liaison with medical and clinical stakeholders, and provides leadership to the Innovation Center’s clinician community. In addition, Dr. Hughes is part of the CMS Innovation Center’s Senior Leadership Team, helping to provide enterprise-level leadership and strategic direction to the Center.  In this interview, we discuss the elevated national consciousness to advance health equity, how ACOs and other risk bearing entities can succeed with a health equity strategy, and the work being done by the Innovation Center to redesign alternative payment models for equity.  We spend considerable time discussing ACO REACH and value-based Medicaid transformation as well.  This is certainly a conversation you should listen to as you plan for success in your Race to Value!

Episode Bookmarks:

01:30 Health Value has become synonymous with Health Equity — everyone needs a fair and just opportunity to attain their highest level of health.

02:30 Introduction to Dora Hughes, M.D., M.P.H., the chief medical officer at the CMS Innovation Center (CMMI)

04:30 If you control for all variables that may contribute to health disparities, African Americans still get the worst quality of healthcare of any demographic in the country.

05:30 The first pillar of CMS’ Strategy Plan is Health Equity

06:30 Cara James, Ph.D., president and CEO of Grantmakers in Health: “I’m someone who’s working on equity before it became cool to work on equity.”

07:00 Referencing the seminal findings of the Heckler Report in the 1980s that investigated racial and ethnic disparities in the United States.

08:00 Momentum has been building towards addressing health inequities, despite the historical lack of national prioritization.

08:30 “It really took the pandemic and police brutality to blast the issues of health inequities into the national consciousness.”

09:00 Disparities go beyond COVID (e.g. black disparities in maternal health, colorectal cancer, kidney disease)

09:45 “Executive pay is now being tied to reduction in disparities. You wouldn’t have heard that 10 years ago or even perhaps five years ago.”

10:00 Referencing CCSQ Deputy Jean Moody-Williams: “For those of us engaged in health equity, this is our moment, but it is only a moment.”

10:30 Actions Needed: collecting and analyzing demographic and health data,  knowing patients individually and at the population level, identifying disparities, implementing evidence-based interventions.

11:45 “It takes vibrancy, resiliency, and an indomitable spirit to tackle disparities and scale progress at a national level.”

13:00 CMMI’s work to address Social Determinants of Health (SDOH), e.g. ACOs, Accountable Health Communities (AHC) Model

14:30 80% of what contributes to health reflects non-medical or social determinants of health (e.g. healthy eating, stable housing, educational economic opportunity, jobs)

15:00 “To maximize our patients health, we as providers have to think about our role both inside and outside the health system.”

15:45 The revolutionary nature of the AHC model in fostering healthcare and community partnerships to plan SDOH interventions.

16:30 Results from the AHC Model showing a 9% reduction in emergency department use among participants.

17:00 “Our understanding of healthcare has evolved. We are not going to be able to achieve our health goals without addressing health related social needs.”

17:30 The flaw of Medicare FFS that does not allow providers to code for SDOH interventions.

18:00 The flexibility of MA benefit design and capitated payments in advanced Medicare APMs supports hiring of social workers and CHWs.

18:45 Dr. Hughes responds to criticism from providers that SDOH interventions are “out of my lane” when it comes to health care delivery.

19:30 The need for health policies to address food deserts, lack of affordable housing, weak transportation infrastructure, etc. at the community level.

20:00 Dr. Hughes describes how CMS and other agencies are working to support culturally-competent and linguistically-appropriate care.

20:45 Resources: “A Physician’s Practical Guide to Implementing Culturally Competent Care” (CMS), “Think Cultural Health” (OMH), and “Multicultural Health Care” (NCQA)

22:00 Is implicit bias within current payment models contributing to health inequities?

24:00 Referencing Dr. Hughes’ and Melissa Majerol’s recent blog in Health Affairs: “CMS Innovation Center Tackles Implicit Bias”

25:00 How the estimated glomerular filtration rate (eGFR) leads to erroneous results and findings of kidney disease in African Americans.

26:00 Another example of how a heart disease risk calculator may incorporate racial bias into diagnosis of disease.

27:30 Identifying potential sources of bias before the launch of new payment models.

29:30 The longstanding history of bipartisan support for the movement to VBC and accountable care.

30:00 The 2021 performance year marks the fifth consecutive year that the MSSP has generated net positive savings to CMS. (See recent Race to Value podcast and Institute Brief)

31:30 Dr. Hughes responds to concerns about the reduced growth and participation in the Medicare ACO program and how this challenge is addressed in the CMMI Strategy Refresh.

33:00 Addressing health equity and ACO growth through external partnerships like the Health Care Payment Learning & Action Network (LAN) and provider site visits.

35:00 Developing a CMS-wide vision for Accountable Care expansion (Referencing recent NEJM Article on “Expanding Accountable Care’s Reach among Medicare Beneficiaries”)

35:45 The ACO program is a chassis for testing innovation center models in achieving 2030 accountable care goals.

36:00 CMS has proposed scaling successful features of the ACO Investment Model (AIM)and will leverage ACO REACH more broadly in years to come.

37:30 The ACO REACH program unlike other APMs to date, has made health equity a bedrock of payment model design.

39:30 Dr. Hughes on healthcare complexity, PCP and specialist fragmentation, and the challenges of reforming the system to better care for underserved communities.

41:00 MSSP ACOs and ACO REACH models are helping providers coordinate care and improve health outcomes for Medicare beneficiaries.

42:30 How the ACO REACH model provides flexibility to healthcare providers in how they deliver and they coordinate care (e.g. telehealth, diabetes preventive care, dental care, pharmacy integration)

44:30 “ACO REACH is forging new ways to address the health inequities underserved communities experience.”

44:45 Health Equity Action Planning and Health Equity Benchmark Adjustments under ACO REACH.

46:00 Dr. Hughes addresses concerns expressed by critics of the ACO REACH model.

50:30 Dr. Hughes provides perspective on CMS’s newly refined eligibility criteria and design characteristics for ACO REACH and why it matters to advance health equity.

55:45 Dr. Hughes discusses the work that CMS is doing to advance accountable care to Medicaid beneficiaries and how they are engaging with safety-net providers.

62:00 Parting thoughts from Dr. Hughes on how CMMI is engaging beneficiaries and caregivers in conceptualizing, designing, and testing payment models.

The Health Care Payment Learning & Action Network (HCP LAN or LAN) is an active group of public and private health care leaders dedicated to providing thought leadership, strategic direction, and ongoing support to accelerate our care system’s adoption of alternative payment models (APMs). The LAN mobilizes payers, providers, purchasers, patients, product manufacturers, policymakers, and others in a shared mission to lower care costs, improve patient experiences and outcomes, reduce the barriers to APM participation, and promote shared accountability.

Last month the LAN held their 2022 Summit, and this year’s event featured appearances by CMS and CMS Innovation Center leadership, the release of the 2022 APM Measurement Effort results, a discussion on the HEAT’s Social Risk Adjustment Guidance for APMs, and the announcement of the LAN’s 2030 APM Adoption Goals for Medicare, Medicaid, and commercial plans.  Joining us this week in the Race to Value are LAN Executive Forum Co-Chairs, Dr. Judy Zerzan-Thul and Dr. Mark McClellan.  They discuss the overall goal of the LAN and the LAN Summit is to collaborate and act on strategies that will accelerate the transition to innovative, patient-centered payment models by focusing on equity, access to high-quality and affordable care, engagement of patients, and reduced provider burden.

HCP-LAN Fall 2022 Summit: Summary

Visit the Institute for Advancing Health Value’s website.

Visit the LAN’s website:

Episode Bookmarks:

01:30 The purpose of the Health Care Payment Learning & Action Network (HCP LAN)

03:00 Introduction to Dr. Mark McClellan and Dr. Judy Zerzan-Thul

05:45 Dr. Mark McClellan speaks to the impact of the pandemic on value-based health reforms

06:45 “Payment flexibilities are one of the unsung heroes in the pandemic when it comes to value transformation.”

07:15 How capitation enabled some to navigate the pandemic favorably, while others struggled with FFS revenue disruption, team-based care, and telehealth deployment.

08:45 CMS payment flexibilities will soon go away so prepare for continued focus on patient-longitudinal well-being and outcomes tracking.

09:45 The especially challenging times of high inflation and workforce resilience and how value transformation is a strategy for sustainability.

12:00 Dr. Zerzan-Thul speaks about the Accountable Care Commitment Curve and how that can guide organizations to advancements in Health Equity.

13:30 The LAN’s Health Equity Advisory Team (HEAT) and its recommendations for developing a Health Equity action plan.

14:30 Measuring equity outcomes through an enhanced data infrastructure and community partnerships.

15:45 Dr. McClellan speaks to how Social Risk Adjustment (SRA) can advance health equity through APMs (starting with ACO REACH)

17:30 The challenges of implicit biases in individual measures of social risk.

18:15 “Risk factors like food insecurity and transportation will eventually get more built in to our approach to health care.”

19:00 The additional considerations of community engagement, peer transformation, and other payment incentives to advance health equity.

20:30 The recent release of the APM Measurement Effort (survey data compiled the HCP LAN).

21:30 Dr. McClellan discusses the current status of 2022 APM adoption (see interactive graphic showing that nearly 20% of payments flowing through Category 3B-4 models.)

24:30 Dr. Zerzan-Thul comments on trajectory of APM adoption and current status of Medicaid transformation in population-based payment.

27:00 Dr. McClellan discusses the Accountable Care Commitment Curve more at length.

29:00 “You can’t get to a critical mass of value transformation in the U.S. healthcare system without multistakeholder alignment.”

30:00 Dr. Zerzan-Thul speaks to what state agencies like the Washington State Health Care Authority can do to move healthcare organizations along the Commitment Curve.

31:00 Examples of legislative tools in Washington State that are advancing value-based payment and collaboration.

33:00 Data and transparency – how do we measure progress in health equity and value transformation?

34:30 Dr. Zerzan-Thul speaks about the work LAN is doing with State Transformation Collaboratives (STCs) (see Summit video on State Transformation)

35:00 Primary care transformation and multi-payer alignment as the starting points to transform healthcare at the state-level.

36:00 The impact of the economic downturn and Medicaid transformation in states moving to value.

37:00 Dr. McClellan on the importance of state leaders (e.g. policymakers, employers) to reform healthcare.

38:30 The STC pilot states (Arkansas, Colorado, California, North Carolina) are working closely with CMS in reaching their value-based care goals.

39:30 Key directional alignment between CMS and states will reshape health policy at the federal level.

41:45 Dr. Zerzan-Thul discusses the importance of FQHCs as “safety net” providers and how they can transition to APMs.

42:45 Oregon, Colorado, and Washington are leading states in FQHC adoption of APMs.

43:30 Dr. McClellan on how Medicaid payment shifts in Washington State are bringing more affordable and accountable care to patients.

46:00 Dr. McClellan discusses the strategic importance of multi-payer alignment in the national movement to value-based care.

49:00 Reducing care variation and supporting more efficient processes in delivering care across disparate populations.

50:00 Dr. Zerzan-Thul on how multi-payer alignment of quality measures can lead state-level value transformation efforts.

51:00 “We are asking payers to align on paying primary care at a Level 4 level, and we have commitments from payers to do that.”

52:00 Data aggregation and exchange at the state-level.

52:30 Certifying advanced primary care at a centralized level as a means to direct payment transformation.

53:15 Engaging health plans in various states to adopt and scale APMs in the transition away from FFS.

55:00 How the LAN, in partnership with states, are engaging purchasers in the commercial market.

56:30 Dr. McClellan on how to get patients to understand “accountable care” or “value-based care” by delivering on our goals.

58:00 “Value-based care is not a privatization plot of Traditional Medicare.”

59:00 Paying for “health” can help with the reduction of chronic diseases.

59:30 The political pressures of disrupting the status quo in healthcare.

60:00 The importance of effective storytelling in value-based care success as a way to inform legislators.

61:30 Dr. Zerzan-Thul on how the U.S. is 4% of the world’s population but spends half of the $8T global spend on healthcare services.

62:30 How do we measure whether people are getting person-centered care? (We need patient-reported outcomes in addition to CAHPs.)

65:00 Dr. McClellan on the imbalances of healthcare worker supply and demand.

63:30 Capital investments in value-based care are going towards digital transformation and upskilling of the workforce.

65:30 “The biggest challenge in the movement to value-based care is the workforce.”

67:30 Dr. Zerzan-Thul speaks about the challenging demands of managing the workforce pipeline for behavioral health professionals.

68:00 The importance of team-based care (everyone) in guiding us to the health care that we want.

69:20 APMs and the work of the LAN is key to building a better workforce and improving health care!

As we look around to see what is enduring in our society, it is the work that was accomplished through loving relationships and mutual understanding.  The power of love-driven leadership has the potential to change the world; and in healthcare, it can transform the lives of people undergoing immense suffering. Healthcare leaders must collaborate on solutions to overcome barriers in health equity through a deeply rooted commitment to social justice and love to improve the human condition. Leaders in population health must be willing to step forward – even if it is uncomfortable – to build a community of love that will last forever.

On the Race to Value this week, we interview Geoffrey M. Roche – a leader in healthcare innovation, future-focused strategy, DE&I, and workforce development.  This is a conversation that all healthcare leaders should hear. Geoffrey engaged this interview with utmost authenticity as leader with a willingness to get in “good trouble” for speaking about the issues that many would prefer to ignore or not accept as real.  In this podcast, you will learn about the power of community partnerships in improving health equity to overcome the “political determinants of health” that prevent societal progress. You will also learn about the paramount importance of workforce development and scalable educational solutions in catalyzing a transformation in care delivery and culture change that values the moral imperative of value-based care. The empowerment and education of our workforce holds the key to eliminating workforce burnout and moral injury! And lastly, you will gain perspective on love-driven leadership that can overcome toxic tribalism and hyper-polarization in our society.

Geoffrey is a proponent of love-driven leadership and advocacy for our most vulnerable in society, and his leadership in health equity has been recognized at a national level.  If you need inspiration to overcome the inertia in your health system towards real and impactful change, don’t miss this very important conversation!

Episode Bookmarks:

01:30 Introduction to Geoffrey M. Roche – a leader in healthcare innovation, future-focused strategy, DE&I, and workforce development.

04:00 Collaborating on solutions to overcoming barriers in health equity is informed by a deeply rooted commitment to social justice.

05:30 Geoffrey speaks about his early leadership work at Lehigh Valley Hospital-Pocono taking sojourns into homeless encampments in East Stroudsburg, Pennsylvania.

07:00 Leadership from a Hospital CEO and social justice warrior – how that led to an authentic impact in the population health of underserved communities.

08:00 Serving as Chair of the Commission’s Advisory Board to deal with homelessness – how that taught Geoffrey the “power of partnerships”

08:30 Uniting community stakeholders to eliminate stigmas and facilitate a better understanding of homelessness.

09:30 As a population health leader, you’ve got to be willing to step forward – even if it is uncomfortable. The community of love that you is built will be something you treasure forever.”

10:30 “The Health Equity Tracker” – a tool that aims to give a detailed view of health outcomes by race, ethnicity, sex, socioeconomic status, and other critical factors.

12:00 Geoffrey’s service on The National Health Equity Task Force under the leadership of Dr. Rachel Levine.

12:30 Participating in a national advocacy effort to address the disproportionate health outcomes of the COVID-19 pandemic.

14:30 The Health Equity design sprint led by Karen DeSalvo and Google to examine COVID-19’s impact on vulnerable populations.

15:00 What would it look like if we lived in a society without health disparities? – Geoffrey speaks about the power of data to knock down silos in healthcare that prevent equity.

16:00 The Leadership of David Satcher and Daniel Dawes in addressing disparities through holistic approaches to data, community, intersectionality, policy, healthcare, and SDOH

17:00 “There are so many people that don’t understand why we talk about issues of inequity and health disparities. We have to look through every lens to address this issue systemically.”

18:00 “Speak up, speak out, get in the way. Get in good trouble, necessary trouble, and help redeem the soul of America.” – John Lewis

19:00 How the risk-averse nature of healthcare is a barrier to the adoption of innovative products, treatments, interventions, and technologies that could help transform thousands of lives.

20:30 Board members and trustees of hospitals and health systems need to be educated in value-based care and health equity.

21:30 “If there is one aspect of our U.S. healthcare system that we have not done well, it is the engagement of our governance structure in health equity and value-based care.”

23:00 Geoffrey explains how entrenched organizational inertia within functional departments of health systems stifles innovation to advance equity.

24:15 Overcoming the “Political Determinants of Health” by fostering public-private partnerships.

25:30 The reskilling and upskilling of the workforce to ensure a high-value system will require scalable educational solutions.

26:30 Geoffrey discusses the importance of certificate and microcredential programs to address future workforce needs in value-based care.

27:45 “We have to create a society in healthcare that values the importance of workforce education to advance health equity and population health.”

28:30 “Health systems that do not embrace Competency-Based Education are actually harming their workforce strategy.”

29:00 Overcoming the slow resistance to education to empower healthcare transformation.

30:30 “The education of the healthcare workforce should not be managed by Human Resources.  It should be managed by Strategy and Transformation.”

31:45 The World Economic Forum estimates that, by 2025, 50% of all employees will need reskilling due to the adoption of new technologies and innovations.

33:00 Geoffrey speaks about the need for health systems to partner with Higher Education to develop a collaborative ecosystem for upskilling/reskilling the workforce.

36:00 The intentionality required to think about pathways and pipelines to ensure a diverse healthcare workforce.

36:45 The moral imperative of culturally competent care empowered by an effective DE&I strategy.

37:30 How can Higher Education become an incubator for healthcare system workforce development?

38:00 We are not prepared for the “Baby Boomer tsunami” that will decimate the supply of workers.

39:00 Career mobility is a secret weapon in the ongoing struggle to retain talent.  How can value-based care support workforce strategies for attraction, retention, and mobility?

40:00 Geoffrey explains why talking about the resilience of the healthcare workforce is insufficient in addressing the root causes of burnout and moral injury.

41:00 Engaging the workforce in value-based care is critical in care delivery redesign and cultural transformation.

42:00 Provider and workforce experience is just as important as patient experience.

43:00 Creating a “safe space” where workers are empowered to speak up about issues impacting patient safety.  How workforce fears leads to patient deaths.

44:30 Addressing Health Worker Burnout (35-54% of nurses and physicians and 45-60% of medical students and residents are reporting symptoms of burnout!)

45:30 Researchers estimate that annual burnout-related turnover costs are $9 billion for nurses and $2.6 to $6.3 billion for physicians.

46:30 The need for healthcare leaders to addressing workforce burnout with systems-oriented, organizational-level solutions (not just pizzas, back massages, yoga, and mediation apps)

47:30 Governing Boards need to address workforce burnout as their fiduciary responsibility.

49:00 The need to change nursing shifts and provide opportunities for workforce debriefings to reflect on care processes.

50:00 Healthcare workers should be treated like athletes and given breaks (rest brings about higher performance).

51:45 Referencing Chris Lowney’s book “Heroic Leadership”

52:15 Geoffrey shares his insights on the importance of love-driven leadership and the importance of authenticity and mentorship.

53:30 The culture of bullying in the medical profession needs to be overcome with love-driven leadership.

54:00 Mentorship programs that provide love, guidance, and inspiration.

55:00 Leaders that do not proactively seek out opportunities as a mentor – “It is time for them to go!”

55:45 Cultural awareness of the need for belongingness and inclusion and why leadership is not about titles.

56:45 Toxic tribalism and hyper-polarization on major societal issues impacting public health…issues like mass shootings, climate change, abortion rights, and gender-affirming care models.

58:00 “If you don’t advocate on these issues, you will further exacerbate the trajectory of health disparities.”

59:00 Advocacy for marginalized populations goes back to the origins of our healthcare system. Getting into “good trouble” is the right thing to do.

In the uncertainty of today’s healthcare industry, we must continue to persevere towards our true north.  The moral imperative to improve the quality of care for patients through better care coordination, including those are underserved, can only be achieved by the realities of the digital age. This transformation will require the medical profession to create a modernized Hippocratic Oath that extends to the broader health ecosystem. The proliferation of interoperable technology and digital health tools has the potential to catalyze value-based care delivery innovation and transparency. However, it must come along with an ethical commitment to guide data sharing, integration, and technical processes. True North will ultimately prevail in connecting value-based networks to those most in need; however, it will take continued progress in amplifying the demand signal for value-based care.

On the Race to Value this week, you will hear from one of the top healthcare revolutionaries in our country.  We are honored to bring you, the one and only,Aneesh Chopra – the first chief technology officer of the United States who was appointed by President Obama and the Co-Founder and President of CareJourney. In this episode, you will be party to a powerful conversation on the promise of the digital age in healthcare.  You will learn about how health policy and innovation is ushering in a new era of data flow and interoperability, consumer-driven innovation, price transparency, and clinically-relevant analytics for the future of value-based care delivery transformation. Aneesh Chopra also explains why he feels so strongly why ACO REACH will help us reach True North.

Episode Bookmarks:

01:30 Introduction to Aneesh Chopra –  – the first Chief Technology Officer of the United States and Co-Founder and President of CareJourney

04:00 The need for the medical profession to galvanize around the immense opportunity to transform care delivery by embracing the realities of digital age.

06:30 Why do we need a digital Hippocratic Oath to transform medicine?

08:00 The gap between patients being seen on a given day and the 98% of the patient panel that are not.

08:30 Designing database queries and algorithms to Identify patients in need of care.

09:30 Creating a compact between analytics communities and physicians to ensure patients are getting appropriate care.

10:45 The self-imposed barriers to technical and semantic interoperability that come from our current FFS model.

12:00 How the HITECH Act manifested in technology gaps, despite widespread EHR penetration.

14:00 “The delay in the demand signal for value-based care resulted in the de-prioritization in the market for interoperability.”

15:30 The regulatory goals of the 21st Century Cures Act to scale interoperability and eliminate information blocking.

16:45 Cures Act regulatory emphasis on population health is now reaching the market.

17:00 FHIR Interoperability Standards will ultimately deliver on the promise of population health through widespread data exchange and API-led connectivity.

18:00 Ensuring value-based care organizations a “plug and play” approach to unify electronic health records.

19:00 The promise of widespread data exchange in value-based care delivery and how it parallels with the consumer banking industry.

20:30 Similarities between Dodd-Frank Act (banking sector) and the Cures Act (healthcare sector) in regard to consumer data protections.

22:30 JPMorgan cutting off access to Mint because screen-scraping was far less secure than API connectivity.

25:00 If value-based care became the dominant delivery model, the industry wouldn’t need so much regulatory oversight.

26:00 The Cures Act is beginning to reverse FFS-driven market failures in order to create a much more rational economic model.

27:00 Referencing the opinion piece in STAT by Aneesh Chopra and Seema Verma about the new price transparency regulations in healthcare.

28:30 Economic research that shows how price transparency in healthcare doesn’t always lead to empowered consumerism.

29:30 Using fiduciaries in a VBC network to guide patients to the most appropriate clinical setting and provider.

30:00 How did hospitals, health plans, and employers respond to the federal requirement to disclose prices without any technical guidance?

33:00 “I believe in our vibrant technology economy to be helpful in converting raw transparency data into meaningful guidance for patients in VBC.”

33:30 The leadership of Todd Park and Farzad Mostashari in Health IT transformation and consumerism.

34:00 Coupling health information fiduciaries with population health best practices at scale could eliminate healthcare economic drag and improve care quality.

35:00 “A patient fiduciary equipped with price and quality information would improve patient matching to care resources and make a big difference in the system.”

36:00 How CareJourney is providing clinically-relevant analytics for value-based networks so they can succeed in care delivery transformation.

37:00 Affordable Care Act, Section 10332 provides the release of Medicare data for provider performance measurement

38:00 HHS initially blocked the release of Medicare performance data for fear that physician compensation would become public domain.

39:00 President Obama created the US CTO position and appointed Aneesh Chopra to create “a more open and transparent government”.

40:00 CMS created a program for researchers to access Medicare longitudinal data for provider performance measurement

41:00 CareJourney is creating a “Dartmouth Atlas-style” variation analysis for patients with certain disease conditions and monitoring their journey over time.

42:00 Looking at care variation in clinically relevant cohorts to identify where best practices exist in value-based care.

42:00 Applying well-defined, publicly accessible cost and outcomes measures to find the highest value doctors, facilities, and networks.

43:00 Using public data to determine which interventions have the highest level of return in population health outcomes.

44:00 The Biden administration aims to have all Medicare FFS beneficiaries in an accountable care relationship by 2030.

44:30 A recent CareJourney analysis showing that Medicare patients enrolled in value-based care arrangements were nearly two times more likely to get mammograms.

45:30 Many dual eligible patients in underserved communities are not able to access Medicare ACOs (their only choice for value-based care is Medicare Advantage)

47:00 The hope for the 2030 goal by CMS to reverse health inequities in underserved communities.

47:30 The historically paternalistic approach to value-based care led to an exclusion of the patient voice.

48:30 The lack of meaningful patient engagement in the Medicare open enrollment process.

49:00 The reason why Aneesh Chopra is excited about models like ACO REACH

50:00 Moving value-based care away from paternalistic, algorithmic models to true relationship-based care

50:30 “True North will prevail.  We have to find a way to connect value-based networks with those most in need. That day is coming, and it will happen first with ACO REACH.”

51:00 Health Equity as True North and the upcoming Institute virtual summit on Dec 1st. (Population Health Equity: The North Star for Value)

52:00 Referencing a recent article written by Aneesh Chopra and Rick Goddardoutlining the four programmatic Health Equity Components in ACO REACH.

54:00 How a ACO REACH Health Equity Plan will be a catalyst for change. (“looking inward for clinical priorities to demonstrate progress”)

55:30 Adjustments to benchmarking methodology for REACH ACO patients living in underserved areas.

56:30 Increased ACO recruitment of underserved beneficiaries through voluntary alignment because of changing financial incentives and accountability plans.

58:00 “Look to ACO REACH for a whole range of goodies, not the least of which is to get underserved populations into better coordinated care models.”

58:30 Aneesh discusses concerns by REACH ACOs that CMS may erroneously apply a retroactive trend adjustment to the benchmark during reconciliation.

62:30 What should the ACO REACH reference population be?

63:30 How can CMS constrain financial arbitrage opportunities while also providing predictability to benchmarking methodology?

64:30 Using responsible AI in healthcare (“Innovation can happen only at the speed of trust.”)

66:00 The spread of disinformation in a digitalized market-driven economy and why healthcare can’t follow the path of social media.

68:00 Aneesh provides perspective on the current development landscape of AI models to improve clinical care outcomes.

70:00 Parting thoughts on “precision health” and personalized care pathways by leveraging genomic sequencing, AI, and biometric data from wearables

72:00 Reflections on the leadership of Michael Leavitt and appreciation for the work of the Institute for Advancing Health Value.

The Institute for Advancing Health Value has recently released two new Intelligence Briefs highlighting two major impactful events in the movement to value-based care.

Check out this special bonus episode where Eric and Dan interview Kate de Lisle on her research analysis on these recent CMS announcements.  You may also download these Intelligence Briefs at  https://www.advancinghealthvalue.org/analysis-of-mssp-2021-and-aco-reach-2023/

Episode Bookmarks:

01:30 Download the new Institute intelligence briefs on the 2021 MSSP Performance Results and the ACO REACH Final Cohort

02:30 Background on Kate de Lisle, Senior Manager of Payment & Delivery Transformation at Leavitt Partners

04:00 Recently announced MSSP Results as an important bellwether for the success of the value movement

05:30 Total program savings of nearly $5.4 billion over the model’s lifetime

06:30 5th consecutive year of net savings – has the MSSP demonstrated proof of concept?

07:00 Was 2021 a good year for the MSSP since the net savings wasn’t quite as large as the year prior?

07:30 The average per beneficiary PMPM savings amount was $164 (double what it was in 2019)

08:00 81% of ACOs generated savings and 58% earned a Shared Savings bonus.  Quality scores were also high.

08:45 89% of ACOs taking downside risk generated savings (compared to 76% that saved in an upside-only track)

09:15 Risk-bearing ACOs generated $5.3M per ACO (compared to $2.9M for non-risk bearing)

09:45 ACOs led by physician groups realized the most savings.

10:00 Hospital-led ACOs realized a decline in savings.

10:30 Years of experience in the MSSP is no longer a straightforward predictive indicator of performance success.

14:00 Last month, CMS released the names of the 110 provisionally-accepted organizations selected to join the ACO REACH model starting in 2023

15:30 Only 47% of REACH applicants were provisionally accepted.

17:30 New cohort had similar profiles of selected groups accepting Global and Professional Risk.

18:00 New entrants are serving vulnerable and high-risk populations.

19:00 Groups moving from Next Gen ACO to ACO REACH

20:30 Far fewer payer-led ACOs in the new REACH cohort

21:30 What considerations did CMS take into account when selecting for participation in the new REACH program?

22:00 Sustained interest in ACO REACH from VBP enablement companies (e.g.Aledade, agilon health)

23:30 Provider-owned enablement companies participating REACH (e.g. Castell Health)

24:30 Upstart primary care companies accepted into ACO REACH (e.g. Oak Street Health, Iora Primary Care, ChenMed, Cano Health, Cityblock, ConcertoCare)

25:00 ChenMed  (a leading full-risk MA primary care practice in the country) is included in the new ACO REACH cohort.

25:30 OneMedical has also been accepted into the program.

26:30 The Institute for Advancing Health Value has a complimentary membership for provider organizations!

27:00 Will CMMI be sunsetting various APMs, including specialty care models like BPCI and CJR programs?

28:30 Kate speaks about the “weak signals” being broadcasted by CMMI around the future of the APM portfolio.

30:00 What impact will ACO REACH have on the CMS 2030 Goal?