Relentless Health Value

Jed Constantz, DBA As a Healthcare Finance and Delivery Strategic Consultant, Dr. Constantz ensures existing and prospective clients receive maximum value from current and future strategies and initiatives. In previous roles, Jed advised employers on measures to develop regional and community-based physician accountability and commitment through means of enhanced benefits and reduced costs; with the significant benefit of creating sustained loyalty between providers, patients and payers. He has successfully offered strategies that built on four pillars: actionable data, physician alignment, high-risk member targeting and network re-engineering. Having begun his career on the payor's side of healthcare (Blue Cross/Blue Shield of Central New York), Dr. Constantz has served in several positions for hospitals, home health agencies, physician organizations and physician/hospital organizations. Over his 30 plus years in healthcare, Jed has developed tools and resources for primary care providers and employers seeking to reduce costs, drive greater efficiency and quality outcomes and thereby create a "featured-and-favored" network in their regions and community. This process includes a deep focus on the selection of the right community of primary care physicians and specialists, a thorough audit of existing patient and population data, commitment to accountable care standards and improved compensation for the physician. The end-objective is a better healthcare delivery model with an alignment of "enlightened self-interests" and a balance between rewards and value for the employer, employee and provider. For the employer, the financial benefits are immediate with on-going healthcare savings, a healthy workforce, and improved physician relationships. The provider can see greater patient volumes, improved care standards and compensation tied to performance. The employee will feel an improvement in care and attention, benefit with reduced out-of-pocket expenses and sense a higher level of satisfaction. You can learn more by visiting Jed on his LinkedIn page.

For this inbetweenisode, I decided to pick up all this tape on the cutting room floor and see if I could find any themes that might be intriguing to clip together. And so it happened. We start out with some fighting words on what is disruption and what it takes to create disruption in health care. We end with who drives disruption, really.

Today's episode features the following guests: Ross Bjella, MBA, is the founder and CEO of Alithias, a patient advocacy and population health analytics company serving self-insured employers, insurance companies, networks, and third-party administrators. (EP163) John Lynn is the founder of the HealthcareScene.com network, which currently consists of 10 blogs containing over 11,000 articles, with John having written over half of the articles himself. These EMR and health care IT-related articles have been viewed over 18 million times. (EP124/171) Gary Frazier is a disrupter and founder of OM Healthcare, Inc., a health care technology start-up established in 2015. He has over 18 years of business development experience and over 13 years of executive-level hospital and health system strategy expertise. (EP168) David Smith is from Avia and founder of Third Horizon Solutions. He is chief development officer, where he is responsible for expanding the firm's influence in the health care market. (EP135) Alex Jung is global strategist at Ernst and Young. She is a partner/managing director in Parthenon-EY, where she works primarily on growth strategy projects. (EP189) Joe Murad is president and CEO at Pokitdoc. He most recently served as managing director and head of individual exchange solutions for Willis Towers Watson, where he was responsible for the largest private health insurance exchange. (EP183) Frazer Buntin is president of value-based services from Evolent Health. He has worked in strategic and operations leadership positions for the past 17 years. He is responsible for managing the operational performance of Evolent Health's partners. (EP202) A.G. Breitenstein is a partner at Optum Ventures. She was most recently the co-founder and chief product officer at Humedica, one of the earliest big-data analytics companies in health care. (EP207) 02:21 Ross Bjella's short list—5 action items—for employers to get the most for their money out of the health care system. 03:05 Take control of employer health care costs by gaining access to their health care data. 03:18 Offer an incentive-based plan design. 03:32 Create virtual narrow networks. 03:46 Offer live care navigators. 04:10 The importance of controlling health care costs. 04:43 The emotional component behind what an employer must do to maximize the value of their health care. 05:10 Disruptive vs incremental change, and what's really happening in health care. 06:17 John Lynn of HealthcareScene.com, and why it's so tough for disrupters to break into the health care system. 07:26 The weird dynamic of the false market that is health care. 08:46 Health care regulations making it difficult to disrupt the market. 13:15 Gary Frazier's opinion on connecting value-based care and empowered patients. 15:20 What value-based care is really about. 16:17 David Smith elaborates on the problem with assuming empowered patients change health care. 18:21 Rational decision making and how that isn't always present in health care. 19:19 Alex Jung and the "messy middle" of the economic side of health care. 19:44 How the economic model, not the business model, of health care is broken. 21:36 "Is [this] necessary?" 22:13 Joe Murad and the "messy middle" in medical services pricing. 23:11 Frazier Buntin and where we are in the transition from fee for service to value-based care. 24:09 Is this change driven from the health system or major employers? 25:00 A.G. Breitenstein and the power of consumers en masse to move markets.

Eric Weaver, DHA, MHA, is nationally recognized for his work in primary care transformation and value-based care. As a corporate vice president for Innovista Health Solutions, he oversees enterprise strategy and technology adoption for a fast-growing population health management services organization. Dr. Weaver has been recognized for his contribution to the health care industry by receiving the ACHE Robert S. Hudgens Award for Young Healthcare Executive of the Year and the Modern Healthcare "Up & Comers" Award in 2016. Prior to joining the Innovista leadership team in 2015, he was the president and CEO of Austin, Texas–based Integrated ACO—one of the more successful physician-led accountable care organizations in the country.

Today I speak with A.G. Breitenstein, partner at Optum Ventures. She talks about what she looks for in health care businesses poised for success, and considers how they intersect with people. She says real people move markets, even markets as big as the one Optum currently occupies and occasionally completely dominates. I found it very interesting learning how Optum views the universe, at least the side of Optum concerned with potential future disruption.

A.G. is a partner at Optum Ventures. She was most recently the co-founder and chief product officer at Humedica, one of the earliest big-data analytics companies in health care. Following its acquisition by Optum, she became chief product officer at Optum Analytics. She began her career as an attorney, founding a non-profit aimed at helping homeless youth at high-risk for HIV infection. A.G. expanded her mission by obtaining a degree in public health from Harvard. She is a mission-driven leader focused on transforming the health care system into a health system.

There was great hope for consumerism. By pushing the burden onto patients/employees to find high-quality care at a fair price, we assumed that health care delivery would level up. But anyone would be hard pressed to claim success beyond cost shifting by brute force. Turns out providers wield a lot of influence. If we want high-value health care, we need to contemplate the recommendations providers make. Today I speak with Ashok Subramanian, CEO and founder of Centivo, a new kind of self-funded health plan.

Ashok founded Centivo in 2017 after observing the inefficiency in the health care system and the pain that has resulted for employers and employees. Prior to Centivo, Ashok co-founded Liazon, operator of the nation's industry-leading private benefits exchange for active employees. Liazon was acquired by Willis Towers Watson in 2013, and after the acquisition, Ashok served as managing director for Willis Towers Watson's Group Exchange business. Prior to Liazon, Ashok was an associate principal at McKinsey and Co., where he served as a leader in the firm's health care and private equity practices. ​In addition to his role at Centivo, Ashok serves as an independent Board director at Artemis Health as well as a senior adviser to Silversmith Capital, a growth equity firm. Ashok received his undergraduate degree from Princeton University, a master's degree from Stanford University, and an MBA from the Stanford Graduate School of Business.

TJ is a designer at heart and a pharmacist by training. He started his career at his family’s long-term care pharmacy in 2004 and has worked at Target pharmacy, a local community pharmacy, and Massive Health (acquired by Jawbone). He holds a doctor of pharmacy (PharmD) degree from Massachusetts College of Pharmacy and Health Sciences. In 2015, Forbes named TJ to its 30 under 30 List in Healthcare. In 2018, PillPack was acquired by Amazon.

 

02:20 TJ talks about his origin story with PillPack. 04:16 TJ explains what PillPack is and how it works as a full-service pharmacy. 06:57 One of the biggest challenges is getting across to patients that there is a better option to approaching their health. 10:06 How the customer experience is different between PillPack and a retail pharmacy, and how PillPack is working toward eliminating the frustration that comes with a normal retail pharmacy. 11:13 PillPack’s average customer age is 49. 12:42 How PillPack addresses the issue of customer loyalty and the personalized experience that might be offered by retail pharmacies. 15:01 Providers and prescribers often spend somewhere around 30% of their time prescribing medication, when a more efficient solution can be to implement a start and end order. 20:16 The illogic behind using expirations on prescriptions to entice patients to remain accountable at doctor visits. 22:47 How PillPack steps in to be the medication coordinator for individuals. 26:32 The complicated issue of nonadherence and what this means. 27:57 How PillPack reminds the patient about being proactive about refilling prescriptions. 33:29 How patients pay to use PillPack. (Hint: It’s the same cost as going to a traditional pharmacy.)