Listening In (With Permission): Conversations About Today's Pressing Health Care Topics

Suzanne Delbanco speaks with Jason Richmond, Head of Consultant Relations at Ginger, a digital mental health care provider.

Jason Richmond explores the supply demand imbalance between mental health patients and providers in the United States right now, and why the traditional provider network model to access care doesn’t carry over well into the mental health space. Jason describes the evolution that mental health care has gone through in recent years, transforming from a one-size-fits-all care program into a de-stigmatized spectrum of treatment plans, including behavioral health coaches. Finally, Jason offers advice for business leaders on how to de-stigmatize mental health care and use employee feedback to design a health benefits structure tailored to your covered population's needs.

Suzanne Delbanco speaks with Michelle Zettergren, President of Labor and Public Sector markets and Chief Sales and Marketing Officer for Brighton Health Plan Solutions, a health enablement company that serves as third-party administrator to self-funded employers and other health care purchasers. Michelle heads marketing, customer retention, and business intelligence units for the company, bringing over 30 years in the health insurance industry.

Michelle Zettergren explores the barriers and benefits of employers contracting directly with a health system, and why this solution has earned a high Net Promoter Score among enrollees. Michelle also points to Centers of Excellence for high-cost procedures, like total joint replacement surgeries, as a proven way for employers to contain health care costs and secure high-quality care. Finally, Michelle shares what Brighton Health Plan Solutions is doing to help employer clients prepare for new ERISA regulations set to take effect in 2022 and 2023.

Suzanne Delbanco speaks with Scott Doolittle, CFO of Quantum Health, a health care navigation company providing care coordination and navigation support. Scott oversees Quantum Health’s business intelligence units, where he leads a team that validates the company’s actuarial results.

Scott Doolittle provides insights into how Quantum Health engages both consumers and providers navigate the eligibility and coverage of each consumer’s specific benefits plan. In this episode, you’ll learn how health care navigation helps employers increase plan member uptake of benefits programs.

Featured quote:

“A provider is always going to want to get paid. They’re always going to call to make sure the member’s covered, and if we’re that single point of entry and can provide that expertise and do it in a way that drives satisfaction for them, they’re more likely to leverage us as we talk about care planning on a go-forward basis.”

Suzanne Delbanco consults Bob Berenson, MD, Institute Fellow at the Urban Institute, on what's going on with telehealth payment policy in both Medicare and the commercial sector and why employers should be paying attention.

In May 2021, Bob Berenson testified at the Senate Finance Committee, where he laid out the reasons why fee-for-service is a not a viable way to continue paying for telehealth visits, especially in the primary care context. Listen in to learn about the intricacies of telehealth payment in Medicare, how the commercial sector has taken a different approach, and why a payment arrangement known as partial capitation holds the most promise for balancing the convenience of telehealth for patients with financial sustainability for health care purchasers.

Suzanne Delbanco speaks with Nate Freese, MBA, Senior Director of Data Strategy at Grand Rounds Health, a health care quality and navigation solution offering employers a data-driven clinical navigation platform paired with patient advocacy tools. Nate leads data strategy at Grand Rounds Health, where his team is responsible for building algorithms that match patients with the right providers based on billions of historical clinical interactions.

Nate offers a helpful introduction to data science by describing the three types of analyses that data science tackles as well as use-cases that help physicians, pharmaceutical companies, and patients make informed value-oriented choices. He then explores the major challenges that health tech companies face in bringing their data use-cases to life, including the siloed and unstructured nature of health data and the talent shortage of data science professionals across the country. Finally, Nate shares the approach Grand Rounds Health uses to track and improve its ability to reduce health care disparities.

Data science simplifies the unimaginably complex and predicts the future to help us make better decisions. In health care, the difference between the right and wrong decision can result in hundreds of thousands of dollars in spend, hospitalizations, or worse. In this episode, you’ll learn how Grand Rounds Health is using data science to power its clinical navigation platform and patient advocacy tools, with an eye toward health equity and cost containment.

Featured quotes:

“Messy data is another challenge for applying data science in health care. The data often requires a lot further processing to make it useful, and is often inconsistent – you have systems with different definitions of the same concept or information. Ultimately, it takes very specific skills sets and domain expertise to make health care data sets useful. And that gets to the next big challenge, which is talent shortage.”

“There’s a big disconnect between the number of companies out there that have a compelling vision for how they could use data in a health care context, and the number of companies that are actually doing so. A big factor is finding the people they need to realize that vision.”

“Data scientists are not one-size-fits-all. It’s usually not that you need 1 or 5 data scientists at your company to realize your vision for using data. It’s more likely that you need a couple of data engineers, you might need a couple of machine learning experts, a natural language processing expert, a statistician and a couple of epidemiologists. Each of these people are data scientists, but they bring a different skillset to the picture, and you need several of them to suite a particular use-case.”

Suzanne Delbanco talks with David Vivero, CEO and Co-Founder of Amino Health, a health care financial wellness solution that combines data, design, and consumer-first thinking to curate personalized recommendations for specific care needs. Prior to Amino, David was VP of Rentals at Zillow, a consumer internet company that has transformed the home and rental marketplace through increased transparency and a strong user experience. A self-described “product guy,” David Vivero shares his view on where price transparency can make the biggest impact for patients and plan sponsors in the commercial health care market.

David and Suzanne discuss the federal government's recent price transparency legislations, including the Hospital Price Transparency Rule, the Transparency in Coverage Rule, and the No Surprises Act. Taken together, these three pieces of legislation have the potential to catalyze a “Cambrian Explosion” of new digital health tools, consumer experiences, and potentially even new types of health plans or business models that improve coverage and care delivery. As David wrote in a June 2021 commentary for Fast Company, these regulations bring “health care one step closer to obeying traditional market dynamics in which cost and value are correlated.”

In this podcast, David Vivero explores why he’s hopeful that the Transparency in Coverage Rule will create more of an impact than the Hospital Price Transparency rule has to date. A major difference lies in the penalties: the Transparency in Coverage Rule is a lot heftier at $100 per person per day for plans compared to $300 per day for hospitals in the Price Transparency rule. Finally, David shines a light on how new industries take time to reach their full potential, which is why he enthusiastic about the role of health technology products can play in helping make health care more affordable and user-centric moving forward.

Featured quote:

“In my view, price transparency is a platform. It’s like Microsoft Windows, a basic platform or operating system. And, on top of that, all sorts of applications can be built that further the objectives of the U.S. health care system and the American economy.”

Suzanne calls Patrick Tigue, the Health Insurance Commissioner for the State of Rhode Island, to discuss the Office of the Health Insurance Commissioner (OHIC)'s initiatives to stem health care cost growth in RI.

Rhode Island has established a cost growth benchmarking process to bring greater transparency to the market. They've also created a first-in-the-nation initiative that caps annual growth in prices paid by commercial health plans. Patrick and Suzanne chat about the impacts these programs have had on the market, and what may be ahead for Rhode Island and other states that follow its lead.

Suzanne Delbanco talks with Thi Montalvo, Health Analytics Practice Leader – Health and Benefits for Willis Towers Watson. In her role, Thi helps employers and other health care purchasers make data-driven decisions for their health benefits strategy. While she’s seen many successful use-cases over her nine years specializing in health analytics, she’s also seen firsthand the many problems that are hindering the acquisition and use of data for optimizing employer-sponsored health benefits. From onerous legal agreements limiting the use of the data, to incomplete data fields, to lack of visibility into necessary information like diagnosis codes or provider specialty information, employers and other health care purchasers are struggling to put their own benefits data to use, despite being the ones who are footing the bill.

Learn how the proliferation of condition-specific benefit programs (often referred to as “point solutions”) has changed the data landscape in the employer-sponsored health care market, and what hoops benefit consulting firms like Willis Towers Watson have to jump through to perform the analyses that their clients need. Thi Montalvo and Suzanne also discuss what’s necessary to improve data sharing moving forward, and how the secure and reliable flow of aggregated, de-identified health data is an important piece of the evolving journey to improve price and quality transparency in the commercial health care sector.

“Are there opportunities to steer to a quality provider or facility down the street? If we can’t do that with the data, then we’re not serving the interest of our employers and their employees and getting them the health care that they need.” – Thi Montavlo, Willis Towers Watson

Suzanne Delbanco calls CJ Stimson, MD, the Senior Vice President of Value Transformation at Vanderbilt University Medical Center (VUMC), to discuss Vanderbilt’s direct contract bundled payment arrangement for maternity care with Metro Nashville Public Schools (MNPS). This call serves as follow-up to the webinar hosted by CPR in March 2021, where Dr. Stimson and David Hines of MNPS shared their insights one year after the program’s implementation.

Dr. Stimson received both medical and law degrees from Vanderbilt, and is currently an Assistant Professor at VUMC, as well as a practicing urologic surgeon. Here, he and Suzanne discuss why VUMC and MNPS decided to launch a direct contract program on maternity care, the scope and contents of the bundle, and how payers and providers have reacted to this innovative strategy. CJ also takes a guess at what may be ahead for direct contract bundled payments, and what it will take to get more organizations on board with a similar arrangement.

Suzanne Delbanco chats with Nathan Counts, a seasoned health benefits professional who recently joined Amtrak as Head of Total Rewards. Previously, Nathan was Assistant Vice President – Global Benefits for a leading telecommunications company, where he actively participated in CPR membership activities, helping shape CPR’s Shared Purchaser Agenda between 2017 and 2020.

Nathan, who holds a master’s in mathematics and got his start as an Actuarial Consultant, is at the forefront of the data revolution in health benefits. In 2018, he was recognized by Workforce for helping make his former employer’s benefit design decisions “truly data-driven.” In this interview, he raises the need for a unified data set for the commercially-insured population, citing the usefulness of the Medicare’s data set in answering valuable population health questions.

Listen in as Nathan Counts reflects on his career in health benefits, why he sees alignment between Medicare and the commercial sector as critical, and what he thinks are the most promising opportunities to improve member experience.