Rural Healthcare – The Race to Value Podcast™

In rural communities, the transformation towards value-based care is an ongoing journey rather than a fixed destination. Rural healthcare faces unique challenges such as geographic barriers, limited resources, and reduced access to specialized care. The value journey in these communities involves adapting care models to meet the specific needs of rural populations. It requires innovative solutions to overcome barriers which can bridge the distance between patients and healthcare providers.  It represents a fundamental shift in healthcare delivery, focusing on improving patient outcomes, enhancing the patient experience, and controlling costs. Ultimately, this journey involves continuous adaptation, collaboration, and innovation that is fostered by a mission-driven culture to improve community health and wellbeing.

One of this nation’s leading examples of value-based rural health transformation is the Bassett Healthcare Network, and we are joined this week Leonard Lindenmuth, their Vice President of Strategy and Population Health.  Since 2014, he has been leading value-based care transformation throughout Central New York. In this episode you will learn about what it takes to lead a successful value journey through a cultural evolution that increasingly seeks innovation to improve rural health outcomes.  We discuss such topics as risk progression, the use of commercial ACOs as a learning laboratory in value-based care, population health playbook success that focuses on pharmacy optimization and interdisciplinary team-based care, deploying remote patient monitoring to rural populations, how workforce burnout is related to fee-for-service payment, and the importance of SDOH innovation to better serve vulnerable patients in underserved communities.

Episode Bookmarks

01:30 Introduction to Leonard Lindenmuth, DHA – Vice President, Strategy & Population Health, Bassett Healthcare Network

02:00 Bassett Accountable Care Partners, LLC – BHN’s Accountable Care Organization founded in 2014

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

05:30 How a data-enabled value-based care journey changed the culture of the health system.

05:45 “The value journey helped us understand much more about ourselves so we can better care for our rural communities. It has evolved our culture.”

06:00 A calculated progression to downside risk as a rural healthcare provider.

09:00 An increase in Medicare Advantage penetration in the marketplace and how that is impacting value-based care strategy.

10:00 Developing a co-branded regional MA product and the intention to take aggregated risk with a national MA plan.

12:00 Leveraging brand equity of the health system to develop a MA plan in the future.

12:30 Approaching MA risk-readiness of providers through coding education.

13:00 “MA Risk is clearly on the horizon.”

14:45 Leonard describes BHN’s commercial value-based playbook strategy that includes focus on pharmacy spend.

15:30 The Ambulatory Intensive Pharmacotherapeutics (AIP) program to reduce pharmacy costs through lower medication-related adverse events, avoidable hospital admissions and ED visits.

16:00 How the AIP program reduced BHN’s commercial spend on pharmacy through comprehensive medication management.

16:30 1% of the population drives 55% of specialty drug costs.

17:00 Risk progression in a two-sided risk arrangement with Excellus Health Plan (a local Blue Cross affiliate).

18:00 What being in a Commercial ACO has taught BHN about value-based care transformation.

18:30 How a rural health system balances the “two canoes” – volume vs. value.

19:00 “We have to get to a point where value drives the equation, but it is not an overnight transformation.”

19:30 How a healthcare organization performs better – both financially and clinically – under a fully-capitated environment.

21:30 An alarming divergence of health outcomes and life expectancy between urban and rural populations.

22:00 The challenges of improving population health in rural communities that are highly agricultural and farm-based.

23:00 Leveraging remote patient monitoring and other digital devices to better serve rural populations in upstate New York.

24:00 Bridging the digital divide in rural communities where access to broadband access is limited.

24:45 The Bassett Research Institute conducts research to understand and improve the health and well-being of rural populations.

25:00 Leonard describes the rural community of Cooperstown, New York and how their patient population is challenged by SDOH (lack of transportation, housing instability, food insecurity).

26:00 Medicaid expansion in New York fostered partnership and innovation with Community Benefit Organizations (ex: partnership with a local food bank).

28:00 Creating an anchor institution in a community where the health system is an enabler of improvement in social determinants of health.

29:00 Moving the needle on value by moving closer to the premium dollar and building infrastructural capability to manage delegated premiums from payers.

30:00 The maldistribution of premium dollars that disproportionately benefits insurers through excess profits (at the expense of health system investment to improve patient outcomes).

31:30 The imperative to adopt a payment system that supports lower costs and improved population health outcomes.

32:00 The importance of knowing trends in medical claims costs and utilization.

33:00 Being conscious of what you are getting into when it comes to assumption of risk-based payment.

33:45 Lessons learned from building a vertically integrated system and how that informed perspective on opportunities in a risk-based world.

34:45 Referencing prior podcast — Ep 141 – Cultivation of Physician Wellbeing in the Value Journey, with Dr. Dike Drummond, Dr. Moshe Cohn, Dr. Amadeo Cabral

35:00 How capitation can alleviate workforce burnout and moral injury.

36:00 The unsustainable pharmaceutical cost trajectory, with Americans spending an average of over $1,500 per person on prescription drugs, paying much more than comparable nations.

37:00 Leonard discusses the challenges of pharmacy spend and how Comprehensive Medication Management (CMM) has become an important area of focus in their population health playbook.

39:30 Understanding disease-specific use cases for pharmacy optimization and the340B Drug Pricing Program.

40:30 “Increased pharmacy spend is only acceptable if it crowds out medical spending on the inpatient side.”

41:30 The role of pharmacists in interdisciplinary team-based care and how they can meaningfully collaborate with physicians.

43:30 Value-added pharmacy programs that create a win-win-win for patients, providers, and payers.

45:00 The ticking timebomb of the healthcare workforce!

46:30 Alarming rates of nursing turnover resulting in higher costs due to increased reliance on agency nursing.

48:00 “At any given shift, we are down anywhere from 6-16 nurses. We have the demand to fill our beds, but we can’t get them in because of the nursing shortage.”

49:00 How nursing burnout is ultimately related to the dependence on a fee-for-service payment model.

50:45 New York is one of a number of states that is attempting to address the social needs of Medicaid enrollees through Section 1115 waivers with SDOH-related provisions.

53:00 Economic development zones and SDOH networks in New York supported by Section 1115 demonstration projects.

55:00 Examples of innovative SDOH programs (ex: giving patients free air conditioners to prevent acute exacerbations of chronic asthma).

56:30 Tackling disparities in care through VBC will drive community health outcomes (more so than philanthropic support of CBOs).

58:00 Parting comments on the challenges of health equity transformation.

Paying it forward begins in the heart. Leaders who use their gifts in the service to others are those who understand that value given is value added.

By every measure of success, Dr. Shawn Griffin has become one of the most impactful physician executives in value-based care transformation. And his story is all about how he recognized his unique gifts and built amazing teams to improve population health outcomes. Additionally, his sharing of best practices and key learnings with others across the country – through peer learning and mentorship – has amplified impact in improving the lives of others. The host of this podcast, Eric Weaver, was one of the people impacted by the mentorship of Dr. Shawn Griffin. His mentorship inspired Eric to make a difference as an evangelist for a better way of delivering care in this country.

In this episode, you will gain access to an in-depth conversation with Dr. Shawn Griffin, the President and CEO of URAC. You will be inspired by his servant leadership in the pursuit of value-based medicine, and you will learn of his career path from rural physician to one of the leading physician executives in the country. We discuss the important of team-based care delivery and primary care transformation.  We also cover such important topics as healthcare accreditation, quality improvement, rural health care, pharmacy integration, technology innovation, and genomics-based care.

The truest measure of a leader is whether they are generous, have a big heart, and pay it forward. Dr. Shawn Griffin is the quintessence of this type of servant leadership in the race to value!

Episode Bookmarks:

01:30 Introduction to Dr. Shawn Griffin, the President and CEO at URAC

04:00 Eric shares a personal extension of gratitude to Dr. Griffin for the mentorship he provided years ago.

06:45 Dr. Griffin describes his journey in value-based care, beginning in the early days of practicing rural family medicine.

08:00 The United States is an outlier in that Primary Care is not at the center of medical care delivery.

08:45 A decision to impact more lives by taking on leadership roles in system design and care delivery transformation.

09:30 How love for family and others manifested into a commitment to patient care quality.

10:30 Building an effective Population Health Team at Memorial Hermann ACO during his leadership tenure.

11:00 The importance of effective storytelling and celebrating wins to drive value transformation.

12:00 “One has to decide in life if they are going to use their gifts to help themselves or help others.” (how VBC leadership is Dr. Griffin’s way of paying it forward)

12:45 The impact of constantly changing health policy on ACO success (and how frustration led Dr. Griffin to make a difference at a federal level).

13:30 How mentorship and teaching in value-based medicine can transform care delivery on a national scale.

17:00 Dr. Griffin explains the importance of accreditation programs and how URAC was founded to set standards in healthcare.

19:00 Specialty Pharmacy Services Accreditation as an example of standard setting to drive quality improvement.

20:00 Telehealth Accreditation and how “Telemedicine is more than just a good camera. It is good quality medical care using technology to do it.”

21:00 “Raising the bar and advancing the quality mission as things change is what accreditation should be doing.” (Reference video on revamping telehealth accreditation)

22:00 Why an accredited program (e.g. URAC Gold Star) provides a basis for a patient to validate their trust in the care provided.

23:00 Dr. Griffin discusses how URAC accreditation is driving care delivery redesign across the world (e.g. Egypt and Saudi Arabia).

25:00 The challenges of defining health care quality.

26:30 “Measuring quality is an ongoing unsolved problem in health care.”

27:30 The power of a trusting patient-provider relationship in care quality and how patient definitions differ.

28:30 The limitations of HEDIS measures.

29:30 Quality measurement data capture at the point-of-care is a major contributor to provider burnout (“checking the boxes”)

32:00 “Most of us have better information available on picking a hotel in Paris than we do selecting a high quality primary care provider.”

34:00 Realigning incentives to get more medical students to practice family medicine in rural communities.

35:00 The role of the federal government to ensure adequate access to primary care in rural areas.

36:00 The crushing economic pressures on rural hospitals.

36:30 “We talk about food deserts in cities. We have provider deserts in the country.”

37:30 “If we are concerned about providing electric charging options for someone’s Tesla crossing the country, perhaps a bigger concern is whether you can receive healthcare in rural parts of the country.”

40:00 Dr. Griffin on opportunity for pharmacy integration and team-based care.

41:00 “One of the good things about medicine in the last 40 years is the recognition that a ‘captain of the ship’ model is not sustainable for doctors or patients. Team-based care is the way to go.”

42:30 The role that URAC is playing in Pharmacy Accreditation and Rare Disease Certification.

45:30 Dr. Griffin on the importance of data liquidity and information sharing in value transformation.

47:00 How concerns about HIPAA compliance (a “HIPAA-chondriac”) can contribute to the problem of data siloing.

47:30 “More data is not always better for physicians. Technology will not always make health care better. A relationship will do more for a person’s health.”

49:00 Balancing Population Health Management with Targeted, Individualized Interventions (examples such as Kaiser Permanente, Intermountain, UPMC).

52:30 Dr. Griffin discusses how the pandemic shifted consumer demand for telemedicine and what we should expect for telehealth delivery in the future.

54:00 Behavioral health telemedicine visits are effective. Pre-surgical screening for heart transplants does not work with telemedicine.

55:00 The “Telemedicine Tug-of-War” going on nationally and why we must always consider the most appropriate application of technology.

56:00 Convenience doesn’t trump quality.

57:00 Telemedicine, Remote Patient Monitoring, Wearables, ML/AI – these will not suddenly make healthcare the “Garden of Eden” overnight.

58:30 Parting thoughts on genomics-driven care and individualized-care planning in a population health model.

59:00 A patient’s Walmart receipts are more valuable to a physician than genomic data.

60:00 Screening genomics for hereditary diseases are scaling as costs come down, but we still cannot discount the impact of lifestyle choices on health.

63:00 How to find out more about URAC and the importance of peer learning and sharing of best practices.

A bright future for the nation depends on the health and prosperity of rural America, and unfortunately, we are at a moment in time where life is not ideal in the rural heartland.  Although most rural Americans are generally satisfied with the overall quality of life and see their communities as safe, we are reaching a crisis when it comes to financial insecurity, trouble accessing affordable, high quality health care, a lack of high-speed internet access, housing problems, and isolation/loneliness. When it comes to health care, even though most rural Americans have health insurance, about one-quarter say they lack adequate health care access, as they have not been able to get the care they needed at some point in the past few years. Consequently, potentially preventable deaths from the five leading causes are consistently higher in rural counties, especially with heart disease.  (Nearly half of deaths from heart disease in rural counties are preventable, compared with 18% in large metropolitan areas.)  All of this has culminated into a mistrust of the traditional, fee-for-service dominated healthcare system and created a “shadow population” of underserved minorities and the socially isolated who are dealing with significant cardiovascular metabolic disease.

The Arkansas Lincoln Project is an important population health program focused on improving cardiovascular health in highly underserved, under-resourced areas of the Arkansas Delta Region where economic and health disparities have life altering consequences for rural residents.  Joining us this week, we have two population health leaders sharing their insights about their work in deploying community-based cardiovascular health interventions led by community health workers. Chip Purcell is the director of cardiology research at the University of Arkansas Medical Sciences and the principal investigator of the Arkansas Lincoln Project.  Joining him is Dr. Jessica Barnes, the co-founder and CEO of 20Lighter, LLC – an award winning cardiometabolic health program, delivering dramatic reductions in inflammation and visceral fat.  Together they are winning the “Race to Value” by fighting cardiovascular metabolic disease in the Arkansas Delta, the worst region in the nation for healthcare quality and population health outcomes.

Episode Bookmarks:

01:30 The challenges of obesity and cardiometabolic disease disparities in Rural America

02:00 Rural Americans facing financial insecurity, poor healthcare access and hospital closures, a lack of high-speed internet access, housing problems, and isolation/loneliness

02:45 “Nearly half of deaths from heart disease in rural counties are preventable, compared with 18% in large metropolitan areas.”

03:30 Introduction to Dr. Jessica Barnes (CEO of 20Lighter, LLC) and Chip Purcell (UAMS Cardiology Research and the principal investigator of the Arkansas Lincoln Project)

05:00 “Rural Americans tend to have higher rates of cigarette smoking, hypertension, and obesity, and report less leisure-time physical activity than their urban counterparts.”

06:20 The US News & World Report ranks Arkansas 50 out 50 states for overall healthcare quality with higher-than-average obesity rates and overall preventable hospital admissions

07:00 “Arkansas is the worst of the worst in health outcomes, and that is where we can make a difference.”

08:00 Mistrust of the healthcare system is pervasive in the Arkansas Delta Region

09:30 The exponential growth curve in building trust through improvement in individualized patient outcomes

10:00 Studying out-of-hospital, premature natural deaths as a proxy for determining population health needs in Eastern Arkansas (how the Lincoln Project began)

12:30 The use of geospatial mapping to identify the highest risk communities to target with cardiovascular health interventions led by community health workers

16:30 The economic challenges of Phillips County, Arkansas and the history of racial discrimination and conflict, including the Elaine Massacre of 1919 (the bloodiest racial conflict in history)

18:00 Implementation of the door-to-door novel intervention model to address cardiovascular health disparities

19:45 Guiding interventions to elicit behavioral change and the challenges of addressing multiple social determinants of health all at once

20:30 “Women are a very fast growing subset of the population that is struggling with cardiovascular disease.”

21:00 Lower income and higher poverty with women in rural areas creates another layer of challenges (e.g.  “inequities in the inequities”)

22:00 “Ultimately our vision is to introduce practical community-centered interventions that improve rural health.”

23:30 “Community Health Workers (CHWs) are the most under-utilized resource we have in healthcare right now.  They should be the face of healthcare to overcome patient mistrust of the system.”

26:00 How the Lincoln Project trains CHWs to navigate the medical and social resources available to improve population health outcomes

28:30 Ensuring patient compliance to support the behavioral changes needed to improve community health

29:30 Referencing recent study showing how Massachusetts General Hospital was able to reduce 30-day readmissions among ACO patients supported by trained community health workers

30:30 “Changing cardiovascular disease outcomes is a longer-term goal but utilization and compliance measures are interim measures of success in the short-term.”

31:30 “Community Health Workers actually come from the local, underserved community and really care about the community members they are helping.”

33:00 How 20Lighter (a unique, comprehensive cardiometabolic telehealth program)engaged African American women in a pilot program aimed at improving risk and burden of cardiovascular disease

38:30 The 20Lighter strategy to dramatically reduce inflammation and visceral fat in hypertensive and diabetic community members

44:00 Utilizing telehealth interventions to support precision medicine programs for rural patients at high cardiovascular risk

45:00 How COVID-19 enhanced the value of telehealth by healthcare consumers and patients

46:30 Tech + Touch = Scalability and Personalization

48:00 How a CHW holistic model of community outreach can help providers better communicate with patients and improve health literacy

49:45 Facilitating health literacy in Phillips County whose community members, on average, have a 4th Grade reading level

52:30 “Fee-for-service created a shadow population — usually underserved minorities and the socially isolated — who are unable or unwilling to involve themselves in healthcare.”

53:45 Why capitation will eventually transform the health of the rural South

54:30 Changing the way people think about wellness by overcoming the failed fads of the weight loss and employee wellness industries

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

A guiding principle of Cumberland Center for Healthcare Innovation, CCHI, is that communities and the state benefit from healthier families, and it’s not just about cost savings or longer lives. Better health means a more productive workforce and greater opportunity for economic development. CCHI is focused on a structured approach to build economic strength in the community. And their approach is working – since being established in 2012, CCHI has saved CMS over $43 million and achieved a 98.48% quality score! In PY 2019 CCHI was one of the top performing ACOs in the nation, without any adjustment for benchmark.

In this episode, Dr. Brent Staton, CEO, and Dr. Ty Webb, CMO, share important insights into the challenges and successes of rural primary care. With a very lean team, they work with providers across more than 80% of Tennessee to provide personalized care at the practice-level. They truly fulfill their mission to demonstrate the value of rural independent primary care physicians in communities throughout Tennessee. Their model gives value-minded professionals nationwide an effective example for succeeding in the race to value.

Episode Bookmarks:

04:48 “Rural healthcare is personal” – having a deep personal awareness of each patient’s needs, values and preferences

06:58 Dr. Webb speaks about the challenge of getting physicians to practice medicine in rural areas

08:11 Dr. Staton on how the roots of family and growing up on a farm led him to a career in rural medicine

09:30 Dr. Staton on how hauling hay and stripping tobacco instilled the Rural American values of hard work in his life

10:50 The health and socioeconomic challenges in rural Tennessee and the opioid epidemic

12:22 “The depth of the challenges in rural health care is as deep as the sea.” (Staton)

12:40 The impact of the opioid epidemic, poverty, SDOH, and lack of health care resources in rural communities

14:05 High-touch approach to primary care and how ideas and best practices spread across various counties in the ACO

16:30 The mission of the ACO and how improving health will build economic strength in the community

17:20 “We saw that if we had healthier students, we could improve education.  We saw that if we had a healthier workforce, we could improve productivity and attract new businesses and job opportunities to our communities.” (Staton)

18:30 “Rural communities grow and develop over time, in much the same way as a field or a meadow in the study of natural history and biology. The same pattern of strength, complexity, and diversity is there.” (Webb)

19:05 Education and Health care are important foundations for rural communities to grow, develop, and progress.” (Webb)

19:30 Hospital closures in rural communities

20:11 The economic contribution of physician practices and hospitals to rural communities

20:45 “Hanging on by a thread really isn’t enough – whether it is your health or your economic solvency as a family or company.” (Webb)

21:10 Practice stabilization through communication of best practices, standardized care delivery, and revenue stabilization

24:02 Dr. Staton on how a large physician-led ACO can collaborate with hospitals

25:17 “Acuity of care for a hospital is more important that ‘heads in beds’. Our goal is not to prevent a necessary hospitalization or preventing emergency care when it is needed. Our goal is to make sure that patients get appropriate care and early interventions that they need and deserve.  (Staton)

29:00 The resiliency of CCHI’s primary care practices during COVID-19

31:12 Telehealth implementation and the benefits of telemedicine in rural communities

35:50 The lack of access to broadband internet access in rural communities and the need for additional infrastructure

37:37 CCHI’s COVID Task Force to prevent the spread of the virus

41:20 CCHI’s Shared Savings Success: $43 million in the Medicare ACO program (positive in corridor every year of ACO existence)

48:52 CCHI’s focus on Quality Reporting Performance and how the ACO had improved its quality scores over the years

49:51 CCHI’s expansion of its multipayer contract portfolio and how it learned to analyze data to identify cost containment opportunities

53:30 “We’re not in it for the dollars.  My grandfather always told me – whether it is pumping gas, washing windows, or hauling hay – if you do the right thing, the money will come.” (Staton)

54:44 Applying high touch primary care across the entire contract portfolio (not just risk-based contracts)

57:38 The relationship between quality and cost

58:00 The correlation between happier doctors and better patient outcomes (The Quadruple Aim)

1:00:00 Approaching the presentation of data and analytics to physicians with the art of simplicity

1:04 Decentralizing care coordination by activating practice-level staff to support ACO needs

1:11 Trust and teamwork in leading a Rural ACO (“Trust goes to the core of what we do.”)