Workforce – The Race to Value Podcast™

In today’s episode we chat with Geoffrey Roche, MPA. Geoffrey is the son of a nurse, future of work and education expert, diversity, equity, inclusion, and belonging advocate, champion for transforming health equity, and the host of the Ed Up Health Up podcast. His professional career includes over nine years in hospital administration as a strategic advisor to the President and CEO and department director of various departments, including Business Development and Planning, Government Affairs, Community Health, and Public Relations, for Lehigh Valley Hospital-Pocono. At Lebanon Valley College and Harrisburg University of Science and Technology he held senior leadership roles focused on strategic partnerships, organizational strategy, and business development. As Senior Vice President, Business & Workforce Development at Dignity Health Global Education, he led a diverse team focused on developing institutional relationships with leading health systems while simultaneously championing national conversations and initiatives to develop innovative diversity, equity, and inclusion solutions for the healthcare workforce.

“We expected to see a drop in enrollment before the pandemic for all healthcare programs. Why did Healthcare and Education not come together to combat this?” – Geoffrey Roche

“We have made bad decisions as a society when taking care of our healthcare workforce.” – Geoffrey Roche“We have five generations of people in the workforce, and this is the first time we have had this.” – Geoffrey Roche“As Leaders we need to harness the creativity and passion for all generations in the workforce.” – Geoffrey Roche

2:25: What is happening in the nursing workforce?

8:00: Millennials in the workforce and creating a culture that allows people to be the best they can be by creating a community and culture that allows them to thrive. This means they must be valued and heard.

Crossing the Value-Based Healthcare Rubicon isn’t just a journey, it’s a revolution in care, where the currency is quality, and the compass is compassion. This transformation is both an economic and moral imperative, and in the alchemy of healthcare, transforming economics isn’t just about numbers; it’s the catalyst for transmuting care outcomes into golden results that enrich both lives and ledgers.

This week you have access to two of the leading minds in value transformation. We are joined by Dr. Edward McEachern (Executive Vice President and Chief Medical Officer for PacificSource) and Jenni Gudapati (Value-Based Healthcare Program Director and Clinical Associate Professor at Boise State University).

In this illuminating episode, we delve into the transformative realm of value-based healthcare with a diverse range of topics. Our insightful interview explores the value movement and its profound impact on economics and care outcomes. We unravel the intricate dynamics of care management, particularly in the context of chronic diseases, while shedding light on the crucial aspects of risk adjustment, Annual Wellness Visits, and Quality Improvement. We also investigate the concept of “Gold Carding” and the role it plays in healthcare transformation. Furthermore, we delve into higher education’s pivotal role in shaping the future of healthcare value, emphasizing the essential skills that healthcare leaders of tomorrow must possess. Tune in for an enlightening discussion that navigates the evolving landscape of healthcare, economics, and leadership!

This week’s episode is brought to you by Edifecs – an EMR-agnostic, interoperable, and AI-enabled technology helps providers unify and utilize data for a more complete digital portrait of patient populations. The result: better clinical, financial, and compliance outcomes.  To learn how Edifecs’ applications can enhance prospective risk adjustment and value-based contract performance, visit edifecs.com today.

Episode Bookmarks:

01:30 Introduction Edward McEachern, M.D. and Jenni Gudapati, MBA, RN

06:50 The slow uptake of accountable care (HCP-LAN: only 20% of healthcare payments flow through Categories 3B and 4 APMs).

07:20 Provider challenges: supply chain disruptions, labor shortages, high inflation, and the end of COVID-19 relief payments.

08:20 Congressional Budget Office projects insolvency of the Medicare Trust Fund by 2026.

08:50 The economic necessity of value-based health care to reduce unnecessary spending.

09:35 “In the shadow of COVID we have crossed this Rubicon where there is a push on the current paradigms of care delivery and payment.”

10:15 Stressor #1: The retirement of the Boomer workforce will create a 14% structural deficit in accessible labor.

10:30 Stressor #2: FFS infrastructure collides with APM adoption strategies and cannot support value transformation.

11:20 Stressor #3: Shift of hospital care delivery to the outpatient and home setting. (“It is never coming back.”)

11:50 “This chronic complex system of care that takes care of people in the post-acute setting is not adequately available in most communities.”

12:20 “LAN 3B and 4 payments will only help in the context of the operational reshaping of the health delivery system.”

12:50 Value-based consumer perspective needed: 46% cannot afford out-of-pocket healthcare expenses!

13:20 Low value services that do not track to best patient outcomes.

13:50 Revenue dependency on a sick-care model of fee-for-service medicine.

14:35 “Too many health inequities exist. We need to financially incentivize providers to take care of underserved populations.”

15:20 “Healthcare is the only industry that is Yelp proof.” (the dislocation between costs and consumerism)

16:20 What if we created a well-financed and integrated SDOH health system to work alongside the sick care health system?

17:50 The power of the Annual Wellness Visit (AWV) in patient-centered care.

19:20 Clinical intuition in assessing patient risk during the AWV (going beyond the diagnosis code).

21:35 Mapping the system of care to improve patient navigation.

22:20 Healthcare costs for chronic conditions totals $1.65 trillion—equivalent to nearly eight percent of the nation’s GDP. (Projected to be $6 trillion by 2050!)

24:50 PacificSource’s collaboration with Summit Health (ex: managing burden of illness through care management and gold carding.)

27:50 Scaling telehealth, RPM, and home-based CCM through financial incentives.

28:50 Lowering readmissions and ED utilization comes at the expense of lost FFS revenue.

29:35 Prevention programs are core to a clinician’s identity in the promotion of health and wellness.

30:50 PMPM-based prospective payment in the glidepath to value.

31:50 Systems of care for patients stratified in disease-specific high segments.

32:20 Payer-provider collaboration in gold carding.

32:50 The need for real-time bidirectional patient information.

33:50 92% believe quality of care will improve with VBP. (Recognition the care coordination is a critical success factor.)

34:20 Gold Carding as a way to streamline pre-authorizations between a provider and a health plan to support value based healthcare.

35:20 “CDS Hooks” (a HL7 specification that integrates clinical decision support and enables data exchange between payers and providers).

36:50 Dr. McEachern provides additional insights on gold carding, evidence-based PA adjudication, advanced CDS, and interoperability.

43:50 Risk adjustment is so much more than a RAF score and a lever for revenue.

45:20 Jenni expounds on the importance of risk-recapture and accurate charting strategy to reflect true burden of illness in a population.

46:50 Shared decision-making and reflective care planning as a risk mitigation strategy.

49:35 A RAF increase of 0.1 in a population of 1,000 patients = $1M

50:50 Boise State University’s Value-Based Healthcare Program – nationally-recognized education for preparing future healthcare visionaries.

52:50 Master of Population and Health Systems Management – “the juncture between actuarial science, epidemiology, and population health studies”

54:35 Partnership with HFMA – the marrying of Business with Higher Education to meet future workforce needs.

56:50 A vision for “creating a community of Healthcare Transformationalists”.

62:20 Future leaders in value transformation will need expertise in epidemiology, finance, and clinical operations.

63:50 Grit, passion, and optimism are the most important intangible attributes of future leadership success.

66:35 Parting thoughts from Dr. McEachern and Jenni Gudapati.

This week is National Nurses Week, and it is a time to honor the contributions and sacrifices of nurses who perform some of the most difficult and heartbreaking tasks in the medical world.  As workers who perform the most essential healthcare tasks, nurses serve as the first point of contact for most patients…and they save lives and restore health in the process.  Yet, nursing is often a thankless profession that is underappreciated and experiences high levels of burnout and moral injury.  There are a multitude of factors related to societal attitudes towards the nursing profession, and many of them result in a lack of recognition and support, inadequate compensation, limited opportunities for career advancement, and ultimately a lack of respect and appreciation for the work they do.  We must begin to think about how to better position the profession to take a leading role in healthcare innovation.  Nurses must become more empowered as we transition to a future of value-based care.

This week on the podcast, we are honored to be interviewing Rebecca Love.  She is an experienced nurse executive, the first nurse featured on Ted.com, and part of the first nurse panel at South by Southwest. Rebecca is a regular contributor on the Forbes Business Council, and has been featured in BBC, Fortune, Becker’s, Forbes, Chief Healthcare Executive Magazine and ABC news. Rebecca, was the first Director of Nurse Innovation & Entrepreneurship in the United States at Northeastern School of Nursing – the founding initiative in the Country designed to empower nurses as innovators and entrepreneurs, where she founded the Nurse Hackathon, the movement has led to transformational change in the Nursing Profession. In early 2019, Rebecca, along with a group of leading nurses in the world, founded and is President Emeritus of SONSIEL: The Society of Nurse Scientists, Innovators, Entrepreneurs & Leaders, a non-profit that quickly attained recognition by the United Nations as an Affiliate Member to the UN. Rebecca is a world renowned Nurse Entrepreneur and currently serves as the Chief Clinical Officer of IntelyCare.

Episode Bookmarks:

01:30 National Nurses Week – a time to honor the contributions and sacrifices of nurses who perform some of the most difficult and heartbreaking tasks in the medical world.

02:00 We must better position the nursing profession to take a leading role in healthcare innovation.  Nurses must become more empowered as we transition to a future of value-based care.

02:30 Introduction to Rebecca Love – a nationally-recognized nurse executive and entrepreneur, the first nurse featured on TED.com, and part of the first nurse panel at SXSW.

03:00 Rebecca founded and is President Emeritus of SONSIEL: The Society of Nurse Scientists, Innovators, Entrepreneurs & Leaders and currently serves as the Chief Clinical Officer of IntelyCare.

04:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.

04:30 How do we better position the nursing profession in the value-based care movement?

06:30 “There is going to be no healthcare in the future without nurses leading value-based care.”

07:00 How tracking VBC outcomes by Provider NPI # is a challenge since nurses do not have assigned NPI #’s.

07:45 Nursing costs were rolled into room rates in the 1930’s with the establishment of modern-day insurance models. This occurred due to a male physician-dominated environment.

08:30 Nurses are the only clinical professional in the healthcare environment without a NPI for billing or tracking outcomes!

08:45 “Value-based care cannot fully be amplified or adopted until we address the lack of a NPI number with nurses.”

09:30 The infuriating pay inequity between executives and nurses. (Nonprofit hospital CEOs make on average 10X the rate of nurses!)

10:00 Should we align compensation to both executives and clinicians tied to patient outcomes?

10:45 North Carolina’s seven largest hospital systems reaped billions of dollars in profit from COVID Relief Funding but couldn’t afford to pay nurses!  (Read more hereand here)

12:00 CEO pay doubled over five years in North Carolina, but nursing pay there only increased 12-14% over the last decade!

13:00 The national increase in nurses pay over the last decade was 1.6% per year(less than the increase in cost of living).

13:45 The UK Nurses Strike – the largest labor protest in the history of the nursing profession.

14:00 How the cost allocation methodology for nursing will cause continued exacerbation of the nursing working shortage in the U.S.

14:45 “We have to find a way to unpack nursing overhead from the room rate to make sure our healthcare system stays operational and can support our communities.”

15:30 Inspiration from President John F. Kennedy about recognizing the opportunity in a crisis.

16:00 There is a shortage of 450,000 nurses in the US today, and it is projected that over 1 million registered nurses in the U.S. will leave the workforce by 2030.

16:45 70% of new nursing graduates have left the bedside since last year!

18:00 Rebecca speaks about the compassion and empathy of nurses and how they are suffering due to burnout and moral injury.

19:30 How the healthcare industry treats nurses like an “endless commodity” and does little to address their burnout.

20:00 What if we invested only a quarter of what we spend in healthcare technology on nurses?

20:30 “Nurses have been degraded and relegated to the lowest rung of healthcare delivery today. If we want VBC to be successful, we must stabilize the nursing workforce.”

21:00 “Value-based care will certainly not survive without the nursing workforce at the heart and the center.”

22:00 93% of nurses are experiencing staffing shortages in their hospitals, which is a significant increase from 59% in a 2020 survey.

23:00 Last year over 90,000 qualified nursing applicants to nursing school were turned away due to lack of space!

24:00 We have more nurses today than any other time in American history, but we have a critical shortage because they are unwilling to work in the current healthcare environment.

24:30 The highly controversial RaDonda Vaught Homicide Case where a nurse was found criminally negligent for a self-reported medical error.

26:00 1 in 3 bedside nurses have left the profession since the RaDonda Vaught case!

26:30 Nurses and CNAs being criminally prosecuted for errors in long-term care delivery when not a single owner is held responsible for the unsafe care environment!

27:00 Rebecca speaks about the role of Higher Education in building bridge pathways and ensuring diversity to support the nursing workforce shortage.

30:30 Workforce challenges are now the #1 issue on the mind of hospital CEOs (ACHE Survey)

31:00 Hospitals have turned to travel nurses to ease staffing shortages during the pandemic, contract labor expenses have risen more than 250% over the past three years!

31:30 Annual burnout-related turnover costs are $9 billion for nurses!

32:30 Rebecca speaks about the need to enable more nurses to serve in senior leadership roles and as governing fiduciaries on hospitals boards to redesign care delivery.

33:30 “Innovation is opposite of the definition of insanity.”

34:00 How hackathons can be utilized in the empowerment of a nurse-led innovation movement.

35:30 Investing in technology to improve nurse staffing (e.g. improving float pool and per diem services).

35:45 80% of women nurses do not return full-time after they have a baby! (Could tech solutions provide staffing flexibility to empower nurses to continue working?)

37:00 “Reverse pitch events” – honing frontline innovation to address adverse events in the healthcare setting.

37:45 Applying the UI/UX methodology to the healthcare end user in order to improve care delivery at scale.

40:30 The lack of nursing input when health systems role out new technologies (and how these tech decisions often end up creating more work and administrative complexity).

42:30 The importance of the Chief Nurse Health Informatics Officer.

43:45 The role technology can play in Patient Safety.

46:00 The work of Healing Politics in getting nurses more involved in the political arena to reshape healthcare.

47:00 The lack of business education in nursing programs.

48:00 The need for more nurses holding political positions and why more nursing input is needed in health policy. (Betty Rambur is currently the only nurse on MedPAC.)

49:00 Nurse-led innovation happens when nurses are trying to save lives!

50:00 How the COVID-19 pandemic depended on nurse-led innovation.

51:30 “Why are we not trusting in nurses now – to hear them and trust them – so we can build the system needed to sustain workforce, sustain healthcare, and sustain our communities?”

52:00 How Florence Nightingale forever fundamentally changed the future of science, history, and medicine with the establishment of the nursing profession.

54:30 Rebecca discusses how attending a healthcare hackathon changed her life and led to a career path in nursing innovation!

60:00 What the hackathon taught Rebecca about the importance of the nurses voice and how they can save healthcare.

62:30 Parting thoughts from Rebecca and the life lesson learned from surviving a shipwreck at sea.  (Bet on yourself and believe you can overcome adversity!)

64:00 “Were there none who were discontented with what they have, the world would never reach anything better.” – Florence Nightingale

65:00 2030:  Florence Nightingale’s prediction of a future nursing renaissance.

Three perfect storms in recent years – the health storm produced by the COVID-19 pandemic; the economic storm that resulted from its disruptions; and the social storm that followed the murder of George Floyd which sparked fresh outrage at longstanding inequities – have sharpened and added important nuances of what health care really means. The goal of health care has always been to reduce suffering, but we must now prioritize transformation in leadership now more than ever. Building trust, eliminating inequities, and ensuring high reliability are of the highest magnitude of importance as we blaze a new path forward.

This week, on the Race to Value, we are joined by Thomas H. Lee, M.D., the author of the new book “Healthcare’s Path Forward” to discuss how the healthcare industry is being transformed by deeper knowledge of what suffering means for patients, their families, and healthcare providers themselves. Since healthcare is not working for anyone, Dr. Lee provides wisdom and insights of optimism for where true change can happen in creating new standards for excellence.

In addition to being a bestselling author and expert on healthcare transformation, Dr. Lee is the Chief Medical Officer of Press Ganey.  He brings more than three decades of experience in healthcare performance improvement as a practicing physician, leader in provider organizations, researcher, and health policy expert. He’s responsible for developing clinical and operational strategies to help providers across the nation measure and improve the patient experience, with an overarching goal of reducing the suffering of patients as they undergo care and improve the value of their care.

Episode Bookmarks:

01:30 Introduction to Thomas H. Lee. M.D. and his new book “Healthcare’s Path Forward”

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

04:00 The six elements of organizational culture that lead to transformation – Excellence, Trust, Respect, Inclusion, Resilience, Reliability

05:00 John Nash (“A Beautiful Mind”) and Non-Cooperative Game Theory

06:00 Optimism for healthcare because how bad things really are!

07:00 Nash Equilibrium states are commonplace in healthcare – it creates inertia and stifles change.

08:30 “Equilibrium states break down when the pain of the status quo exceeds the fear of the unknown for multiple parties.”

09:00 “Healthcare is not working for anyone.  That is where real change can happen and what makes me optimistic.”

09:45 The destabilizing trends of supply chain disruption, social unrest, political divisiveness, consumerism, demographic shifts, workforce drain, and environmental disasters.

11:30 Responding to social justice, climate change, and the need to redesign healthcare – is it too much for us to tackle all at once?

12:00 “Changing the way healthcare is paid for – in absence of other reforms – is grossly inefficient.  There are many other things that have to happen.”

12:30 Michael Porter’s Value Chain and the importance of clarity and differentiation in the creation of value.

13:30 “Payment reform is just one activity of healthcare reform.  We also need trust in the workforce and with patients, an understanding of what safety means, and a response to consumerism.”

15:00 In times of turmoil, healthcare organizations need more than a performance culture; they need a learning culture.

16:30 The most important part of transformational leadership is division of responsibilities and areas of key focus to enact organizational change.

17:30 No one can do everything!  If leaders focus on only three things, they will be successful in strategy execution.

18:30 3 Functions of Governing Boards and Executives: Articulate the Core Values, Develop Strategy, Understand the Value Chain

18:45 “An organization is the lengthened shadow of its leaders.” – Ralph Waldo Emerson

20:30 3 Functions of Managers: Create Social Capital, Bring High Reliability Principles to Life, Eliminate Waste of all Types

21:30     “Social capital is more important than financial capital in the times in which we live.”

22:00 Applying High Reliability to all the dimensions (including patient experience) and refusing to tolerate failure in matters of trust.

23:45 “Culture of No Waste” – includes both time and resources

24:30 3 Functions of Frontline Caregivers: Create a Culture of Respect, Be Full Participants on Great Teams, View Job as Shaping the Memories of Patients and Families

25:30 The healthcare workforce often feels that they are part of a organization that does not respect them.

26:30 “Treating people with respect should be treated in the same way that the industry tackled hand hygiene to improve patient safety.”

27:45 Referencing the TED Talk from Daniel Kahneman: “The Riddle of Experience vs. Memory”

29:00 Frontline caregivers are like Steven Spielberg, i.e. they are the producers and directors of the patient memories.

32:00 “We live in a time where trust is under attack in society.  You can’t take trust for granted in healthcare.”

33:00 Trust goes beyond the clinician encounter – it encompasses the whole episode of care, including the web presence of the provider before the visit.

35:30 The importance of 5-Star Ratings online in building trust.

36:30 “Patients are unnerved from friction, chaos, and any indication that they may not be safe. The pandemic has really heightened their fears.”

38:00 Dr. Lee discusses how Press Ganey has begun surveying patients on their perceptions of patient safety.

39:45 High-reliability and the Anna Karenina Principle (“Happy families are all alike; every unhappy family is unhappy in their own way.”)

41:45 In 2021, the Press Ganey Employee Engagement Indicator declined in every single job category!

43:00 Dr. Lee discusses how building trust with workers coincides with the actions taken to build trust with patients.

44:30 Personal Pride:  Pride in the organization, Pride in what you do for the organization, Pride in what your team does.

45:30 Personal Alignment: Aligning with the cultural beliefs of employees and the need for inclusion. (Lack of DEI creates a 4X greater risk of employee turnover.)

46:00 Personal Resilience: Activation (employee motivation) and Decompression (ability of employees to forget about work when at home).

47:30 Activation is increasing in healthcare, but decompression continues to go down!

50:00 Dr. Lee explains how the pandemic and social unrest has created a deeper understanding of human suffering and how systems create harm.

50:30 Understanding Patient Safety beyond Physical Harm by also considering Emotional Harm (e.g. not feeling safe or financial distress due to healthcare)

51:30 The nuance of perception in Patient Safety (an example of how patients didn’t feel safe when a change when a hospital starting using odorless disinfectant).

53:00 Lack of respect as a safety issue.

53:00 The murder of George Floyd prompting an examination of the impact of inequality throughout society.

54:00 Diversity, Equity, and Inclusion in healthcare as a form of social capital and the pursuit of zero inequity.

55:00 The importance of DEI in health equity is now understood at a deeper level by healthcare leaders following the murder of George Floyd.

56:00 “Zero Inequity should be our goal just like Zero Harm is our patient safety goal.”

56:45 The data from safety net hospitals showing continued challenges in assessing pain with African American patients.

58:00 How organizational mistreatment of patients creates mistreatment of workers (and why lack of patient-centeredness is main reason for employee turnover).

61:00 Dr. Lee touts the virtues of healthcare and why it is such a great industry to work in.

62:00 New Skills for the Era Ahead:  Strategy (Porter’s Value Chain), Social Capital (Teamwork, Leadership), Growth Mindset (read Grit: The Power of Passion and Perseverance!)

64:00 The potential to do great work in medicine and making a difference in the lives of others.

64:30 “This is the best time to be going into healthcare. You can really make a difference in a noble field.”

65:00 How to reach out to Dr. Lee and learn more about his work in healthcare transformation.

The healthcare industry is facing immense financial pressure. Staffing shortages, skyrocketing labor costs, continuing supply chain disruptions, inflation, rising interest rates, and volatile markets are pressuring both revenue and expenses for provider organizations. These economic challenges, however, are an opportunity to catalyze value-based care.  The promise of value in health can lift up communities through improved clinical outcomes, reduced disparities, financial rewards associated with population health, and emerging opportunities for upskilling the workforce.  Now is the time to prioritize value-based care as a key strategic priority for long-term success and sustainability. There are few other health systems in the country that have demonstrated more of a longstanding commitment to transformation than Ochsner Health through its population health enterprise.

A leader in innovative healthcare delivery, Ochsner Health Network (OHN) is the accountable care network of the massive Ochsner Health system – the largest nonprofit, academic healthcare system in Louisiana (and one of the largest health systems in the Southeastern region of the US). Ochsner has 47 hospitals and more than 370 health and urgent care centers across Louisiana, Mississippi, Alabama, and the Gulf South. Ochsner Health Network – the value-based care arm of the health system –has 277 affiliated physician practices with nearly 3,500+ physicians spanning 625 locations. They are responsible for managing 406,000 lives across six risk-based, accountable care contracts in their value-based care portfolio. Through its collaborative efforts, OHN is making a difference for the nearly 1 million patients throughout Gulf South communities each year.

In this week’s episode of the Race to Value, we are engaging two incredible leaders from Ochsner Health Network (OHN). As Chief Executive Officer for OHN, Eric Gallagher is responsible for directing network and population health strategy and operations, including oversight of value-based performance management operations, population health services and care management programs, post-acute and home care strategies, value-based analytics, and OHN network development and administration.  Joining him is Dr. Sidney “Beau” Raymond, the Chief Medical Officer for OHN who is board-certified by the American Board of Internal Medicine and has been on staff at Ochsner since 2016 and practicing medicine since 2000.  These two leaders discuss what it takes to transform a health system in the “race to value” and how to ultimately improve the health for an entire state in the process!

Episode Bookmarks:

01:30 Ochsner Health Network (OHN) is the value-based care arm of the Ochsner Health system – the largest nonprofit, academic healthcare system in Louisiana.

02:30 Through its collaborative efforts with patients, communities and employers, OHN is caring for nearly 1 million patients in Gulf South communities.

04:00 Introduction to Eric Gallagher (CEO, OHN) and Dr. Sidney “Beau”Raymond (Chief Medical Officer, OHN)

05:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts!

06:00 A recent Kaufman Hall report on the mounting pressures facing providers (e.g. staffing shortages, labor costs, supply chain disruptions, inflation, rising interest rates, volatile markets).

07:30 Eric Gallagher discusses the critical challenges of staffing shortages and the skyrocketing cost of labor.

08:30 “Staffing shortages and rising costs of labor is a critical challenge. It serves as a catalyzing environment for value-based care.”

09:30 Investments in value-based infrastructure has forged collaborative relationships within the entire system.

11:00 Dr. Raymond on how post-pandemic workforce pressures have impacted primary care access and care delivery innovation.

13:00 The number of Americans ages 65 and older is expected to more than double over the next 40 years.

14:00 Approximately 10,000 Americans are aging into Medicare each day.

15:00 The Ochsner value journey in caring for seniors — from global capitation risk in Medicare Advantage to the Ochsner Accountable Care Network (OACN) ACO.

15:30 OCN/OACN have saved CMS over $100 million in the last 5 years! (recent press release on OACN Shared Savings Results)

16:30 Ochsner Health Plan – the only Medicare Advantage plan sponsored by and fully integrated with Ochsner Health.

17:30 Oschsner 65 Plus – a new initiative consisting of freestanding, PCP value-focused clinics delivering high touch, team-based primary care for seniors.

20:00 In the last three years, OACN MSSP ACO has doubled in size to 63,000 attributed beneficiaries.

21:30 How Ochsner has improved quality results performance in the ACO and is scaling it through continued growth.

23:00 The importance of value-focused leadership in building infrastructure and culture to drive performance outcomes.

23:45 “You can’t undervalue the importance of having the talent, leadership-buy-in, and investment to drive value-based outcomes.”

26:00 How senior-level engagement and alignment creates an environment for care delivery innovation.

27:45 The elevation of value-based care to one of four pillars of success for Ochsner Health.

28:00 Hardwiring VBC success into the compensation model for both system executives and physicians in the Ochsner Health enterprise.

28:30 How primary care engagement has led to next-level partnerships with specialists in the network.

30:00 How compensation plans and bonus incentives have driven provider engagement in value-based performance.

33:00 Ochsner’s partnership with Walmart to provide integrated, coordinated, high value care for employees across Louisiana.

34:30 The importance of employer-provider partnerships in improving the health and wellness of a workforce.

35:30 Sharing of financial-risk with self-funded employer-sponsored health plans.

37:00 Negotiating PMPM prospective payment with employers for a care management team model that improves clinical outcomes.

40:00 How Ochsner has been very intentional in building a population health data infrastructure to support its partner physicians.

41:00 Using claims groupers and population-based analytics to evaluate the totality of care spend for specific patient populations.

41:45 Collaborating with partner hospitals and community physicians to democratize population health data analytics at the point-of-care.

43:00 “HIT infrastructure capability and democratization of data at the point-of-care are the dual challenges in reaching greater depths of analytical precision.”

43:45 Ochsner’s patient population: 14-percent have diabetes and 40-percent have hypertension.

44:00 Improving outcomes for patients through enrollment in the Ochsner Digital Medicine program.

46:30 The use of algorithms for personalized care interventions to better engage chronically ill patients.

47:00 Overcoming physician concerns that the use of digital medicine is competitive to in-person E&M encounters.

47:30 The digital medicine program has improved outcomes (e.g. screenings, care gap closures, patient engagement) without diminishing office-based RVUs.

48:30 Piloting digital medicine for Medicaid populations and how that has increased care access and engagement.

50:00 Digital Health as a core component of Ochsner Health’s strategy (along with value-based payment).

51:00 The role of innovationOchsner (iO) as an important think tank and lab for digital health innovation.

52:00 Piloting the Ochsner Connected Stability Fall Prevention digital health program for MA members who are the highest risk of falls.

56:30 How the Ochsner population health enterprise delivers integrated behavioral health in the primary care setting.

58:00 Virtual behavioral health integration as the next big opportunity for care delivery innovation.

59:00 The Office of Professional Well-Being at Ochsner that has been established to improve the well-being of the workforce.

60:00 The growing concern of burnout and moral injury with physicians, APPs, and other clinicians.

61:30 A conscious effort to minimize inbox messaging for providers as a way to eliminate administrative burdens that contribute to provider burnout.

62:30 Integration of pharmacists in primary care setting to help manage prescription refills.

63:30 Team-based care (e.g. social workers, nurses, care coordinators, dieticians, patient engagement specialists) as an opportunity to improve overall workforce outcomes.

66:30 Partnering with Higher Education for interprofessional upskilling opportunities (e.g. Delgado Community College partnership in training nurses and CHWs).

69:00 The Healthy State by 2030 initiative as a catalyst to improve health equity in marginalized and underserved communities in Louisiana.

71:00 Community partnerships that recognize the impact of education as an opportunity equalizer.

74:00 Parting comments on the importance of health equity as a societal priority that is a shared responsibility in communities.

The Quadruple Aim of physician satisfaction is such an important aspect of value-based care. In the predominant world of fee-for-service reimbursement, physicians are struggling and burned out. Consequently, over half of all doctors won’t even recommend medicine as a career.  This negative shift in wellbeing is important to understand because the attitudes and feelings of doctors bear directly on the way they treat patients. A recent Harvard report calls physician burnout “a public health crisis that urgently demands action.” Some physicians are even going as far as to say the profession is dealing with moral injury because the word “burnout” is insulting and insufficient in describing the pain they feel when the fee-for-service system prevents doctors from doing what’s right, thereby forcing them to inflict harm on patients – where physicians themselves experience a form of injury.

The business of fee-for-service medicine continues to get in the way of physicians healing patients. It breaks the spirit and the heart of our physician workforce, and it is imperative that physicians become empowered to lead a system transformation.  Value-based care will be a losing effort if we do now cultivate physician wellbeing in the value journey.

In this podcast, you will hear from three physician thought leaders about the plight of physician burnout and its impact in advancing the aims of the value-based care movement. Most importantly, you will learn the tools necessary to transform organizational culture to ameliorate this important workforce challenge.

Speakers:

– Dike Drummond, M.D., CEO, Physician Coach & Speaker, TheHappyMD.com

– Moshe Cohn, M.D., Associate and Advisor, Moral Injury of Healthcare

– Amadeo Cabral, M.D., President, Turning Point Healthcare Consultants

Sponsored by: VBCExhibitHall.com (VBCEH)

Episode Bookmarks:

01:30 The differentiation between physician burnout and moral injury.

02:15 “Physicians need to heal in order to provide their best care for patients.”

03:00 Moral injury is a symptom of something larger – our broken health care system.

04:00 Introduction to Drs. Drummond, Cohn, and Cabral

05:45 Physician burnout and moral injury is a leadership failure.

06:30 Dr. Drummond provides context for why the physician workforce is suffering.

07:30 “The business of fee-for-service medicine gets in the way of physicians healing patients. It breaks our spirit and breaks our heart.”

07:45 “Burnout is a symptom of overwhelm in a physician that cares about what they do, when their purest expression of healer, helper, and light worker is blocked.”

08:15 Burnout is a physician impairment when it comes to ensuring quality and patient satisfaction.

08:45 Dr. Cohn explains the concept of why “language really matters” in communicating the public health crisis of physician burnout.

10:00 How physician moral injury is related to a clinical diagnosis of PTSD.

11:00 The leadership need for healthcare executives to address the repeated moral injury of their physician workforce.

12:30 How physician burnout differs from burnout we observe in other facets of the non-healthcare workforce.

13:15 The repeated barriers imposed by a system that prevents physicians in getting patients what they need to get better.

14:00 Dr. Cabral explains how the “slow boiling” public health emergency of physician burnout differs from more explosive public health emergencies like COVID-19.

15:00 Referencing confirmatory research (e.g. New York Times, Advisory Board) on the incongruence between the business of medicine and relationship-based care.

15:30 “Healthcare is not a broken “business” model — it is a broken “health care” model.  It is imperative that physicians are at the table to lead a transformation.”

16:00 How do we get the incentives of business and medicine to merge into a congruent state?

17:30 The “canary in the coalmine” – physician suicides are signaling that something is wrong with the overall healthcare system.

18:00 An interesting dialogue about how Don Berwick posed an expansion to the Quadruple Aim as an apology for the Triple Aim.

19:00 Dr. Cabral on how true Value-Based Care (a wellness model) is a solution for physician wellbeing which can sometimes differ from the business model of VBC.

20:30 Dr. Cohn discusses the need a better definition for “Value” and why the Triple Aim does a disservice to the industry when the overall cost model is broken.

22:30 “As a physician, the only thing we really care about is patient outcomes. However, our outcomes are now mostly centered on checking boxes.”

24:20 Dr. Drummond reflects on the need for physicians to carve out a more rewarding practice in the reality of their business model.

24:45 Does capitation actually produce a healthier physician workplace with better patient outcomes?

26:30 The need for non-physician administrators to respect the healing encounter. (How many leaders regularly shadow their doctors?)

28:30 Dr. Cohn reflects on how investment levels prioritize societal importance (in relation to pediatrician compensation, mental health, education)

29:30 Dr. Cabral on how other countries are able to better align the incentives of their health care systems.

30:30 The physician burden of meeting end-of-life treatment expectations with heroic interventions that are costly (profitable) and result in poor quality of life.

31:45 The “classically American” problem of patients seeking low value care at end of life. (How does this factor into value-based care?)

32:45 “Eighty-percent of the hospital beds in our country are unnecessary if we granted our society the ability to determine what is a reasonable and unreasonable investment in quality of life.”

33:00 Dr. Cohn compares the current healthcare delivery system to a “fast food” model influenced by big money and advertising.

34:00 Advancements in technology and innovation in healthcare does not mean that we can fix everything that is wrong with patients.

36:15 Dr. Cabral discusses how patient satisfaction scores are being weaponized against providers.

37:30 The need for quality measures to translate into quality outcomes. (The misalignment leads to “check the box” medicine and weaponization against physicians.)

39:30 Dr. Cohn tells the painful story of a pediatric patient with a terminal brain bleed that led him to the realization of how administrators value documentation over human emotion.

41:30 Dr. Drummond explains how patient satisfaction should never be 100% (unless you are a criminal!)

42:00 “A true value journey requires a culture of provider support and a proactive burnout prevention strategy.”

42:30 The need for a super-majority value-based revenue tipping point in a contracting portfolio to bring about true cultural change.

43:45 Dr. Cabral on how the $4T American healthcare system spends 30% on administration (compared to 9-10% in other countries).

44:15 Healthcare Job Growth since 1970’s: 200% for providers and 3500% for non-clinical providers!

46:00 Drs. Cabral and Cohn speak about the monolithic structure of medical education that is over 100 years old and why that is a barrier to team-based care.

48:30 Dr. Drummond on how there are no leadership classes in medical school or residency (leadership is instead learned once practicing in a broken industry).

50:00 Dr. Drummond references Team Care Medicine, Dr. Jim Jerzak, and Dr. Corey Lyon as leading exemplars in team-based care models.

51:00 Dr. Cabral on how physicians “crossing the schism” into leadership often imposes unrealistic meeting expectations (unless the practice of medicine is completely abandoned).

52:45 Dr. Cohn on how healthcare leaders takes physicians for granted (referencing “The Daily Exploitation of Medical Staff” by Danielle Ofri)

54:00 Dr. Drummond – Should I go the extra mile for a patient if the organization gets in my way and it is unhealthy for me and my family?

55:30 Parting thoughts from our guests on implementing strategies to cultivate physician wellness.

Equitable and accessible care must ensure appropriate and optimal use of medications since nearly 70 percent of clinician visits involve drug therapies. However, each year there are an estimated 275,000 deaths and $528.4 billion wasted in the US due to suboptimal medication use through inaccurate prescribing, medication errors, adverse drug reactions, skipped doses, or treatment failures.

Given that most therapeutic options for the treatment of illness involve pharmaceutical interventions, we must find a way to maximize medication benefits and mitigate harm.  That promise for a more patient-centered approach to optimize medication use can be found through Comprehensive Medication Management (CMM).  The GTMRx Institute defines CMM as: “The standard of care that ensures each patient’s medications (whether they are prescription, nonprescription, alternative, traditional, vitamins, or nutritional supplements) are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the comorbidities and other medications being taken, and able to be taken by the patient as intended.”

Joining us this week on Race to Value are three amazing thought leaders who recently wrote a Health Affairs article on how CMM should be integrated within value-based care delivery:

In this episode, we discuss the role of CMM in value-based care, the importance of interprofessional collaboration, CMM implementation strategies, CMM use cases, HIT infrastructure requirements, pharmacoequity, and value-based payment reforms needed for CMM adoption growth and sustainability.

Episode Bookmarks:

01:30 Nearly 70 percent of clinician visits involve drug therapies; however, there are an estimated 275,000 deaths and $528.4 billion wasted due to suboptimal medication use.

04:00 Introduction to Dr. Michael Barr, M. Shawn McFarland, Pharm D., and Katie Capps (and their recent Health Article on CMM and VBC)

07:00 Katie defines Comprehensive Medication Management (CMM).

07:45 Dr. Barr further explains that CMM helps provide “better care for people” and the work GTMRx Institute is doing to bring much-needed attention to it.

09:00 Katie outlines the multitude of problems in care delivery associated with the inappropriate use of medications (e.g. polypharmacy issues, adverse events, high costs)

10:00 The important role of a clinical pharmacist working in close collaboration with physicians.

10:30 Shawn discusses the success of CMM in the Veterans Affairs system.

13:45 Shawn describes the confusion about the role of the pharmacist and how CMM can expand the profession.

15:00 The role of the pharmacist in interprofessional, team-based care and how CMM relates to winning teams in football.

16:45 “When we integrate a pharmacist on a care team to provide CMM, we provide the utmost benefit to patients and can win together by improving outcomes.”

17:30 CMM services have an estimated 12:1 return on investment when used for patients with chronic conditions. (Referencing Fairview Case Study)

18:45 Dr. Barr describes his prior experiences with team-based care with a clinical pharmacist.

20:00 Katie describes how a winning strategy for interprofessional, team-based care is to appropriately define roles.

21:45 USC School of Pharmacy study that shows 87% of patients receiving CMM reached their blood pressure targets within 45-days.

22:45 “Adding a clinical pharmacist to the interprofessional team makes sense from a clinical and economic perspective – and it is a more humane way to manage medication needs.”

25:30 Shawn outlines the three components of successful CMM implementation.

25:45 #1 Success Strategy: “Philosophy of Practice”

26:30 #2 Success Strategy: “Fidelity to the Practice Management components CMM”

28:00 CMM Practice Management Assessment Tool

28:40 #3 Success Strategy: “Well-Defined Patient Care Process”

30:30 Katie references the multitude of free CMM resources that are available through GTMRx (GTMRx Resource Page on Value-Based Care)

31:20 The confusion between CMM and MTM

32:00 Dr. Barr discusses the importance of trust in interprofessional, team-based care delivery and the need to make CMM broadly available.

33:00 Katie describes how trust brings about success in performance measurement and accountability.

35:00 Shawn provides an example of how the VA incorporates patient experience into the delivery of CMM services.

37:00 How the VA enhanced patient access – creating an additional 3 weeks of provider availability – by implementing CMM.

38:30 “CMM occurs over the journey of healthcare – not just in the 30-minute patient appointment.”

40:30 The extensive studies that show how pharmacist integration improves clinical outcomes.

41:00 How CMM decreases provider burnout and improves patient satisfaction.

42:45 Dr. Barr explains how clinical pharmacist integration can impact on CAHPs scores, HEDIS measure performance, and overall Medicare Advantage Stars Ratings.

44:15 Katie references the GTMRx Library of CMM Use Cases and further explains how Fairview Health received 12:1 ROI on CMM and lowered overall healthcare costs by 31.5%

46:00 The HealthPartners CMM Use Case showing 3.5 ROI with $1,268 PMPM healthcare cost reduction.

49:00 The Four Formative Pillars: Top Health IT Capabilities that will Improve Comprehensive Medication Management

49:30 Dr. Barr speaks to how CMM success is at the mercy of a sophisticated data infrastructure.

52:20 How important is Artificial Intelligence in CMM?

53:00 Katie on the importance of liberating actionable data at the point-of-care.

54:00 Identifying all drug therapy problems (not just those related to one medical condition).

54:45 Creating a care plan, that includes medication management, in collaboration with patients.

55:30 Shawn provides an example of how the VA creates automated dashboards for recommending patients to CMM.

58:00 Recent JACCP issue on pharmacoequity and how equitable medication use is paramount to eliminating health disparities.

59:00 Dr. Barr discusses the intersection of health equity and Comprehensive Medication Management.

60:30 The origin of the term “pharmacoequity” by Dr. Utibe Essien as a policy prescription for reducing health disparities.

61:00 Shawn discusses the integration of health equity within the VA system.

65:00 Katie on why a common definition for CMM is important for value-based payment policy reforms.

66:00 Shawn provides an in-depth explanation comparing CMM vs. MTM (Patient-focused process vs. medication-focused activity)

68:20 The Medicare Modernization Act was an early attempt to promote CMM, but it fell short.

69:00 Katie on why value-based payment needs to evolve to a point where care teams are directly reimbursed for CMM services.

70:20 “Value-based payment models are optimal for the provision and sustainability of CMM.”

72:00 Measuring the value of CMM with attributable patient outcomes measures and clinical information provided at the point-of-care.

72:30 Integrating pharmacogenomics into the CMM process to improve clinical decisionmaking.

74:00 Will the new vision for Medicare to advance accountable care and health equity by 2030 catalyze policy changes to support patient-centered CMM programs?

75:30 Focusing only on drug costs does not support access and appropriateness in medication use.

The need for physician leaders has never been greater. As the healthcare industry continues to undergo significant change, there is a clear opportunity for physicians with extensive administrative experience to rise up. In order to drive value-based care, physicians will need to assume leadership positions that are all too often filled by executives who do not possess medical training.  In the emerging health value economy, a physician leader needs to have both medical expertise and a business acumen to succeed.  However, how can physician leadership thrive when the entire profession is beleaguered, burned out, and depressed? Fee-for-service medicine is causing moral injury in the medical profession and doctors suffer immensely when the system prevents them from doing what’s best in the care of their patients.  Consequently, 50% of physicians are considering a career change, and it will cost health systems upwards of $1 million to replace a physician who leaves profession.  A balanced value strategy to ensure future success will ultimately require effective cultivation of both physician leadership and workforce wellness.

Joining us this week on the podcast is Dr. Peter Angood, the Chief Executive Officer and President of the American Association for Physician Leadership (AAPL). AAPL focuses on maximizing the potential of physician-led, inter-professional leadership to help create personal and organizational transformation that benefits patient outcomes, improves workforce wellness, and refines the delivery of healthcare internationally. Since inception nearly 50 years ago, AAPL remains the only healthcare organization solely focused on providing full-service professional development offerings, an array of information resources, leadership education, and management training oriented toward the physician workforce and the organizations where physicians work or represented. AAPL CEO Dr. Peter Angood is an industry leader, a researcher that has authored over 230 publications, and he is a well-recognized international speaker on the host of issues related to physician leadership. His recent book, “All Physicians Are Leaders: Reflections on Inspiring Change Together for Better Healthcare”, has been well received the medical profession.

Episode Bookmarks:

01:30 Register today for the “Population Health Equity: The North Star for Value” Virtual Event (December 1, 2022)

03:00 Introduction to Dr. Peter Angood and the American Association for Physician Leadership (AAPL)

05:30 Defining Value-Based Care (the changing value equation and the Quintuple Aim)

07:00 Patients don’t understand the language we use to define value-based care!

08:00 Patient perspective is the most important in defining value creation in the health system.

09:00 The aspiration of person-centered care is not being realized because of system complexity.

09:30 The need for physicians to have both medical expertise and administrative experience for leadership effectiveness.

11:00 Patient-physician relationships drive the majority of care delivery.

11:30 “The medical profession does not provide physicians with adequate training or experience in leadership or management.”

12:15 Additive training beyond medical school and residency is necessary for physicians to become leaders.

13:00 Non-clinical administrators can be effective, but there is an added benefit of physician leadership.

13:45 Quality performance outcomes are 25-33% better in health systems with physician CEOs.

14:30 Health systems in the US News & World Report rankings are predominantly led by a physician CEO.

15:00 The length of the education track for physicians delays leadership impact potential.

16:15 Mutual respect between clinical and non-clinical administrators as a key to organizational success.

17:30 Value-based care experimentation (e.g. Medicare Innovation Center, employer-based risk contracts with providers)

18:00 The capitation engine is driving from groups like Oak Street Health, ChenMed, One Medical and Iora Health.

19:00 “The complexity of the healthcare system hinders the success and sustainability of value-based initiatives.”

20:30 Are leading companies in value-based care truly focused on what is best for patient care?

21:15 The unwieldly payment model portfolio for CMMI will not be effective unless streamlined.

21:45 “Non-profit hospitals have experienced a 20% drop in cash flow. How can you innovate if you are trying to keep the doors open?”

23:30 Value-based care exemplars have not yet proven they can scale at a national level.

25:30 “Burnout and suicidality impacts the entire healthcare workforce – not just physicians. The pandemic showed us that a wellness strategy is desperately needed.”

27:00 The altruistic idealism of medical students erodes once they formally enter the profession.

27:30 The average student debt load for medical school graduates is $250-300K.

28:30 Decreased physician compensation and productivity pressures are adversely impacting the morale of physicians.

29:30 “The real driver of a well-balanced value-based care strategy is the patient-physician relationship.”

30:00 Burnout Strategy #1: Provide support services for physicians dealing with burnout and moral injury.

30:45 Burnout Strategy #2: Process improvement to optimize provider workflow and how it will improve workforce morale.

31:30 Burnout Strategy #3: Engage physicians in the process of continuous quality improvement to drive value creation.

32:30 The benefit of peer-to-peer networking in a team-based work environment.

33:00 Since the pandemic, there has been an 8% increase in clinical labor cost per patient – an additional $17M in cost for average sized hospital!

34:00 50% are considering a career change, and it will cost upwards of $1 million to replace a physician who leaves profession.

36:00 Workforce wellness and retention is a top concern for healthcare CEOs.

37:00 Physician employment – what is needed to ensure mutual respect and a successful workforce strategy?

39:00 50-70% of physicians are currently employed – does physician employment create a better work-life balance?

40:30 Physician employment may lead to lack of respect and agency to influence change — will the resultant burnout swing the pendulum to physician independence?

42:00 The exodus of the healthcare workforce is a high risk that demands wellness strategy prioritization.

43:00 This loss of physician independence limits value-based care effectiveness and, in most situations, employing physicians is like putting fee-for-service on steroids!

43:30 Physician-led ACOs outperform their health system ACO counterparts by a significant margin. Provider consolidation drives up healthcare costs.

44:30 M&A, private equity, and corporatization of healthcare – will this trend truly create more value in the system?

46:00 Dr. Angood provides an example of how an independent practice model can support long-term success.

47:45 Physician-owned systems will become more predominant in next 5-10 years as care delivery shifts more to the ambulatory sector.

48:00 Will Amazon, Google, Facebook, and Apple “figure out” healthcare?

49:30 Telemedicine usage surged during the pandemic where it accounted for 69% of doctor-patient visits but has since resettled into more of a pre-pandemic norm.

50:30 Physician-led vs. non-physician-led innovation (the concern of low-value technology solutions from companies lacking medical expertise)

52:30 An example of a family accessing an innovative subscription-based urgent care service

54:00 Hospitals are reevaluating post-pandemic telehealth utilization due to reimbursement challenges.

55:00 Electronic health records are poorly designed and contributing to physician burnout.

56:00 Three generations of physicians are currently in the workforce – Baby Boomers born before 1965, Generation X born between 1965-1980 and Generation Y born between 1981-2000.

58:00 Respecting intergenerational differences between physicians – wisdom (older cohort) vs. innovation (younger cohorts).

59:00 Idealism and altruism is a strong driving force for all generations of practicing physicians; however, work-life balance is more important for younger physicians.

60:00 Societal shifts to work and live in different ways and how that will impact future models of care delivery.

63:30 Upskilling and reskilling the healthcare workforce and reforming medical education for the future of value-based care.

65:30 Medical schools training physicians on the importance of SDOH-based interventions.

67:00 The continued challenges of achieving diverse representation of minorities in the medical profession.

68:00 The importance of regulatory oversight to reform medical school curricula in support of population health.

70:00 Parting thoughts from Dr. Angood on physician leadership and the work of the AAPL.

As we look around to see what is enduring in our society, it is the work that was accomplished through loving relationships and mutual understanding.  The power of love-driven leadership has the potential to change the world; and in healthcare, it can transform the lives of people undergoing immense suffering. Healthcare leaders must collaborate on solutions to overcome barriers in health equity through a deeply rooted commitment to social justice and love to improve the human condition. Leaders in population health must be willing to step forward – even if it is uncomfortable – to build a community of love that will last forever.

On the Race to Value this week, we interview Geoffrey M. Roche – a leader in healthcare innovation, future-focused strategy, DE&I, and workforce development.  This is a conversation that all healthcare leaders should hear. Geoffrey engaged this interview with utmost authenticity as leader with a willingness to get in “good trouble” for speaking about the issues that many would prefer to ignore or not accept as real.  In this podcast, you will learn about the power of community partnerships in improving health equity to overcome the “political determinants of health” that prevent societal progress. You will also learn about the paramount importance of workforce development and scalable educational solutions in catalyzing a transformation in care delivery and culture change that values the moral imperative of value-based care. The empowerment and education of our workforce holds the key to eliminating workforce burnout and moral injury! And lastly, you will gain perspective on love-driven leadership that can overcome toxic tribalism and hyper-polarization in our society.

Geoffrey is a proponent of love-driven leadership and advocacy for our most vulnerable in society, and his leadership in health equity has been recognized at a national level.  If you need inspiration to overcome the inertia in your health system towards real and impactful change, don’t miss this very important conversation!

Episode Bookmarks:

01:30 Introduction to Geoffrey M. Roche – a leader in healthcare innovation, future-focused strategy, DE&I, and workforce development.

04:00 Collaborating on solutions to overcoming barriers in health equity is informed by a deeply rooted commitment to social justice.

05:30 Geoffrey speaks about his early leadership work at Lehigh Valley Hospital-Pocono taking sojourns into homeless encampments in East Stroudsburg, Pennsylvania.

07:00 Leadership from a Hospital CEO and social justice warrior – how that led to an authentic impact in the population health of underserved communities.

08:00 Serving as Chair of the Commission’s Advisory Board to deal with homelessness – how that taught Geoffrey the “power of partnerships”

08:30 Uniting community stakeholders to eliminate stigmas and facilitate a better understanding of homelessness.

09:30 As a population health leader, you’ve got to be willing to step forward – even if it is uncomfortable. The community of love that you is built will be something you treasure forever.”

10:30 “The Health Equity Tracker” – a tool that aims to give a detailed view of health outcomes by race, ethnicity, sex, socioeconomic status, and other critical factors.

12:00 Geoffrey’s service on The National Health Equity Task Force under the leadership of Dr. Rachel Levine.

12:30 Participating in a national advocacy effort to address the disproportionate health outcomes of the COVID-19 pandemic.

14:30 The Health Equity design sprint led by Karen DeSalvo and Google to examine COVID-19’s impact on vulnerable populations.

15:00 What would it look like if we lived in a society without health disparities? – Geoffrey speaks about the power of data to knock down silos in healthcare that prevent equity.

16:00 The Leadership of David Satcher and Daniel Dawes in addressing disparities through holistic approaches to data, community, intersectionality, policy, healthcare, and SDOH

17:00 “There are so many people that don’t understand why we talk about issues of inequity and health disparities. We have to look through every lens to address this issue systemically.”

18:00 “Speak up, speak out, get in the way. Get in good trouble, necessary trouble, and help redeem the soul of America.” – John Lewis

19:00 How the risk-averse nature of healthcare is a barrier to the adoption of innovative products, treatments, interventions, and technologies that could help transform thousands of lives.

20:30 Board members and trustees of hospitals and health systems need to be educated in value-based care and health equity.

21:30 “If there is one aspect of our U.S. healthcare system that we have not done well, it is the engagement of our governance structure in health equity and value-based care.”

23:00 Geoffrey explains how entrenched organizational inertia within functional departments of health systems stifles innovation to advance equity.

24:15 Overcoming the “Political Determinants of Health” by fostering public-private partnerships.

25:30 The reskilling and upskilling of the workforce to ensure a high-value system will require scalable educational solutions.

26:30 Geoffrey discusses the importance of certificate and microcredential programs to address future workforce needs in value-based care.

27:45 “We have to create a society in healthcare that values the importance of workforce education to advance health equity and population health.”

28:30 “Health systems that do not embrace Competency-Based Education are actually harming their workforce strategy.”

29:00 Overcoming the slow resistance to education to empower healthcare transformation.

30:30 “The education of the healthcare workforce should not be managed by Human Resources.  It should be managed by Strategy and Transformation.”

31:45 The World Economic Forum estimates that, by 2025, 50% of all employees will need reskilling due to the adoption of new technologies and innovations.

33:00 Geoffrey speaks about the need for health systems to partner with Higher Education to develop a collaborative ecosystem for upskilling/reskilling the workforce.

36:00 The intentionality required to think about pathways and pipelines to ensure a diverse healthcare workforce.

36:45 The moral imperative of culturally competent care empowered by an effective DE&I strategy.

37:30 How can Higher Education become an incubator for healthcare system workforce development?

38:00 We are not prepared for the “Baby Boomer tsunami” that will decimate the supply of workers.

39:00 Career mobility is a secret weapon in the ongoing struggle to retain talent.  How can value-based care support workforce strategies for attraction, retention, and mobility?

40:00 Geoffrey explains why talking about the resilience of the healthcare workforce is insufficient in addressing the root causes of burnout and moral injury.

41:00 Engaging the workforce in value-based care is critical in care delivery redesign and cultural transformation.

42:00 Provider and workforce experience is just as important as patient experience.

43:00 Creating a “safe space” where workers are empowered to speak up about issues impacting patient safety.  How workforce fears leads to patient deaths.

44:30 Addressing Health Worker Burnout (35-54% of nurses and physicians and 45-60% of medical students and residents are reporting symptoms of burnout!)

45:30 Researchers estimate that annual burnout-related turnover costs are $9 billion for nurses and $2.6 to $6.3 billion for physicians.

46:30 The need for healthcare leaders to addressing workforce burnout with systems-oriented, organizational-level solutions (not just pizzas, back massages, yoga, and mediation apps)

47:30 Governing Boards need to address workforce burnout as their fiduciary responsibility.

49:00 The need to change nursing shifts and provide opportunities for workforce debriefings to reflect on care processes.

50:00 Healthcare workers should be treated like athletes and given breaks (rest brings about higher performance).

51:45 Referencing Chris Lowney’s book “Heroic Leadership”

52:15 Geoffrey shares his insights on the importance of love-driven leadership and the importance of authenticity and mentorship.

53:30 The culture of bullying in the medical profession needs to be overcome with love-driven leadership.

54:00 Mentorship programs that provide love, guidance, and inspiration.

55:00 Leaders that do not proactively seek out opportunities as a mentor – “It is time for them to go!”

55:45 Cultural awareness of the need for belongingness and inclusion and why leadership is not about titles.

56:45 Toxic tribalism and hyper-polarization on major societal issues impacting public health…issues like mass shootings, climate change, abortion rights, and gender-affirming care models.

58:00 “If you don’t advocate on these issues, you will further exacerbate the trajectory of health disparities.”

59:00 Advocacy for marginalized populations goes back to the origins of our healthcare system. Getting into “good trouble” is the right thing to do.