Relentless Health Value

Chris Sloan is an associate principal at Avalere Health, a Washington, DC–based nonpartisan consulting firm. He advises a number of clients—including pharmaceutical manufacturers, health plans, providers, and patient groups—on key policy issues facing the health care industry. His particular areas of expertise include drug pricing, the Affordable Care Act, generics, and biosimilars. Additionally, Chris is a recognized expert in the health care policy issues facing people living with HIV/AIDS and multiple sclerosis. Chris's economic analyses of key policy proposals and issues, including drug pricing and the repeal and replace efforts around the Affordable Care Act, have been featured in a wide range of publications such as the Wall Street Journal, the New York Times, Politico, Vox, and others. He has a BBA degree in economics and marketing from the College of William and Mary.

In collaboration with CEEK Enterprises, HealthPrize recently released a new report, “The Pharmaceutical Triple Aim,” about how higher medication adherence improves patient outcomes and lowers health care costs.

Pharma companies can be part of adherence solutions, or at least pay for them. But here’s the thing: Pharma won’t do much of anything unless it’s shown to be able to increase revenue and boost earnings per share. This report shows how that can be done if adherence is improved.

Tom Kottler is co-founder and chief executive officer of HealthPrize Technologies, the leading cloud-based patient experience and adherence platform for life science companies. In collaboration with CEEK Enterprises, HealthPrize recently released a new report, "The Pharmaceutical Triple Aim," showing how 21 of the world's top pharmaceutical companies can increase revenue and boost earnings per share with improved adherence. Tom has led multiple high-growth organizations during his career, including Advanced BioHealing, which was acquired by Shire for $750 million, and MedAptus, an innovative health care IT company based in Boston. 01:10 A new study on medication nonadherence. 02:36 The pharmaceutical triple aim. 02:47 The 4 ways Pharma can make money. 03:04 The pressure on the key elements of the pharma business model. 03:45 The big revenue opportunities for Pharma and how they're really difficult things to solve for. 05:39 "Adherent patients get better outcomes, and they cost less … all the way around."

On January 1, 2019, CMS mandated hospitals publish their chargemasters. Chargemaster prices serve as starting points for negotiations with insurance carriers. Because of this, prices tend to be exorbitant. The issue being chargemaster-based balanced billing: Patients without insurance, get out-of-network care, or haven’t met deductibles get charged based on chargemaster rates. Caroline Znaniec from Luna Health offers practical advice to help hospitals fix these issues.

Caroline Znaniec, MBA, MS-HCA, is the founder and principal of Luna Healthcare Advisors LLC. Her boutique consulting group provides revenue integrity advisory services to other consultancies and large advisory firms, software companies and developers, and health system and physician providers. Caroline writes and speaks regularly on topics of revenue integrity for many nationally recognized professional associations, including the Association of Healthcare Internal Auditors (AHIA), American Health Information Management Association (AHIMA), Health Care Compliance Association (HCCA), Healthcare Financial Management Association (HFMA), and National Association of Healthcare Revenue Integrity (NAHRI). She has more than 20 years of industry experience, having worked with the nation's top health systems and health care talent.

Today I’m speaking with Don Lee, who, besides being the host of The #HCBiz Show! podcast, has co-founded the upcoming VBP Forward Conference, to be held in Buffalo, NY, on February 20 and 21, 2019.

Don helps organizations launch new health IT products and services. He's a product and business development consultant and accomplished health IT expert with a 20-year track record of driving value with technology. Don began his career as a custom software developer and eventually built and led a team of more than 30 engineers. Later, he was the subject matter expert, product manager, and head of sales and marketing for a digital health start-up that launched a software as a service (SaaS) platform focused on administrative simplification in health care. Today, Don is president of Glide Health IT, LLC, a consulting firm that helps forward-looking organizations align their health IT and business strategies. The firm specializes in business and product development with a focus on data aggregation, interop, analytics, and quality measurement. Don is also the host of The #HCBiz Show!, a podcast dedicated to unraveling the business of health care, as well as a partner at VBP Forward, a new conference focused on value-based payment for complex and special needs populations. 01:09 What problems the VBP Forward Conference aims to solve. 01:45 "Providers are being asked to take on risk." 03:13 "The health systems have to engage with these existing resources." 03:27 Bridging gaps in order to solve a common goal. 03:45 Finding the shared priority. 04:03 Value-based care conference vs a value-based payment conference. 05:44 Care = perspective; payment = retrospective. 05:58 National conference vs regional conference.

Innovation is both an art and a science, but it’s also a process. There’s never been a great idea that went anywhere without some decent implementation/operational strategy. It’s a common mistake to let common sense fly out the window when we become enraptured by our own genius. Lucky for us, there are people out there like Katie D. McMillan from Duke University Health System and Roylyn Fernandez of DeLappe Consulting who specialize in how to take a great idea and get it used by providers and patient

Katie D. McMillan, MPH, has dedicated her career to imagining and building technology to improve health care for patients and providers. Her experience spans multinational global health organizations, lean software start-up companies, and large academic medical centers. Katie's latest venture is the creation of the Mobile App Gateway (MAG) at Duke University Health System. The MAG serves as the hub for digital health at Duke and provides product consulting services to clinicians and researchers, monthly events and workshops, and content exploring the many facets of the health tech industry. Roylyn Fernandez, RN, has more than 15 years of combined experience in clinical and informatics roles integrating technologies such as electronic health records (EHRs), virtual desktop infrastructure (VDIs), and mobile applications into system processes. Her passion for nursing and health care enable her to leverage her clinical, operational, and informatics knowledge to design and execute technology adoption strategies that support organizational goals related to quality, patient safety, and revenue capture initiatives. In 2016, Roylyn joined DeLappe Consulting after leading enterprise-wide technology implementation and optimization projects for Kaiser Permanente, Sutter Health, and Cottage Health Systems.

Louis Morrow is regional director of sales for Intelligent Retinal Imaging Systems (IRIS), the leading comprehensive solution provider of diagnostic telemedicine services committed to ending preventable blindness due to diabetic eye disease. Louis was one of the earliest builders at IRIS and has played a major role in saving the eyesight of over 55,000 patients (so far) through the partnerships built with major health systems and integrated delivery networks across the country. He’s an award-winning consultative sales team leader with more than 20 years of successful experience in the eye care space and has held senior sales leadership positions across multiple companies.

Tiffany Wandy is executive director of the Clinically Integrated Network for LifeBridge Health, a regional health care organization based in northwest Baltimore and its surrounding counties. LifeBridge Health consists of Sinai Hospital of Baltimore, Northwest Hospital, Carroll Hospital, Levindale Hebrew Geriatric Center and Hospital, LifeBridge Health & Fitness, hundreds of primary care and specialty physicians throughout the region, and many affiliated health-related partners. Prior to joining LifeBridge, Tiffany was a senior data analyst and lead program consultant for the CareFirst Patient-Centered Medical (PCMH) Program, where she served as an adviser to primary care providers on best practices relating to the implementation of coordinated care delivery models. Tiffany has both payer and provider experience and leverages this knowledge to drive increased use of analytics, business development, and practice transformation for rural, suburban, and urban organizations.