Health Value Strategy – The Race to Value Podcast™

The World Health Organization has declared climate change as “the greatest threat to global health in the 21st century.” As our planet grapples with the accelerating impacts of climate change, it is crucial that we adopt a climate lens in the value transformation of our healthcare industry. The repercussions of climate change extend far beyond environmental shifts; they manifest in various health issues, including challenges with clean water access, increased allergens, respiratory diseases, heat induced illnesses, and the proliferation of infectious diseases. It’s essential to acknowledge that while climate change affects everyone, the burden falls disproportionately on historically marginalized populations, highlighting the interconnectedness of climate impacts and social determinants of health in underserved communities.

In our pursuit of delivering safe, effective, and efficient care amid the climate crisis, we as healthcare leaders also bear the responsibility to address the substantial greenhouse gas emissions generated by the sector. Accounting for nearly one fifth of the U.S. gross domestic product, the healthcare industry possesses considerable purchasing power that can be harnessed to steer the nation toward cleaner energy and a low carbon supply chain. Beyond mitigating environmental harm, embracing preventive models of care and enhancing care quality that lowers excess utilization naturally aligns with lower carbon footprints. Value-based care, therefore, can become a powerful catalyst in propelling us toward a net zero carbon future that will build a sustainable, resilient future for our planet.

This week we are  interviewing Dr. Vivian Lee, a healthcare executive dedicated to the advancement of value-driven transformation in health and tackling climate change. Author of the acclaimed book,The Long Fix: Solving America’s Health Care Crisis with Strategies that Work for Everyone, she is an Executive Fellow at Harvard Business School and Sr Lecturer at Harvard Med School. Prior to her Executive Fellowship at Harvard, she was the founding President of Verily Health Platforms, an Alphabet company combining a data-driven, people-first approach to precision health.  Dr. Lee is also a former health system CEO, medical school Dean and member of the National Academy of Medicine. She is regularly listed among Modern Healthcare’s Most Influential Clinical Executives as well as Modern Healthcare’s Most Influential People in Healthcare.

Episode Bookmarks:

01:30  The World Health Organization has declared climate change as “the greatest threat to global health in the 21st century.”

02:00  Climate change burden falls disproportionately on historically marginalized populations.

02:30  The responsibility to address the substantial greenhouse gas emissions generated by the healthcare sector.

03:00  Introduction to Vivian Lee, M.D.

04:30  One in four deaths can be attributed to preventable environmental causes…and climate change is exacerbating these risks.

06:00  Climate change resilience as a lens for value-based transformation.

06:45  The irrefutable scientific evidence about the unprecedented levels of carbon dioxide in our atmosphere.

07:00  What are health care leaders going to do about this?  (The need to manage the crisis through an empowered workforce.)

08:30  Exposed vulnerabilities in our supply chain as a complication to address climate-related crises.

09:00  The healthcare industry is responsible for 8-10% of the overall carbon footprint of the country (more than twice the #2 country!)

10:00  How do we decarbonize healthcare in order to “do no harm”?

11:45  Pollution from health care–associated energy use results in an estimated 405,000 disability-adjusted life years annually (a burden comparable to that of preventable medical errors).

12:30  The strong business case for health care organizations to reduce their carbon footprint.

13:00  Tax credits offered by the Inflation Reduction Act to decarbonize hospitals.

14:30  “Renewable energy actually costs less than fossil fuel energy.”

14:45  The Inflation Reduction Act will cover about 30% of the capital needed to invest in a renewable energy system.  (Add another 10% each for serving underserved regions and buying American made!)

15:00  ROI in the tens of millions for health systems going green! (“doing good and doing well”)

16:00  Non-productive energy use (e.g. ~60% of energy consumed by MRI and CTs occur when offices are closed on evenings and weekends!)

17:00  Putting high intensity imaging machines in idle mode would reduce the carbon footprint at a level equivalent to the NHS!

18:45  Kaiser Permanente became carbon neutral.  (Referencing Kathy Gerwig article co-written with Dr. Lee – “Decarbonizing Healthcare“)

19:30  Boston Medical Center reduced carbon emissions by more than 90%.

20:00  Resources: Kathy Gerwig’s book, “Greening Health Care: How Hospitals Can Heal the Planet”, the AHRQ Climate Change Primer, and Health Care Without Harm, Medical Society Consortium on Climate & Health

22:00  “There are so many opportunities for aligning with the decarbonization effort that are completely synergistic with value-based care.”

22:45  “Primary care has a much lower carbon footprint than high intensity tertiary or quaternary care.”

23:20  How can we utilize telehealth and telenursing to reduce patient and clinician transportation needs?

24:30  Referencing the influence of Don Berwick in medical waste elimination. (see article “Eliminating Waste in U.S. Health Care“)

25:30  “Eliminating health care waste will do good for the planet, do good for the communities, and actually make ourselves financially healthier as well…all in the spirit of bringing more value to our health care system.“

26:45 The AMA is encouraging physicians to assist in educating patients and the public on sustainable practices and to serve as role models in providing environmental sustainability (see AMA Code of Medical Ethics Opinion on Climate Change)

28:00  Dr. Lee discusses the role of clinicians to advocate for eco-friendly practices in patient communities.

30:00  An example of how a pediatrician conducts climate change counseling (see Dr. Andrew Lewandowski’s study)

34:00  The tech-based application of AI, data, and analytics to combat climate change through value-based care delivery.

35:45  Using a health meter to advise patients on how best to deal with extreme heat and bad air advisories.

37:00  Lowering the health care carbon footprint through supply chain optimization.

39:00  The need for more engineering and technical innovation to support innovation in climate resilience.

39:30 The White House and HHS launched the Health Sector Climate Pledge to cut greenhouse gas emissions by 50% by 2030 and net zero by 2050.

40:00  “Solving the climate crisis is the greatest and most complex challenge that Homo sapiens have ever faced. The main solution, however, is so simple even a child can understand it. We have to stop our emissions of greenhouse gases. And we either do that or we don’t.”  — Greta Thunberg

41:00  Parting thoughts from Dr. Lee on value-based care and climate change resilience. (“It doesn’t matter what political party or what socioeconomic class you are.  We can’t escape this issue of climate change.  We are all on this planet together.”)

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.

Many factors impact our health beyond genetics and aging.  Collectively, these are called social determinants of health and include factors such as education, housing, income, occupation, hunger, language, literacy, where we live, and access to affordable healthcare services. However, there is a gap in the current list of social determinants of health, and that is the influence of “information” or an “information ecosystem” on patients’ behavior, engagement, and health outcomes. It is critical to consider “information” as another social determinant of health since it can be used to drive positive patient health outcomes.  How we deliver it, where we deliver it, and who delivers it is crucial to value-based health care transformation and patient-centeredness.

So, how do we harness this idea that information can change health outcomes?  To answer this question, we have invited Debbie Welle-Powell back to the Race to Value!  As a 30-year healthcare executive veteran, value-based care thought leader, and educator, she is committed to the empowerment of change management principles to drive population health at the intersection of patient engagement and information sharing. In this episode, we discuss what is needed to empower the patient and clinician, technology-enablement and value-based payment to fine tune the delivery system, and the information ecosystem needed to drive healthy outcomes.

As a companion to this podcast, make sure to read Debbie’s new article on this topic.  It is available for download on the Race to Value webpage for this episode!

Episode Bookmarks:

01:30 Introduction to Debbie Welle-Powell, a healthcare executive veteran whose work focuses on delivering affordable and accessible high quality care.

02:45 Reference previous R2V episode – “Climbing the Mountain: Reaching New Heights for a Transformative Future”)

03:00 Read the companion article to this interview on the Race to Value episode website!

03:45 Debbie provides a brief update on her professional work in value-based care (and her mountain climbing adventures!)

05:30 The influence of “information” or an “information ecosystem” on patients’ behavior, engagement, and health outcomes.

06:30 Should we consider information as another Social Determinant of Health (like transportation, education, housing, and food security)?

07:30 “Information only really matters if it helps patients change behaviors.  The delivery of information is crucial to empowering health outcomes.”

08:30 “The American healthcare system is not as patient-centric as it claims to be because of a failure to provide empowering information.”

09:00 The roles of clinicians and patients to improve health literacy.

10:00 Patient noncompliance – Ex: 20-30% do not pick up prescriptions, 30-40% do not follow-through on referrals.

10:45 The challenges of interpreting and addressing SDOH challenges to avoid unnecessary utilization.

12:00 The importance of the patient-provider relationship. (Eric shares insights from his healthcare trip to Cuba.)

14:30 Technology enablement and health system evolution to better address patient information needs.

15:00 Improving patient engagement through the online user journey (i.e. the digital front door).

15:45 Debbie shares a personal example from her cancer journey where the care team failed to provide adequate information.

17:00 Half of patients seeking receive misleading information when independently searching online sources.

17:30 The opportunity for clinicians to provide trusted and reliable online educational resources.

18:00 The hyper-saturation of online content (e.g. 500 hours of content uploaded to YouTube per minute!)

18:30 How the value-based care movement provides incentives for improving patient engagement.

19:30 The use of Generative AI in the clinical setting to help patients better navigate their care journey.

20:45 Merging the science of medicine with the art of information – how to best engage patients during a formidable time of distress.

22:30 Realigning healthcare investments into patient engagement information systems, AI-based tools, and team-based care delivery.

23:30 The need for change management tools at the system-level to improve patient engagement.

24:00 Transforming clinical practice using the Prosci ADKAR change management model.

25:45 Creating a patient advisory council to guide health systems in the optimal curation of patient information.

26:30 Addressing chronic disease through online resources, team-based care delivery innovation, and value-based payment.

27:00 The importance of neuroplasticity (rewiring of the brain’s neural pathways) to reinforce new habit formation.

28:00 Mountain climbing as a metaphor for behavior change in chronically ill populations (i.e. dealing with pain, incremental progress).

28:45 The overwhelming challenges of addressing SDOH in underserved communities.

30:00 Differing perspectives on the role of the individual in health accountability.

31:00 Merging system-level patient-centered engagement with individual-level accountability.

32:00 Deploying information tools to empower health and improve SDOH screenings.

32:45 Rethinking medicine to live better longer (referencing new book, “Outlive: The Science and Art of Longevity” by Dr. Peter Attia).

34:00 “Poor health literacy is a public health problem.” (9 in 10 adults exhibit poor health literacy when under extreme stress.)

34:30 Population health resources should be written at a 5th grade level to ensure they are readable, actionable, and trustworthy.

35:00 Improving Health Literacy Could Prevent Nearly 1 Million Hospital Visits and Save Over $25 Billion Per Year. (see UnitedHealth study)

35:30 The importance of primary care in empowering patient education.

36:30 A recent court ruling threatens access to critical preventative care for more than 150 million people! (see USofCare Preventive Services Resource Hub)

38:00 The importance of Patient Advisory Councils in care delivery design (e.g. telehealth, AWV campaigns, patient portal design, refill strategies)

38:45 CBO Partnerships as an opportunity to “learn, course correct, and transform.”

39:00 The flawed structure and lack of funding for a Public Health system that improves health equity and fosters patient trust.

41:00 The intergenerational impact of health information in improving health, supporting families, building social cohesion, and ensuring economic competitiveness.

42:00 What is the role of government in creating a healthy, well-educated population?  How can CMS improve beneficiary engagement?

42:30 Prioritizing multipayer alignment, administrative simplification, and health equity accountability to promote value-based care.

43:30 The 21st Century Cures Act is a health policy focused on information sharing and care coordination.

44:00 Creating accountability in underserved communities through workforce competency and alignment of payments.

45:00 “You can’t talk about quality unless you talk about equity.”

46:45 ADKAR is an acronym for the five outcomes of successful change management: “Awareness, Desire, Knowledge, Ability, and Reinforcement”.

47:00 Debbie discusses the systemwide application of ADKAR as a powerful tool for change management at an individual level.

48:00 How did the ADKAR change management model improve care delivery at Essentia Health?

49:45 Applying change management principles to achieve patient-centricity.

50:45 The promise of precision medicine (at the individual level) as a compliment to community health (at the group level).

52:30 Developing a roadmap to make wellness and prevention a priority (versus sick care and chronic disease management).

53:30 Parting thoughts from Debbie on actions that can be taken today to improve patient communications.

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.

The plasticity of primary care, in the new value-based era, embodies remarkable adaptability, innovation, and responsiveness to evolving community health needs. As our understanding of health and well-being expands, primary care stands as the first line of defense, ready to transform and customize its services to address the unique challenges faced by diverse populations. This flexibility allows primary care providers to pivot swiftly, whether it’s in responding to public health crises, addressing disparities in healthcare access, or integrating innovative technologies into daily practice. In embracing this plasticity, primary care not only becomes a cornerstone of community health but also a powerful catalyst for positive change, driving us closer to the goal of a healthier, more equitable society.

In this week’s episode of the Race to Value, we are joined by R. Shawn Martin, Executive Vice President and Chief Executive Officer for the American Academy of Family Physicians. The AAFP is the medical specialty organization representing 129,600 family physicians and medical students nationwide. Shawn Martin works with the AAFP Board of Directors on the mission, strategy and vision for the AAFP and provides representation to other organizations, including medical, public, and private sectors. He is nationally recognized for his thoughtful leadership on a range of healthcare and workforce issues. While his career portfolio has focused on numerous health care and public-policy issues, he is best known for his extensive work on the development and implementation of primary care delivery and payment models.

In this episode, we discuss such things as payment reforms in primary care, the industry impact of primary care consolidation, physician-led ACOs, the new Making Care Primary (MCP) payment model and the need for multipayer collaboration, health equity, rural healthcare transformation, physician workforce challenges, and the future implications of AI on the medical profession. With leadership from Shawn and his constituents throughout the primary care ecosystem, we are well-positioned for transformation in the race to value!

Episode bookmarks:

01:30 The plasticity of primary care and how it can evolve to meet community health needs in the new value era.

02:30 Introduction to R. Shawn Martin, the Executive Vice President and Chief Executive Officer for the American Academy of Family Physicians.

04:45 People who have access to advanced primary care tend to have better health, receive timelier diagnoses, and get more prompt treatment when it is needed.

05:30 The U.S. spends only 5-7% of its healthcare dollars on primary care — less than half of the 14% average in Western European countries.

06:00 AAFP Advocacy Priorities:  Fighting for Family Medicine!

07:00 Shawn discusses the need for additional investment in primary care at a national level.

08:30 The misalignment of fee-for-service in the primary care setting.

09:00 “Appropriate investment in primary care, coupled with a prospective payment model, will transform both patient experience and care team performance.”  

09:45 PCP Infrastructure Investments + Rapid Transition to Value-Based Care = Primary Care Transformation

10:45 Vertical integration of primary care can lead to higher prices and costs, including insurance premiums, without improving care quality or patient outcomes.

11:30 Site-of-service payment differentials create uneven playing field between independent practices and hospital-owned primary care.

12:00 Shawn’s congressional testimony to the Senate Finance Committee on the “Consolidation and Corporate Ownership in Health Care”

13:00 The Medicare program created siloed benefits between hospitals and physicians, and these design flaws created incongruencies in system economics and patient health outcomes.

14:30 The inability of independent physician practices to survive on the regulatory framework of the modern healthcare system.

15:30 Community-based primary care innovation empowered by partnerships.

16:30  The explosion of IPAs and clinically integrated networks and how these models are applied to population health management.

17:00 Data sharing and interoperability empowering chronic care management and transitional care pathways.

17:30 The trend of provider consolidation within “payvider” platforms offered by major payers (e.g. Optum, Centerwell).

17:45 Wall Street interest in primary care that led to additional capital infusion in the absence of public payer support.

18:30 “Private equity investment has created a necessary lifeline of capital for primary care to survive the onramp of value-based care.”

19:00 “It is difficult to focus on primary care transformation when you are seeing 30-35 patients a day, 6 days a week, for 48-49 weeks out of the year.”

19:30 How investments in primary care created the physician mindshare needed to transform their practices.

20:45 On average, physician-led ACOs produce almost 7 times the amount of Medicare savings per beneficiary than hospital-led ACOs.

22:45 Shawn discusses how the autonomy of physician-led ACOs leads to them having better Shared Savings results than their hospital counterparts.

23:00 “The empowerment of PCPs with the autonomy to be patient-centered at the point-of-care has shown what is possible with value-based care.”

24:00 “The challenging occupancy-dependent model of hospitals is not insurmountable if you create collaborative, community-based physician networks.”

24:45 Overcoming the toxicity of fee-for-service in primary care.

25:00 “Primary care is built upon the foundation of a trusting, longitudinal relationship between a patient, their caregivers, and the primary care team.”

25:45 Leveraging virtual care and telemedicine to enhance relationships in the primary care setting.

26:00 “The combination of primary care autonomy with risk-based payment models will help us overcome the toxicity of fee-for-service.”

26:30 The new state-based multi-payer model from CMMI, “Making Care Primary” (MCP), supporting primary care practices in the transition to prospective value-based payment.

27:00 Recent AAFP Press Release: “Primary Care-focused APM Checks AAFP Advocacy Boxes”

27:30 Shawn discusses how the multipayer MCP model construct (Medicare/Medicaid) will serve to eventually bring value to primary care at scale.

29:30 The rationale behind making MCP a 10-year transformation project (instead of a 3-4 year evaluation cycle).

30:00 The imperative for CMMI to transition providers to more sophisticated payment models with downside risk over time.

31:00 Referencing Shawn’s recent article: “How Moneyball can teach us to invest in primary care”

32:00 A recent AAFP member survey that indicated while 85% of surveyed physicians believe social needs are directly related to poor health, 80% are not confident in their ability to address their patients’ social needs.  

33:00 Inspiration from Michael Lewis regarding the applicability of Moneyball in healthcare transformation.

34:00 “The single best investment to improve health equity in our system is primary care. It is a main street discipline of care in our communities that is not confined to a building.”

34:30 The plasticity of primary care to meet community health needs and why equity must start with empowered, community-based PCPs.

35:00 The AAFP formed the Center for Diversity and Health Equity to address social determinants of health with The EveryONE Project.

35:30 “You cannot even begin to change the trajectory of health inequities in our health system without primary care.”

36:00 Meeting the workforce goals having access to primary care in every community.

37:00 Mortality rates are 23% higher for people living in rural communities than those who live in urban communities.

38:00 “The movement to prospective, capitated payment models is nowhere more important than in rural communities.”

38:45 How trusting relationships and localized interventions drive patient engagement in rural communities.

39:00 Shawn shares the lessons learned from his father who was a primary care physician in a rural area.

40:00 The relationship between the physician workforce and critical access hospitals and the opportunity to reinvent the rural healthcare ecosystem.

41:30 Physicians have higher levels of satisfaction when practicing in a value-based environment.

42:30 U.S. health is threatened by a primary care workforce shortage, and the country will need up to 48,000 more primary care physicians by 2034.

43:00 Shawn shares his perspective on the physician workforce and the how the AAFP is working to ensure that we have an adequate physician workforce in the decades to come.

45:00 The “infatuation of specialization” that favors procedural intensity.

46:30 The multi-faceted roles of primary care are not fully understood in medical schools.

47:30 How specialty economics contribute to the shortage of primary care.

49:00 The transformative potential of AI in family medicine.

49:45 AAFP recently adopted a policy on the “Ethical Application of Artificial Intelligence in Family Medicine.”

50:30 The need for transparency in the development and implementation of AI in healthcare.

51:30 How AI can be used to reduce administrative burden in primary care practices (e.g. documentation, prior authorizations, utilization management, chart reviews)

52:00 Using AI to decompress the knowledge management of specialization in medicine in order to support more comprehensive primary care.

53:00 The future of AI-enabled, comprehensive primary care.

53:00 Empowering patients with AI through lifestyle-based knowledge transfer and improvement of health literacy.

55:45 Parting thoughts of optimism on the future of primary care and how the value movement will drive us to improved population health.

58:00 The presence of primary care increases life expectancy.

59:00 Stay connected with Shawn on social media and find out more about the work of the AAFP.

Democratizing access to value in healthcare through primary care enablement is the compass guiding us toward a future where health is a universal right, not a privilege, and where the promise of value-based care is accessible to all. It represents a fundamental shift in our approach to healthcare delivery. By prioritizing primary care and leveraging technology, we can extend the reach of healthcare services, making them more affordable and accessible to diverse populations. This approach emphasizes preventive care, early intervention, and patient education, reducing the burden on emergency rooms and hospital admissions. Ultimately, primary care enablement has the potential to transform the healthcare landscape, promoting healthier communities and improving the overall well-being of individuals while also making healthcare a more equitable and sustainable system for everyone.

Joining us this week on the Race to Value is Michael Kopko, the CEO of Pearl Health – a company that is on a mission to democratize access to value in healthcare. More than 800 primary care providers across the country partnered with Pearl to align payments with patient health and leverage emerging data and technology to achieve better outcomes more efficiently. And earlier this year, they closed on a $75M Series B funding round to bring even more capability to the health value economy, by empowering providers to transition to a more proactive care model, enabling them with a technology solution that surfaces urgent cases before they become emergent, and rewarding them for outcomes aligned with value. This is a company that you need to know about, and it is my pleasure to have Mike on the podcast this week to discuss the challenges facing our industry and how Pearl Health is accelerating the development of innovative solutions that place providers at the center of healthcare delivery and cost management.

Episode Bookmarks:

01:30 Introduction to Michael Kopko and Pearl Health — a company that is on a mission to democratize access to value in healthcare.

03:30 After more than a decade of value-based care efforts, the U.S. still pays about twice as much for healthcare than any other country, despite underperforming in quality and outcomes.

04:00 How do we reach a critical mass with ACOs and other APMs to save the Medicare Trust Fund from insolvency by catalyzing care delivery transformation?

05:45 There is reason for optimism for healthcare in the long-term, e.g. R&D in the health sector, the steady march to value since Michael Porter coined the term in 2006.

07:00 The increasing adoption of Medicare APMs and value-based Medicare Advantage (see HCP-LAN APM Measurement Effort).

07:30 “The underlying infrastructure and operating system for healthcare is positioned well for value.”

07:45 More work needs to be done, e.g. Medicare negotiations with pharma companies to lower drug costs, further realignment of incentives.

08:00 Medicare cost growth has abated.  (See recent NYT article: “A Huge Threat to the U.S. Budget Has Receded. And No One is Sure Why.”)

08:30 The need to balance ACO Shared Savings performance over time with the democratization of data to improve population health outcomes.

09:00 “We are starting to get the highways and freeways established for data interoperability to be very proactive in creating health value.”

09:30 “Our healthcare system has so much money that with the right capability sets and incentives, we will solve any problem as long as we have the will to do so.”

10:00 Pearl has seen 10X year-over-year growth, expanding from 10 to 29 states, since its founding in November 2020.

11:00 Technology enablement requires the harmonization of the platform with the wisdom of experienced healthcare professionals.

12:30 Michael shares key learnings in his healthcare leadership journey and how that led to the founding of Pearl Health.

14:45 The realization that the missing piece of value transformation was the enablement of PCPs to visualize and understand how to better care for patients.

15:00 “VBC is no longer a gamble when the right physicians are plugged into the right enablement partners.”

15:45 The renaissance of primary care due to value-based care and business intelligence (and how that is addressing historically high levels of PCP burnout).

16:30 Predictive analytics in primary care (e.g. future diagnosis codes, ER admissions, missed medication moments).

17:30 Aggregation of data to power an Urgency Score, which prioritizes patients in need of outreach and creates holistic, longitudinal visibility.

18:30 The overburden of primary care (e.g. it would take 21.7 hours/day for a PCP to accomplish everything that he or she is expected to do to for patient care and maintaining a business.)

20:00 The assembly line of FFS compared to the “New World of Value” and how innovation can reduce administrivia and create cost effectiveness.

22:00 Using automation to streamline patient outreach efforts.

22:30 The delayed absorption of technology into healthcare as compared to other business sectors.

23:00 “The future of automation and AI in healthcare is just beginning, and that is a reason for optimism.”

23:30 Does the MIPS program really add to population health? (JAMA article: Time and Financial Costs for Physician Practices to Participate in the Medicare Merit-based Incentive Payment System)

23:45 How ACO REACH reduces the administrative burden of MIPS. (Reach for Simplicity: How ACO REACH Makes Quality Measurement Easy)

24:30 Since FFS favors procedural intensity over cognitive care, population health suffers. And the mental health of primary care physicians suffers too.

27:00 The crucible moment for PCPs to become elite practitioners in our healthcare system!

27:30 Getting “above the visit” by combining tools and technology to succeed in VBC.

28:00 A renewal of entrepreneurship and a willingness to change your business model.

28:30 An elite segment of the PCP landscape (5-10%) with business performance that surpasses FFS, along with impacts made in community health.

29:00 Solow Growth Model – the application of technology, labor, and capital to support long-run economic growth.

29:30 The enablement sector in value-based care is not feeling the pain of capital constraints.

30:00 “People are adopting and considering value-based models more rapidly than I’ve ever seen in a decade of working with and building networks in healthcare.”

31:00 The average PCP generally earns relatively little but influences ~$10M in downstream healthcare costs.

31:30 PCPs taking fully capitated risk must get specialists contracted into VBC arrangements and that requires overcoming friction due to oligopolistic market dynamics.

33:00 Recent Atul Gawande article in The New Yorker about the Costa Rica healthcare system (improved population health and longer life expectancy through primary care enablement).

33:30 The regression equation for healthcare – advanced primary care with optimal specialty management would address 60-80% of medical costs!

34:00 The changing business model for specialists due to advancements in VBC.

35:00 The tipping of the fulcrum – alignment of primary and specialty care is progressing due to data interoperability.

36:00 Democratization of access to value due to changes in enablement and economics.

37:00 Will advanced hospital systems have a role to play in the future of value?

38:00 Innovators and disrupters will be at the leading edge in VBC  because they will be more nimble, agile, and unconflicted.

39:30 15% of the insurance premium dollar goes to administration and profit.  (The shift of risk to providers will lower that admin cost to 4-5% or less!)

40:00 Upstarts can create real economic value.  (Just look at how AWS disrupted intensive server requirements for businesses.)

40:30 VBC enablement can be as revolutionary as cloud-based computing!

41:00 Michael’s advice to entrepreneurs: “Focus on creating value in a thesis of change.”

41:30 Other opportunities for disruption, e.g. Drug delivery and development, AI and automation, data interoperability.

42:00 Creating an escape velocity through TAM (Total Addressable Market) and Team.

43:00 ACO REACH is a gamechanger for value because it presents an opportunity for PCPs to increase and stabilize revenue with prospective payment.

44:30 Keys to success in models like ACO REACH: reducing the cost of access and improving intelligence capabilities.

45:30 “ACO REACH is a cheaper, faster path to an alignment shift.”

46:30 “Healthcare doesn’t have a data problem. The real test now is what data matters and when does it matter. How do you synthesize and distill information at the POC in a salient way that is actionable.”

47:00 Developing an urgency score,  promoting the patients that are most at-risk, and surfacing interventions through a suggestion engine.

48:45 The trend towards PCPs selling their practices to larger enterprises like hospitals and PE-backed physician aggregators.

49:30 The benefit of working within a larger primary care practice (more capabilities, risk protection, negotiation leverage).

50:00 Autonomy and independence of PCPs and how that can happen in a corporatized model.

51:00 Clinical integration – “Hospitals are a key ingredient in VBC when properly applied.”

52:00 Finding a business model that is aligned morally and ethically to what one wants to contribute to the world.

53:00 “The new practice of the future will be less capital intensive with these new value-based models becoming more proliferated.”

53:30 “Culture is what everyone says it is at that moment in time. It’s an evolving organism.”  (A Values-Based Culture: Principles at Pearl)

54:00 Creating a company with a strong value compass.

55:00 Transparency and Interoperability.

56:00 Recognition that you get what you pay for. (FFS rewards chronic disease.  We need to realign incentives to reward health.)

57:00 Technology, Automation, and Artificial Intelligence.

58:30 The value of health equity in value-based care transformation.

59:00 How ACO REACH finally put an emphasis on the importance of equity in the value movement.

59:30 “Start where the patient is, not where the business model begins.”

60:30 Multidisciplinary care to enhance the health of communities and how capital markets are the great unlock.

61:30 “The model of providing agency to the stakeholders generating high costs is a backwards model.  We need a more proactive, sentient system.”

63:00 Parting thoughts on transforming a complex system.

Crossing the Value-Based Healthcare Rubicon isn’t just a journey, it’s a revolution in care, where the currency is quality, and the compass is compassion. This transformation is both an economic and moral imperative, and in the alchemy of healthcare, transforming economics isn’t just about numbers; it’s the catalyst for transmuting care outcomes into golden results that enrich both lives and ledgers.

This week you have access to two of the leading minds in value transformation. We are joined by Dr. Edward McEachern (Executive Vice President and Chief Medical Officer for PacificSource) and Jenni Gudapati (Value-Based Healthcare Program Director and Clinical Associate Professor at Boise State University).

In this illuminating episode, we delve into the transformative realm of value-based healthcare with a diverse range of topics. Our insightful interview explores the value movement and its profound impact on economics and care outcomes. We unravel the intricate dynamics of care management, particularly in the context of chronic diseases, while shedding light on the crucial aspects of risk adjustment, Annual Wellness Visits, and Quality Improvement. We also investigate the concept of “Gold Carding” and the role it plays in healthcare transformation. Furthermore, we delve into higher education’s pivotal role in shaping the future of healthcare value, emphasizing the essential skills that healthcare leaders of tomorrow must possess. Tune in for an enlightening discussion that navigates the evolving landscape of healthcare, economics, and leadership!

This week’s episode is brought to you by Edifecs – an EMR-agnostic, interoperable, and AI-enabled technology helps providers unify and utilize data for a more complete digital portrait of patient populations. The result: better clinical, financial, and compliance outcomes.  To learn how Edifecs’ applications can enhance prospective risk adjustment and value-based contract performance, visit edifecs.com today.

Episode Bookmarks:

01:30 Introduction Edward McEachern, M.D. and Jenni Gudapati, MBA, RN

06:50 The slow uptake of accountable care (HCP-LAN: only 20% of healthcare payments flow through Categories 3B and 4 APMs).

07:20 Provider challenges: supply chain disruptions, labor shortages, high inflation, and the end of COVID-19 relief payments.

08:20 Congressional Budget Office projects insolvency of the Medicare Trust Fund by 2026.

08:50 The economic necessity of value-based health care to reduce unnecessary spending.

09:35 “In the shadow of COVID we have crossed this Rubicon where there is a push on the current paradigms of care delivery and payment.”

10:15 Stressor #1: The retirement of the Boomer workforce will create a 14% structural deficit in accessible labor.

10:30 Stressor #2: FFS infrastructure collides with APM adoption strategies and cannot support value transformation.

11:20 Stressor #3: Shift of hospital care delivery to the outpatient and home setting. (“It is never coming back.”)

11:50 “This chronic complex system of care that takes care of people in the post-acute setting is not adequately available in most communities.”

12:20 “LAN 3B and 4 payments will only help in the context of the operational reshaping of the health delivery system.”

12:50 Value-based consumer perspective needed: 46% cannot afford out-of-pocket healthcare expenses!

13:20 Low value services that do not track to best patient outcomes.

13:50 Revenue dependency on a sick-care model of fee-for-service medicine.

14:35 “Too many health inequities exist. We need to financially incentivize providers to take care of underserved populations.”

15:20 “Healthcare is the only industry that is Yelp proof.” (the dislocation between costs and consumerism)

16:20 What if we created a well-financed and integrated SDOH health system to work alongside the sick care health system?

17:50 The power of the Annual Wellness Visit (AWV) in patient-centered care.

19:20 Clinical intuition in assessing patient risk during the AWV (going beyond the diagnosis code).

21:35 Mapping the system of care to improve patient navigation.

22:20 Healthcare costs for chronic conditions totals $1.65 trillion—equivalent to nearly eight percent of the nation’s GDP. (Projected to be $6 trillion by 2050!)

24:50 PacificSource’s collaboration with Summit Health (ex: managing burden of illness through care management and gold carding.)

27:50 Scaling telehealth, RPM, and home-based CCM through financial incentives.

28:50 Lowering readmissions and ED utilization comes at the expense of lost FFS revenue.

29:35 Prevention programs are core to a clinician’s identity in the promotion of health and wellness.

30:50 PMPM-based prospective payment in the glidepath to value.

31:50 Systems of care for patients stratified in disease-specific high segments.

32:20 Payer-provider collaboration in gold carding.

32:50 The need for real-time bidirectional patient information.

33:50 92% believe quality of care will improve with VBP. (Recognition the care coordination is a critical success factor.)

34:20 Gold Carding as a way to streamline pre-authorizations between a provider and a health plan to support value based healthcare.

35:20 “CDS Hooks” (a HL7 specification that integrates clinical decision support and enables data exchange between payers and providers).

36:50 Dr. McEachern provides additional insights on gold carding, evidence-based PA adjudication, advanced CDS, and interoperability.

43:50 Risk adjustment is so much more than a RAF score and a lever for revenue.

45:20 Jenni expounds on the importance of risk-recapture and accurate charting strategy to reflect true burden of illness in a population.

46:50 Shared decision-making and reflective care planning as a risk mitigation strategy.

49:35 A RAF increase of 0.1 in a population of 1,000 patients = $1M

50:50 Boise State University’s Value-Based Healthcare Program – nationally-recognized education for preparing future healthcare visionaries.

52:50 Master of Population and Health Systems Management – “the juncture between actuarial science, epidemiology, and population health studies”

54:35 Partnership with HFMA – the marrying of Business with Higher Education to meet future workforce needs.

56:50 A vision for “creating a community of Healthcare Transformationalists”.

62:20 Future leaders in value transformation will need expertise in epidemiology, finance, and clinical operations.

63:50 Grit, passion, and optimism are the most important intangible attributes of future leadership success.

66:35 Parting thoughts from Dr. McEachern and Jenni Gudapati.

Now is the time to embark on a journey towards a brighter and more resilient future. As the U.S. healthcare system grapples with the aftermath of a global pandemic, we find ourselves at a pivotal crossroads. This episode delves deep into the profound changes brought about by the pandemic, examining how it has exposed vulnerabilities in our existing systems and ignited conversations about the need for transformative change. Join us as we navigate this critical juncture, exploring the shifts in healthcare, economy, and societal values that could ultimately lead us to a high-value system that prioritizes well-being and sustainability for all. Get ready to be inspired and informed as we embark on this enlightening exploration of the post-pandemic world.

Joining us in the Race to Value this week is David B. Nash — an American physician, world renowned scholar and public health expert, and Founding Dean Emeritus of the Jefferson College of Population Health. His accolades and achievements in healthcare transformation are innumerable. (The week before this interview was recorded he had received the Lifetime Achievement Award from the American Association for Physician Leadership.) Dr. Nash is also a bestselling author with his new book, “How COVID Crashed This System: A Guide to Fixing American Health Care.”  In this episode, we discuss insights from Dr. Nash’s research on COVID-19’s impact on the healthcare system and how this post-pandemic era can help us transition to a high value health care system.

Episode Bookmarks:

01:30 Introduction to Dr. David Nash, an American physician, world renowned scholar and public health expert, and Founding Dean Emeritus of the Jefferson College of Population Health.

03:30 Have we learned our lessons from the COVID disaster?

05:00 Dr. Nash reflects on his recent experience with Dr. Ashish Jha on the last day of service to our country as the White House COVID-19 Response Coordinator.

05:30 “The office of the presidential response to COVID is now a janitorial closet somewhere in the West Wing of the White House…it is sad.”

06:00 “1.2 million dead from COVID-19 is more than the total of all combat casualties of every war since the Revolutionary War of the United States!”

06:30 “Sadly in the history of our country, when the dying stops, the forgetting begins.”

07:00 PTSD from the pandemic with physicians and healthcare professionals, coupled with societal apathy towards COVID-19 and surging cases in China.

08:00 Medicaid Redetermination as the consequence of the end of the Public Health Emergency and how lost coverage will impact marginalized populations.

09:00 3,000+ people died from 9/11, and we are still taking our shoes off at the airport.  1.2M died from COVID-19, and it is back to business as usual.

09:30 Societal issues (e.g. structural racism, inequality) persist in our country.

10:00 What is the True North for American Healthcare really?  ($4 Trillion in spend with significant amount of low value care, declining life expectancy, low ranking in world health rankings)

10:30 Additional societal measures of a poor performing health system (alcoholism, depression, suicide, opioid abuse).

11:30 How Philadelphia is suffering an exacerbation of  pre-pandemic problems (lack of access, redlining, crime, homelessness, educational disparities).

11:45 There is a 20-year disparity in life expectancy between rich and poor communities in Philadelphia.

13:00 The persistence of health inequities and social injustice since the transatlantic slave trade.

13:30 COVID-19 blasted a searing light on social determinants of health!

14:30 “You can’t have value-based care without equity.” – the costs of health inequities are in the hundreds of billions (see recent JAMA article).

15:00 Employer engagement in health equity transformation.

15:30 “The emergence of the payvider model has given value-based care additional energy.”

17:00 The evolution of medical and nursing education to improve health equity.

18:00 Testing of innovations at scale during the pandemic (e.g. telehealth, hospital-at-home, physical infrastructure changes, novel medical devices).

18:30 The extension of Medicare telehealth flexibilities and the extension of the Acute Hospital Care at Home Program through 2024.

19:00 Bridging the digital divide in Philadelphia through the provision of telehealth services at Jefferson Health.

20:00 The economic incentives that led to the rapid adoption and diffusion of innovation.  What is next for digital health post-pandemic?

20:45 The opportunities for applying precision medicine in cancer care and generative AI in healthcare.

22:00 “Amazon, Walgreens, Walmart, and CVS are the Big 4 disruptors of technology innovation in healthcare. This is where the action is.”

24:00 The existential threat of Artificial Intelligence and the forthcoming technological singularity.

25:00 Personal reflections on the disruption of ChatGPT in healthcare and medical education.

26:00 The need for clinical rotations of medical residents in retail-based healthcare settings (e.g. Walmart, Oak Street, Walgreens, Iora Health).

27:30 AI should not need to be a threat to physician autonomy.

28:00 The collision of moral and fiduciary responsibility in healthcare.

28:45 Referencing Dr. Nash’s article, “Population Health is the New Public Health” – “The virus exposed a truth that the public health paradigm is outdated and insufficient.”

30:00 Public health spending is $400 per person in the U.S. (compare that to healthcare spending at a rate of $10k per capita).

31:00 Dr. Leana Wen – “Public health saved your life today. You just didn’t know it.”

31:30 The structural, financial, and cultural challenges of public health and why it is not an attractive career trajectory for physicians.

32:30 The leadership needed to fix public health.

33:00 Dr. Nash expresses his concerns about the not-for-profit governance of health systems that overemphasis profit motives.

34:00 Putting C-Suite leaders at personal financial risk for improving population health and health equity. (a controversial idea to find our True North!)

36:30 Reference Don Berwick’s article: “Salve Lucrum: The Existential Threat of Greed in US Health Care”

38:30 Addressing the challenges of pharmaceutical drug shortages.

41:30 The emerging focus on SDOH tools and measures for optimization of provider EHR workflows.

46:30 The Four Horsemen of the Mental Health Apocalypse (e.g. Opioid, Alcoholism, Depression, Suicide) – how COVID-19 and social isolation exacerbated the crisis.

47:30 The PTSD of the younger generation due to their pandemic experiences.

48:00 How life expectancy in Blue Zones is impacted by community relationships and the need to overcome tribalism in the U.S.

48:45 The incontrovertible evidence of how one’s health is affected by the political party of a state’s governor.

49:30 Putting mental health training, research, and payment on par with traditional health services delivery.

51:30 Realigning economic incentives for physicians as the be all, end all starting point for healthcare transformation.

53:00 Dr. Nash provides his perspective on Risant Health (the value-based care merger between Kaiser Permanente and Geisinger).

55:00 Parting thoughts from Dr. Nash on what it will take to heal our country in the post-pandemic era.