MediStrategy with Kip Piper offers informative interviews with healthcare leaders and insights on hot business and policy issues in Medicare, Medicaid, and health reform. Health executives, policymakers, entrepreneurs, authors, and other influencers share challenges and opportunities in America’s rapidly changing $3.2 trillion health care system. MediStrategy is hosted by Kip Piper, a national expert on Medicaid, Medicare, and the Affordable Care Act (ACA or Obamacare). An influential consultant, speaker, and author, Kip Piper advises health plans, hospitals and health systems, states, pharmaceutical and biotechnology firms, medical device and diagnostics companies, and investment firms. Kip Piper blogs on health business and policy issues at www.PiperReport.com. Learn more at www.KipPiper.com and follow on Twitter @KipPiper.
MediStrategy Ep 11 - Juan Pablo Segura, Babyscripts
MediStrategy with Kip Piper Episode 11:
Improving Prenatal Care and Birth Outcomes Via Mobile Technology: Interview with Juan Pablo Segura of Babyscripts
What if we could eliminate preterm birth by 2027? There’s an app for that.
That is the moonshot goal of Babyscripts, a new model in pregnancy management that seeks to improve prenatal care and birth outcomes by supporting both pregnant moms and their physicians. The app has been adopted by several of the nation’s top health systems, including MedStar Health, George Washington University Medical Faculty Associates, Northwestern Medicine, UT Physicians, and Aurora Health.
A graduate of Notre Dame’s Mendoza College of Business, Juan Pablo Segura is the Co-founder and President of Babyscripts, the only doctor-delivered digital health tool that employs remote monitoring and big data to detect problems sooner. The innovative Babyscripts technology has been recognized by Startup Health as a ‘Healthcare Transformer’ and by CTIA as a ‘Wireless Lifechanger.’ The venture was also a member of the inaugural GE Consumer Healthcare program. Segura is a sought-after speaker on the future of digital health and consumer empowerment in the healthcare space; he has given presentations at mHealth, HIMSS, WEGO Health, Health Datapalooza, and Health 2.0.
Today Segura discusses how the Babyscripts mobile app can improve birth outcomes, more rapidly detect at-risk pregnancies, facilitate patient-doctor communication between office visits, improve patient satisfaction, increase reimbursement for obstetricians, and lower overall healthcare costs. Listen and learn how the Babyscripts team has ‘labored’ to create and test a groundbreaking, evidence-based mobile app available only through obstetricians.
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[2:25] The nuts and bolts of Babyscripts
New model for managing pregnancy Employs remote monitoring and big data Detect problems faster Help obstetricians deliver better care and improve birth outcomes [4:38] How the Babyscripts app works for doctors and moms
Pregnancy is, of course, not a ‘disease’ 60-70% of pregnancies are low-risk App functions to detect complications in a preventative manner [8:25] Segura’s motivation to focus on prenatal care
His mother experienced two miscarriages, yet no explanation offered Fascinated by ‘internet of things’ and data Wants to rethink how pregnancy care is delivered [13:35] How Babyscripts is distinct from other pregnancy apps
Only available through doctor (mobile prescription) Partnership with physician increases engagement Automation allows doctor access to data on blood pressure and weight [21:18] How Babyscripts functions
App provides expectant mothers to-do list, with evidence-based tasks approved by their doctor Mommy Kit shipped to patient containing blood pressure cuff and weight scale Minimum of one reading per week sent to doctor Doctor are alerted to abnormalities in real time [28:16] The process of validating the ROI story
Majority of doctors paid lump sum for prenatal care and delivery (regardless of number of visits) Data collected at home reduces 40-50% of visits to doctor’s office Frees up slots to maximize revenue and reduce costs Allows doctors to spend more time with patients with high-risk pregnancies [39:30] Why treating obstetrical care like a commodity does not produce optimal results
System imposes one-size-fits-all model Money not spent in most beneficial way [44:52 ] The traction Babyscripts is gaining with health plans, state Medicaid programs, and leading health systems
Used to providing reimbursement for scientifically validated methods Fond of innovation Babyscripts studies have proven increased compliance and patient satisfaction [58:39] Segura’s best advice for ent
MediStrategy Ep 10 - Nancy Kohler, Value-Based Purchasing
MediStrategy with Kip Piper Episode 10:
Value-Based Purchasing with Healthcare Consultant Nancy Kohler of Sellers Dorsey
Savvy consumers seek the best value for their money, evaluating the benefits of a product prior to purchase. Elsewhere in the economy, it seems obvious that we should hold a manufacturer accountable for delivering a quality product. With health care reform, this concept has at last been applied to medical care via the value-based purchasing model. Rather than simply paying fee-for-service which rewards volume, health care consumers, health plans, and purchasers - state Medicaid programs, federal Medicare program, and employers - can hold providers responsible for outcomes.
As a consultant with Sellers Dorsey, Nancy Kohler provides assistance in federal and state health policy issues, financial analysis, and project management. Before joining the firm, she played a key role in the implementation and operational aspects of the Statewide Quality Care Assessment for the Pennsylvania Department of Human Services. The initiative provided millions of dollars in revenue to the Commonwealth's many hospitals and modernized Pennsylvania Medicaid hospital reimbursement.
Ms. Kohler's comprehensive portfolio of experience includes both large and small scale public health program operations, policy development and fiscal analysis. She spent 20-plus years at KePRO, dedicating the last six years of her tenure as the vice president of public programs. Nancy Kohler has her master’s degree in Health Services Administration and is a Registered Health Information Administrator and Certified Professional in Healthcare Quality.
In this episode, she outlines the core characteristics of the value-based purchasing model, the challenges faced by Medicaid in transitioning to value-based purchasing, and the federal and state collaboration key to further reform efforts. Well-versed in how current legislative proposals might affect value-based purchasing, Kohler explores Congress' efforts to repeal and replace the ACA, the fate of MACRA, and HHA Secretary Price’s advocacy for relief from administrative burdens.
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[2:48] How Kohler got involved in value-based purchasing
Working in healthcare for 25 years Managed large, complex federal and state projects in quality improvement Appreciates the diversity of a career in health care management Values the ability to make an impact on the health and well-being of populations served Welcomes the opportunities for innovation and learning Led TRICARE national quality monitoring contract, gained insight into how managed care organizations provide oversight Current role involves value-based purchasing initiatives for several state Medicaid programs [6:47] Goals of value-based purchasing model
Control rising costs Improve outcomes Replace ineffective volume based fee-for-service model [7:36] Core characteristics of value-based purchasing
Measures provider performance Assigns accountability (transparent, timely, actionable approaches) Uses reimbursement/incentive pay to achieve quality-related goals Aligns finances of reimbursement with patient outcomes Places providers at risk for their performance Drives care delivery reform [11:01] Challenges faced by Medicaid in transition to value-based purchasing
Complying with fluid, highly complex federal regulations Limited experience with new payment models Complexity of implementation Limited resources Budget planning processes Collection, exchange, a and integrity of data [14:08] The role of the state with respect to value-based purchasing
Hold providers and managed care organizations accountable for cost and quality of care Lead and grow innovations in VBP Implement alternative payment models (states as laboratories of reform) [20:38]
MediStrategy Ep 09 - Bill Lucia of HMS on Medicaid Program Integrity
MediStrategy with Kip Piper Episode 09:
Fighting Healthcare Fraud and Ensuring Medicaid Program Integrity: Interview with Bill Lucia, Chairman and CEO, HMS
“Fighting health care fraud is like playing Whac-A-Mole.”
Our nation’s $3.2 trillion healthcare system is a complex beast. To ensure its integrity, we must combat a range of issues – from unintentional errors to criminal activity. Today’s guest is an industry leader in leveraging data analytics and the benefit of a national perspective to identify bad actors and ensure that Medicaid is the ‘payer of last resort.’
Bill Lucia is Chairman and CEO of HMS Holdings, the nation’s largest and most successful company dedicated to providing the broadest range of healthcare cost containment solutions to help purchasers, plans, and at-risk providers improve performance. HMS works with 45 state Medicaid programs, 250 health plans, Medicare, large employers, and provider organizations to help contain costs and protect our nation’s healthcare system from fraud, waste, and abuse.
Lucia joined HMS in 1996, becoming chairman, president, and CEO in 2009. He is responsible for leading HMS through the evolving healthcare landscape, demonstrating the ability to formulate and implement key strategic initiatives.
Today he shares HMS’s holistic approach to safeguarding the integrity of the $590 billion Medicaid program via technology, know-how, and advanced analytics. Listen and learn about HMS’s pioneering work in the areas of fraud detection, overpayment recovery, and coordination of benefits as well as the organization’s policy recommendations for Medicaid reform.
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The mission of ensuring the integrity of nation’s healthcare system by reducing costs and removing fraud, waste, and abuse.
The complex nature of the Medicaid system:
$590 billion program Over 1 in 4 Americans enrolled in either Medicaid or CHIP (77 million in Medicaid and 6 million in CHIP) Covers more types of services and providers than Medicare or any private insurer Serves the most clinically and demographically diverse and most vulnerable, highest cost populations Constantly changing How HMS works to ensure program integrity in Medicaid:
Verify that claims paid by appropriate party (coordination of benefits, third-party liability) Confirm that claims are paid accurately (billed appropriately, medically necessary services, no errors related to policy) How technology, know-how, and analytics are used to:
Identify providers with a propensity for incorrect billing Recognize program rules that cause errors Anticipate potentially fraudulent activity How pattern recognition is used to detect inaccuracies and fraud in claims:
Unintentional errors in billings to Medicaid and commercial health plans) Fraud such as billing in excess of 24 hours/day, 230 days/year The significant return on investment from HMS program integrity work:
Over $1B in taxpayer dollars recovered annually Far more saved through cost avoidance 90% of their work is done on contingency Average return on investment (ROI) is 15:1 One state reported 900% ROI How to make the case for preventative measures (vs. recovery dollars):
States always looking to rein in costs and balance budget Keeps the state in compliance Benefits constituents who might not have healthcare otherwise How HMS has built the industry standard with regard to coordination of benefits:
Feed eligibility data to established database Identify beneficiaries with third party coverage (10%-13% of Medicaid enrollees also have private coverage) Ensure that Medicaid is the ‘payer of last resort’ How to leverage advanced analytics:
Employ visual and geospatial analysis to identify fraud Track members with chronic conditions (23% of members incur 90%
MediStrategy with Kip Piper Ep 08 - Gil Carrara, MD on Physician Recruiting
MediStrategy with Kip Piper Episode 08 - Recruiting Top Physician Talent: Interview with Gil Carrara, MD, Leading Health Care Executive Recruiter
This episode offers valuable insight into recruiting physicians for leadership, management, clinical, and scientific roles. Today's competitive policy landscape has fundamentally changed physician recruiting. Industry leader Dr. Gil Carrara discusses the changes in health care recruiting, and what health care organizations need to know to identify, recruit, and retain top physician talent. He offers tips for aspiring executives and physician leaders who want to position themselves for advancement.
Topics covered also include how the new public rating systems for physicians, hospitals, and other providers is changing the industry and how “people analytics” are transforming recruitment, hiring, assessment, and retention practices.
Understanding new developments in physician recruiting and retention is critically important to health insurers, hospitals and health systems, integrated delivery systems, accountable care organizations, life sciences companies, multi-physician practices, and government health agencies - as well as physicians seeking leadership and management roles in the healthcare industry.
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Health care organizations can do better to recruit top talent.
Organizations need to understand that:
● Competition for top physician talent is fierce.
● Candidates are very aware of the marketplace and their value in that marketplace.
● Organizations need to articulate their organizational culture and share that with candidates.
● Candidates want to know about opportunities for career advancement within the organization.
● The process doesn’t stop with hiring — organizations must maintain sustained contact with the new hire.
Recruitment and hiring practices in the health care industry are changing dramatically.
In the past, hires hinged on the size of someone’s CV, the institutions they’d worked with, the universities they graduated from, or how well the candidate interviewed.
Core competencies, and the means to accurately assess those competencies, are the future of successful recruitment.
The new star rating systems (publicly rating health plans, hospitals, and physicians on their performance) is an industry game changer and will change how hospitals, health systems, health plans, and others operate and what they need in physician leaders.
There are exciting new tools more effectively identify and screen top talent, like people analytics.
● People analytics herald a sea change in how human resource departments make hiring decisions.
● The approach gives more effective, unbiased assessments of candidates.
● It can help bring more diversity to the workplace, short-circuiting the tendency of hiring managers to hire people just like them.
Innovations in the health care industry are changing the kind of leadership and management that organizations need.
Big changes in the health care industry include:
● CRISPR, or gene editing, allows researchers to cut out faulty, damaged, or disease-causing pieces of DNA, replacing them with healthy pieces. This technology will potentially revolutionize how we treat diseases.
● Big data, or new ways of understanding the data we’ve already collected, will change the face of the industry.
● Consumer health care, including wearables, is pushing health care back towards the patient. There will be dramatic changes as healthcare is put back into the individual’s hands.
How aspiring health care executives and physician leaders can better position themselves for career advancement.
● Educate yourself on the marketplace. Talk to other people, network, and learn about different companies and their cultures.
● Manage e
MediStrategy with Kip Piper Ep 07 - David Lansky, PhD, Value-Based Health Care Purchasing
Value-Based Health Care and Purchaser Value Network: Interview with David Lansky, PhD, President and CEO, Pacific Business Group on Health
Today’s episode is about value-based health care and the Purchaser Value Network, a new nationwide initiative to educate key purchaser sectors – private employers, states, and federal purchasers – on value-based purchasing and to leverage best practices and lessons learned to accelerate the adoption of value-based payment and care delivery reforms. Kip Piper interviews David Lansky, PhD, President and Chief Executive Officer of the Pacific Business Group on Health on the Purchaser Value Network.
Led by the Pacific Business Group on Health or PBGH, the Purchaser Value Network is a network of and for purchasers that aims to accelerate the adoption of high value healthcare delivery and payment models through policy advocacy, education and training, and purchaser engagement. It is an effort to inject purchaser perspectives and innovative best practices into federal and state policy decision making, educate employers about value-based purchasing and advocacy opportunities, and align the most powerful buyers of healthcare - private employers, state Medicaid agencies, public employers, and the federal Medicare program - around evidence-based practices.
The Pacific Business Group on Health represents large national and regional purchasers, both public and private, that together buy health care for some 10 million individuals across the US. PBGH, which runs an impressive array of successful health innovations to manage costs and improve outcomes, also collaborates with a diverse range of stakeholders on national health care policy issues.
Dr. David Lansky, one of the nation’s top experts in accountability, quality measurement, and health IT, has led PBGH since 2008. Dr. Lansky’s impressive background includes service on the boards, as a founder, or as an advisor to many of the nation’s top organizations dedicated to improving outcomes, reforming payment, reducing medical errors, increasing transparency, and advancing the use of health information technology.
Learn more about the Purchaser Value Network at www.pvnetwork.org. Learn about the Pacific Business Group on Health at www.pbgh.org and follow on Twitter at @PBGH_Updates.
The MediStrategy podcast covers hot business and policy issues in Medicaid, Medicare, and health reform, with interviews with leaders and experts and insights on health policy, finance, and business strategy. Subscribe free and listen on iTunes, SoundCloud, Stitcher, or any podcast app. Learn more at www.MediStrategy.com.
MediStrategy is hosted by Kip Piper, a national expert on Medicare, Medicaid, and health reform. A prominent consultant, speaker, and author, Kip Piper advises health plans, hospitals and health systems, state Medicaid agencies, pharmaceutical and biotechnology firms, medical device and diagnostics companies, private equity firms, and health industry groups.
MediStrategy with Kip Piper Ep 06 - Nona Footz, Life Sciences Industry Recruiting
Board Director and Executive Recruiting in Life Sciences Companies: Interview with Nona Footz, Managing Director, RSR Partners
The life sciences companies are looking for new board members and senior executives. In this episode, learn how pharmaceutical, biotechnology, medical diagnostics, and medical device firms find new board directors, chief executive officers, and other leadership talent. Nona K. Footz, managing director of RSR Partners, explains how the needs of the life sciences industry have changed dramatically, with companies now seeking different backgrounds and experience for open board director and c-suite positions. Ms. Footz shares valuable insights into today’s search process, explains how retained recruiters work with companies, and offers advice on working effectively with recruiters. Nona Footz and her colleagues are on the web at www.RSR Partners.com and on Twitter @RSRPartners.
The MediStrategy podcast covers hot business and policy issues in Medicaid, Medicare, and health reform, with interviews with leaders and experts and insights on health policy, finance, and business strategy. Learn more at www.MediStrategy.com.
MediStrategy is hosted by Kip Piper, a national expert on Medicare, Medicaid, and the Affordable Care Act. A prominent consultant, speaker, and author, Kip Piper advises health plans, hospitals and health systems, state Medicaid agencies, pharmaceutical and biotechnology firms, medical device and diagnostics companies, private equity firms, and health industry groups.
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Five stars! I've had the privilege of Kips professional influence and this podcast is best in class. Current, concise and relevant. You won't be disappointed.