We are in a race to make health value work in the country. The imperative to drive health value is no longer an optional transition. The unsustainable upward cost trajectory of U.S. healthcare spending, coupled with declining outcomes and disparity gaps, are leaving vulnerable populations woefully underserved. To win the “race to value” we me must have disruptive innovation, spirited collaboration, democratized knowledge, realignment of the healthcare workforce towards value-based care competencies, and a collective moral purpose to reform our industry.
In this podcast, leaders from the Accountable Care Learning Collaborative (ACLC) interview the top healthcare executives and entrepreneurs to discuss healthcare’s value economy. Race to Value is the show to connect you with other healthcare leaders working to create better value in health, including provider organizations —hospitals and health systems, physician practices, and post-acute providers — health plans, pharmaceutical and life-science firms, health information technology firms, medical device manufacturers, and a multitude of other stakeholders. We are the ideal resource for leaders of healthcare organizations looking to transition to and thrive in the new reality of value-based care.
The race to value is not unlike any other social movement. As a nonprofit organization focused on industry transformation, the ACLC is here to catalyze a movement to value-based care. Patients are being harmed by the current healthcare system which is fraught with perverse financial incentives and structural distortions. Additionally, physicians are experiencing moral injury because they cannot care for patients in the way in which they intended when they began medical training. With its Accountable Care Atlas, a development guide for competency implementation, the ACLC is working with healthcare organizations all over the country to create the workforce of tomorrow.
There is a better way. The Race to Value podcast is here to bring to you the brightest minds making waves in the industry with their leadership and innovation. Our mission is to harness their brainpower to facilitate transformation in our country’s healthcare system. Come join us to listen to these disrupters as they share their vision to reorder the healthcare universe. Now is the time to get inspired -- we can win this race to value.
Black Health Matters: Improving Population Health Equity within African American Communities, with Dr. Richard W. Walker
It’s no secret that the Black community tops the list of groups afflicted by hypertension, stroke, diabetes, heart disease, kidney failure, and cancer. What the statistics do not show is the pain, misery, and despair that these conditions create—not only for the individual, but also for family and friends. As an African-American doctor, Dr. Richard Walker has studied these conditions among his patients for many years. Now, in his new book, “Black Health Matters”, Dr. Walker offers a number of commonsense ways to prevent, manage, and possibly eliminate these killers, turning the tide of African-American health. And he not only provides us with a construct for thought leadership in population health equity, he practices this type of care at his home-based primary care practice TVP-Care in Houston, Texas.
Dr. Walker has spent considerable time in researching the health and healthcare journey of African captives into slavery and understands what current African Americans now to need to do to survive nutritionally and culturally. He is truly on a mission to overcome the chronic ill health and early death that is so pervasive in Black communities. Most importantly, however, Dr. Walker is a leader in the value movement that believes traditional medicine should be merged with lifestyle medicine. He understands that African Americans can turn their health around by understanding and incorporating better nutrition, nutritional supplements, exercise, and regular healthcare checkups into their lives. In this important podcast discussion, we you will learn from a leading clinician and entrepreneur how we should go about improving Population Health Equity within African American communities in this Race to Value!
01:30 Introduction to “Black Health Matters” and the work of Dr. Richard Walker in the health value movement
03:30 What does the use of the word “value” mean when it comes to community health?
05:00 Dr. Walker discusses his upbringing in Spanish Harlem and how that experience led him to become a physician leader seeking to advance health equity
07:00 The “mystery” of excessive hospitalizations due to sugar consumption and how that led to an epidemic of Type 2 Diabetes in the African American community
09:00 The misperception in the African American community that most common chronic diseases are genetic (instead of caused by environmental of lifestyle factors)
10:00 Dismantling the informational disadvantage that leads to a misunderstanding of Social Determinants of Health
12:00 The impact of the murder of George Floyd and the BLM social justice movement and how that inspired Dr. Walker to write “Black Health Matters”
14:30 How the collective experience of African Americans over the last 400+ years has been based on “waiting” (e.g. slavery, citizenship, civil rights)
16:00 “Taking care of your own life is all about taking charge of the environment by understanding the root causes that lead to disease.”
16:30 How poor nutrition in the African American community stems from the slavery era and persists to this day
17:30 The inadequate training of the healthcare workforce further exacerbates preexisting issues of poor health among African Americans
18:30 “Black Health Matters” is all about understanding the progenitors of chronic disease that are not genetic, and how to mitigate them in African American communities.
19:00 Environmental hazards and chemical toxicities are more common in underserved, minoritized communities
20:30 Research that confirms the presence of systemic issues in the healthcare industry related to institutional racism
22:00 “The concept of value-based care is transformational because it has the potential of changing the course in healthcare b...
Reclaiming Trust: Addressing Cardiovascular Health Disparities in Rural, Underserved Communities through CHW-Led Interventions, with Dr. Jessica Barnes and Chip Purcell
A bright future for the nation depends on the health and prosperity of rural America, and unfortunately, we are at a moment in time where life is not ideal in the rural heartland. Although most rural Americans are generally satisfied with the overall quality of life and see their communities as safe, we are reaching a crisis when it comes to financial insecurity, trouble accessing affordable, high quality health care, a lack of high-speed internet access, housing problems, and isolation/loneliness. When it comes to health care, even though most rural Americans have health insurance, about one-quarter say they lack adequate health care access, as they have not been able to get the care they needed at some point in the past few years. Consequently, potentially preventable deaths from the five leading causes are consistently higher in rural counties, especially with heart disease. (Nearly half of deaths from heart disease in rural counties are preventable, compared with 18% in large metropolitan areas.) All of this has culminated into a mistrust of the traditional, fee-for-service dominated healthcare system and created a “shadow population” of underserved minorities and the socially isolated who are dealing with significant cardiovascular metabolic disease.
The Arkansas Lincoln Project is an important population health program focused on improving cardiovascular health in highly underserved, under-resourced areas of the Arkansas Delta Region where economic and health disparities have life altering consequences for rural residents. Joining us this week, we have two population health leaders sharing their insights about their work in deploying community-based cardiovascular health interventions led by community health workers. Chip Purcell is the director of cardiology research at the University of Arkansas Medical Sciences and the principal investigator of the Arkansas Lincoln Project. Joining him is Dr. Jessica Barnes, the co-founder and CEO of 20Lighter, LLC – an award winning cardiometabolic health program, delivering dramatic reductions in inflammation and visceral fat. Together they are winning the “Race to Value” by fighting cardiovascular metabolic disease in the Arkansas Delta, the worst region in the nation for healthcare quality and population health outcomes.
01:30 The challenges of obesity and cardiometabolic disease disparities in Rural America
02:00 Rural Americans facing financial insecurity, poor healthcare access and hospital closures, a lack of high-speed internet access, housing problems, and isolation/loneliness
02:45 “Nearly half of deaths from heart disease in rural counties are preventable, compared with 18% in large metropolitan areas.”
03:30 Introduction to Dr. Jessica Barnes (CEO of 20Lighter, LLC) and Chip Purcell (UAMS Cardiology Research and the principal investigator of the Arkansas Lincoln Project)
05:00 “Rural Americans tend to have higher rates of cigarette smoking, hypertension, and obesity, and report less leisure-time physical activity than their urban counterparts.”
06:20 The US News & World Report ranks Arkansas 50 out 50 states for overall healthcare quality with higher-than-average obesity rates and overall preventable hospital admissions
07:00 “Arkansas is the worst of the worst in health outcomes, and that is where we can make a difference.”
08:00 Mistrust of the healthcare system is pervasive in the Arkansas Delta Region
09:30 The exponential growth curve in building trust through improvement in individualized patient outcomes
10:00 Studying out-of-hospital, premature natural deaths as a proxy for determining population health needs in Eastern Arkansas (how the Lincoln Project began)
12:30 The use of geospatial mapping to identify the highest risk communities to target...
Bending the Arc of the Future Towards Person-Centered, Value-Based Care, with Dr. Mark McClellan
The arc of the future bends in the direction of person-centered care. While payment reform is critical, our nation must also deliver whole-person care models that are exquisitely attuned to both medical and non-medical needs and intentional about addressing unique problems facing racial and ethnic minorities. The entrenched interests perpetuating the status quo of the fee-for-service, medical-industrial complex are immense; however, the pandemic is a catalyst for consumer-driven, value-based payment reform.
In this week’s episode of Race to Value, you will hear from Dr. Mark McClellan, former CMS Administrator and current Director of the Duke Margolis Center for Health Policy. As one of the leading physician economists and health policy leaders in our country, he discusses the future of health reform and value-based care. We cover such topics as health policy and alternative payment models, COVID-19 impacts on healthcare, advanced primary care that goes upstream in the detection and treatment of chronic disease, technology-enabled care delivery transformation, health equity and social determinants of health, specialist integration in person-centered care models, and the path forward to comprehensive value-based care in our country.
01:30 Introduction to Dr. Mark McClellan
03:00 Launching Medicare Part D, Medicare Advantage, and the ACLC (now the Institute for Advancing Health Value)
04:00 “While payment reform is critical, there are other essential steps that go along with it.”
05:30 “In this journey to value that we need to bring all patients along. That means explicit and intentional attention to equity and the special problems facing racial and ethnic minorities.”
06:00 Achieving a whole-person approach to health reform through patient engagement and “going upstream”
07:30 Upstream opportunities to address the prevention and management of cardiovascular disease
09:00 The impact of the COVID-19 pandemic on Value-Based Care and the recent advancements in biotechnology and clinical treatment
12:00 The parallel transformation in care delivery and organizational culture that happens in value-based payment reform
14:00 How innovation in through emerging medical technologies and virtual care technologies will delivery value (even if costs increase)
15:00 Digital apps, home based care, and community-based care to address upstream non-medical factors that the social drivers of poor health
16:00 The limitation of current reimbursement models in addressing the social factors that influence health
16:40 “Payment reform remains an important component of making faster progress in achieving value and achieving equity in our health care system.”
17:00 The work that Drs. McClellan and Mark Harrison from Intermountain are doing as co-chairs of the Health Care Payment Learning Action Network (HCP-LAN)
18:30 The current pace of the value movement and how “accountability for results and value at the person level is really the core theme behind payment reform”
19:20 “The arc of the future for medical care bends in the direction of person-centered care.”
20:00 Perspective on value-based reform success between Medicare, Medicaid, and Commercial plans
20:45 The importance of measuring race and ethnicity reliably and then incorporating a focus on equity for traditionally underserved populations
21:30 Healthcare revenue disruptions during the pandemic as a recognition for the need of value-based payment reforms
23:30 How organizations that were further along in adopting advanced payment reforms experienced less financial disruption during COVID-19
24:30 The newfound appreciation that the American public ...
Defeating Political Sectarianism to Achieve Analytics-Based Value Innovation, with Michael Millenson
As we talk about the current zeitgeist moving us towards value and equity, we also have to think about how polarized our country is politically. Democrats and Republicans live in separate worlds, or “echo chambers,” with each side prone to bias or “motivated reasoning.” This has created an existential threat of tribalism where partisanship has turned Americans against one another. The term that best describes our strife is “political sectarianism,” or the tendency of political groups to align on the basis of moralized identities rather than shared ideas or policy preferences. However, the promise of value-based care is something that we should all agree on in a bipartisan way. The Race to Value is both an economic and a moral imperative, and it can be actualized through relationship-based care, collaborative health models, and the power of advanced analytics.
In this week’s episode, we interview Michael L. Millenson, an internationally recognized expert on making American health care better, safer and more patient-centered. As a leading expert on health policy, quality improvement, and patient-centered care, he provides a deeply informed and unfiltered perspective on how to defeat political sectarianism to achieve analytics-based value innovation. This intellectual conversation leaves nothing unsaid and will provide you with an enhanced understanding of the political challenges of value transformation and how analytics will drive collaborative health in the Information Age.
01:30 Introduction to Michael Millenson
03:30 The “Race to Value” — is this a revolution?
06:00 “Value-based care is the ethically right thing to do.”
06:45 Confusion about value in health. (Public perception equates the term “value-based care” to fast food.)
07:30 Referencing Walter McClure, Ph.D and the ‘Buy Right’ strategy of health care reform
08:00 “Value-based care is the most important transformation of American medicine in our lifetimes.”
10:30 The dilemma of VBC (you must first recognize that poor quality exists currently to realize the potential for value)
12:00 Political sectarianism – how tribalism and entrenched interests hinder health policy
13:30 Winners and Losers in health policy reform and how “motivated losers” fight back!
15:30 How social media and suspicion stifles value-based payment innovation and the promise of bipartisan reform
16:30 Authentic healthcare leaders realize the need for value (there is hope!)
18:30 How do you engage providers to root out clinical variation and unnecessary care?
20:00 The need for Patient Safety and Quality Improvement in Healthcare
21:00 Referencing Michael’s book, “Demanding Medical Excellence: Doctors and Accountability for the Information Age”
22:00 “Hospitals often do not do what it takes to be as safe as possible because there is no return on investment.”
24:30 Referencing Michael’s article “Why We Still Kill Patients: Invisibility, Inertia, and Income”
26:00 The moral challenges of bureaucratic medicine and misaligned economics and how it creates preventable harm
29:00 The disconnect between Cost and Quality
31:00 The ethics of value-based care and the travesty of physicians not speaking up (Referencing Michael’s article “The Silence”)
33:30 The promise of “Analytics” in the future of healthcare (and the similarities to the “Plastics” scene in The Graduate)
34:30 Enhancing clinical outcomes through semantic interoperability, AI, and predictive analytics
37:30 The misperception that population health analytics will impinge on clinical autonomy
39:30 Smart phone technologies and “proactive benefits” to eng...
Effective COPD Management to Achieve Value-Based Care Goals, with Dr. MeiLan Han
Healthcare costs due to Chronic Obstructive Pulmonary Disease (COPD) is in excess of $32 billion due to high rates of re-hospitalizations and ED visits, complex and inefficient clinical pathways during transitions of care, and intensive resource burden on clinical and administrative staff. The average cost per COPD patient readmission in the U.S. typically falls between $9,000 and $12,000. Unlike other high cost chronic conditions like CHF and diabetes, it seems that many ACOs are not as purposeful in their targeting of COPD as part of their population health playbook. This is a massive unmet need with many COPD patients experiencing fragmented and inconsistent care that drives poor clinical outcomes and high economic burden. Consequently, COPD now represents the 3rd leading cause of death and the 5th most costly chronic disease in the US. What is it about this particular chronic condition that makes it so less prone for population health management with ACOs and other risk-bearing entities? Why is this chronic disease so universally undiagnosed? How can we implement chronic care management programs that actually make an impact on patient lung health and clinical outcomes?
For anyone that wants to know more about “Effective COPD Management to Achieve Value-Based Care Goals”, look no further than this week’s episode with Dr. MeiLan Han. She is Professor and Chief of Pulmonary and Critical Care Medicine at the University of Michigan who is widely known for her expertise on Chronic Obstructive Pulmonary Disease. Dr. Han is a leading pulmonologist, researcher, lung health advocate, consultant, and national volunteer spokesperson for the American Lung Association. She is also the author of the new book, “Breathing Lessons: A Doctor's Guide to Lung Health.”
01:30 Introduction to Dr. MeiLan Han (pulmonologist, COPD researcher, lung health advocate, author, and speaker)
05:30 Origins in rural, small town America that led to a career in pulmonary medicine and research
07:00 “Many people that have lung damage and don’t know it. We don’t do a good job of diagnosing lung disease in this country.”
07:30 Only half of the 25-30M Americans with COPD even have a diagnosis!
08:00 Undiagnosed lung disease led to server morbidity and increased mortality during COVID-19 pandemic
08:30 Research continues to be under-funded due to lack of awareness of lung health importance
09:20 11M Americans suffering from long-haul COVID
09:40 Societal threats to lung health (ex: air pollution, hazardous chemicals, plastic microparticles in lungs)
10:00 “The pandemic was a golden opportunity to raise awareness for lung health, but now people are starting not to listen.”
12:00 The impact of race and socioeconomic status on COVID death rates, and overall poor lung health in marginalized communities
13:30 COPD is more common in rural communities where there is less access to care
14:20 Virtual care is not a perfect solution in areas where there is a “digital divide”
16:00 Half of adult Americans have at least one chronic condition and more than two thirds of Medicare patients have two or more.
17:00 Ambulatory Care Sensitive Conditions as an opportunity for ACOs to achieve cost savings
18:30 The challenges of developing and implementing COPD Quality Improvement Measures
19:00 Difficulties in collecting data from spirometry and PFTs in the Electronic Medical Record
20:00 Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations and the difficulties of tracking symptoms and exacerbations
22:00 The lack of reporting requirements on COPD has limited progress of health systems and EHR companies
The Hero’s Journey to Health 3.0, with Dr. Zubin Damania (“ZDoggMD”)
This week we are talking about how value-based care transformation is related to the “Hero’s Journey” monomyth that was initially described by Joseph Campbell, an intellectual known for his work in comparative mythology and religion. Campbell studied religions, all of the greatest literary achievements, mythologies, folklores, and fairytales and discovered that they all involve a hero who goes on an adventure, is victorious in a decisive crisis, and comes home changed or transformed. Leaders in healthcare transformation are on a Hero’s Journey, not unlike Jesus, Buddha, Krishna, Apollonius of Tyana, Odysseus, Superman, Luke Skywalker, and Harry Potter! We all have one thing in common -- we follow our bliss in becoming captivated by population health and health equity and then reach for the stars!
Joining us this week in the Race to Value is the one and only Dr. Zubin Damania. Dr. Damania (aka “ZDoggMD”) is a physician Leader, internet personality, and healthcare influencer with 2.5M Facebook followers and 75M YouTube views. In this special podcast episode (a recording from the closing keynote at the Advancing Health Value Summit), Zubin discusses the transition to Health 3.0 through the monomyth of the Hero’s Journey. In this podcast, we pay special attention to the issues of burnout and moral injury in the healthcare workforce and how we forge a new way for delivering care that is compassionate, relationship-based, and technology-enabled. Can our nation’s healthcare industry successfully make the transition from Health 2.0 to Health 3.0 in this Hero’s Journey? Will health leaders heed the call for adventure and come back home completely transformed? Meet Dr. Damania, your mentor in this journey to provide you (the Hero) with guidance and inspiration to dispel your doubts and fears, while also giving you strength and courage to begin the quest.
03:00 Introduction to ZDoggMD (and how Eric first met him at a 6-day silent mediation retreat!)
05:00 “We are all trying to forge a new way of being in the world when it comes to health care.”
05:20 COVID-19, system fragility, and workforce burnout
06:20 An opportunity for optimism and the two sides of “hero’s work here”
07:30 The Hero’s Journey in healthcare (Health 1.0 à Health 2.0 à Health 3.0)
08:20 Zubin explains “Health 1.0” as a way physicians practiced holistic medicine based on relationship and intuition
10:15 Physician paternalism in Health 1.0 began the Hero’s Journey (just like Luke Skywalker on Tattooine deciding to forge a new path forward)
11:00 The excessive utilization, care variation, and escalating costs of Health 1.0
12:00 The dominator physician hierarchy of Health 1.0 and how that relegated nurses to a lower status
13:30 The origins of “Health 2.0” – a technology-enabled, data-driven business model
15:30 Right-brain (holistic care) vs. Left-brain (reductionist care) that led to a clash in medicine between 1.0 and 2.0
16:30 The shadow side of Health 2.0 (reductionist de-humanization, commodification, and de-personalization) due to the dominator administrator hierarchy
17:30 “Burnout is like renal failure. You are being dialyzed due to chronic moral injury.”
18:00 What is moral injury and how does it apply to healthcare?
19:00 The suffering created by Health 2.0 and how looking inward can help the workforce find equanimity (Awakening)
20:00 The negative feedback loop caused by a flawed system and how that contributes to moral injury
20:20 The Empire of 2.0: How de-personalized EHR systems defeat healthcare heroes by turning them into data entry clerks
22:00 How Zubin reached the apex of 2.0 due to pressures to practice medicine on an assembly l...
The depth you crave
I’ve been to a lot of conferences where I’ve been so excited about the line up of panels, only to feel the moderator barely scratched the surface to what I hoped to hear and learn. This is the alternative where you get free flowing insights in a no rushed way. Eric and Daniel ask well researched questions to pull out the details of the successes and lessons from these leaders that I haven’t heard anywhere else. Note that the episodes are a bit long (that’s the trade off of really getting to the meat of the matter) but well worth the time when it’s a topic or leader you really want to learn from.
Asks the right people the right questions
Always an interesting conversation! I’m an avid listener of healthcare podcasts and think Race to Value is a great addition. The long-form episodes are worth your time.