Patient Experience – The Race to Value Podcast™

On today’s episode, Ashley sits down with with Keith Somers.  CRO at HealthCorum.  Keith is an entrepreneur with a finance background who co-founded HealthCorum after a series of frustrating experiences navigating the healthcare system as a patient and caregiver. As CRO at HealthCorum, he leads the sales/marketing team on all market interactions while maintaining responsibility for company operations.

HealthCorum is a company that provides data analytics and insights focused on the healthcare industry. They specialize in analyzing data on healthcare providers, such as hospitals and physicians, to assess their quality, efficiency, and overall value in comparison to other similar providers. HealthCorum’s platform and underlying data helps healthcare organizations, insurers, and employers identify high-performing providers, reduce costs, and improve the quality of care.

The future of care is not confined by walls; it thrives in the heart of homes, where compassion meets innovation, and healing becomes a daily experience. Home-based primary care with full-risk Medicare Advantage is a transformative model that not only brings health care to the doorstep of our seniors but also places the responsibility for their well-being squarely in the hands of dedicated providers, creating a proactive and patient-centered approach to aging with dignity and comprehensive care. By making primary care easier to access for our nation’s seniors, we can deliver personalized care that meets their needs; help them stay healthy and feel better; and live well with existing conditions so they can prepare for what’s ahead.

This week we are joined by two executive leaders from WellBe Senior Medical — the largest and fastest growing independent home-based medical group in the country. WellBe is a global risk medical group that provides longitudinal geriatric care to underserved, frail, complex, and homebound Medicare Advantage beneficiaries. In this episode, we feature Dr. Jeffrey Kang, Chief Executive Officer and Mike Stuart, Chief Growth Officer from WellBe Senior Medical.

Dr. Kang is a geriatrician with extensive experience in global risk and primary care for frail, elderly, and disabled populations.  Mike Stuart has extensive experience in fostering partnerships with health plans, health systems, and provider groups and leads commercial strategy and partnership development for WellBe Senior Medical.  In this interview you will learn about the home-based care continuum, primary care innovation, mission-driven leadership, Medicare Advantage risk, and the future of value-based primary care.

Episode Bookmarks:

01:30 An overview of WellBe Senior Medical – a global risk primary care group providing longitudinal geriatric care in the home.

02:30 Introduction to Dr. Jeffrey Kang, WellBe CEO (formerly served as ChenMed President, Walgreens SVP, Cigna CMO, and CMS CMO).

03:00 Introduction to Mike Stuart, WellBe Chief Growth Officer (formerly served in executive leadership roles at Somatus and Evolent).

05:00 An overview of the home care continuum (e.g. acute, post-acute, custodial, longitudinal primary care, DME, home infusion).

08:00 How WellBe is helping patients navigate and coordinate the fragmentation of home care point solutions.

10:30 A mission to help senior patients “lead healthier meaningful lives by delivering the most complete care”.

11:30 Opportunities to make care in the home more multidisciplinary, personalized, and SDOH-responsive.

12:00 Proactive vs. Reactive Care (leveraging analytics and unique provider skillsets for population health).

13:30 The clinical persona of the “frail elderly” and why WellBe focuses on this target population.

14:30 “Everything done in a primary care office can actually be done at home.”

15:30 “Home-based primary care is the best thing to do. You get better outcomes and better patient satisfaction.”

15:45 Is it possible to deliver high quality primary care (like ChenMed or Oak Street) in the home setting?

16:30 Referencing Marcus Welby, M.D. as an example of an empathetic approach to delivering care in the home (see Season 1 Trailer)

17:00 Care Fragmentation Challenges – NEJM found that the average Medicare patient sees a median of two PCPs and five specialist physicians per year.

18:00 “Quality of Life” is more important than “Quantity of Life” (why empathy and compassion matter most in caring for frail seniors).

19:30 Patients define a good doctor by bedside manner and respect given.

20:30 How the economics of full global risk enable complete care models for seniors.

20:30 Scalable home-based primary care is a new approach in value-based care.

23:00 WellBe’s results (e.g. >50% neighborhood engagement, patient satisfaction is at 95%, and MLR improvement >40% in 3yrs).

23:30 The importance of reaching a 4 Star Rating in a Medicare Advantage plan.

24:45 Key Measures of success:  Patient Engagement, HEDIS, Medical Costs and MLR

25:45 Bringing health plan leaders on a ride-along to see high quality care in action.

26:00 Negotiating global risk deals with MA plans that offer favorable economics for both parties.

27:00 The starting HEDIS Stars score of a typical WellBe patient is 2.3-2.5 (polychronic, frail, high-risk).

27:45 “When you are at full global risk, it is in your interest to do care innovation.”

28:00 Innovation #1 = Access (“Primary care in the home needs to be both convenient and responsive.”)

29:00 How WellBe developed a mobile paramedic program to enhance responsiveness to emergent acute care needs.

30:00 Mobile paramedic program reduced emergency room visits by 33%!

31:00 Dr. Kang’s recent article in Health Affairs responding to concerns from Berwick and Gilfillan about Risk Adjustment in MA.

31:30 The CMS-HCC V28 changes to the Risk Adjustment model that begin the phasing in next year.

33:00 The evidence for Medicare Advantage being overpaid relative to FFS?

33:45 Eliminating disease-based risk adjustment is the wrong policy (e.g. need for fair payment for complex populations, avoidance of cherry picking healthy populations).

35:30 The case for HCC under-coding in Traditional Medicare (due to lack of incentives in FFS).

36:45 “The bulk of the problem with HCC coding is under-diagnosis in fee-for-service Medicare – not over-coding in MA.”

38:00 Modern Healthcare Best Places to Work 2023 – WellBe Senior Medical

38:30 WellBe Senior Medical providers see 4-5 patients per day allowing them to build trusting relationships.

39:30 A recent study from Elation Health and the AAFP confirms that VBC can ameliorate the suffering of the physician workforce!

40:30 The culture of WellBe that empowers workforce collaboration with a “patients first” mentality.

42:00 Examples of how risk-based economics improve patient care.

43:00 Creating a foundation of values to underpin a culture of collaboration is crucial before accepting risk!

43:30 A clinically-led culture vs. a financially-led culture (“If you take good care of the patients, the financials will follow in a value-based model.”)

45:00 A financially-led organization will focus almost exclusively on risk adjustment (as opposed to delivering patient-centered care).

45:30 “Most of our MLR improvement is from medical cost reduction, not HCC coding.”

46:45 Wellbe Senior Medical is now in 7 states caring for 107,000 MA patients (20% of them which are dual eligibles).

48:00 Proving the scalability of a home-based primary care model.

48:45 Expansion into rural areas.

49:45 Future growth plans.

50:00 Advantage in Scalability: (“When launching new markets, we could actually be up and running in 90-days – we don’t have the problem of bricks and mortar.”)

51:00 Disadvantage in Productivity: (ChenMed and Oak Street providers can see 20 patients a day in the office, while we are only seeing 4-5.”)

52:30 The ethno-geriatric imperative (one-third of older Americans are projected to be from one of the minority populations by mid-century).

54:00 Dr. Kang discusses how the Chinese cultural significance of taking care of elders informs his leadership at WellBe.

54:45 Healthcare disparities are driven by inadequate access to care.

56:00 An example of how WellBe provides linguistically appropriate and culturally competent care in Chicago.

57:00 The number of Americans aged 65 and older will more than doubling over the next 40 years — reaching 80 million in 2040.

58:00 Optimism for the value-based future of caring for seniors – does hope mostly reside only with Medicare Advantage and ACO REACH?

61:00 Multi-payer alignment in value-based care as an imperative to a hopeful future.

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.

Everyone needs access to quality, affordable health care regardless of health status, social need or income.  To reach this paradigm shift, healthcare leaders must evangelize within industry and communities they serve.  There is a better path forward for American health care – one that is people-centered and transformational; however, to get there we must unite the power of one at the intersection of people, policy, and politics. By listening to people’s needs, jointly developing policy solutions, and partnering with others, we can ensure our health care system works for everyone.

This week on the Race to Value, we bring to you Natalie Davis and Dr. Venice Haynes at the United States of Care, a nonprofit organization focused on an ambitious goal to achieve universal access to quality and affordable healthcare for all Americans. It brings together stakeholders from various backgrounds, including healthcare experts, patients, policymakers, and advocates, to develop and implement practical, bipartisan solutions to improve the healthcare system in the United States. By fostering dialogue and collaboration, conducting research, and advocating for policies that enhance access, lower costs, and improve healthcare outcomes, the organization finds common ground and works across party lines and ideological divides to address the healthcare challenges facing the nation.

As CEO and Co-Founder of the United States of Care, Natalie Davis is on a mission to reshape and implement American health care policies that improves the lives of all people.  Dr. Venice Haynes, the Director of Research & Community Engagement for United States of Care, is a social and behavioral scientist focused on an overarching research agenda to address social determinants of health and health disparities in underserved populations using qualitative and community-based participatory approaches.  In this episode we talk about the tenets of patient-first care (a.k.a. value-based care) including affordability, dependability, personalization, and understandability.  We also have an in-depth conversation on the power of storytelling in health care transformation and the imperative to overcome structural barriers in the creation of health equity.

Episode Bookmarks:

01:30 United States of Care, a nonprofit organization focused on an ambitious goal to achieve universal access to quality and affordable healthcare for all Americans.

02:00 Introduction to Natalie Davis, Chief Executive Officer and Co-Founder.

02:45 Introduction to Venice Haynes, PhD, Director of Research & Community Engagement.

05:00 Natalie shares her personal story that led her towards an entrepreneurial career path in health care policy transformation.

07:30 Mentorship from Andy Slavitt and his advice to get out of Washington, D.C. to make an impact on health policy.

08:30 Venice discusses how her science and public health background inspired her to lead people-centered health care change.

11:45 Inspiration from Camara Phyllis Jones, a physician, epidemiologist, and anti-racism activist who specializes in the effects of racism and social inequalities on health.

14:30 When offered an alternative, by a 4:1 margin, people favor a model that compensates providers for improving overall health, delivering superior care, and coordinating patient care.

15:30 What it means for United States of Care to be at the intersection of people, policy, and politics in health care transformation.

16:00 Research and listening to people as a way to overcome tribalism and build an agenda of reform for the whole country!

16:45 The 4 goals and 12 solutions of United States of Care to meet the needs of people across demographics and can drive collection action to build a better health care system.

18:30 “The 4 goals of United States of Care – Affordability, Dependability, Personalization, and Understandability – comprehensively cannot be done in a fee-for-service model.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

70:00 The amazing opportunity in engaging patient communities!

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

There is a dynamic interplay between health economics, patient-centricity, and value assessment—an intersection that holds the key to unlocking better health outcomes, improved access to care, and sustainable healthcare systems.  With the principles of health economics guiding our decision-making processes in healthcare, we can allocate resources effectively and maximize the value delivered to patients. Patient-centricity lies at the heart of this convergence, emphasizing the importance of putting patients and their unique needs at the forefront of healthcare delivery.

Despite decades of investment in patient-centered health care, decisions about access and value are typically made in the context of financial risk management, and often without the input of those who should benefit from care. In addition to a myriad of payment reform strategies, rising interest in cost-effectiveness evaluation commands a central place in the debate about how to measure and pay for high-quality, efficient, and equitable health care.

This week on the Race to Value we are joined by Dr. Jason Spangler, the Chief Executive Officer for The Innovation and Value Initiative (IVI).  The IVI is a collaboration of scientists, patient organizations, payers, life sciences companies, providers and delivery systems dedicated to finding scientifically credible approaches to measuring value in healthcare.  The IVI provides the technical knowledge, resources, and collaborative learning platform that facilitate exploration and application of value-based care. In this podcast episode, you learn how partnership with patients, researchers, and industry and purchaser stakeholders can build consensus on the scope and inputs  needed for value assessment models.  Only by assessing true value in health care will we win the Race to Value!

Episode Bookmarks:

01:30 Podcast Introduction with background on Dr. Jason Spangler, the Chief Executive Officer for The Innovation and Value Initiative (IVI).

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

04:30 Creating open-source models that allow researchers and decision-makers to explore, apply, and test scientifically credible approaches to measuring value in health care.

05:30 “The IVI is a nonprofit research organization that focuses on the science and the methodology for determining value, new medical technologies, and innovations.”

06:00 Health technology assessments (HTA) typically have only included payer perspectives (not the patient perspective!)

07:30 Going beyond the academic research understanding of value assessment to reflect real world patient experience.

08:00 How is patient-informed value assessment and comparative effectiveness research used to impact health policy at a national level?

11:00 Defining “value” from a health economist perspective provides the standard equation.

11:45 What is important to patients beyond the clinical outcomes – these must be measured too!

12:30 The costs of healthcare beyond the financial domain (e.g. time, future prospects, family) forces us to deviate from the simple value equation.

12:45 The “Value Flower” – the elements of value that are important to all stakeholders (e.g. QALYs Gained, Net Cost, Productivity, Equity, Hope, Knowing, etc.)

14:00 Asking patients what is important to them in the formation of specific patient-reported outcome measures.

15:00 “We typically look at cost effectiveness in terms of patient populations and averages. This must be balanced with individual patients or smaller patient communities.”

15:45 How good are we…really…in actually listening to patients?  Fee-for-service care complexity gets in the way of meaningful connection.

17:00 Using both qualitative and quantitative data to advance patient-centered innovation.

17:30 The IVI is driving innovation in value assessment through the Open-Source Value Projectwhich is a laboratory for advancing the science and improving the practice of value assessment in the U.S.

19:30 Guiding Principles for Value Assessment in the U.S. (e.g. Patient-Centricity, Transparency, Equity, etc.)

21:00 Identifying specific disease conditions in the creation of an open-source value assessment.

22:30 Innovation in the science and research of developing new value assessment models ( e.g. pharmacologic and non-pharmacologic interventions of major depressive disorder).

23:30 Innovation in the development of models for rare diseases.

24:45 “If we are really serious about being patient-centric, we have to stretch the bounds of how we look at value (beyond just cost effective analysis or budget impact).”

27:30 Dr. Spangler discusses how health economists drove the development of the Value Flower construct.

29:45 “Having a value-based healthcare system  is not as important as having a patient-centric healthcare system.  Value flows from patient-centeredness.”

30:00 The “Value Spillover” as an opportunity to look at innovations more specifically, beyond the immediate benefits of healthcare interventions beyond their primary targets.

32:00 Health Equity and SDOH as spillover effects from value-based health care interventions.

33:00 Creating a learning health system to drive value-based innovation.

34:30 The Gartner Hype Cycle has all to often become the reality of what many expect from innovative technologies and interventions in healthcare.

36:00 IVI was created to address the lack of patient-centered health technology assessment (HTA).

36:30 HTA in other countries often results from the fiscal planning requirements of government-led healthcare systems.

38:00 The complexity of having a hybrid public/private healthcare system when developing a patient-centered HTA model.

39:00 Lessons learned from HTA models in other countries.

41:00 Incorporating Value Flower dimensions into the science of HTA.

42:45 Medicare Drug Price Negotiation is an opening for the U.S. to influence health policy through HTA.

45:00 The IVI Health Equity Initiative — a 2-year initiative that aims to define gaps in value assessment practice as it relates to health equity.

46:00 Taking a leadership role in catalyzing action for the development of methods in value assessments that promote equity.

46:45 “There is no value without equity.  They are so intrinsically intertwined that you can’t have one without the other.”

47:30 Changing the core of HTA to incorporate Equity – It requires redesign of the fundamentals, stakeholder accountability, and the adjustment of power structures.

49:00 Equity as a collective responsibility that requires meaningful engagement between stakeholders.

49:30 Don’t wait to address health equity until you have perfect data and be willing to use a mixed method approach (both qualitative and quantitative).

51:30 The need to ensure that clinical trials have more diverse populations.

52:00 Creating a diverse patient advisory group to advise health plans on benefit design and community support models.

53:30 Stakeholder accountability mechanisms to advance health equity.

54:00 A leading example:  the work CMS is doing to advance Health Equity.

54:30 Americans owe nearly $195 million in medical debt, and these financial burdens are worse for middle aged and BIPOC people dealing with chronic diseases.

55:00 IVI and AcademyHealth recently partnered to develop a research framework to address the full range of economic impacts on patients and caregivers.

56:00 The role that the Patient-Centered Outcomes Research Institute (PCORI) has played in cost and cost-effectiveness analysis.

58:00 Jason discusses the importance of assessing economic impacts in the consideration of health outcomes.

59:00 “Our health is not just direct medical care. And our health costs are not just related to direct health care costs.”

59:30 The overlap of non-medical economic impacts and health equity on health outcomes.

61:00 Prioritizing needs of families beyond just care planning and treatment.

62:30 Implementing effective health policy to affect change on the economic impacts of health (e.g. aligning incentives and creating public-private partnerships).

65:45 Parting thoughts on the importance of collaboration to reshape American healthcare in solidarity with one another.

69:30 Overcoming polarization through the willingness to listen to opposing views – we are all allies in wanting a better healthcare system!

72:00 Find out more about IVI online or social media!  Feel free to email Dr. Spangler directly if you have questions.

Three perfect storms in recent years – the health storm produced by the COVID-19 pandemic; the economic storm that resulted from its disruptions; and the social storm that followed the murder of George Floyd which sparked fresh outrage at longstanding inequities – have sharpened and added important nuances of what health care really means. The goal of health care has always been to reduce suffering, but we must now prioritize transformation in leadership now more than ever. Building trust, eliminating inequities, and ensuring high reliability are of the highest magnitude of importance as we blaze a new path forward.

This week, on the Race to Value, we are joined by Thomas H. Lee, M.D., the author of the new book “Healthcare’s Path Forward” to discuss how the healthcare industry is being transformed by deeper knowledge of what suffering means for patients, their families, and healthcare providers themselves. Since healthcare is not working for anyone, Dr. Lee provides wisdom and insights of optimism for where true change can happen in creating new standards for excellence.

In addition to being a bestselling author and expert on healthcare transformation, Dr. Lee is the Chief Medical Officer of Press Ganey.  He brings more than three decades of experience in healthcare performance improvement as a practicing physician, leader in provider organizations, researcher, and health policy expert. He’s responsible for developing clinical and operational strategies to help providers across the nation measure and improve the patient experience, with an overarching goal of reducing the suffering of patients as they undergo care and improve the value of their care.

Episode Bookmarks:

01:30 Introduction to Thomas H. Lee. M.D. and his new book “Healthcare’s Path Forward”

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

04:00 The six elements of organizational culture that lead to transformation – Excellence, Trust, Respect, Inclusion, Resilience, Reliability

05:00 John Nash (“A Beautiful Mind”) and Non-Cooperative Game Theory

06:00 Optimism for healthcare because how bad things really are!

07:00 Nash Equilibrium states are commonplace in healthcare – it creates inertia and stifles change.

08:30 “Equilibrium states break down when the pain of the status quo exceeds the fear of the unknown for multiple parties.”

09:00 “Healthcare is not working for anyone.  That is where real change can happen and what makes me optimistic.”

09:45 The destabilizing trends of supply chain disruption, social unrest, political divisiveness, consumerism, demographic shifts, workforce drain, and environmental disasters.

11:30 Responding to social justice, climate change, and the need to redesign healthcare – is it too much for us to tackle all at once?

12:00 “Changing the way healthcare is paid for – in absence of other reforms – is grossly inefficient.  There are many other things that have to happen.”

12:30 Michael Porter’s Value Chain and the importance of clarity and differentiation in the creation of value.

13:30 “Payment reform is just one activity of healthcare reform.  We also need trust in the workforce and with patients, an understanding of what safety means, and a response to consumerism.”

15:00 In times of turmoil, healthcare organizations need more than a performance culture; they need a learning culture.

16:30 The most important part of transformational leadership is division of responsibilities and areas of key focus to enact organizational change.

17:30 No one can do everything!  If leaders focus on only three things, they will be successful in strategy execution.

18:30 3 Functions of Governing Boards and Executives: Articulate the Core Values, Develop Strategy, Understand the Value Chain

18:45 “An organization is the lengthened shadow of its leaders.” – Ralph Waldo Emerson

20:30 3 Functions of Managers: Create Social Capital, Bring High Reliability Principles to Life, Eliminate Waste of all Types

21:30     “Social capital is more important than financial capital in the times in which we live.”

22:00 Applying High Reliability to all the dimensions (including patient experience) and refusing to tolerate failure in matters of trust.

23:45 “Culture of No Waste” – includes both time and resources

24:30 3 Functions of Frontline Caregivers: Create a Culture of Respect, Be Full Participants on Great Teams, View Job as Shaping the Memories of Patients and Families

25:30 The healthcare workforce often feels that they are part of a organization that does not respect them.

26:30 “Treating people with respect should be treated in the same way that the industry tackled hand hygiene to improve patient safety.”

27:45 Referencing the TED Talk from Daniel Kahneman: “The Riddle of Experience vs. Memory”

29:00 Frontline caregivers are like Steven Spielberg, i.e. they are the producers and directors of the patient memories.

32:00 “We live in a time where trust is under attack in society.  You can’t take trust for granted in healthcare.”

33:00 Trust goes beyond the clinician encounter – it encompasses the whole episode of care, including the web presence of the provider before the visit.

35:30 The importance of 5-Star Ratings online in building trust.

36:30 “Patients are unnerved from friction, chaos, and any indication that they may not be safe. The pandemic has really heightened their fears.”

38:00 Dr. Lee discusses how Press Ganey has begun surveying patients on their perceptions of patient safety.

39:45 High-reliability and the Anna Karenina Principle (“Happy families are all alike; every unhappy family is unhappy in their own way.”)

41:45 In 2021, the Press Ganey Employee Engagement Indicator declined in every single job category!

43:00 Dr. Lee discusses how building trust with workers coincides with the actions taken to build trust with patients.

44:30 Personal Pride:  Pride in the organization, Pride in what you do for the organization, Pride in what your team does.

45:30 Personal Alignment: Aligning with the cultural beliefs of employees and the need for inclusion. (Lack of DEI creates a 4X greater risk of employee turnover.)

46:00 Personal Resilience: Activation (employee motivation) and Decompression (ability of employees to forget about work when at home).

47:30 Activation is increasing in healthcare, but decompression continues to go down!

50:00 Dr. Lee explains how the pandemic and social unrest has created a deeper understanding of human suffering and how systems create harm.

50:30 Understanding Patient Safety beyond Physical Harm by also considering Emotional Harm (e.g. not feeling safe or financial distress due to healthcare)

51:30 The nuance of perception in Patient Safety (an example of how patients didn’t feel safe when a change when a hospital starting using odorless disinfectant).

53:00 Lack of respect as a safety issue.

53:00 The murder of George Floyd prompting an examination of the impact of inequality throughout society.

54:00 Diversity, Equity, and Inclusion in healthcare as a form of social capital and the pursuit of zero inequity.

55:00 The importance of DEI in health equity is now understood at a deeper level by healthcare leaders following the murder of George Floyd.

56:00 “Zero Inequity should be our goal just like Zero Harm is our patient safety goal.”

56:45 The data from safety net hospitals showing continued challenges in assessing pain with African American patients.

58:00 How organizational mistreatment of patients creates mistreatment of workers (and why lack of patient-centeredness is main reason for employee turnover).

61:00 Dr. Lee touts the virtues of healthcare and why it is such a great industry to work in.

62:00 New Skills for the Era Ahead:  Strategy (Porter’s Value Chain), Social Capital (Teamwork, Leadership), Growth Mindset (read Grit: The Power of Passion and Perseverance!)

64:00 The potential to do great work in medicine and making a difference in the lives of others.

64:30 “This is the best time to be going into healthcare. You can really make a difference in a noble field.”

65:00 How to reach out to Dr. Lee and learn more about his work in healthcare transformation.

This week on the Race to Value you will hear from Dr. Neil Wagle, the Chief Medical Officer at Devoted Health. This is a company we have been wanting to profile on the podcast for quite some time! Devoted Health is a healthcare company that designs Medicare Advantage plans for seniors; however, they are so much more than just a MA plan. Devoted Health has built a different model of care that starts with knowing their members on a personal level and earning their trust. By focusing on each member as a person and not as a chart, they are able to provide the best quality care for older Americans through an all-in-one healthcare solution combining the MA plan, access to high quality local providers alongside virtual and in-home care, and full-service guides—with world-class proprietary technology powering it all. This company is a leading innovator in value-based care.

Dr. Neil Wagle knows a thing or two about transforming healthcare. He is an internal-medicine physician by training, spent six years at Partners Healthcare (now Mass General Brigham) leading the health system’s efforts to improve the quality of care for patients. In 2017, he joined Devoted Health, a $12.7 billion health-insurance startup. As its chief medical officer, he’s spearheading the development of a model of care aimed at improving the health of older Americans by getting them the right care at the right time while saving costs for the US healthcare system.

In this episode, we discuss clinician burnout and moral injury, post-pandemic recalibration of the healthcare system, virtual care delivery, the benefits of a fully-integrated technology platform, health equity transformation, creating a virtual “Blue Zone”, patient-reported outcome measures, activation of chronically ill patients, and the importance of company culture in delivering relationship-based care.

Episode Bookmarks:

01:30 Introduction to Dr. Neil Wagle, the Chief Medical Officer at Devoted Health.

03:45 Dr. Wagle provides his background as a “synthesizer between medical-scientific world and the business world.”

04:15 Inspiration and mentorship from Dr. Tom Lee and being a part of Mass General Brigham’s first value-based contract.

04:45 “We’ll probably lose $70m in the first year, but we’re moving to value-based care because it is the right thing for patients.”

05:45 A chance coffee meeting with Ed Park led to the “ridiculously challenging” quest to build a system that could radically transform healthcare!

07:00 Provider burnout and moral injury is one of the major crises in healthcare (along with rising costs and inadequate care for aging Americans).

08:45 Dr. Wagle on how the pandemic has exacerbated moral injury and why we need to return to the altruistic underpinnings of medicine.

09:30 “The ability for physicians to connect with others has been decimated by overbooked 15-minute visits.”

09:45 How documentation requirements in fee-for-service medicine robs providers of “pajama time” with their families.

10:00 The Great Resignation in healthcare is being driven by the perpetuation of the fee-for-service business model.

10:30 Resolving the three crises of healthcare (i.e. Provider burnout, aging population, and rising healthcare costs) through care delivery transformation.

11:00 The good news in VBC: providers want to practice medicine in this way and patients actually have better outcomes with lower costs!

11:45 “You have to be able to monetize fewer hospitalizations. If you can’t, the value-based model of care won’t work financially.”

12:30 The emotional fuel of seeing better patient outcomes in VBC drives continual value-based care transformation.

13:00 The new wave of healthcare consumerism from the pandemic is causing a much-needed recalibration of care delivery.

14:00 “COVID exposed cracks in our fee-for-service model…”

15:45 “Value-based care is actually the ideal home for virtual care services because you don’t have to worry about over-utilization.”

16:00 Dr. Wagle describes how Devoted Health dramatically improves the health and wellbeing of Americans through person-centered care.

16:30 The “all-in-one healthcare” offering of Devoted Health as a virtual in-home medical group and MA plan, enabled by full-service guides and integrated technology.

17:30 Medicare Advantage patients receive this “all-in-one” care for free as part of their enrollment in the health plan.

17:45 Scaling a virtual care model further enhanced Devoted Health’s mission to treat members like family.

19:15 Overcoming the challenges of loss aversion in the perception of patients when adopting a virtual-first care delivery model.

20:00 The benefits of a virtual-first mentality when it comes to organizational scalability and culture.

21:30 Devoted Health has developed an end-to-end data and technology system that choreographs care delivery in a single, vertically integrated, tech-enabled model.

22:00 Dr. Wagle on the well-deserved skepticism of technology as a panacea…but how that is balanced with the practical vision of Ed and Todd Park.

22:45 Building a full-stack technology platform from the ground up was necessary (market-based solutions are based on FFS medicine and are incredibly fragmented).

23:00 Full-stack tech platform at Devoted does everything! (e.g. sales, enrollment, pharmacy, medical claims, prior authorizations, customer service, full EHR)

23:30 “Having a full-stack technology platform with all information in a single place allows us to deliver on the promise of complete, coordinated, and customized care.”

24:00 How human-centered technology design drives targeted population health interventions and personalized care delivery.

27:00 Human connection (relationship-based care) can be fostered with a full-stack technology platform because people don’t have to remember minute details.

28:00 Enabling tech-enabled rapid cycle innovation to deliver improved population health outcomes.

29:00 The challenges of defining “value-based care” and how health equity is changing how we understand value.

30:30 The historical debate about the adjustment of outcome measures to account for demographic factors.

31:00 “The world has moved to a different place where we have put a spotlight on health equity itself, rather than burying it in adjustment methodologies.”

31:45 How “Community Guides” at Devoted Health correlate the overcoming of SDOH with the Maslow Hierarchy of Needs to help members achieve full potential.

32:30 An example of how helping a member successfully enroll for public benefits can give them an extra $ 325/mo.

33:00 The development of a Health Equity Dashboard to measure their impact in closing equity gaps.

34:00 The product goal of Devoted Health is to be the world’s first virtual “blue zone” where people enjoy much longer, healthier lives than average.

35:00 “Longevity is not the ultimate goal. The first task of a health system is to make sure we treat people like family so they are happy and fulfilled.”

36:30 Dr. Wagle on what it really means to create a virtual Blue Zone at Devoted Health.

37:45 Creating the “Devoted Social Club” to help members overcome loneliness and social isolation through human connectedness and resilience tools.

39:30 Dr. Wagle on why the people and the culture is the foundation of Devoted Health.

41:30 “As we go out and look for new team members we look for experience, clinical acumen, and love in your heart.”

43:00 Caring for the clinician workforce so they can cultivate the love in their heart for the caring of others – it is a self-perpetuating phenomenon.

45:00 Keeping the mission as a “prime directive” by closing your eyes and imagining someone you love…than take action.

46:45 How Community Guides cultivate trusting relationships with members and help people overcome their mistrust of the healthcare system.

47:30 Spending time with members as an enabler of trust and empathy (e.g. a 90-minute phone call).

49:00 Trusting relationships are why Devoted Health has such a high net promoter score of 79 (higher than Apple, Netflix, and Amazon).

50:30 Starting with “Patient Priorities Care” in member engagement first…and then moving to data-enabled, rapid-cycle deployment of interventions.

51:30 Dr. Wagle discusses the importance of Patient-Reported Outcome Measures in value-based care.

54:00 6 in 10 adults have a chronic disease, and it is the leading driver of the nation’s $3.8T healthcare spend.

54:30 Dr. Wagle provides examples of how Devoted Health is making an impact in medication adherence and Hgb A1c reduction.

56:00 85% of diabetic members have their blood sugar under control, with an average A1c reduction of 2.3 within 100 days.

56:30 77% of hypertensive members now have their blood pressure under control, with an average reduction in systolic BP of 15.2 within 40 days.

57:00 Reduction of acute events related to Congestive Heart Failure by 50%.

57:45 Dr. Wagle shares an a research example of “learned helplessness” in dogs and how that behavioral pattern relates to most chronically ill patients managing their disease.

60:00 “We must relate clinical outcomes back to patient priorities. Those cycles are what capture momentum.”

61:30 Dr. Wagle discusses company growth and expansion and how Devoted Health is entering eight new states in 2023.

62:15 How will Devoted Health consistently replicate and scale as it enters into new markets at a national level?

64:00 Parting thoughts of appreciation from Dr. Wagle and how gratitude makes dreams come true in value-based care!

64:45 “Value-based care is more than possible…it is coming.  The arc of history is bending towards progress, and I am grateful to be a part of that journey.”

Oprah Winfrey began her crusade to change the healthcare system when COVID-19 elevated our national awareness of health inequities in our country – a result of exacerbated health outcomes triggered by coronavirus infection across racial lines and the longstanding preexisting disparities that were already there. She launched The Color of Care education  campaign to prepare current and future doctors, nurses and medical professionals to play an active role in combating systemic racism in the delivery of healthcare, as well as provide others with the necessary tools to advocate for and empower patients who experience these inequities. The Color of Care movement for more equitable healthcare in America began when Oprah Winfrey was inspired to take action following the death of Gary Fowler.

In this episode, we discuss the tragic and unnecessary death of Gary Fowler inflicted by a grossly negligent and racist healthcare system.  Multiple hospitals have the blood of Mr. Fowler on their hands; however, this is a story of hope in that his death started a national campaign for health equity. Oprah says the following about the death of Mr. Gary Fowler: “I read a story that haunted me…the story of the Fowler family. When Mr. Fowler became ill, three different hospitals turned him away. He went home, sat in his recliner, and died. I wondered how many different Gary Fowlers there are out there. What if I told you the biggest indicator of how long you are going to live is your zip code? What if access to lifesaving care for somebody that you love depended on the color of their skin? The COVID pandemic exposed a tragic divide in our healthcare system. We now need to stand up, and we need to do something about it. We need to change an entire system. This is something you start now! Together we can make it better.”

The story of Gary Fowler’s death is the focal point of the recent documentary, The Color of Care that premiered on the Smithsonian Channel earlier this summer. From executive producer, Oprah Winfrey, this new documentary chronicles how people of color suffer from systemically substandard healthcare in the United States and how COVID-19 exposed the tragic consequences of this inequity.  The Color of Care documentary traces the origins of racial health disparities to practices that began during slavery in the U.S. and continue today. Using moving testimony from those who lost loved ones to COVID-19 and frontline medical workers in overwhelmed hospitals, it interweaves expert interviews and powerful data to expose the devastating toll of embedded racism in our healthcare system. The Color of Care is produced by Harpo Productions with executive producers Oprah Winfrey, Terry Wood, and Catherine Cyr. The film is directed by OSCAR®-nominated and Emmy® award-winning director Yance Ford and produced by Kate Bolger and Yance Ford. After listening to this podcast, I urge you to watch the Color of Care to understand how the system was built, why it doesn’t work for everyone, and how together we can make it better!

This episode is sponsored by the American College of Lifestyle Medicine.

How to get involved and learn more!

Episode Bookmarks:

01:30 The tragic and unnecessary death of Gary Fowler inflicted by a grossly negligent and racist healthcare system.

01:45 How the death of Gary Fowler inspired Oprah Winfrey to start the The Color of Care movement for more equitable healthcare in America.

02:30 “We now need to stand up, and we need to do something about it. We need to change an entire system. This is something you start now! Together we can make it better.” – (Oprah Winfrey Special PSA)

03:30 How do the murders of George Floyd, Breonna Taylor, and Ahmaud Arbery impact societal awakening for social justice and health equity?

04:00 The Color of Care documentary that traces the origins of racial health disparities to practices that began during slavery in the U.S. and continue today (watch trailer here)

05:00 Join the Color of Care movement as a Medical or Nursing Student, Medical Professional, or aDoctor or Nurse

05:30 Learn more about this week’s sponsor, The America College of Lifestyle Medicine and download the new Institute/ACLM Intelligence Brief on Lifestyle Medicine and Health Equity

06:30 Introduction to Keith Gambrell, the son of Gary Fowler

07:00 “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.”  — Martin Luther King, Jr.

07:30 Keith Gambrell tells the story of the death of his father, illustrating how systemic racism and anti-blackness are a public health crisis.

09:45 The hospital sends Gary Fowler home despite him being acutely ill from COVID-19.

10:00 “The doctors wrote him off and didn’t listen to him. The health system didn’t give him a fighting chance and failed my father. They sent him home to die.”

10:15 Keith’s grandfather passed away from COVID-19 just hours before the passing of his father.

11:30 “He shouldn’t have had to go to three different hospitals to seek treatment…and he didn’t even get treated after all of that.”

12:00 “Every hospital sent us a billed after my father died…for services they didn’t even render when they refused to treat him.”

12:30 The body of Gary Fowler resided in the home for over 10 hours after death from COVID-19.

13:00 Keith’s mother comes down with COVID-19 within a few hours after the death of her husband.

13:30 A patient with food poisoning from bad sushi was admitted to the hospital at the same time Keith’s mother was denied admission.

14:30 Keith is forced to take his mom to a second hospital (after his father dies from COVID-19 upon being denied treatment by three hospitals!)

15:45 Keith’s mother is sent home from the hospital after only two days. (She ends up developing pneumonia and blood clots post-discharge.)

17:00 “My dad would be here today if he wasn’t written off by the healthcare system.”

17:15 “Health equity is an issue that needs to be discussed in America. Why aren’t we receiving health care? We are equal human beings just like everyone else.”

18:30 “Our lives begin to end the day we become silent about things that matter.” – Martin Luther King, Jr.

19:30 Keith discusses his experience working with Oprah Winfrey and The Color of Care documentary.

20:30 Keith’s job now is to use his voice to advocate for health equity so we can eliminate racial disparities in our country.

21:00 Referencing Keith’s Op-Ed on the deaths of Floyd, Arbery, and Taylor and how there are

22:20 Keith discusses the parallels between the death of his father and racially-motivated killings.

23:30 “No one cares about us. The entire system needs to be overhauled.”

24:30 How COVID-19 raised awareness of health inequities in African American communities that have persisted for centuries.

26:00 “Doctors should listen more to patients. They should learn how to take into consideration what patients are telling them.”

27:30 Keith advocates for the need for medical schools to provide training in culturally competent care for minority populations.

28:00 Eric explains how value-based care is about health equity and relationship-based care.

29:00 Gary Fowler was never tested for COVID-19 – despite providers knowing that he had been exposed by close contact to his father who had tested positive, and was hospitalized!

30:30 Keith discusses the role that churches can play as a cornerstone for activism, resources, and community building to improve the health for communities of color.

31:30 Daniel explains the importance of culturally competent care in the provision of health equity.

33:00 “All people, regardless of color, should be treated equally when going to the hospital.  My dad was begging for his life and sent home with a piece of paper.”

34:00 The medical establishment has a long history of mistreating Black Americans — from gruesome experiments on enslaved people to forced sterilizations and the infamous Tuskegee syphilis study.

35:30 Keith provides perspective on what it will take for Black people to begin trusting the healthcare system.

37:00 The resilience of black communities in Detroit

38:00 “My family had to learn how to take something so negative and make it positive. Our pain can change the world.  It is time for a change in the healthcare system.”

38:45 Keith wears the ashes of his father and grandfather around his neck inside gold teddy bear pendants to remember their legacy.

39:00 Don’t be afraid to speak out. Watch The Color of Care documentary and get involved!

40:00 Keith shares personal stories about who his father and grandfather were and how their lives impacted him.

42:30 Parting thoughts from Keith on the need to change healthcare for the better.

43:00 The Color of Care education campaign is working to prepare current and future doctors, nurses, and medical professionals to play an active role in combating systemic racism in healthcare.

44:00 The Institute for Advancing Health Value is screening The Color of Care on 11/30 and hosting a Virtual Health Equity Summit on 12/1!

The Physician Organization of Michigan Accountable Care Organization (P.O.M. ACO) is a statewide ACO in the Medicare Shared Savings Program that has saved the Medicare Trust Fund more than $199 Million to-date. It is a physician-led partnership in operation since 2013 that supports more than 5,000 providers serving approximately 60,000 Medicare beneficiaries.  P.O.M. ACO aligned with the University of Michigan Health System, whose Faculty Group Practice participated in a Medicare demonstration project that paved the way for ACOs under federal health care reform years ago.  This is an outstanding Accountable Care Organization led by Dr. Tim Peterson and Kendall Cislo who are featured in this week’s episode of the Race to Value.

In this interview, you will learn how P.O.M. ACO has been successful by enabling localized solutions, in partnership with their provider network and beneficiary population, to improve care outcomes.  We discuss how the ACO engages their beneficiaries through committee and Board participation, how primary care providers and specialists work together to build “localized” population health programs, and how care management interventions can provide meaningful outcomes in both rural and urban settings.  This is an important interview for ACO leaders to listen to who are looking to establish improved relationships with both providers and patients to drive more effective care management interventions in caring for seniors and underserved populations.

Episode Bookmarks: 

02:00 Physician Organization of Michigan Accountable Care Organization (P.O.M. ACO) —  a statewide ACO that has saved more than $199 Million

02:40 Introduction to Dr. Tim Peterson (Population Health Executive for Michigan Medicine and ACO Executive and Chairman for P.O.M. ACO) and Kendall Cislo (Chief Operating Officer at P.O.M. ACO)

05:30 How ACO success has been determined by collaboration between a faculty academic practice and groups of independent physicians

10:00 Dr. Peterson discusses some of the unique public health and chronic disease challenges facing urban and rural Michiganders and how medical management programs of P.O.M. ACO meets patient needs

12:00 “Part of our ACO success has been the enablement of local solutions to address local problems.”

12:45 Recent study on patient perceptions of ACOs: Only 7 percent of 55- to 64-year-olds and 4 percent of those over 65 reported ever hearing about value-based care!

13:40 How beneficiary engagement and “the voice of the beneficiary” impact quality improvement and the Triple Aim

15:30 Why the economics of value-based payment shouldn’t matter to patients (focus on quality care and out-of-pocket burden most important)

17:30 Utilizing a beneficiary engagement advisory committee as a key strategy for performance success

21:40 “The goal of our ACO is not to build a centralized infrastructure – it is instead to build localized solutions with our network of providers.”

24:30 Engaging patients to raise awareness of high cost (low value) specialists in the area

25:40 Partnering with dialysis centers to more effectively engage patients with kidney disease

28:30 “The key message to remember in healthcare is that we do everything for the patient.  What would you do for a patient if it was your Mom.”

31:20 Engaging physicians to more effectively collaborate with them in population health and quality improvement strategies

34:30 Collaborative conversations to improve risk adjustment coding documentation to more adequately reflect burden of illness in the patient population

38:00 Building local market capabilities for pharmacy integration in rural primary care practices

40:30 Annual Wellness Visits as opportunities to address what is most important in a patient’s life and how that has transformed the ACO

44:30 The importance of clinical integration in improving care coordination and why specialist participation in an ACO is a performance advantage in improving patient outcomes

47:30 Primary care and specialist collaboration to improve utilization associated with inpatient hospitalizations and readmissions

50:30 Addressing health equity through localized problem-solving and practice-based population health interventions

51:30 “Clarity of data” to better understand beneficiary issues with social determinants of health

52:30 Using ACO beneficiary input to craft partner-based solutions to address social isolation and loneliness

54:00 Asking the inverse question of what services are being under-utilized and how “positive healthcare utilization” can be used as a lever to move away from overutilization of other services

56:00 Dr. Peterson (an Emergency Medicine physician and an ACO executive) explains how we should define “failures” associated with ED utilization

60:00 Parting thoughts from Kendall and Dr. Peterson on the future of the value-based care movement

Sydney Townsend was diagnosed with cancer in June 2018, three months after giving birth to her first child.  As a former boxer, she realized she was in the fight of her life and never gave up.  After surviving her bout with cancer, her healing journey came full circle by joining the staff of Texas Oncology in 2021 (the practice that treated her cancer) as their Director of Virtual Care so she can provide care to others in the fight.

Joining Sydney in this episode is Dr. Kathryn Hudson, her hematologist and oncologist. Dr. Hudson is also the Director of Survivorship for the practice which allows her to extend the impact she makes as a clinician by improving supportive care models for cancer patients and survivors. When you hear from Dr. Hudson in this interview, you will immediately realize the power of the relationship she had with Sydney and how important this is in value-based oncology care.

Value-based care always starts with a deep and trusting relationship between a patient and provider.  There is no stronger of an example of this than Sydney and Dr. Hudson.  Together in this very special episode they discuss “Cancer Survivorship and the Power of Relationship-Based Care.”  This is an interview that conveys triumph and inspiration for those either fighting cancer or seeking to provide truly patient-centered care!

Bookmarks:

01:40 An introduction to Sydney Townsend and her story of cancer survivorship

02:45 An introduction to Dr. Kathryn Hudson – hematologist, oncologist, and Director of Survivorship at Texas Oncology

04:30 Dr. Hudson provides a brief overview of the patient-centered model of care at Texas Oncology

05:30 Sydney explains how “telemedicine is more than just a tool for episodic care” and discusses how cancer survivorship is a “superpower”

07:00 Dr. Hudson discusses how her work as an oncologist and survivorship leader connects to her personal “Why”

08:15 Dr. Hudson provides a comprehensive overview of TXO’s cancer survivorship program

10:00 Sydney’s shares her heartfelt and deeply personal story of her cancer fight and healing journey over the last three years

15:20 The beautiful connection of motherhood between Sydney and Dr. Hudson and how that cultivated a deep and trusting relationship

17:30 Dr. Hudson discusses the deep empathy and personal connection she has for Sydney and how that informed her treatment decisions

20:30 Sydney describes the initial difficulties in establishing trust and how she eventually overcame her fear and suffering in the early stages

22:45 “Trust is something that takes time to build between a physician and a patient.”

25:15 Dr. Hudson discusses the importance of involving a patient’s family during cancer treatment

28:15 Sydney draws parallels between her bout with cancer with her prior experiences as a boxer

29:40 Dr. Hudson shares how inspired she was by Sydney’s mental fortitude during cancer treatment and survivorship

30:20 Sydney’s goal of getting back to the boxing gym in her “path to a new life”

31:30 Sydney describes her “ultimate Zen training” experience during chemotherapy and how mindfulness and meditation helped her to heal

33:15 How “being in the present moment” taught Sydney how to carry on through her survivorship (“I’ve been forged in fire, and it feels good!”)

35:20 Malnutrition during cancer is a main reason for avoidable ED visits and hospital admissions, and cause 1 in 5 cancer-related deaths

36:20 Dr. Hudson discusses the role that nutrition care plays in cancer treatment and how it lowers total cost of care and improves outcomes

39:10 Sydney discusses what she learned about nutrition during her cancer journey

41:45 Sydney explains how changes in telemedicine payment rules catalyzed adoption

42:45 How virtual care can be utilized to improve health equity and provide care in underserved areas

43:10 The challenges of “the digital divide” in the deployment of virtual care and how government and communities are solving for it

44:10 The deployment of telemedicine at TXO during the pandemic and how that transformed care

46:30 Dr. Hudson on building a patient community that promotes survivorship skills and wellness for cancer survivors and loved ones

50:00 Dr. Hudson provides additional information on the importance of virtual care during survivorship

50:45 Sydney describes how telemedicine and telehealth is related to value-based oncology care

52:10 Dr. Hudson explains the importance of using telemedicine to treat patients who are immunocompromised or have transportation issues

53:35 Parting thoughts from Sydney: Leaning in to your care team, family, and friends to create a universe of support.

54:40 Parting thoughts from Dr. Hudson and how to find out more about Texas Oncology