Relentless Health Value

This episode seemed particularly relevant right now because it gives insight into how large self-insured employers are prioritizing their efforts to disrupt health care revenue streams that do not provide adequate health outcomes for dollars spent. This episode's conversation is with Lee Lewis. This is an encore episode. The original was recorded when Lee was the newly minted chief strategy office...

One way to spot a flash point is to notice when people are using different words to describe the same concept. Throughput is one example of this. On one side of the table, you have those who grasp that if a provider organization is concerned about patient outcomes, with few exceptions, building relationships with said patients is essential. It's not entirely clear to anyone anywhere how you manage...

Imagine if innovators in other businesses operated in the way that some health care status quo doomsayers finger wag. So much for failing fast, iterating, and folding learnings into something that might work better. I don't like to see screeds that seem to advocate an approach of "try it a few times at a minimum half-heartedly, fail, and then just quit, because obviously anything worth doing shoul...

If you listen to this show on the regular, you probably have a pretty good bead on a couple of things I've been really into lately. One of them is high-value care versus low-value care. These are terms that are really easy to throw around. You also can get pretty much everybody to agree with a plan to deliver only high-value care and quit it with the low-value care … in theory. But the wheels fall...

When I was talking with Dr. David Carmouche from Ochsner in EP316 about the importance of collaboration amongst anybody trying to actually pull off value-based care, we took a little detour, which I wound up cutting out, into the potential and challenges for health systems to collaborate and do value-based contracts with pharmaceutical manufacturers. It's a really interesting sidebar, though, that...

If you want to hear what my mom and dad, both Medicare Advantage patients in their late 70s, have to say about telehealth (or teleconferencing, as my dad puts it), you'll have to listen to the episode. They are not and have never been health care professionals, but they fully get that the question "What's better—telehealth or in-person care?" asked like it's some kind of winner-takes-all cage figh...

I'll tell you what I wanted to figure out: How does care improve in SNF (skilled nursing) or assisted living facilities? My starting point in contemplating a possible path toward this goal was advanced primary care. There is so much talk and evidence these days about advanced primary team-based care and how much patients like it, the low-value care it could potentially prevent downstream, and the...

I heard someone say the other day, "Practicing medicine without pharmaceuticals is like running to the ten-yard line, putting down the ball, and walking off the field." So, it's pretty imperative that providers and Pharma know how to work together to get the best outcomes for patients. In this context and in this podcast, when I say "get the best outcomes for patients," I kinda mean it. There's a...

Let's get a fast bead on what's going on with drug pricing reform, shall we? Every time I wade into these waters, my head about explodes. So, I very much appreciate the opportunity to quiz Josh LaRosa from the always-well-informed Wynne Health Group. Here's the goings-on in a nutshell: There's goings-on. This infrastructure bill that's in all the news all over the place right about now? You know w...

I don't know what I thought we were going to talk about during my interview with David Carmouche, MD; but I'm glad it turned out exactly as it did. Lately, we've had a number of guests on Relentless Health Value talking from the point of view of the employer: what a self-insured employer wants and needs from the large, and small, providers in their network. In this episode, we're flipping the scri...

Medicine is complex. It's getting more complex. We double what we know in medicine every 73 days. There's 800,000 journal articles published every year. It is impossible for any human to keep up. It's just impossible. There's a lot of talk about amazing technology to help humans manage the 26,000 variables in heart failure treatment or what have you. And, yeah, I'm a huge fan of technology doing w...

Have you never heard of the Nuka System of Care? If that's the case, it is an award-winning and really remarkable health system in Alaska. In this 5-minute "An Expert Explains," Dr. Douglas Eby, medical director over at Nuka, gets directly to the point. A key component to making sure that the people/customers in your plan get the best care is to make sure that they have access to a team of provide...

This episode is for anyone as curious as I have been about pharmaceutical supply chain goings-on in long-term care facilities like skilled nursing facilities, otherwise known as SNFs. There are a lot of players in the mix: You have your PBMs. You have your wholesale pharmacies. You have your LTC (meaning long-term care) pharmacies. You have the facilities themselves. You also have Medicare Part A...

Let's talk about one aspect of health care that's not talked about possibly often enough: big national health care players siphoning money out of local communities—potentially a lot of money depending on where you are and considering that health care is inching toward about 20% of the GDP. But besides the money leaving the community, another downside of large national players is that sometimes pro...

This episode is a master class in raising health outcomes at lower costs from an award-winning health care system in … Alaska?! Who knew? In fact, I learned about the work of the Southcentral Foundation and the Nuka System of Care only because I happen to listen to Swedish health care podcasts and heard about them on one of those shows. Color me surprised when the interview suddenly switched to En...

This episode might be about local providers getting disintermediated not by virtual front doors like I discussed with Jeff Hogan in EP309 but by entities providing virtual continuous care at home. Predictivae and proactive, the idea is to help reduce acute events requiring on-premises care. But if someone does wind up needing ramped-up care, they can get it hospital at home or SNF (skilled nursing...

In this health care podcast, Ge Bai explains GoodRx's business model and how PBMs and pharmacies fit in to that business model. Here's the short version: GoodRx takes advantage of the dysfunction in the pharmacy supply chain. And while they help patients save money, their master plan only works because pharmacies would be charging cash pay patients too much in most circumstances. Why, you might as...

The Shkreli Awards have been published each year, for the past five years and counting, by the Lown Institute. The Shkreli Awards are a much-anticipated top 10 list of the worst examples of profiteering and dysfunction in health care. This year's list, celebrating the most excellently egregious profiteering in 2020, are unique in the sense that everybody on this list this year—every one of them—de...

This episode is a tale of what happens when some employers decide to open up a few virtual front doors and when these virtual front doors lead only to referrals to providers who are willing to be accountable and offer financial predictability. That's what these employers want, after all. They want accountability and financial predictability. Many employers now have access to all claims databases a...

And here I thought I knew a lot about value-based care. In this health care podcast, I am speaking with Mark Fendrick, MD, who is the director over at the University of Michigan Center for Value-Based Insurance Design. This conversation is for those of you who already know pretty much about value-based care concepts. If you do not, I'd go back and listen to, say, Encore! EP206 , with Ashok Subrama...

In this health care podcast, I speak with Loren Adler, who is the associate director of USC-Brookings Schaeffer Initiative for Health Policy and has a particular focus on surprise billing. I wanted to talk to Loren about the surprise billing legislation that is going into effect on 1/1/22. I will let Loren explain, but, in short, this legislation removes the patient from the mix. If a provider dec...

Here's a trigger warning: This show gets pretty deep into some of the nether regions of PBM (pharmacy benefit manager) contractual terms with pharmacies. If you are not, I'm gonna say, pretty familiar with PBM goings-on, I'd suggest you listen to EP241 with Vinay Patel first or skip the first third of this show.   In this health care podcast, I am speaking with Ge Bai about Amazon's pharmacy busin...

My guest in this health care podcast is Darrell Moon, who is the CEO over at Orriant. I was super intrigued by some of the work that Darrell and his team are doing regarding high-cost claimants. Said a different and probably better way, certain people in need of care were identified because they were costing so much. Year after year after year, these individuals—I call them hyper-users during this...

I had a vision for this inbetweenisode. I wanted to highlight the wisdom of our amazing guests this year. I really wanted to find some theme that might be a key to our health care transformation. To achieve maximum suspense, here's the very short story of how I got from "Is there a common thread of wisdom throughout all the RHV episodes this year?" to "Why, yes, there is … and it's a good one!" So...

In this health care podcast, I speak with Steve Blumberg, VP of practice transformation for GuideWell Health, a subsidiary of GuideWell. How's this for an interesting career trajectory? Steve spent the last decade working on population health and value-based care delivery ... on the provider side. Recently, he transferred over to the payer side, working for GuideWell Health, which is the health se...