Primary Care Transformation – The Race to Value Podcast™

It’s no secret that the Black community tops the list of groups afflicted by hypertension, stroke, diabetes, heart disease, kidney failure, and cancer. What the statistics do not show is the pain, misery, and despair that these conditions create—not only for the individual, but also for family and friends. As an African-American doctor, Dr. Richard Walker has studied these conditions among his patients for many years. Now, in his new book, “Black Health Matters”, Dr. Walker offers a number of commonsense ways to prevent, manage, and possibly eliminate these killers, turning the tide of African-American health. And he not only provides us with a construct for thought leadership in population health equity, he practices this type of care at his home-based primary care practice TVP-Care in Houston, Texas.

Dr. Walker has spent considerable time in researching the health and healthcare journey of African captives into slavery and understands what current African Americans now to need to do to survive nutritionally and culturally. He is truly on a mission to overcome the chronic ill health and early death that is so pervasive in Black communities. Most importantly, however, Dr. Walker is a leader in the value movement that believes traditional medicine should be merged with lifestyle medicine. He understands that African Americans can turn their health around by understanding and incorporating better nutrition, nutritional supplements, exercise, and regular healthcare checkups into their lives. In this important podcast discussion, we you will learn from a leading clinician and entrepreneur how we should go about improving Population Health Equity within African American communities in this Race to Value!

Episode Bookmarks:

01:30 Introduction to “Black Health Matters” and the work of Dr. Richard Walker in the health value movement

03:30 What does the use of the word “value” mean when it comes to community health?

05:00 Dr. Walker discusses his upbringing in Spanish Harlem and how that experience led him to become a physician leader seeking to advance health equity

07:00 The “mystery” of excessive hospitalizations due to sugar consumption and how that led to an epidemic of Type 2 Diabetes in the African American community

09:00 The misperception in the African American community that most common chronic diseases are genetic (instead of caused by environmental of lifestyle factors)

10:00 Dismantling the informational disadvantage that leads to a misunderstanding of Social Determinants of Health

12:00 The impact of the murder of George Floyd and the BLM social justice movement and how that inspired Dr. Walker to write “Black Health Matters”

14:30 How the collective experience of African Americans over the last 400+ years has been based on “waiting” (e.g. slavery, citizenship, civil rights)

16:00 “Taking care of your own life is all about taking charge of the environment by understanding the root causes that lead to disease.”

16:30 How poor nutrition in the African American community stems from the slavery era and persists to this day

17:30 The inadequate training of the healthcare workforce further exacerbates preexisting issues of poor health among African Americans

18:30 “Black Health Matters” is all about understanding the progenitors of chronic disease that are not genetic, and how to mitigate them in African American communities.

19:00 Environmental hazards and chemical toxicities are more common in underserved, minoritized communities

20:30 Research that confirms the presence of systemic issues in the healthcare industry related to institutional racism

22:00 “The concept of value-based care is transformational because it has the potential of changing the course in healthcare by recognizing the true value of the individual.”

23:30 Will value-based care bring us to the “Quintuple Aim” that includes health equity?

24:30 How the founding vision of Dr. Walker’s value-based, patient-centered medical practice has been informed by emerging payment models from CMS

27:20 Recent McKinsey & Company study estimating that up to $265 billion worth of care (representing up to 25 percent of the total cost of care) could shift to the home by 2025

28:30 Dr. Walker provides an overview of his MSO and primary care medical practice business model

31:30 Going upstream with patient-centered, reengineered primary care through an enabled access model that provides care in the home

32:30 Fostering trust and creating meaningful relationships between patients and providers through home-based care delivery

34:00 The enablement of remote patient monitoring, chronic care management, and telehealth to enhance home-based, primary care

34:30 Care coordination and chronic care management delivered by interdisciplinary teams supporting a primary care provider

35:30 “Smaller primary care patient panel sizes leads to better patient outcomes and providers with a better quality of life.”

36:30 “Micro” Social Determinants of Health that can be managed by the medical practice

39:30 Improving care for the 5% of the population driving healthcare expenditures is an economic opportunity for our country

41:00 Recent research showing significantly lower levels of telemedicine usage among Black patients, particularly those over age 65, as compared with white patients

42:00 “21st century care technologies – RPM, telehealth – are a gamechanger for primary care.”

44:00 The human-to-human relationship as the driving force of patient-centered, reimagined primary care (ex: the interaction of having tea with a patient in their home)

46:30 Dr. Walker describes the use of remote patient monitoring technology in his medical practice

47:30 The challenges of ethnogeriatric care focused on African Americans and the Aging Process can be overcome by addressing SDOH

50:00 The importance of workforce sufficiency and education to provide culturally-competent care

52:00 How concerns about implicit bias in care delivery may limit the progress of transformation (balancing the need to deliver the best care you can under the circumstances)

54:30 The role of the “Community Organizer” in bridging the gap in trust between patients and the healthcare system

56:30 The words of Dr. Martin Luther King, Jr: “Of all the forms of inequality, injustice in health is the most shocking and inhumane.”

58:00 Functional medicine as a more holistic approach to delivering whole-person care to the individual

60:00 Healthcare providers must recognize the need for human connection, love, and trusting relationships to ensure equity in health

62:30 WGU and the Institute for Advancing Health Value as an example “as a lighthouse for the rest of the academic world and the healthcare industry”

ChenMed is a family-owned, physician-run organization that was created to better serve low-moderate income elderly patients. Starting in 1985, Dr. James Chen created ChenMed as a one-stop shop where physicians are held accountable for their patients, and now ChenMed operates over 100 senior health centers across the US. The full-risk, capitation model of ChenMed aligns economic incentives where preventative value based care is the foundational framework.  However, what really allows ChenMed to transform care delivery in the U.S. is how they honor the sacred nature of the physician-patient relationship. The ChenMed model for primary care exemplifies the power of the provider-patient relationship and realigns physicians with their altruistic calling.  In doing so, clinicians are able to address the moral determinants of health that lead to improved health equity and social justice in our society.

Joining us this week is Dr. Faisel Syed, the National Director of Primary Care at ChenMed. Dr. Syed believes a physician-led culture can improve primary care influence and lead to a new era of transformation in the United States.  He is on a mission to restore the intimate and sacred nature of the doctor-patient relationship and, in doing so, create care models that can replicate at scale.  In this episode, Dr. Syed discusses how ChenMed honors seniors with affordable, VIP care that delivers better health. He shares how this moral consensus has an enormous impact on patients and the health of communities.  A physician-led culture in primary care, coupled with trusting relationships, can truly change the world!

Episode Bookmarks:

01:30 Background on Faisel Syed, M.D. and the full-risk capitation model of ChenMed

03:30 The ChenMed model as “old-fashioned medicine with technology that treats patients like family”

04:30 How family influence and emerging technologies created a calling to practice medicine

07:15 “We should restore the intimate and sacred nature of the doctor-patient relationship.”

09:20 Don Berwick’s article on “The Moral Determinants of Health”

10:20 “ChenMed starts with the mission to honor seniors with affordable, VIP care that delivers better health. That is our moral consensus.”

11:00 Healthcare as a right – everyone deserves access to primary care, especially those in underserved communities

12:45 Referencing Michael Marmot’s book, “The Health Gap: The Challenge of an Unequal World” and the impact of income inequality on health

14:30 “Understanding pathophysiology alone is not enough to improve health. We must address social determinants of health.”

15:30 Faisel provides an excellent overview of SDOH and how ChenMed’s relationship-based care model improves population health outcomes

18:30 1 out of 5 Americans (over 51 million) are living with a behavioral health condition and 20 million individuals have a substance use disorder

19:30 How a holistic (non-transactional) approach to primary care with aligned financial incentives impacts behavioral health outcomes

22:00 The sacred nature of healing relationships that goes back to the roots of shamanism (and how transactional economics limits healthcare effectiveness)

24:00 Reflections on how the ChenMed model supports healing through trusting relationships

25:00 How openness and trust between a doctor and a patient prevents avoidable ER visits

28:30 How a famous clip from “I Love Lucy” sums up physician burnout that results from the culture of a fee-for-service system

29:30 How ChenMed allows physicians to truly fulfill their purpose in practicing medicine (and how that prevents the burnout all too common in FFS)

32:30 Referencing the article “Primary Care, Specialty Care, and Life Chances” and how PCPs in a given geography correlate with lower mortality and improved societal health

34:00 Primary care doctors need “influence and leadership” to catalyze a national transformation of healthcare in our country

35:30 How PCPs must first become better influencers and then become a disruptive force in value-based care transformation

36:00 Referencing recent Deloitte survey of physicians that predicts a forthcoming shift in the U.S. healthcare model towards value-based care

38:00 Faisel discusses how medical schools should approach the redevelopment of their curriculum to support the future of value-based care

39:00 “IQ versus EQ” – the role of emotional intelligence in medicine to build powerful relationships that drive superior health outcomes

42:00 How financial risk in an accountable care model leads to enhanced profitability (and improved patient outcomes)

42:45 Unnecessary hospitalizations as the main contributor to waste in the U.S. healthcare system

44:00 How ChenMed is replicating their care model in low income neighborhoods across the country

45:45 “Replication at scale”: ChenMed now has 100 centers in 12 states (quadrupling of size since Faisel joined ChenMed 4 years ago

46:30 How ChenMed develops doctors into mentor, coaches, and business leaders to influence the next generation of healers

47:20 “Our goal is to transform healthcare delivery in the United States.”

48:30 How a physician-led culture can improve primary care influence and lead to a new era of transformation

50:20 Serving the greatest generation of patients and how health equity creates social justice

51:00 Visit www.chenmed.com to learn more and explore career opportunities

Joining us on the podcast this week is Dr. Clive Fields, the Co-Founder and Chief Medical Officer for VillageMD. Dr. Fields is a leader of high influence in the value economy, having been named to Modern Healthcare’s lists of the 50 Most Influential Clinical Executives and the 100 Most Influential People in Healthcare.  His company, VillageMD, is a leading, national provider of value-based primary care services that partners with physicians to deliver high-quality clinical care and better patient outcomes, while reducing total cost of care. In the years since Dr. Fields co-founded the company, VillageMD has grown to 15 markets and is responsible for more than 1.6 million patients. In 2021, VillageMD received a $5.2 billion investment from Walgreens Boots Alliance, which is looking to expand its healthcare offerings with VillageMD as a partner. This significant multi-billion investment will accelerate the opening of at least 600 Village Medical at Walgreens primary care practices in more than 30 U.S. markets by 2025 and 1,000 by 2027, with more than half of those practices in medically underserved communities.

The Race to Value is honored to have Dr. Fields share his perspective on the opportunity for consumer-centric care delivery in our country.  We discussed important issues such as health equity, digital transformation, integrated pharmacy, home-based care delivery, multipayer contracting, health policy, and employer healthcare costs. Don’t miss out on this important interview so you can learn what it takes to succeed for the future of value-based care!

Episode Bookmarks:

01:40 Introduction to Dr. Clive Fields and VillageMD

05:00 The intersection between value-based care delivery and consumerism

07:00 “Value-based health care success requires affability, availability and ability.”

08:40 Using a team-based, proactive, risk-stratified approach to care to deliver the best outcomes

09:00 Are we using the term “value” incorrectly in the industry?

10:00 VillageMD’s recently announced partnership with Walgreens and how it will provide scalability

12:00 How outcomes-based reimbursement can improve health equity in underserved communities

13:00 The transformative impact of the value movement on primary care

16:00 The acceleration of virtual care and the role it plays in a consumer-centric care delivery

18:00 What will virtual care look like in the post-pandemic era?

18:45 How the economics of global capitation drives improved health outcomes

20:00 The role that pharmacy integration plays in value-based care

21:45 Dr. Fields discusses how pharmacists should be utilized in the ambulatory care setting

23:00 Lessons learned from pharmacy integration and how that informed VillageMD’s collaboration with Walgreens

24:20 How pharmacist intervention can improve both provider and consumer experience by switching to formulary-equivalent drugs

26:45 Referencing recent McKinsey & Company study that projects up to $265B in facility care shifting to the home setting by 2025

27:45 Village Medical at Home – a leading example of home-based care delivery

28:40 “The lack of home-based care is partly related to the hubris of physicians.”

29:30 Dr. Fields reflects on how office-based care contributes to a misinterpretation of social barriers

31:45 Care in the home as the safest and most comfortable option

34:00 How VillageMD has cares for all patient populations (not just particular high-risk segments)

36:20 “We built a model that actually expands doctors’ panels – not limiting them to a certain product or payer.”

37:45 Managing risk across different populations with segregation by SDOH and risk determination (not payer status)

39:30 Referencing Dr. Fields’ most recent Op-Ed in Modern Healthcare addressing the criticisms of the Direct Contracting model

40:30 Dr. Fields provides commentary on the hyper-politicized debate related to public-private partnerships in the Medicare program

43:00 How a program like Direct Contracting can improve care for patients in underserved communities

46:00 Dr. Fields on how employers our now reaching an inflection point in addressing unsustainable healthcare costs

47:30 Brokers, payers, and providers working together to collaborate with large, self-funded employers

48:00 The co-location of primary care clinics with employer groups

50:00 The total addressable market for VillageMD is projected to grow 7% annually through 2025 to $1.4 trillion

50:30 Why Dr. Fields feels “overly bullish” about the state of the value-based care movement (outcomes-based reimbursement)

52:30 How VillageMD is positioning itself for the future of outcomes-based reimbursement with a model that can replicate at scale

54:45 VillageMD will have at least 50% of primary care locations in underserved communities

56:45 Parting comments from Dr. Fields and how to find out more about VillageMD

In a career focused on improving global health value through systems transformation, relationship-based primary care has been at the heart of Dr. Paul Grundy’s crusade.  Dr. Grundy is a data transformation advocate, active writer, social entrepreneur, speaker on global healthcare transformation, humanitarian, diplomat, and trusted healer.  He has traveled the world more than any other physician that has ever lived and seen how other country’s deliver health care.  Dr. Grundy is such a transformational force for social change that Nelson Mandela even called him a “good troublemaker” as someone who is always looking for innovative disruptions to benefit humankind.  We often reflect on those great leaders in American History who challenged us to be better…from JFK asking individuals to step up, and Ronald Reagan admonishing communists to join the free world, to Martin Luther King, Jr. who provided us with a powerful anthem for change with his work in advocating for civil rights.  In the healthcare history books Dr. Grundy will be known as a crusader with his own version of the “I have a Dream” vision for transformation!

Our guest this week is Dr. Paul Grundy, commonly known in industry as “The Godfather of the Patient Centered Medical Home.” Although he didn’t invent the medical home model, he gave it a voice, definition, structure, and made it real. The model is focused on that which is most important – the cultivation of a trusting patient relationship. Whether you call it a milestone or the finish line, that trusting relationship is critical in the race to value.

Episode Bookmarks:

02:00 Introduction to Dr. Paul Grundy – a humanitarian and healthcare legend in patient-centered care models and value transformation

04:30 Referencing Dan Pelino’s book, “Trusted Healers” that was written about Dr. Grundy’s worldwide crusade for better healthcare

05:00 Dr. Grundy’s international healthcare experiences as a humanitarian and diplomat that has traveled more air miles than any physician in history!

06:00 Dr. Grundy’s work with Nelson Mandela and how he become known as a “good troublemaker” looking for innovative disruptions to benefit humankind

07:00 How growing up in Africa informed Dr. Grundy of the importance of a traditional healer in creating relationships that drive better patient outcomes

07:30 “A relationship of trust must be the basis for an accountable health care delivery system that works.”

08:00 Reflections from observing health systems all over the world and how Denmark is the leading example of relationship-based primary care

08:45 Research showing that relationship-based primary care reduces both healthcare costs and mortality rates

09:10 Dr. Grundy speaks about his prior work at IBM and how IBM viewed the Patient-Centered Medical Home as foundational for “system integration”

09:30 The history of the Patient-Centered Medical Home and how shared data underpins the success of the model

10:15 Accountable Care begins at the intersection of trusted healing (relationships) and systems integration (coordinated data sharing)

11:00 Formative experiences growing up in the African bush and how that enabled Dr. Grundy to understand and apply deeply held tribal beliefs into his own life

13:00 Dr. Grundy discusses how Quakerism and The Eight Laws of Social Change has been his guiding light to seek social impact through global health reforms and value-based care

16:30 How early followers are just as important as revolutionary leaders in creating social change

17:00 “The current healthcare delivery system is a form of violence when an episode of care is what is valued – whether that episode of care is necessary or not. We need a cultural shift away from an episode of care to managing population health.”

18:00 The importance of accessing data at the point-of-care to improve population health outcomes

19:00 Eric engages Dr. Grundy on his leadership in the Patient-Centered Medical Home movement and how it is not unlike leading a social movement for civil rights

21:30 Dr. Grundy tells the story of how he received the ‘Godfather’ name by “changing the covenant” for primary care and data activation to achieve health value

25:00 Managing difficult diagnostic dilemmas and creating relationships of trust are the primary responsibilities for physicians

25:30 Specialized clinical programs (e.g. comprehensive medication management, behavioral health, education) are best delivered by interdisciplinary system in an integrated system

27:10 Building accountable care (like the Denmark health system) through integrated systems of care under the ownership of the physician

30:00 The impact that value-based care has on reducing physician burnout and why forcing physicians to be scribes is a terrible idea!

32:00 Teaching medical students that being a physician is “team sport” and redesigning for team-based care delivery

36:00 Referencing Dr. Grundy’s book entitled “Lost and Found: A Consumer’s Guide to Healthcare”

36:30 Dr. Grundy shares his views on healthcare consumerism and how patients can best navigate the obstacles that stand between them and high-quality, affordable healthcare

37:30 Access and availability is cornerstone of consumer-centric models and how Tom Lee, M.D. founded One Medical on this premise

38:00 Realignment of financial rewards with service through value-based payment and how low value care arises due to misaligned incentives

39:20 Community health centers as an consumer-centric model of care

41:30 “Data is going to do for a doctor’s mind what x-rays did for changing a doctor’s vision.”

42:20 Referencing The Flexner Report (a landmark report of medical education written 110 years ago) and how healthcare is the last industry running on the “master builder” model

43:20 The superiority of a data-based population health model to augment physician brainpower

44:30 How to modernize healthcare through pattern recognition empowered by Machine Learning/Artificial Intelligence models

46:00 “Data supports the relationship of trust with the healer. Having both working together is what enables you to make a difference in someone’s life.”

46:30 Dr. Grundy shares a story of how understanding data allowed for an effective intervention to address food insecurity

47:30 Dr. Grundy differentiates Machine Learning from Artificial Intelligence and the implications of Natural Language Processing (NLP) as a branch of AI

52:00 The concept of self-driving cars and how computers can understand patient communication better than doctors!

54:00 The Value-Based Care certificate program at Western Governors University

55:30 Dr. Grundy provides parting thoughts on the importance of workforce development in creating a cultural shift for healthcare transformation

57:00 More information on ACLC/Innovaccer, CareAsOne, and the Get the Medication Right (GTMRx) Institute

Mahatma Gandhi once said, “The true measure of any society can be found in how it treats its most vulnerable members.”  The same can be said of healthcare organizations serving patients within their local communities.  In value-based care, the truest measure of any healthcare organization’s success (from both an economic and a moral imperative) is how it treats its most vulnerable patients.  It doesn’t get any clearer than that – serving the underserved…the 5% that drives 50% of medical spend…those that are dealing with serious illness due to chronic disease, mental health issues, or substance abuse is the most important focus we should all have as an industry. And with this intersection between vulnerability and minoritized populations, we have to start thinking about value-based care and health equity as one and the same. 

In this week’s episode, we are joined by two mavens, Michael Radu, CEO, and Dr. Gregory Foti, Chief Medical and Transformation Officer of AbsoluteCare. AbsoluteCare, is a leading innovator in patient-centered, value-based care. They are what I would call an integrated Chronic Care Patient Centered Ambulatory ICU that partners with health plans to care for only the most vulnerable complex patients. They are similar to other high-touch, relationship-based primary care centers; however, they don’t spread risk by accepting global capitation within the entirety of a normalized managed population, including caring for those who are relatively healthy.  AbsoluteCARE sees only the sickest of the sick, and they are getting positive results with their comprehensive multidisciplinary care model by focusing on all aspects of a patient’s life issues – social, behavioral, substance use disorders and medical – to give patients the resources they need to fully change their lives. Listen today to learn from these leaders in the race to value!

Episode Bookmarks:

05:00 The AbsoluteCare Care Model and its clinical and utilization impressive outcomes

07:00 Dr. Greg Foti explains his personal “Why” and how his disillusionment with FFS made him a champion for value-based care

08:20 Building trust with members as the “secret sauce” and why it is important for clinicians to take time to listen

09:45 How relationship-based care supports SDOH interventions and closing gaps in care

10:25 Mike Radu discusses how AbsoluteCare takes time with patients by lowering the patient panel per clinician and adding support teams

12:00 Promoting literacy and understanding of care plan and discharge instructions with post-visit follow-up from care team coordinator

12:50 Social workers and RNs as an additional wraparound support model to enhance member outcomes

13:45 “Beyond Medicine” and SDOH – an example of how AbsoluteCare helped a member overcome housing instability

15:45 Focusing on the top 4-6% of highest utilizers within the most vulnerable, complex, marginalized populations

16:50 Dr. Foti describes how AbsoluteCare provides housing interventions and build partnerships with communities and health plans

18:30 Addressing food insecurity through food bank partnerships and a “food as medicine” strategy

19:05 Helping members dealing with social isolation by building a community-based outreach structure

20:00 Mike Radu provides additional context on AbsoluteCare helps members dealing with food insecurity, housing instability, and health illiteracy

22:00 Using Member Rewards (re-loadable gift cards) that incentivizes members to engage in their own health

23:10 Dr. Foti discusses how innovative care delivery is only possible with value-based contracts that provide prospective funding for investments

24:30 “Dismantling the fence” in society to remove barriers (such as institutional racism and SDOH) that create inequities

27:00 Mike Radu provides perspective from his time with CMMI on how value-based care innovation is solving for health equity

29:30 The need for CMS to innovate Risk Adjustment methodology to include SDOH data

30:30 Measurement of impact (e.g. ER diversion, rehospitalizations) is needed to justify value-based care program investments

31:00 Reporting voluntary Z codes to capture SDOH data and how AbsoluteCare uses them for risk stratification and attribution logic

32:00 “Our North Star is to change the trajectory of a child’s life and address health equity for the next generation.”

34:00 The importance of culturally competent care to better connect with complex populations in minoritized communities

35:30 How AbsoluteCare provides transgender care through trust building and culturally competent care

36:45 Building health centers only in those communities most in need and the importance of recruiting employees from those communities

39:40 Suboptimal health literacy is an independent risk factor for poor health outcomes, including increased risk of hospitalization.

41:00 Dr. Foti describes the difficulties in navigating the healthcare system and why care coordination is needed (especially for most vulnerable)

43:00 Using information exchanges and ADT feeds to provide alerts to Interdisciplinary care team

44:00 “Hub and Spoke” care model (health centers and embedded community-based care teams)

44:45 How AbsoluteCare approaches integration of behavioral health and pharmacy within primary care model

46:00 Infusion Center for acute care treatment of chronic disease exacerbation

47:45 In-house Laboratory to support members at the point-of-care

49:00 Workforce development for all care team members and the importance of daily team huddles

51:00 Mike Radu describes the data and analytics infrastructure at AbsoluteCare

53:00 Transportation services to pick up members for primary care visits and also delivery medications to their home

54:15 The need for complex medication review (average member has 13 diagnoses and 10 medications)

55:30 Dr. Foti fully describes the integrated pharmacy model at AbsoluteCare

61:00 Dr. Foti fully describes behavioral health integration (Collaborative Care Model) at AbsoluteCare

66:00 Mike Radu on how AbsoluteCare leverages complex algorithms to drive community-based interventions

69:30 Entrenched economic interests and the difficulty of burning the ships to settle in the “New World” of value-based care

71:00 A reason for optimism in the value movement

In recent years, the role of retail in health care has grown beyond the co-location of clinics and pharmacies, with many large retailers now expanding their care delivery practices to include full-service health centers, telehealth offerings, and home delivery of pharmaceuticals. Retailers like Walmart, CVS, Amazon, Walgreens, and Target are all pursuing a healthcare strategy. The opportunity to bring consumerism to the forefront in healthcare has never been more promising, and these retail companies are looking to deliver consumer-centric innovation in a way that the traditional healthcare system has been unable to. In addition to the provision of a high-touch, technology-enabled primary care delivered in existing brick-and-mortar facilities that are highly convenient and familiar to patients, these companies have begun to leverage other assets, including online platforms, robust supply chain and delivery infrastructures, and access to capital to grow their health care offerings.

In this episode, you are going to hear from three thought leaders with unique perspectives on this important topic. We have Dr. David Nash (Founding Dean Emeritus at Jefferson College of Population Health), Marcus Osborne (Senior Vice President of Walmart Health), and Darrell Moon (the Founder and CEO of Orriant).

Episode Bookmarks:

02:00 Retail companies (e.g. Walmart, CVS, Amazon, Walgreens) are bringing consumer-centric innovation to healthcare

03:15 Introductions to Marcus Osborne (SVP, Walmart Health), Dr. David Nash (Dean Emeritus, Jefferson College of Population Health), and Darrell Moon (CEO, Orriant)

04:30 The traditional American healthcare is one of the least consumer-centric models ever developed in a capitalist economy

06:25 Dr. Nash describes the current socioeconomic challenges of Philadelphia as a construct for how poverty contributes to adverse health outcomes

08:50 Dr. Nash reference the seminal article by Dr. David Kindig, “What is Population Health?” and how population health relates to SDOH and institutional racism

11:30 Is retail-based primary care the answer to improved population health through more effective patient engagement?

13:00 Referencing Fred Lee’s book, “If Disney Ran Your Hospital” in thinking about how we can optimize the patient experience and deliver personalized service

14:40 Marcus describes how supply and demand challenges of primary care in the effective management of chronic disease

16:30 “The biggest issue we face in healthcare is variation in care delivery.”

18:00 Technology, innovation, and interdisciplinary care teams as the ultimate solution to address population health challenges

19:00 The role of the “Professionally Nice Person” in consumer-centric care delivery and how Community Health Workers can be used to improve outcomes

20:00 Our challenge is getting the system comfortable with the reimagining of team-based care (not the patients!)

23:00 Darrell describes the importance of “massively powerful primary care” and the power of relationships

25:00 Nuka System of Care – Southcentral Foundation as a leading example of the “best healthcare system in the world” and how it emphasizes relationships, trust, and patient convenience

30:00 Marcus describes the absurdity of the “balanced interest” model in designing healthcare reforms (the interests of the consumers are all that matters!)

34:00 Dr. Nash on how unexplained clinical variation supersedes SDOH in importance when it comes to population health

35:00 Keeping only the wealthy healthy in a retail-based care model will perpetuate health inequities

37:00 Life expectancy is determined primarily by the zip code to which you live (e.g. SDOH disparities contributing to a 20-year variance in adjacent zip codes)

39:00 For-profit, private-equity backed SDOH companies are a driving force to community-based interventions

40:30 Marcus describes how Walmart Health is addressing social determinants of health as both a healthcare provider and an employer

42:00 The Walmart ZP (“Zero Pressure”) platform to share stories with peers and how that contributed to massive weight loss among Walmart associates

45:30 Darrell describes the power of behavior, influence, and storytelling in improving population health

47:00 Storytelling is the primary way to change consumer behavior and reorient them to innovative models of care delivery

48:00 Subscription-based primary care as a foundation to relationship-based primary care, community support models, and realignment of incentives

54:00 Marcus describes the Walmart philosophy of “save money, live better” and how it applies to its price transparency model for consumer-driven healthcare

58:00 Darrell discusses how we will see retail power-players expand beyond massively powerful primary care models, telemedicine, and virtual care to build individual insurance plans in a public marketplace

60:00 The inevitable migration away from employer-sponsored group insurance to employer-sponsored individual insurance!

62:00 Marcus explains the confluence of an emerging new individual insurance products and the focus on improved employee health and productivity

62:30 Marcus on why we should view the Haven as a unbelievably massive success and how the industry mischaracterized the experiment.

64:00 Darrell explains how Europe can be viewed as a model for how employers can support the health of their employers (once the group insurance market goes away)

65:00 Dr. Nash describes how improving employee vaccination rates should be viewed as the #1 priority for employers

66:00 Marcus provides thoughts on post-pandemic healthcare and the integration of omnichannel consumer environments to redefine healthcare

Oak Street Health has an amazing vision to rebuild Health Care as It Should Be: Personal, Equitable, and Accountable. The business was launched with a belief in value-based care that was patient-centered, evidence-based, and ensured equal opportunity for good health outcomes across populations, despite the economics being unproven. The business model depends on global capitation and allows the best service for patients in some of the poorest and most vulnerable communities. The high touch, relationship-based, tech-enabled primary care model includes support with medications, transportation, social work, home visits, and more – the sickest 10% of patients receive 78% of Oak Street’s dollars.

This week, our guest is Dr. Griffin Myers, CMO and co-founder of Oak Street Health. In his own words, the challenge is not providing treatment but winning patients’ “trust and building relationships,” something Oak Street has demonstrated successfully with its ability to rapidly scale, to a network of 90 centers in 15 states. The Oak Street Platform is redefining Primary Care by bringing technology-enabled, value-based care to the seniors that represent the highest proportion of healthcare spending in the country. Winning the race to value will depend on many more following in the footsteps of these leaders!

Episode Bookmarks:

05:35 The “insane” journey of starting a company that takes full-risk on very sick populations

05:55 “The downstream microeconomics of fee-for-service reimbursement has created a janky, inequitable, low quality health care system.”

06:30 The importance of segmenting your patient population within a payment model that is better aligned with care outcomes

06:40  “We take care of community-dwelling older adults with multiple chronic conditions and adverse social determinants.”

06:50 Full risk, global capitation enabled the development of the Oak Street Health platform.

07:00 Oak Street platform: 1) Community-Based Primary Care Centers, 2) Proprietary Technologies, 3) Value-Added Services to Primary Care

07:35 Dr. Myers discusses how the culture at Oak Street, coupled with the power of global capitation, drives value-based care results.

08:45 Oak Street’s Results: 50% reduction of hospital admissions, 52% reduction of ED visits, 35% reduction in 30-day readmission rates, 5-star quality ratings, and a 91 NPS

10:40 Dr. Myers discusses the concept of relationship-based care and how it improves outcomes for underserved populations.

11:20 Referencing Viktor Frankl’s “Man Search for Meaning” and how deeply meaningful and trusting relationships provide purpose

12:05 “Trust is the core input to us being able to help patients navigate adverse social determinants.”

12:10 Critical Success Factors: 1) Spending more time with patients with a consistent presence from a longitudinal care team, 2) Deep sense of accountability (“a promise”), 3) Culturally-Competent Care

12:55 “Having people who live in the neighborhoods to which we serve that share a cultural connection with patients helps form trusting relationships.”

13:30 “A value-based model is simply superior technology compared to fee-for-service. Value allows you to incubate and foster relationships to drive outcomes.”

14:40 Inspiration from John Lewis (“Try to be the pilot light not the firecracker.”) when it comes to building a safer, higher quality, more equitable, more affordable health system.

17:35 Referencing the HBS Case Study: “Oak Street Health: A New Model for Primary Care”

17:45 The role of the Clinical Informatics Specialist at Oak Street

18:30 Dr. Myers discusses the evolution of EHR technology at Oak Street and the development of Canopy (winner of the 2021 EHR Innovation Award)

19:40 The Value Flow of the Canopy EHR: “Data, Insights, and Action”

20:15 Deep and long-term relationships between the patients and providers that allows for enhanced data capture.

20:30 Referencing the recent NEJM Catalyst Article on Oak Street Health: “Interpretable Machine Learning Models for Clinical Decision-Making in a High-Need, Value-Based Primary Care Setting”

21:00 Surpassing off-the-shelf algorithms for patient risk stratification through enhanced data capture in a relationship-based primary care model

21:45 Dr. Myers discusses the difference between Machine Learning and Artificial Intelligence

22:15 Reducing readmissions by 15% with virtual hospital rounding of patients using a data-driven checklist

25:20 Dr. Myers discusses the core value of health equity at Oak Street Health

26:15 “Health disparities are the opportunity in value-based models.”

27:40 Being deliberate about addressing health equity requires three things: 1) Be Local, 2) Focus on Cultural Competence, 3) Prioritize Health Equity and Incorporate in your Values

29:45 The exacerbation of health disparities with COVID-19 and how Oak Street’s innovative care delivery model met needs for underserved communities

30:40 Oak Street delivered 185,000 COVID-19 vaccines across communities

33:25 Dr. Myers discusses Oak Street’s approach to behavior health integration

33:55 Inspiration from Rumi (“Keep your gaze on the bandaged place. That’s where the light enters you.”) when it comes to addressing suffering due to poor behavioral health

34:30 Referencing the IMPACT Study and the Collaborative Care Model (CoCM) in creating successful integration between primary care and behavioral health care

35:25 Cost savings from BH Integration doesn’t come from reduced admissions related to mental health (it instead comes from improved wellbeing that reduces downstream spending on organic illness)

37:15 Dr. Myers discusses “What it means to be Oaky” and Oak Street’s approach to workforce development and company culture

39:55 Oak Street Health earns the “Joy in Medicine” recognition from the AMA in fighting physician burnout through “enlightened clinician leadership”

41:15 Dr. Myers discusses how Oak Street Health is doing in physician satisfaction and retention

44:20 Dr. Myers on the transition to telemedicine during the pandemic and where it fits in within a high touch primary care model

46:10 Dr. Myers discusses the rising role of retail-based primary care and references Oak Street’s partnership with Wal-Mart

47:20 “How beautiful is it that we now have a space in this country where organizations are putting blood, sweat, tears, and capital to serve vulnerable and low-income communities?”

44:80 Inspiration from Viktor Frankl: “Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.”

49:10 Parting thoughts on celebrating the optimism of the moment and seeing hope for the future of value-based care

Employers are on the frontlines in the battle against rising healthcare costs. Legendary investor Warren Buffett said that rising health care costs, not the tax system, are the number one problem that American businesses face. “If you go back to 1960, or thereabouts, corporate taxes were about 4% of GDP. And now, they’re about 2% of GDP,” “At that time, health care was 5% of GDP, and now it’s about 17% of GDP.” In Buffett’s view, this says a lot of what’s playing a bigger role in hindering business activity in the economy. He is famously quoted as saying that “medical costs are the tapeworm of American economic competitiveness.”

Direct Primary Care (DPC) is a unique solution for employers to win the “race to value.” Our guest this week is Dr. Gaurov Dayal, the President and COO for Everside Health and a nationally recognized physician leader, who, in 2019, was selected as a finalist as the Director for CMMI to replace Adam Boehler. Everside Health is tackling employer healthcare costs head on by offering direct primary care services to employers. Their DPC model redirects health care from fragmented care sites such as inpatient and outpatient settings, specialists’ offices, ER and urgent care clinics into the optimized primary care setting. In the longer term, Everside works to deliver cost savings by diagnosing, treating efficiently, and managing the health of a covered population across 32 states with 350 health clinics located at or near the facilities of its employers, unions, and other benefit sponsor clients.

Episode Bookmarks:

02:25 Dr. Dayal shares his recent “once-in-a-lifetime” experience traveling to Iceland!

03:30 Recent APM delays and pullbacks from CMMI – what does this mean for the value movement?

05:05 “The progression to Value-Based Care is a fairly bipartisan issue.”

05:45 Is the COVID-19 pandemic detracting from the current health policy focus on value?

06:45 The deficiencies of the healthcare system highlighted by COVID-19

08:30 Dr. Dayal reflects on his experience interviewing for the Director of CMMI position in 2019to replace Adam Boehler

09:45 “There is a lot of passion at the federal level to push ideas that can improve care for the US population.”

10:40 The challenges of balancing stakeholder interests in the political process and the need for more clinical leadership and influence

13:45 Is capitation truly needed to have value-based care?  Or can you pay for outcomes in a FFS model?

14:45 “The linkage of the payment to the delivery system creates value-based care.”

15:30 Dr. Dayal discusses the capitalistic model of healthcare and how FFS domination prevents large scale change

17:00 “In the history of companies, very few companies are able to successfully transform themselves from one business to another.”

17:30 “We are entering an era of new providers disintermediating in value-based care, rather than old incumbents successfully bridging the gap.”

18:00 Dr. Dayal discusses disruption in the Medicare Advantage space (e.g. ChenMed, Oak Street Health), employers collaborations (e.g. Everside)

19:00 The germination of specialty-focused companies in VBC (e.g. renal care, oncology, orthopedics)

19:30 Dr. Dayal compares the “race to value” to the automobile industry transitioning from combustion engines to electrical power

21:00 Referencing legendary investor Warren Buffett’s position on rising health care costs as the number one problem that American businesses face

22:00 Everside Health’s Direct Primary Care (DPC) model operating in 32 states with 350 health clinics located at or near the facilities of its employers

22:45 The average family spends $20k on healthcare at a time when working Americans are facing wage stagnation and looming inflation

24:30 “Overutilization of healthcare services is as dangerous as underutilization”

25:20 “Everybody in this country needs better access to good primary care.”

26:00 Dr. Dayal explains how Everside serves employers with ongoing access to primary care, including onsite clinics and telehealth.

27:00 Goals of Everside Health: 1) Higher employee engagement with primary care, 2) Healthier Employees, 3) Lower Total Cost of Care

28:00 Foregone employee compensation due to the high costs of healthcare benefits

28:30 How DPC works (no out-of pocket costs for employees, no FFS, aligned physician compensation structure, limited patient panel size)

31:00 The employer-sponsored health insurance marketplace and the shot across the bow from Amazon, Berkshire Hathaway, and JPMorgan Chase

33:00 Dr. Dayal reflects on the failure of Haven and why it happened

34:00 How working with lower-income industries creates more of a “burning platform” for value-based care because of price sensitivity

34:30 Dr. Dayal shares optimism for the future based on a grassroots consumer movement from employees demanding change

36:00 The growth of Medicare Advantage over the last decade as a precursor for what we are about to see in the employer-sponsored insurance market

37:00 A ceiling has been reached with High Deductible Health Plans

37:30 Primary care as the best (and cheapest) solution for healthcare reform

38:30 The challenges of the virtual care/digital health boom related to lack of point-solutions and consolidation

39:20 How Everside is creating a platform company that aggregates the best-of-breed digital solutions with Direct Primary Care

41:00 Referencing the recent Milliman report on Direct Primary Care studying employer ROI

42:30 Dr. Dayal discusses how employers can achieve ROI with long-term investments in Direct Primary Care

43:30 “These models only work when engagement is very strong.”

44:30 Employers will see the highest ROI with DPC will be seen by avoidance of chronic conditions.

49:00 “It is interesting that we have the most expensive healthcare system in the world, but no one seems to be happy with it.”

49:30 The frustration of Primary Care Physicians with Fee-For-Service

50:30 PCPs have better opportunities in the future because of the emphasis on VBC and consumerism

51:30 The limitations of virtual care and urgent care and why more convenience in primary care is the best option

53:30 Addressing Social Determinants of Health and in the primary care setting and the importance of care navigation

56:30 Dr. Dayal discusses the explosion of telemedicine and virtual care during the pandemic and what we should expect in the future

63:00 Parting thoughts of optimism for the future of value-based care

It’s not a secret, the broken healthcare system is exquisitely tuned to react after patients get sick. For the most part, profits are made after we FAIL patients. And it hurts all of the caregivers who face the daily internal conflict of doing what is right for the patient or doing what is right for the business. But there are a few who are positioned differently. When the strategy and business are unconflicted they’re not worried about demand destruction and leakage but are instead focused on prevention and true care management.

It all begins with prioritizing and properly aligning primary care. A group of 100 adult primary care physicians can influence $1 billion in healthcare spend. This is the source of potential power and change in a value-based world, where health will improve for patients and their providers while costs are decreased. Aledade is such a place – by allowing providers to remain independent and unfettered by the constraints of fee for service, Aledade is blazing the path toward true health value.

Episode Bookmarks:

03:30 Comparison of Healthcare Spending ($6M per minute) to Niagara Falls (6M cubic feet per minute)

04:55 Aledade’s success in short lifespan of company (now at 800 practice partnerships with $360 million in healthcare cost savings)

06:05 The misalignment of incentives creating a perverse incentive for poor outcomes (e.g. profitability of treatments following a stroke)

06:45 Dr. Mostashari spending his career trying to find answers to the question, “How do we save the most lives?”

07:20 Adoption of electronic health records (“We succeeded in the battle, but we lost the war.”)

07:45 Provider workflow redesign and optimization (Regional Extension Centers)

08:25 “How can we create incentives so that private profit creates public good?”

09:30 “The Paradox of Primary Care Physician Leadership”  (the influence of primary care on downstream healthcare spend)

11:30 Consolidation of primary care by Optum and private equity firms

12:00 The resiliency of independent primary care practices

12:30 “Independent practices can do what they believe is in the patients’ best interest, without worrying that they’re obligation to the patient conflicts with their obligation to the corporation.”

13:00 Data shows remarkably little change in hospital employment of PCPs, thereby showing resilience in the primary care market

15:00 Movements are led by effective storytelling and these stories can revitalize communities of people

17:00 Primary care heroes during COVID-19, and how society neglected them by failures in supply chains, testing, and vaccines

18:40 Aledade’s support of primary care practices during the pandemic

20:00 “It is remarkable what happens when you do the right thing.”

22:00 Dr. Mostashari’s terror in seeing early ER utilization data in knowing that a pandemic was coming (before the media was covering it)

23:00 Implementation of telehealth, finding PPE, and securing loans for practices in early stages of pandemic

23:25 “The idea of practices going out of business during the pandemic highlights the insanity of fee-for-service payment for primary care.”

24:00 The lessons of COVID-19: 1) Healthcare can change, 2) Primary care doesn’t have to be an in-person visit, 3) Capitation in primary care is preferrable to fee-for-service

25:40 “Primary care is about the relationship between a practice and patient —  it’s not about the 99213 visit.”

27:30 Dr. Mostashari addresses recent delays by CMMI in new APMs and what we should expect in future health policy

28:30 Scaling the models that work is the job of good health policy.  (MSSP compared to CMMI programs)

29:00 The ACO Investment Model (AIM) program was successful and a model for future provider and patient incentive programs

30:30 CMMI delays should not be considered as a question to the direction of value-based models.

32:00 The progress of the ONC in standardizing health information

32:30 The sharing of Admission, discharge, transfer (ADT) notifications as a requirement for hospital participation in the Medicare program

33:00 The need for policy clarity to support improved interoperability and data sharing

35:30 Dr. Mostashari discusses the evidence for the benefits of Medicare Advantage plans

37:00 Could profits for Medicare Advantage plans be lower and still achieve same level of benefit in value-based care?

37:45 The focus should be moving practice panels to risk in order to ensure value-based care standardization

39:00 The murder of George Floyd as a reckoning for society (“We can no longer be bystanders.”)

40:00 Health equity as a company focus for Aledade and reduction of racial disparities in care for severe hypertension

40:30 Outcomes measures for racial disparities of care

41:00 Aledade’s work with majority minority practices

42:10 Aledade’s recent Series D raise and the future growth of the company

45:20 Servant leadership as a core component of company culture

When Thomas Edison created the electric light bulb, he didn’t stop with that one incredible invention. He took the next step and created the industry that would maximize the benefit of that light bulb, the infrastructure needed to make that light bulb become a permeating and permanent piece of society.

This is the type of vision needed for the health care system as a whole, and the type of vision that is occurring in Dallas Texas. Catalyst Health Network’s physicians are intent on the vision of “Primary Care for All”, serving communities that are mired in a systemic, multi-generational crisis—where one in three children in Dallas lives in poverty, the third-highest rate of child poverty in the nation.

This week’s guest, Dr. Christopher Crow, President of Catalyst Health Network, has connected and aligned a network of more than 1,000+ Primary Care Providers with nearly 1 million lives across North Texas, to build a better care model for patients that improves health and lowers cost. His work with Catalyst led them to be the first North Texas physician network to hold value-based contracts with the top four major carriers: Aetna, UnitedHealthcare, BCBSTX, and Cigna. To date, Catalyst has saved an impressive $100 million for the communities they serve. Dr. Crow and Catalyst are a bright example of leadership in the race to value!

Episode Bookmarks:

04:00 Thomas Edison’s signature invention of the light bulb was a little more than a parlor trick without a system of electric power generation and transmission

05:00 How Catalyst you’ve been able to imbue a full spectrum of innovation with its value attempts

06:00 The origin story of Dr. Crow and Catalyst Health Network

07:20 Systems thinking design and strategy as a leading force to payer collaboration

08:20 Dr. Crow’s A-Ha moment when seeing Catalyst’s performance data and how value design and PCMH really does lowers cost and utilization

09:30 How growing up in the small town of Hillsboro, Texas inspired Dr. Crow to help communities thrive

10:50 The three pillars to helping communities thrive are health, education, and business.

11:20 Building a healthcare system to deliver more value starts with team-based primary care.

12:45 f an independent primary care practice can thrive (not just survive), the data shows that the community will thrive as well.

13:30 Centralization of population health management with deep personalization

15:00 Leveraging trust of the physician-patient relationship by extending it to the entire care team at scale

15:35 The concept of relationship compounding in value-based care and how it leads to lower costs and better health

16:40 The income and public health disparities in Dallas, Texas and how life expectancy differs by 24 years between neighboring zip codes!

18:10 Dallas is a tale of two cities – affluence and poverty.  What is Dr. Crow’s vision to help everyone in the community thrive?

19:30 Dr. Crow’s vision for “Primary Care For All” to improve longevity and prosperity

21:00 The impact of COVID-19 on building virtual care and telehealth capabilities within the practice

21:30 The importance of telehealth in addressing issues with Behavioral Health and “healthcare deserts”

23:00 Creating the Catalyst Community Foundation to provide access to affordable, quality care, starting with COVID-19 testing and vaccinations

25:15 “If you really want to create impact with high leverage, go upstream with primary care and social services”.

26:20 Building a business model for a self-sustaining, community-based foundation that will ultimately lead to Primary Care For All

27:30 Private Equity investment and provider consolidation – what does this mean for the future of primary care?

31:00 How Catalyst helps small primary care practices build the table stakes for value-based care from a technology and service standpoint

34:45 Catalyst receiving URAC’s full accreditation in Clinical Integration and how they were able to build a CIN with a network of independent physicians

38:30 Engaging physicians with a playbook for clinical integration

39:00 Joining forces with another prominent CIN (Baylor Scott & White Quality Alliance) to bring even a higher level of innovation and integration to the Dallas market

40:20 Developing a health insurance product for individuals and small employers that offers Primary Care for All in a subscription-based model with prospective payment

43:00 The exploding costs of employer-sponsored health insurance with ‘poor health’ costing employers $530B on top of the $880B they already spend in premium dollars!

45:30 Collaboration with employers and how “Relationships Matter” is the #1 core value of Catalyst Health Network

46:45 How Catalyst generated $100M in savings primarily with a commercially-insured population (not Medicare or Medicare Advantage)

48:30 The thought leadership of Dave Chase and “How Healthcare Stole the American Dream”

48:55 Unnecessary spending and low value healthcare deprives future prosperity of communities

51:00 Redesigning employer plan benefits with an emphasis on Primary Care and prospective payment

52:45 COVID-19 as a wakeup call for large employers

54:40 Medicare Advantage with prospective payment and shared risk

56:00 The new CMMI Direct Contracting model

56:30 How PPOs are the wrong model for value (the “PPO Buffet”) and the HMO backlash

57:24 “If you want a longitudinal model for primary care, with the benefits of relationship compounding, you must pay for it prospectively.”

59:30 How Integrated Pharmacy with a focus on medication adherence can reduce healthcare costs through reduced inpatient hospital stays and emergency visits

1:00 40% of drugs purchased in healthcare are not even taken!

1:02 Integration of pharmacist with a care team to help providers and patients make the right decisions

1:03 “90-day refills are bad for your health!”

1:05 Moving adherence rates for patients with chronic diseases – from 60% to 90%.

1:07 “The Infinite Game” mindset for leadership in primary care transformation

1:08 Winning in America is stock prices and EBIDTA.  Not a different purpose-driven game based on relationships leads to a better future.