The Race to Value Podcast

The World Health Organization has declared climate change as “the greatest threat to global health in the 21st century.” As our planet grapples with the accelerating impacts of climate change, it is crucial that we adopt a climate lens in the value transformation of our healthcare industry. The repercussions of climate change extend far beyond environmental shifts; they manifest in various health issues, including challenges with clean water access, increased allergens, respiratory diseases, heat induced illnesses, and the proliferation of infectious diseases. It’s essential to acknowledge that while climate change affects everyone, the burden falls disproportionately on historically marginalized populations, highlighting the interconnectedness of climate impacts and social determinants of health in underserved communities.

In our pursuit of delivering safe, effective, and efficient care amid the climate crisis, we as healthcare leaders also bear the responsibility to address the substantial greenhouse gas emissions generated by the sector. Accounting for nearly one fifth of the U.S. gross domestic product, the healthcare industry possesses considerable purchasing power that can be harnessed to steer the nation toward cleaner energy and a low carbon supply chain. Beyond mitigating environmental harm, embracing preventive models of care and enhancing care quality that lowers excess utilization naturally aligns with lower carbon footprints. Value-based care, therefore, can become a powerful catalyst in propelling us toward a net zero carbon future that will build a sustainable, resilient future for our planet.

This week we are  interviewing Dr. Vivian Lee, a healthcare executive dedicated to the advancement of value-driven transformation in health and tackling climate change. Author of the acclaimed book,The Long Fix: Solving America’s Health Care Crisis with Strategies that Work for Everyone, she is an Executive Fellow at Harvard Business School and Sr Lecturer at Harvard Med School. Prior to her Executive Fellowship at Harvard, she was the founding President of Verily Health Platforms, an Alphabet company combining a data-driven, people-first approach to precision health.  Dr. Lee is also a former health system CEO, medical school Dean and member of the National Academy of Medicine. She is regularly listed among Modern Healthcare’s Most Influential Clinical Executives as well as Modern Healthcare’s Most Influential People in Healthcare.

Episode Bookmarks:

01:30  The World Health Organization has declared climate change as “the greatest threat to global health in the 21st century.”

02:00  Climate change burden falls disproportionately on historically marginalized populations.

02:30  The responsibility to address the substantial greenhouse gas emissions generated by the healthcare sector.

03:00  Introduction to Vivian Lee, M.D.

04:30  One in four deaths can be attributed to preventable environmental causes…and climate change is exacerbating these risks.

06:00  Climate change resilience as a lens for value-based transformation.

06:45  The irrefutable scientific evidence about the unprecedented levels of carbon dioxide in our atmosphere.

07:00  What are health care leaders going to do about this?  (The need to manage the crisis through an empowered workforce.)

08:30  Exposed vulnerabilities in our supply chain as a complication to address climate-related crises.

09:00  The healthcare industry is responsible for 8-10% of the overall carbon footprint of the country (more than twice the #2 country!)

10:00  How do we decarbonize healthcare in order to “do no harm”?

11:45  Pollution from health care–associated energy use results in an estimated 405,000 disability-adjusted life years annually (a burden comparable to that of preventable medical errors).

12:30  The strong business case for health care organizations to reduce their carbon footprint.

13:00  Tax credits offered by the Inflation Reduction Act to decarbonize hospitals.

14:30  “Renewable energy actually costs less than fossil fuel energy.”

14:45  The Inflation Reduction Act will cover about 30% of the capital needed to invest in a renewable energy system.  (Add another 10% each for serving underserved regions and buying American made!)

15:00  ROI in the tens of millions for health systems going green! (“doing good and doing well”)

16:00  Non-productive energy use (e.g. ~60% of energy consumed by MRI and CTs occur when offices are closed on evenings and weekends!)

17:00  Putting high intensity imaging machines in idle mode would reduce the carbon footprint at a level equivalent to the NHS!

18:45  Kaiser Permanente became carbon neutral.  (Referencing Kathy Gerwig article co-written with Dr. Lee – “Decarbonizing Healthcare“)

19:30  Boston Medical Center reduced carbon emissions by more than 90%.

20:00  Resources: Kathy Gerwig’s book, “Greening Health Care: How Hospitals Can Heal the Planet”, the AHRQ Climate Change Primer, and Health Care Without Harm, Medical Society Consortium on Climate & Health

22:00  “There are so many opportunities for aligning with the decarbonization effort that are completely synergistic with value-based care.”

22:45  “Primary care has a much lower carbon footprint than high intensity tertiary or quaternary care.”

23:20  How can we utilize telehealth and telenursing to reduce patient and clinician transportation needs?

24:30  Referencing the influence of Don Berwick in medical waste elimination. (see article “Eliminating Waste in U.S. Health Care“)

25:30  “Eliminating health care waste will do good for the planet, do good for the communities, and actually make ourselves financially healthier as well…all in the spirit of bringing more value to our health care system.“

26:45 The AMA is encouraging physicians to assist in educating patients and the public on sustainable practices and to serve as role models in providing environmental sustainability (see AMA Code of Medical Ethics Opinion on Climate Change)

28:00  Dr. Lee discusses the role of clinicians to advocate for eco-friendly practices in patient communities.

30:00  An example of how a pediatrician conducts climate change counseling (see Dr. Andrew Lewandowski’s study)

34:00  The tech-based application of AI, data, and analytics to combat climate change through value-based care delivery.

35:45  Using a health meter to advise patients on how best to deal with extreme heat and bad air advisories.

37:00  Lowering the health care carbon footprint through supply chain optimization.

39:00  The need for more engineering and technical innovation to support innovation in climate resilience.

39:30 The White House and HHS launched the Health Sector Climate Pledge to cut greenhouse gas emissions by 50% by 2030 and net zero by 2050.

40:00  “Solving the climate crisis is the greatest and most complex challenge that Homo sapiens have ever faced. The main solution, however, is so simple even a child can understand it. We have to stop our emissions of greenhouse gases. And we either do that or we don’t.”  — Greta Thunberg

41:00  Parting thoughts from Dr. Lee on value-based care and climate change resilience. (“It doesn’t matter what political party or what socioeconomic class you are.  We can’t escape this issue of climate change.  We are all on this planet together.”)

The future of health will be shaped by consumer expectations for a mobile-centric experience with personalized insights and care services.  Information is determinant of health, where people already search for health information on Google hundreds of millions of times a day. Additionally people view YouTube videos about health conditions 100 billion times globally in a year. As consumers seek information ubiquity in their online experience, health information will also become more personalized through wearables and other mobile devices.

Our future in health will also be enabled by AI. Artificial Intelligence has the potential to transform the health of people on a planetary scale akin to the discovery of penicillin.  If developed boldly and responsibly, AI will be a powerful for health equity on a global scale.  It will also bring the joy back to practicing medicine by reducing cognitive burden and giving providers more time to spend with patient.

In this week’s episode, we explore health tech consumerism and AI enablement with Dr. Karen DeSalvo, Chief Health Officer at Google. Dr. DeSalvo is an internist and health leader working at the intersection of medicine, public health, and information technology.  She has dedicated her career to improving health outcomes for all with a focus on solutions that address all the determinants of health.  Dr. DeSalvo continues to be a powerful voice and advocate for eliminating inequities and improving the public’s health.  Under her watch, Google has optimized search and YouTube to better answer common health questions, updated its consumer health wearables to function more like medical devices and built artificial intelligence products to meet industry demands.

This episode covers various topics in the realm of healthcare technology innovation from consumerism, Generative AI and LLMs, health equity by design, and various initiatives underway at Google to connect and bring meaning to health information. In the interview, we also discuss the role of technology in mitigating the health impacts of climate change and addressing the epidemic of loneliness and isolation at a global level.

Episode Bookmarks:

01:30 Introduction to Karen DeSalvo, Chief Health Officer at Google.

03:30 How Google understands “information as a determinant of health.”

05:00 “We see heavy consumer orientation to the way we see our opportunity to improve the health of everyone everywhere.”

05:30 The evolution of healthcare businesses to meet people in an increasingly virtual world with ever-changing consumer expectations.

06:00 Informing health empowerment through high quality information and personalized insights.

06:30 Personal reflections from clinical practice when the flow of information was not enabled by technology automation.

07:30 Modern-day tools for patient education and personal health tracking and measurement.

08:00 The optimization of Google search results to convey trust in the provision of health information.

08:30 “The conveyance of information through trusted messengers is an important way we address information as a determinant of health.”

09:00 Patients showing up with more knowledge and power – a priority goal for Google Health.

09:30 How AI can improve health for everyone everywhere. (Karen’s recent blog on the future of AI as a transformational path forward in population health.)

10:00 Leveraging AI at Google Health to advance medical research, improve accuracy and efficiency of diagnostic processes, and improve health information quality.

11:00 A future world were everyone has access to the best quality care on their phone (e.g. AI-enabled health agents combined with the human care team).

12:00 Developing health technology for the entire world. (“A billion people on the planet don’t have access to primary care.”)

12:15 AI can address workforce challenges by reducing cognitive load to address burnout and filling capability and capacity gaps.

12:45 Using large language models in high risk health scenarios (e.g. suicide-related searches, AFib detection on watch products).

13:45 How ChatGPT elevated the interest in front-facing, consumer-focused large language models.

14:15 Search generative experience and the development of Bard (a conversational AI tool by Google).

14:45 Enhancing the Fitbit experience with generative AI and large language models (seearticle)

15:00 Med-PaLM harnesses the power of Google’s LLMs in the medical domain to accelerate scientific advancement.

16:00 “Do no harm” as the ultimate guiding philosophy in AI innovation.

16:30 Human oversight needed to mitigate the risk of AI hallucinations.

18:30 Google use cases for generative AI in clinical care — from helping radiologists to detect breast cancer, to supporting diabetic retinopathy screening.

19:00 Using AI to enhance radiology clinician workflows in mammogram screening.

20:00 Using AI to identify multi-drug resistant tuberculosis in Sub-Saharan Africa.

21:00 Developing an AI model that can perform many tasks at once (e.g. medical record summary, presenting research evidence and recommended clinical pathways)

22:30 Reduction of algorithmic bias to improve health equity and quality of care.

22:30 “The next generation of AI models are going to bring joy back to medicine. They will reduce cognitive burden and give providers more time to spend with patients.”

26:45 Reduction of implicit bias and the “health equity by design” approach at Google.

28:00 Solving for global health inequities observed with the 4M’s (i.e. metabolic disease, malignancy, maternal health, and mental health).

29:00 Developing cloud partnerships and research collaborations for population health in action.

30:00 Ensuring effective deployment of tools and technology for everyone everywhere.

30:45 Diversity, equity, and inclusion of Google Health’s teams.

31:45 Challenges and risk in the early stages of AI foundation models.

33:00 Additional background on Med-PaLM as a medically-tuned, domain specific large language model.

35:00 Use cases for Med-PaLM in care delivery, payer, and life sciences environments.

36:00 Multimodal application of Med-PaLM with wide-ranging capabilities to enhance clinician workflows.

36:45 “Large language models have many capabilities. Constraining them to do the appropriate thing is such an important priority.”

38:30 There is no one-size-fits-all approach to LLMs – it depends on the preferred use case (e.g. writing contracts, customer chatbots, distilling research insights, pop health enablement).

40:00 Climate change is the biggest threat to global public health.

41:00 “Health is more than health care.” (The impact of social determinants and the physical environment on health and wellbeing).

42:00 Applying data and analytics during the pandemic to improve health equity.

43:00 Novel signals from Google searches on symptoms — identifying trends to inform public health priorities.

44:00 The need for timely, granular, and actionable data in the public health setting.

44:30 AI predictions for future climate risks associated with health, fire, and floods.

45:00 Notifying patients with pulmonary disease of air quality risks in real-time.

46:00 The impact of social isolation on public health due to its association with a range of negative physical, mental, and emotional outcomes.

46:45 The health impact of loneliness is so far-reaching that one study compares it to smoking up to 15 cigarettes a day!

47:45 Dr. DeSalvo’s important work on the WHO Commission on Social Connection to better address the global loneliness challenge.

49:00 Using technology to address loneliness and isolation (e.g. AI and robotics to augment human support for seniors).

50:00 The detrimental impact of social media on the youth – striking a balance between screen time and human interaction.

51:30 Parting thoughts from Dr. DeSalvo pm the importance of health for all and value for all.

In caring for our communities, a carefully designed Care Continuum Blueprint becomes the roadmap to enhanced population health outcomes—a testament to the profound impact of integrated care and strategic coordination.  There has never been a more compelling time to adopt a system of care based on population health management. The COVID-19 pandemic revealed substantial health disparities and compels us to take action. The population is aging, and the Medicare insolvency crisis is looming. Now is the time to move away from fee-for-service care and toward an approach that prioritizes quality, outcomes, and affordability for all populations.

In this week’s episode, we interview Dr. Mark Angelo, a senior administrator of a large accountable care organization and a leader in population health and palliative medicine.  He is the author of the new book Caring for Our Communities: A Blueprint for Better Outcomes in Population Health, that provides tactical guidance for developing effective population health programs and explores value-based care models. Dr. Angelo is an inspirational leader to the health value movement, providing a road map for creating an equitable, outcomes-focused system, using the right resources to nurture the health of our communities.

Dr. Mark Angelo currently serves as CEO and President for the Delaware Valley ACO (DVACO). In this role, he oversees clinical strategy and operations, including quality, population health pharmacy, clinical integration, care coordination, post-acute networks and practice transformation. In addition to serving patient communities as an executive with the ACO, he is a practicing palliative care doctor who continues to see patients.  DVACO has participated in the MSSP since 2014 and also works with commercial and Medicare Advantage payers in an effort to grow and expand the mission of value-based care in the Greater Philadelphia area.

Episode Bookmarks:

01:30 Introduction to Delaware Valley ACO and Mark Angelo, MD, MHA, FACP.

04:30 Referencing Dr. Angelo’s new book Caring for Our Communities:  A Blueprint for Better Outcomes in Population Health.

05:00 “Never doubt that a small group of thoughtful committed citizens can change the world; indeed, it is the only thing that ever has.”  — Margaret Mead

06:00 Dr. Angelo provides his perspective on population health underpinned by his clinical practice of palliative care.

07:30 A care continuum strategy that ensures care continuity, collaborative planning, and case management for complex patients.

09:30 The post-acute care journey at DVACO that began in 2014.

10:30 The Skilled Nursing component of DVACO’s post-acute care strategy.

11:30 Using claims data and real-time readmission tracing to monitor performance of SNF partners.

12:30 Graduating from a post-acute care focus to an overall care continuum strategy.

13:45 Optimizing home health to prevent avoidable hospitalizations.

14:30 How to identify suboptimal hospice care (e.g. length of stay greater than 180 days).

16:30 Home-based therapy as part of the care continuum to reduce TCOC in a frail elderly population.

18:00 An optimal zone of therapy between 12 and 32 therapy units over the course of a year.

19:00 Medicare reimbursement differentials across the different settings in a post-acute care continuum.

20:30 Building a population health playbook in post-acute care begins with SNFs.

22:00 Assessing performance data in developing a small SNF network to guide steerage decisions.

23:30 Applying the SNF assessment strategy in the vetting of preferred providers in home health and hospice.

26:00 Are partnering PAC facilities communicating with you in a meaningful way?

26:45 “Discharge planning shouldn’t happen in the last 24 hours of discharge. It should be happening all along. This is an important factor when it comes to creating partnerships across the care continuum.”

28:00 DVACO (in partnership with Main Line Health) developed a palliative care program that reduced hospitalizations by 50%!

28:45 “If you are an ACO and you are not focusing on your seriously illness population, you are missing a big opportunity.”

29:30 Developing an analytics methodology to identify patients with serious illness.

31:00 Guidance from Dr. Diane Meier, a nationally-recognized geriatrician and palliative care expert.

31:30 Improving lives of patients while decreasing costs at end-of-life through a home-based palliative care program.

34:00 Population health data that confirms the superiority of home-based palliative care (e.g. decreased hospitalizations and ED visits, increased hospice utilization).

37:30 Dr. Angelo provides leadership insights on how best to engage providers in population health approaches to care.

38:45 An example of supporting providers in VBC (a dedicated call center that connects resources to patients most in need).

41:00 SDOH and behavioral health resources for patients (e.g. addressing food insecurity to improve population health).

42:00 Another example in supporting providers in VBC (a successful aging program).

43:00 In-home wellness assessments for patient (e.g. medication reconciliation, dietician and care coordinator consults).

44:45 “We help our providers to better care for patients at the point of care. That is a great way to get providers to want to be part of your ACO.”

46:00 Health equity as a societal flashpoint and the challenges of inequality in the Greater Philadelphia area.

47:30 How DVACO provides a health equity lens in the design and implementation of all population health programs.

48:45 The need to compare QM results between population segments (e.g. an overall mammogram completion rate of 88%).

49:30 How the pandemic highlighted health inequities and reframed opportunities for improving population health.

50:00 “In an Accountable Care Organization, you’re responsible for managing the care of your community, not the care of a fraction of your community.”

52:00 The impact of social isolation on frail and elderly populations.

52:45 People experiencing social isolation have a higher risk of heart disease, stroke, depression, and anxiety.

53:45 Surgeon General Dr. Vivek Murthy’s call to action to address “the epidemic of loneliness” as a public health crisis.

54:00 The correlation between excess utilization of healthcare services and social isolation.

55:00 Building bridges with Community Benefit Organizations to address social isolation.

57:00 The emerging “payvider” trend and how Humana became a valued partner in Delaware Valley ACO.

58:45 The benefits of a strong payer relationship within an ACO.

60:00 “Payvider relationships say to the market that we are laser-focused on the success in value-based programs.”

61:00 The Infinite Game: “Infinite-minded leaders don’t ask their people to fixate on finite goals; they ask their people to help them figure out a way to advance toward a more infinite vision of the future that benefits everyone.”

63:00 Parting thoughts on balancing fee-for-service with the “infinite game” of value-based care.

With 1 out of every 3 U.S. health care dollars emanating from Washington, the federal government is the single largest payer of health services in the United States and accounts for nearly half of all national health spending. As our country ages, these forces are accelerating, with Medicare spending alone projected to increase by 7.5% annually through 2031. Healthcare companies that depend on government revenue – or are downstream from it – must begin to view policymakers as among their most important customers. Impactful organizations that will succeed in the new era of value-based care will learn how to leverage the unparalleled value of internal advocacy.  By creating extraordinarily powerful messaging for policymakers to understand what is needed for value-based innovation, we exercise our right to form a more perfect union.  While healthcare will never be perfect, we must still strive for perfection – that is at the heart of value-based care transformation in our country!

On the Race to Value this week, we interview Andrew Schwab – a value-based care leader, an intentional strategist, and a master of Washington’s internal game.  He brings a bold, brash, no-holds-barred approach to government affairs by coaching and mentoring forward-thinking organizations ready to invest in their internal policy teams so they can thrive in a new era of value-based care.  Prior to establishing his own firm, Platform Government Strategies, Andrew advocated in-house on behalf of both nonprofits and private sector organizations. Most recently, Andrew established Oak Street Health’s first government affairs function that put them at the center of the national value-based care conversation and contributed to their recent acquisition by CVS Health.

Episode Bookmarks:

01:30 The federal government is the single largest payer of health services and accounts for nearly half of all national health spending.

02:00 Healthcare companies that depend on government revenue must begin to view policymakers as among their most important customers.

02:30 Introduction to Andrew Schwab and his public affairs consulting firm, Platform Government Strategies.

05:30 The glacial pace of the value-based care movement.  Is there truly bipartisan consensus on the aims of health value?

07:00 2030 Medicare VBC Goal (“The government is putting its thumb on the scale for value-based care.”)

08:15 The 1st Amendment right to petition government for redress of grievances (“Advocacy and lobbying are quintessentially American.”)

09:00 “Elected officials and appointed regulators in Washington D.C. and in state capitals react to a different set of incentives.”

10:00 Explosive growth of the Medicare Advantage program.

11:00 Consumer-centric innovation and higher quality of care in MA plans.

11:30 Political controversy with MA (e.g. PE-backing, overpayment concerns, risk adjustment gaming, “perverse business model”)

13:00 Critics of MA ranging from physicians and hospitals protecting the “sanctity of fee-for-service” to those leery of privatization.

13:30 The incredible popularity of MA and the research showing it has superior outcomes.

14:00 Mitigating the potential for upcoding with the new V28 risk adjustment methodology being implemented over next 3 years.

15:00 MA is paid more than Traditional Medicare, but it offers more in terms of benefits (e.g. hearing, dental, vision, population health interventions).

16:00 Private equity investment and payvider innovation (e.g. Oak Street Health, VillageMD, Centerwell, Archwell).

17:00 The importance of Patient-Reported Outcome Measures since process measures alone don’t achieve patient-centeredness.

19:00 “Outcomes should be the most important metric by which we judge the health of our healthcare system.”

20:00 “We need to put providers that participate in value-based relationships at the center of advocacy pushes in Washington and in state capitals.”

21:00 If we are incentivized to keep patients healthy and out of the hospital, we will naturally do screenings. (Measuring number of screenings not as important as the outcome itself!)

21:30 NQF guidance on Risk Adjusting Social Risk Factors in quality measurement in order to pay for outcomes.

22:30 “Infusing SDOH, risk adjustment, and quality metrics into everything we do will shift the system to move towards outcomes.”

23:30 The role of CMMI in payment model innovation and the need for the continuation of the advanced APM bonus.

24:30 “True transformation cannot happen unless you have providers willing to take on full risk. Right now, there is not a full-risk track inside MSSP.”

25:00 The “courage of conviction” in knowing you can make people healthy.

25:30 The lack of value-based care training in medical schools and GME.

26:00 Capital requirements for full-risk.

27:00 Lack of clarity in VBC policy will perpetuate a multi-tiered system (e.g. specialists paid on FFS, primary care pushed more to capitation).

27:30 Full-risk is the only way forward to incentivize the entire system!  (Everything else is just half measures.)

28:00 How the medical establishment and generational divides in medicine are holding back the value movement.

30:00 Internal, professional government affairs expertise as an essential corporate positioning and sales function.

31:00 Positioning your views front and center to a government audience through internal advocacy.

32:00 Creating extraordinarily powerful messaging for policymakers to understand what is needed for value-based innovation.

33:30 Speaking to policymakers and elected officials is different than speaking to investors.

35:00 Figuring out the right model for advocacy (a hired gun lobbyist vs. an embedded government affairs function).

36:30 Leveraging the lobbying power of unified voice in a trade association (versus in-house government affairs that emphasizes the uniqueness of a company’s individualized and specific interests.)

38:00 Trade associations as the place where policy gets settled before it is advocated to elected officials.

39:00 Strategies for effective in-house government affairs collaboration with professional associations.

41:30 The need to teach incoming doctors about the benefits of value-based care to prepare them for success.

42:30 It is also important to teach medical students about the importance of advocacy and the effect of health policy on their career.

44:30 Medical school funding should be tied to solving a specific problem (e.g. integrating behavioral health into primary care).

45:00 “If we want to get to VBC and outcomes delivery, we have to start teaching advocacy and policy in medical schools to effectuate the future.”

47:00 Examples of effective advocacy (e.g. addressing the pediatric uninsured, the Chronic Care Act, direct billing of LSWs within Medicare, expansion of mental health workforce)

49:30 Private sector innovation in addressing health disparities in underserved communities (e.g. Oak Street Health).

50:30 “Forming a more perfect union” – always working towards perfection while knowing it will never be perfect.

51:30 How to follow and connect with Andrew!

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

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

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

Episode Bookmarks:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

48:45 Expansion into rural areas.

49:45 Future growth plans.

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

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

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

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

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

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

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

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

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

Many factors impact our health beyond genetics and aging.  Collectively, these are called social determinants of health and include factors such as education, housing, income, occupation, hunger, language, literacy, where we live, and access to affordable healthcare services. However, there is a gap in the current list of social determinants of health, and that is the influence of “information” or an “information ecosystem” on patients’ behavior, engagement, and health outcomes. It is critical to consider “information” as another social determinant of health since it can be used to drive positive patient health outcomes.  How we deliver it, where we deliver it, and who delivers it is crucial to value-based health care transformation and patient-centeredness.

So, how do we harness this idea that information can change health outcomes?  To answer this question, we have invited Debbie Welle-Powell back to the Race to Value!  As a 30-year healthcare executive veteran, value-based care thought leader, and educator, she is committed to the empowerment of change management principles to drive population health at the intersection of patient engagement and information sharing. In this episode, we discuss what is needed to empower the patient and clinician, technology-enablement and value-based payment to fine tune the delivery system, and the information ecosystem needed to drive healthy outcomes.

As a companion to this podcast, make sure to read Debbie’s new article on this topic.  It is available for download on the Race to Value webpage for this episode!

Episode Bookmarks:

01:30 Introduction to Debbie Welle-Powell, a healthcare executive veteran whose work focuses on delivering affordable and accessible high quality care.

02:45 Reference previous R2V episode – “Climbing the Mountain: Reaching New Heights for a Transformative Future”)

03:00 Read the companion article to this interview on the Race to Value episode website!

03:45 Debbie provides a brief update on her professional work in value-based care (and her mountain climbing adventures!)

05:30 The influence of “information” or an “information ecosystem” on patients’ behavior, engagement, and health outcomes.

06:30 Should we consider information as another Social Determinant of Health (like transportation, education, housing, and food security)?

07:30 “Information only really matters if it helps patients change behaviors.  The delivery of information is crucial to empowering health outcomes.”

08:30 “The American healthcare system is not as patient-centric as it claims to be because of a failure to provide empowering information.”

09:00 The roles of clinicians and patients to improve health literacy.

10:00 Patient noncompliance – Ex: 20-30% do not pick up prescriptions, 30-40% do not follow-through on referrals.

10:45 The challenges of interpreting and addressing SDOH challenges to avoid unnecessary utilization.

12:00 The importance of the patient-provider relationship. (Eric shares insights from his healthcare trip to Cuba.)

14:30 Technology enablement and health system evolution to better address patient information needs.

15:00 Improving patient engagement through the online user journey (i.e. the digital front door).

15:45 Debbie shares a personal example from her cancer journey where the care team failed to provide adequate information.

17:00 Half of patients seeking receive misleading information when independently searching online sources.

17:30 The opportunity for clinicians to provide trusted and reliable online educational resources.

18:00 The hyper-saturation of online content (e.g. 500 hours of content uploaded to YouTube per minute!)

18:30 How the value-based care movement provides incentives for improving patient engagement.

19:30 The use of Generative AI in the clinical setting to help patients better navigate their care journey.

20:45 Merging the science of medicine with the art of information – how to best engage patients during a formidable time of distress.

22:30 Realigning healthcare investments into patient engagement information systems, AI-based tools, and team-based care delivery.

23:30 The need for change management tools at the system-level to improve patient engagement.

24:00 Transforming clinical practice using the Prosci ADKAR change management model.

25:45 Creating a patient advisory council to guide health systems in the optimal curation of patient information.

26:30 Addressing chronic disease through online resources, team-based care delivery innovation, and value-based payment.

27:00 The importance of neuroplasticity (rewiring of the brain’s neural pathways) to reinforce new habit formation.

28:00 Mountain climbing as a metaphor for behavior change in chronically ill populations (i.e. dealing with pain, incremental progress).

28:45 The overwhelming challenges of addressing SDOH in underserved communities.

30:00 Differing perspectives on the role of the individual in health accountability.

31:00 Merging system-level patient-centered engagement with individual-level accountability.

32:00 Deploying information tools to empower health and improve SDOH screenings.

32:45 Rethinking medicine to live better longer (referencing new book, “Outlive: The Science and Art of Longevity” by Dr. Peter Attia).

34:00 “Poor health literacy is a public health problem.” (9 in 10 adults exhibit poor health literacy when under extreme stress.)

34:30 Population health resources should be written at a 5th grade level to ensure they are readable, actionable, and trustworthy.

35:00 Improving Health Literacy Could Prevent Nearly 1 Million Hospital Visits and Save Over $25 Billion Per Year. (see UnitedHealth study)

35:30 The importance of primary care in empowering patient education.

36:30 A recent court ruling threatens access to critical preventative care for more than 150 million people! (see USofCare Preventive Services Resource Hub)

38:00 The importance of Patient Advisory Councils in care delivery design (e.g. telehealth, AWV campaigns, patient portal design, refill strategies)

38:45 CBO Partnerships as an opportunity to “learn, course correct, and transform.”

39:00 The flawed structure and lack of funding for a Public Health system that improves health equity and fosters patient trust.

41:00 The intergenerational impact of health information in improving health, supporting families, building social cohesion, and ensuring economic competitiveness.

42:00 What is the role of government in creating a healthy, well-educated population?  How can CMS improve beneficiary engagement?

42:30 Prioritizing multipayer alignment, administrative simplification, and health equity accountability to promote value-based care.

43:30 The 21st Century Cures Act is a health policy focused on information sharing and care coordination.

44:00 Creating accountability in underserved communities through workforce competency and alignment of payments.

45:00 “You can’t talk about quality unless you talk about equity.”

46:45 ADKAR is an acronym for the five outcomes of successful change management: “Awareness, Desire, Knowledge, Ability, and Reinforcement”.

47:00 Debbie discusses the systemwide application of ADKAR as a powerful tool for change management at an individual level.

48:00 How did the ADKAR change management model improve care delivery at Essentia Health?

49:45 Applying change management principles to achieve patient-centricity.

50:45 The promise of precision medicine (at the individual level) as a compliment to community health (at the group level).

52:30 Developing a roadmap to make wellness and prevention a priority (versus sick care and chronic disease management).

53:30 Parting thoughts from Debbie on actions that can be taken today to improve patient communications.

A revolution is imminent in American healthcare, and “the revolution will not be televised” for passive observation.  Value-based care transformation, like any other important movement, requires the active participation of all leaders on the frontlines. However, for these leaders to make the right decisions, they need to embrace innovation in order to realize the fullest potential of generative AI and predictive analytics.  Through the reengineering of care delivery, we can achieve a more personalized, proactive, and efficient outcomes-based model that can ultimately transform population health.

As we navigate this transformative journey, data will play a pivotal role in reshaping the landscape of care delivery.  And no one knows this better than Nassib Chamoun, Founder President & CEO of Health Data Analytics Institute (HDAI), our guest this week on Race to Value.  In this episode, you will hear from a leader and primary inventor of a broad-based population health data analytics platform, enabling healthcare providers to make informed decisions based on real-time information. Tune in to an informative conversation covering such topics as data aggregation, predictive analytics, digital twinning, network management, generative AI in clinical care, and future advancements in technology-enabled value-based care.

Episode Bookmarks:

01:30 The Imminent “Big Data” Revolution in Value-Based Care

02:00 Introduction to Nassib Chamoun of Health Data Analytics Institute

03:00 As a teenager living in Beirut, Nassib experienced the horror of a civil war.

04:00 The inventor of Bispectral Index monitoring – a technology standard in operating rooms around the world.

05:00 Nassib discusses the pivotal moments in his life that shaped a passion for data analytics in healthcare.

07:00 80% of health information in EHRs is unstructured and entirely unusable unless converted to discrete data.

07:45 CMS provided HDAI a highly coveted Innovator’s License that allows the company access to data on 100 million Medicare beneficiaries.

09:00 How Big Data drives powerful AI algorithms and predictive models in healthcare.

10:00 “If you can’t measure something, you can’t improve it.”

11:00 Understanding the intersection between cost, outcomes, and utilization.

11:30 Making data actionable in order to effectuate change in care delivery.

11:45 Data overload can actually lead to clinical inefficiencies if it isn’t curated appropriately.

12:30 The artful curation of data to drive operational improvements at point-of-care.

14:00 The limitations of claims data in making timely clinical decisions and treatment interventions.

15:00 Interpretation of unstructured EHR data to extract potential new conditions and HCC coding opportunities.

16:00 The importance of clinical judgement in augmenting AI-based recommendations in value-based care.

17:00 Combining behavioral, psychosocial, and biometric data with the existing sciences of epidemiology and clinical medicine.

18:00 Generalized clinical use cases of AI at the point-of-care to improve costs, outcomes, and utilization.

19:00 “To be successful in value-based care, you must operationalize two separate goals: Prevention and Avoidance of Complications.”

20:30 “The goal of AI is to very simply do what a clinician does, but do it repeatedly and do it continuously for every patient in their cohort.”

21:00 How staffing limitations and an aging populations necessitates a more optimal use of technology in VBC.

22:00 In 2032, U.S. healthcare spending will reach $8 trillion (ahead of the economy of Japan) making it the third largest economy in the world!

22:45 Leveraging predictive models to drive more effective care coordination and interdisciplinary team-based care.

24:30 Patient engagement as one of the more challenging aspects of value-based care.

26:30 The integration of predictive analytics and digital twinning for individualized patient care.

28:45 Using multiple predictors to serve every component of the care team.

29:30 How the use of RAF scores to normalize utilization creates noise within a dataset.

30:30 Using digital twin matching for improved predictive modeling of patient outcomes.

32:30 Aggregation from the patient level as an opportunity to reduce predictive variance.

34:00 Benchmarking against clinical exemplars in population health management.

35:00 Empowering the care team through AI and predictive analytics to drive clinical interventions.

36:30 How Houston Methodist Coordinated Care leveraged the HDAI analytics platform to enable care teams.

38:30 Using AI as a core capability in a health system (for both FFS and value-based care).

40:00 Leveraging AI to make appropriate care management resource allocation decisions at the network level.

41:00 Using analytics to better understand post-discharge outcomes and mortality.

42:30 Early interventions driven by predictive analytics have reduced both hospital mortalities and readmissions.

44:00 AI insights to drive network management decisions in building a clinically integrated network.

45:00 With the explosion of ChatGPT, we are seeing Generative AI emerge as a technology offering transformative opportunities across society.

47:00 “A lot of the big tech companies have jumped into healthcare without the appreciation of what’s involved here.”

48:00 “There are three components of trustworthy AI in healthcare:  Transparency, Explainability, and Reduction of Bias.”

49:00 Transparency

50:00 Explainability

51:30 Bias

52:30 Overcoming implicit bias in algorithms to reduce disparities in care.

53:30 The complexity of Generative AI algorithms.

54:00 HDAI’s approach to generative AI in the creation of transparent, explainable, and bias-free models.

56:30 Connecting the source code in generative AI to the recommendations made to clinicians.

58:30 Will we eventually see AI models enriched with crime data, geospatial analytics, food availability data, climate change impacts, consumer purchasing data, and biometrics?

60:00 The potential harm of applying negative use cases of AI to restrict care.

61:30 Arthur C. Clarke:  “Any sufficiently advanced technology is indistinguishable from magic.” 

61:45 The 4th Industrial Revolution of technology in healthcare.

63:00 EHR data has been largely underutilized until the recent tidal wave of AI.

64:00 Creating synergies within care teams on the basis of synthesized information and AI recommendations.

64:45 The application of AI in the future of health genomics.

65:30 Parting thoughts of optimism for the future of AI-enabled value-based care transformation.