“Just because it’s healthcare, doesn’t mean it’s good for you.” 

Al Lewis joins MTVA for a lively discussion on patient education, nutrition, and overconsumption of healthcare. After a doctor’s visit for hoarseness where he was recommended unnecessary testing, Al decided to use his background in Trivia and create a new tool for patient health literacy. Quizzify was born! 

Quizzify is designed to promote health literacy in an engaging, user-friendly format – helping make patients better consumers of healthcare. 

The conversation centers on Quizzify’s program for GLP-1 weight loss drugs, which aims to “dissuade the curious, and educate the serious.” This dual goal can help reduce unnecessary spend on expensive medications, and equip those who start GLP-1s to have a higher chance of success in transitioning off. 

Al and MTVA also discuss the importance of lifestyle change, which is made more challenging by deceiving nutrition labels and the relatively higher cost of more nutritious foods. 

“Bad calories have become vastly less expensive, and good calories have become vastly more expensive.”

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We’re excited to welcome like-minded organizations and individuals to join the MTVA Membership program! 

As a 501(c)(3) nonprofit, we rely on support from our grassroots network to advance our mission of creating a value-based health system with high-quality patient outcomes at a reasonable cost. We’re proud to offer two membership models, Ally Member and Trade Member. Tax-deductible membership contributions help us enrich the healthcare environment with quality content – including this podcast – and robust platforms to fuel discussion, collaboration, and advocacy that lead to ground-breaking solutions. 

For more information and to join us, visit our website https://www.movingtovalue.org/membership.  

All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

The Moving to Value Alliance (MTVA) has been promoting value in health care for over 7 years. Though we’ve seen some progress, spending is steadily rising, many health outcomes remain unchanged, and burnout is a real problem for healthcare professionals.

It can be easy to feel discouraged, but that’s not what MTVA – nor our special guest this week – stand for. 

“I feel like it’s a choice in a way to be pessimistic or optimistic. You know that change is slow until it’s really fast, that’s how it always works.”

Who better to discuss the state of the movement to value in healthcare than Stacey Richter?! As host of the top healthcare podcast Relentless Health Value, Stacey is usually the one asking questions – she’s interviewed hundreds of experts from all corners of the industry. We’re honored she let us turn the tables for this conversation with MTVA Board Members. 

Stacey is tuned into the healthcare landscape. In this episode, we learn about her “why” and  discuss the role of technology and operational excellence, the importance of primary care, and how the term “value” has been coopted. Stacey is hopeful for the future, and she points to the local level for sources of inspiration. 

“I firmly believe that when enough people begin to push in the same direction, when the reputational damage starts to happen from people who are overly putting profits over patients in really obvious and unpalatable ways, that's when things start to change.” 

In addition to hosting Relentless Health Value, Stacey is co-president of QC Health – a public benefit corporation finding cost-effective ways to improve the health of Americans. MTVA Board Member John Rodis, MD works with Stacey as the Benefit Director of QC Health.  

Stacey is also co-president of Aventria Health Group, a consultancy working with clients who endeavor to form collaborations with payers, providers, pharma, employer organizations or patient advocacy groups.

Episodes mentioned, from MTVA Unscripted and Relentless Health Value:

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We’re excited to welcome like-minded organizations and individuals to join the MTVA Membership program! 

As a 501(c)(3) nonprofit, we rely on support from our grassroots network to advance our mission of creating a value-based health system with high-quality patient outcomes at a reasonable cost. We’re proud to offer two membership models, Ally Member and Trade Member. Tax-deductible membership contributions help us enrich the healthcare environment with quality content – including this podcast – and robust platforms to fuel discussion, collaboration, and advocacy that lead to ground-breaking solutions. 

For more information and to join us, visit our website ⁠https://www.movingtovalue.org/membership. 

All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

Pharmacists are one of the most trusted professions, yet more and more pharmacies are closing. A recent survey found 2275 pharmacies have closed so far this year, and every day independent pharmacies are shuttering their doors – often leaving “pharmacy deserts” in their wake. 

Vertically-consolidated Pharmacy Benefit Managers (PBMs) have made it practically impossible for local pharmacies to survive, and we’re all paying the price. 

But independent pharmacists are speaking out and pushing back – and they’ve secured wins! 

General Counsel for the National Community Pharmacists Association (NCPA) Matt Seiler joins MTVA to discuss the current state of community pharmacy, how “shareholder capitalism” got us here, and what comes next. NCPA is the voice for independent pharmacy, representing the interests of nearly 19,000 community pharmacies across the country. 

Despite the challenges facing his industry, Matt is optimistic that desperately-needed PBM reform is on the horizon. 

“If there’s one thing that’s brought the political parties together in our country, it’s the dislike for pharmacy benefit managers.” 

Listen to learn more about the unique role community pharmacists play in the health system, why PBM consolidation is particularly acute at the local level, and how NCPA has helped secure bipartisan support for reining in PBMs. 

Check out the other episodes in our “PBM Problems” series: 

Part 1 w/ ERISA Attorney Paul Holmes

Part 2 w/ Mutual Rx CEO Roy Wilkinson

Part 3 w/ Luke Slindee, PharmD

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We’re excited to welcome like-minded organizations and individuals to join the MTVA Membership program! 

As a 501(c)(3) nonprofit, we rely on support from our grassroots network to advance our mission of creating a value-based health system with high-quality patient outcomes at a reasonable cost. We’re proud to offer two membership models, Ally Member and Trade Member. Tax-deductible membership contributions help us enrich the healthcare environment with quality content – including this podcast – and robust platforms to fuel discussion, collaboration, and advocacy that lead to ground-breaking solutions. 

For more information and to join us, visit our website https://www.movingtovalue.org/membership.

All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

Many successful companies have ventured into the healthcare space and failed. 

Why can’t businesses that are household names make it work in our industry? Where do retail investments in health care go wrong? What is missing from their approach to primary care? 

Health care reform legend Brian Klepper joins MTVA to explain the pitfalls companies make and why they can’t seem to nail down a sustainable business model. 

“There is no such thing in health care as ‘health care lite.’” 

Brian Klepper, PhD is one of the nation’s top voices on realizing the potential of primary care, high-performance healthcare, and management of clinical and financial risk. Brian’s writing has been recognized as among the most influential in healthcare, he led several national healthcare reform efforts favoring patient and healthcare purchaser interests, and last year he was honored with the lifetime achievement “Champions in Transparency Rosie Award” from The Health Rosetta. Brian is the CEO of Proven Health and the Founder and Moderator of the Healthcare Benefits Hackers listserv.

“We could do it a lot better, but we’ve got to have the incentives aligned. There’s no way around that.”

Join the Healthcare Benefits Hackers forum: https://proven.healthcare/healthcare-hackers/ 
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We’re excited to welcome like-minded organizations and individuals to join the new MTVA Membership program! 

As a 501(c)(3) nonprofit, we rely on support from our grassroots network to advance our mission of creating a value-based health system with high-quality patient outcomes at a reasonable cost. We’re proud to offer two membership models, Ally Member and Trade Member. Tax-deductible membership contributions help us enrich the healthcare environment with quality content – including this podcast – and robust platforms to fuel discussion, collaboration, and advocacy that lead to ground-breaking solutions. 

For more information and to join us, visit our website⁠ https://www.movingtovalue.org/membership.

We are grateful to our Trade Members and Ally Members, who help make this show possible. 

All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

We all know the cost of prescription drugs in the U.S. is a problem. How did we get here and what can we do about it?  

This week, MTVA Board Members Dr. John Rodis and Dr. Steven Schutzer are joined by MTVA Executive Director Laura Wadsten for an engaging discussion with Senior Pharmacy Consultant ⁠Luke Slindee⁠, PharmD. 

Luke is a second-generation pharmacist who has witnessed first-hand how hidden money flows and increasingly powerful players have hurt his fellow pharmacists, communities, and patients. He’s spent years studying the economics and power dynamics of the pharmacy supply chain, and in this episode he shares some solutions to these problems. 

Tune in to learn more about the monopolies and oligopolies influencing drug costs, key differences in generic and brand markets, and how cash-only independent pharmacies can help solve this crisis.

Check out the other episodes in our “PBM Problems” series: 

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We’re excited to welcome like-minded organizations and individuals to join the new MTVA Membership program! 

As a 501(c)(3) nonprofit, we rely on support from our grassroots network to advance our mission of creating a value-based health system with high-quality patient outcomes at a reasonable cost. We’re proud to offer two membership models, Ally Member and Trade Member. Tax-deductible membership contributions help us enrich the healthcare environment with quality content – including this podcast – and robust platforms to fuel discussion, collaboration, and advocacy that lead to ground-breaking solutions. 

For more information and to join us, visit our website https://www.movingtovalue.org/membership.

All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

“There’s a reason that over the last 45 years, the PBM model has been the darling of Wall Street: because it makes a heck of a lot of money for its investors.” – Roy Wilkinson

PBMs are in the hot seat: Last week, the House Committee on Oversight and Accountability pressed the CEOs of United’s Optum Rx, Cigna’s Express Scripts and CVS Caremark (the “Big 3”) on allegations of profiting from unfair practices at the expense of the American people. A recent report from the FTC also blasted the powerful middlemen for “inflating drug costs and squeezing Main Street pharmacies.” 

In a field characterized by deception and greed, we’re excited to share a “carafe is ¾ full” perspective. The MTVA Board spoke with Roy Wilkinson, a disruptor offering an alternative to PBMs. 

Roy Wilkinson is the CEO and Founder of Mutual Rx – an innovative approach grounded in trust and transparency. After working as a consultant in the field for many years, Roy and his clients were fed up with the lack of transparency and pricing games offered by conventional PBMs, and believed in a better way. 

As Roy explains, “You can’t assess value without knowing what stuff costs.” 

Mutual Rx offers self-directed solutions that empower plan sponsors to personalize their pharmacy benefits and reduce costs. The “mutual” represents their equity model, where clients can reap the benefits of managing their drug spend. Roy and his team act as fiduciaries who protect the interest of the plan and its members, not outside financial influencers. 

Tune in to learn more about how Roy and Mutual Rx are helping plan sponsors save money – reducing costs by 20% or more! 
All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

Rollups, takeovers and buyouts. Oh my!

With increasing fear about private equity in health care, the MTVA Board is joined by Dr. Marco Fernandez and Jack Dillon of the Association for Independent Medicine to discuss their perspectives on private equity and best practices for maintaining or reclaiming an independent practice. 

The Association for Independent Medicine (AIM) believes that maintaining physician control of healthcare decision-making results in the highest quality care for patients and the most efficient use of healthcare resources. The organization supports independent medical practices through education, practice management support and advocacy.

“There’s no better advocate for a patient than an independent physician.” – Dr. Fernandez

Marco Fernandez, MD is President of AIM. He is a cardiac anesthesiologist and President of Midwest Anesthesia Partners, a physician-owned group serving the greater Chicago area.

Jack Dillon, MSHR, MBA is Executive Director of AIM. He’s the CEO of Anesthesia Practice Consultants, an independent group providing anesthesia and sedation services across Western Michigan. 

Though our guests come from anesthesiology, AIM supports practices across diverse specialties who want to be independent – from primary care to cardiology, even veterinary and dental! 

Follow AIM on social media for association news and upcoming events like the virtual AIM Toolkit Series discussions about independent medicine issues - Facebook, Instagram  and LinkedIn. 

All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

Though ERISA is often thought of as an issue for retirement plans, the law has always applied to employer-sponsored health benefit plans. The Consolidated Appropriations Act of 2021 (CAA) sought to put a spotlight on the issue by clarifying responsibilities of health benefit plan fiduciaries and the third-party service providers they contract with. Yet, 3 years after its passage, many plan sponsors still can’t get their vendors or advisors to provide the required fee disclosures. 

“I’m baffled. I’ve never seen such wholesale noncompliance that seems to be just tolerated indefinitely. Something’s got to move there.” — Alden Bianchi

In this conversation with MTVA, attorneys Sarah Raaii and Alden Bianchi of McDermott, Will & Emery’s Employee Benefits & Executive Compensation Group share how to comply with the CAA’s new requirements, and what health plan fiduciaries can do to ensure they fulfill their responsibilities to beneficiaries. 

As attorneys who focus on health and welfare plan issues, Sarah and Alden discuss the history of ERISA, steps that employers and health plan fiduciaries should take, and what it might take to boost compliance. 

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Check out our other episodes on health plan fiduciary responsibility: 

All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

“We have to cherish the opportunity in front of us. We’re at a point that public awareness of the current system failure is unprecedented.” 

American health care is in crisis, but this expert says there’s reason for hope. MTVA spoke with renowned scholar Ge Bai, PhD, CPA about the dynamics underlying problems in our system, and how middlemen keep taking a bigger piece of the pie. She makes the case for removing the confusing layers that separate patients and physicians. Placing power back in the hands of health care consumers will give providers and insurers a strong incentive to innovate – a much-needed course correction. 

Ge Bai is a Professor of Accounting at the Johns Hopkins Carey Business School and a Professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. 

A leading voice in health care finance and policy, Professor Bai’s expansive expertise and extensive body of work is influential. In this episode, she shares insights gleaned from testifying before Congress and explains how to break through the bureaucratic gridlock in Washington, D.C. and transform our system. 

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We’re grateful to our Trade Member sponsor Connecticut Joint Replacement Surgeons LLC for their continued partnership and support of the Moving to Value Alliance.

We’re also excited to introduce the new MTVA Membership program! 

As a 501(c)(3) nonprofit, we rely on support from our grassroots network to advance our mission of creating a value-based health system with high-quality patient outcomes at a reasonable cost. We’re proud to offer two membership models, Ally Member and Trade Member. Tax-deductible membership contributions help us enrich the healthcare environment with quality content – including this podcast – and robust platforms to fuel discussion, collaboration, and advocacy that lead to ground-breaking solutions. 

For more information and to join us, visit our website www.movingtovalue.org/trademember.

All episodes of MTVA Unscripted can be found ⁠here⁠.

This episode is a must-listen for all plan sponsors and employers! 

“In American business you don’t expect your major vendors to be profit-gouging you, and you don’t expect these major consulting firms to be taking their side instead of yours.” – Paul Holmes 

As Pharmacy Benefit Managers (PBMs) face mounting scrutiny from policymakers and the public, health plan fiduciaries can’t ignore the money flows and potential conflicts-of-interest that may be hiding in the pharmacy benefit contracting process. 

In this episode, the MTVA Board talks with ERISA attorney Paul Holmes of Williams, Barber, Morel about the perverse incentives and lack of transparency in PBM contracts. Tune in to learn what plan sponsors need to ask their brokers and consultants and how to comply with new requirements in the Consolidated Appropriations Act (CAA). Holmes also discusses some innovative approaches – like carve-outs for specialty pharmacy and prior authorization – for plan sponsors to consider. 

This is the first episode in a new series from the “MTVA Unscripted” podcast called “PBM Problems” – exploring the middlemen who drive wasteful drug spending and pocket the profits. 

Resources mentioned in the episode:

All episodes of MTVA Unscripted can be found ⁠here⁠.

We’re grateful to Southern New England Healthcare Organization (SoNE Health) for their continued partnership and support as a sponsor of the Moving to Value Alliance. 
You can help advance our mission with a tax-deductible contribution at https://www.movingtovalue.org/jointhemovetovalue.