Moving to Value Unscripted

Thinking about Dermatology may bring to mind Botox injections and commercials for anti-aging skincare products, but behind the scenes, it’s one of the most broken specialties in healthcare. Long wait times for short visits, some of the most expensive drugs on the market, and a system that too often overlooks patients with chronic autoimmune skin conditions. In this episode, we sit down with Olivia...

“Right now, the value-based care reward is coming into the payers far more than it’s coming into the providers.” A primary care provider shortage is on the horizon. Between resolving coverage disputes, trying to get reimbursed for services, and limited time with patients, PCPs are burnt out. But what if we reimagine the primary care payment model to work better for providers and patients?   In thi...

From geography to network adequacy and endless waitlists, getting seen by a specialist can be tricky. And the challenges are even more pronounced for underserved communities – who may be hours away from the provider they need to see, or whose insurance might not be accepted by specialists. Then, after waiting months for an appointment, it may turn out to be one of the many specialist referrals tha...

We’re just a couple months into the second Trump administration, and already we’re seeing a massive push to reduce federal spending. One program that seems to be on the chopping block: Medicaid.  In late February, House Republicans passed a budget resolution that would drastically reduce federal funding for Medicaid . What’s really going on in Washington? How would proposed cuts impact states – an...

Managing chronic diseases like diabetes and hypertension is one of the most pressing challenges facing our health system. And Dr. Bill Bestermann has a solution: Optimal Medical Therapy.  Optimal Medical Therapy is a comprehensive, evidence-based approach with the power to prevent adverse events, improve patient outcomes, and dramatically reduce healthcare costs.  A board-certified internist and e...

“I’d like to leave an infrastructure behind that is better than the one I encountered when I came in, because we're stifling innovation, we're stifling creativity, we’re stifling advance.” How can decentralization and transparent pricing reshape American healthcare? In this episode of Moving to Value , the MTVA Board sits down with Steve Wiggins , a healthcare entrepreneur with 40 years of...

Drug spending continues to escalate, accounting for an even bigger portion of total U.S. healthcare spend each year. Why do we pay so much for medications? Are the drugs we buy truly worth the price we pay? How can we figure out the real value of a medication?  Pramod John joins the MTVA Board to help answer these questions and more. Guided by cold, hard data, Pramod expertly demystifies the drug...

“There are medical schools whose mission is to build the researchers of the future, we all know who those are. There are other medical schools to build the community clinician of the future, great. And I’m about: let’s build the scholars and leaders in quality and in population health for the future.” Professor David Nash, MD, MBA  joins MTVA for a conversation about his trailblazing career and th...

“We are incentivized to practice medicine based on reimbursement, so that has resulted in more procedures, more pharmaceuticals, and less time with our patients. That has to change.” MTVA is joined by Elizabeth Boham, MD to discuss functional medicine. Dr. Boham uses her background in nutrition to help patients improve their health, and manage diseases including insulin resistance, Metabolic Syndr...

“Just because it’s healthcare, doesn’t mean it’s good for you.”  Al Lewis joins MTVA for a lively discussion on patient education, nutrition, and overconsumption of healthcare. After a doctor’s visit for hoarseness where he was recommended unnecessary testing, Al decided to use his background in Trivia and create a new tool for patient health literacy. Quizzify was born!  Quizzify is designed to p...

The Moving to Value Alliance (MTVA) has been promoting value in health care for over 7 years. Though we’ve seen some progress, spending is steadily rising, many health outcomes remain unchanged, and burnout is a real problem for healthcare professionals. It can be easy to feel discouraged, but that’s not what MTVA – nor our special guest this week – stand for.  “I feel like it’s a choice in a way...

Pharmacists are one of the most trusted professions, yet more and more pharmacies are closing. A recent survey found 2275 pharmacies have closed so far this year, and every day independent pharmacies are shuttering their doors – often leaving “pharmacy deserts” in their wake.  Vertically-consolidated Pharmacy Benefit Managers (PBMs) have made it practically impossible for local pharmacies to survi...

Many successful companies have ventured into the healthcare space and failed.  Why can’t businesses that are household names make it work in our industry? Where do retail investments in health care go wrong? What is missing from their approach to primary care?  Health care reform legend Brian Klepper joins MTVA to explain the pitfalls companies make and why they can’t seem to nail down a sustainab...

We all know the cost of prescription drugs in the U.S. is a problem. How did we get here and what can we do about it?   This week, MTVA Board Members Dr. John Rodis and Dr. Steven Schutzer are joined by MTVA Executive Director Laura Wadsten for an engaging discussion with Senior Pharmacy Consultant ⁠Luke Slindee⁠ , PharmD.  Luke is a second-generation pharmacist who has witnessed first-hand how hi...

“There’s a reason that over the last 45 years, the PBM model has been the darling of Wall Street: because it makes a heck of a lot of money for its investors.” – Roy Wilkinson PBMs are in the hot seat: Last week, the House Committee on Oversight and Accountability pressed the CEOs of United’s Optum Rx, Cigna’s Express Scripts and CVS Caremark (the “Big 3”) on allegations of profiting from unfair p...

Rollups, takeovers and buyouts. Oh my! With increasing fear about private equity in health care, the MTVA Board is joined by Dr. Marco Fernandez and Jack Dillon of the Association for Independent Medicine to discuss their perspectives on private equity and best practices for maintaining or reclaiming an independent practice.  The Association for Independent Medicine (AIM) believes that maintaining...

Though ERISA is often thought of as an issue for retirement plans, the law has always applied to employer-sponsored health benefit plans. The Consolidated Appropriations Act of 2021 (CAA) sought to put a spotlight on the issue by clarifying responsibilities of health benefit plan fiduciaries and the third-party service providers they contract with. Yet, 3 years after its passage, many plan sponsor...

“We have to cherish the opportunity in front of us. We’re at a point that public awareness of the current system failure is unprecedented.”  American health care is in crisis, but this expert says there’s reason for hope. MTVA spoke with renowned scholar Ge Bai, PhD, CPA about the dynamics underlying problems in our system, and how middlemen keep taking a bigger piece of the pie. She makes the cas...

This episode is a must-listen for all plan sponsors and employers!  “In American business you don’t expect your major vendors to be profit-gouging you, and you don’t expect these major consulting firms to be taking their side instead of yours.” – Paul Holmes  As Pharmacy Benefit Managers (PBMs) face mounting scrutiny from policymakers and the public, health plan fiduciaries can’t ignore the money...

Join MTVA for a conversation with Dr. Scott Conard, MD, as we delve into the transformative power of purpose-driven healthcare. From fee-for-service models to data-driven initiatives, we explore improving healthcare outcomes, challenges in elder care, and the importance of a social model of care. Discover how autonomy, mastery, and purpose shape healthcare success and the need for a shift toward p...

In this episode, the MTVA team delves into the challenges and obstacles faced by a leading healthcare system in its transition into a patient-centered care model. Joined by Mount Sinai Health System's CMO and Senior VP of Population Health, Dr. Arshad Rahim, we discuss the complexities of aligning financial incentives with outcomes-based care principles, leveraging data-driven insights to driv...

The gig is up. Wake up and smell the coffee. It’s finally happened. After years of speculating what an employee complaint against an employer for breach of fiduciary duty would look like, it has arrived. And this one doesn’t disappoint. Johnson & Johnson is being sued by its employees, alleging that their health plan overpaid for prescription drugs, costing workers money. This suit touches on...

In the last episode of 2023, MTVA team leaders Jeff Hogan, John Rodis, MD, and Lisa Trumble dish out candid insights into the state of value-based healthcare and take a glimpse into 2024. They unpack the trend of primary care physicians shifting gears from employment to independence, delve into the pivotal role of employers in healthcare plan buying and management —hint: data analytics is STILL th...

Buckle up, folks. Things are changing. We’re seeing influencers out there in the healthcare marketplace cause the behemoths to change their behaviors. We're also seeing some of the biggest companies in the country invest in solutions…to give better access to care, create predictability around outcomes, and get their data so they have better insight into their unique populations. Is it too earl...

The MTVA team engages in a thought-provoking conversation with AJ Loiacono, CEO and Founder of Capital Rx, delving into the intricacies of pharmacy benefits and the challenges faced by employers in navigating the healthcare landscape. Loiacono provides insights into the complexities of drug pricing, the far-reaching effects of the Consolidated Appropriations Act (CAA), high-cost drugs, and the imp...