The Race to Value Podcast Institute for Advancing Health Value

As the healthcare industry moves towards achieving CMS’s goal of having every Medicare beneficiary in an ACO or ACO-like model by 2030, we must focus on patients in institutional settings. For long-term care patients, better care and better health means ensuring patients receive advanced care planning and regular wellness visits. And it also requires providers and facilities to work together in preventing avoidable hospitalizations and unnecessary SNF and hospice utilization. Unfortunately, the needs of geriatric patients in an institutional setting are often overlooked as compared to other populations in the vast environment that falls within the influence of value-based care. LTC ACO -- the first ACO in the country focused specifically on the special needs of Medicare beneficiaries residing in long-term care facilities -- is changing that narrative. The mission of LTC ACO is to dramatically improve the quality and cost of healthcare delivered to these Medicare beneficiaries, rewarding participating providers for achieving these outcomes. Using this approach, it is their vision to revolutionize the way healthcare is provided to Medicare beneficiaries residing in long-term care facilities.



Joining us this week in the Race to Value is Jason Feuerman, the President and Chief Executive Officer of LTC ACO. In addition to leading one of the only ACOs that is dedicated exclusively to management of long-term care facility residents, Jason supports managed care and strategic value-based initiatives for Genesis HealthCare, the biggest post-acute care operator in the country. In this episode, you will learn about LTC ACO implemented a program in the traditional Medicare population that mirrors Institutional Special Needs Plans (I-SNPs). He discusses how the ACO engages and incentivizes providers and facilities and has operationalized a data infrastructure to drive care interventions. They have woken up an entire ecosystem with their approach to value-based care and have generated well over $40M in Shared Savings throughout their lifespan. By focusing on improving care outcomes and engaging providers, they have become the industry-leading exemplar for improving patient outcomes in long-term care!



 



Episode Bookmarks:

01:30 Introduction to Jason Feuerman and LTC ACO, the first ACO focused specifically on the special needs of Medicare Beneficiaries residing in long-term care facilities.

03:00 LTC ACO was launched by Genesis Healthcare, the biggest post-acute care operator in the country, with significant experience in MA risk and bundled payment models.

06:00 Lessons Learned from MA: How Institutional Special Needs Plans (I-SNPs)provided an operational thesis for LTC ACO in the Medicare Shared Savings Program.

07:00 By improving quality and driving down unnecessary costs, LTC ACO returns the Shared Savings earned to LTC facilities and the physicians who support them.

08:00 “Waking up the ecosystem” by providing outcomes data to long-term care providers.

10:00 Achieving capital efficiency in a model where there is no downside risk.

12:00 How capital requirements for delegated Medicare Advantage differ from the MSSP model.

13:00 Less than 15% of residents in long-term care facilities are in a MA plan. (Limited business opportunities in Medicare Advantage)

15:30 Applying the same tenets of I-SNPs to a Medicare ACO (e.g. aligning providers and providing rewards with surpluses)

16:00 “Waking up an Ecosystem”:  Most LTC providers do not know what happens to their patients once they leave the long-term care institutional setting.

17:00 How data can be used to inform long-term care providers how their patients are doing across the continuum.

18:30 The use of AI for population-based predictive analytics to identify potential health risk (see recent Press Release regarding ClosedLoop AI partnership)

The healthcare system in the United States is ailing and in need of a massive value-based transformation. While we are increasingly polarized in our politics, there is one issue on which most Americans agree: our health care system is broken. Despite spending more per capita on health care than any other country, Americans are in worse health, with lower life expectancies, higher hospital admissions, and at greater risk of suicide and maternal mortality compared to peer nations. This is largely because our health care model has been focused on “sick care” aimed at addressing acute or chronic conditions rather than preventive health maintenance. We have increasingly placed greater value on specialty care over primary care. If we are to right the course and seize this historic opportunity to deliver care that is patient-centered and financially accountable for outcomes, we must unleash the potential of massively powerful primary care!



This week on the Race to Value, you are going to learn about Southeast Primary Care Partners (SPCP) – an independent primary care MSO committed to upholding the independence, innovation and collaboration of Primary Care Physicians, with the ultimate goal of transforming healthcare and achieving true value-based care everywhere. Eric Lisle is the CEO, President and Co-Founder of Southeast Primary Care Partners. And joining him is Craig Worland, the Chief Development Officer for SPCP. These two industry leaders paving the way for a revitalization of primary care in the Southeast and are leading a value journey that we are excited to share with you on the podcast this week!

Episode Bookmarks:

01:30 Our ailing healthcare system and the need to unleash the potential of massively powerful primary care.

02:30 Introduction to Southeast Primary Care Partners (SPCP) and our guests Eric Lisleand Craig Worland.

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

05:30 Eric Lisle shares his “Personal Why” and how that informs his leadership in value transformation at SPCP.

06:30 “Our passion is bringing the love of medicine back to primary care physicians.”

07:30 Craig Worland describes personal challenges navigating the healthcare system and how that inspired him to create meaningful change.

08:45 “The fee-for-service economic system is not designed to streamline care delivery in a way that keeps the patient well.”

09:30 How pivoting to a new economic model creates enablement for primary care transformation.

12:00 Value transformation in primary care is often limited by regional dynamics in the payment landscape.

13:30 How primary care enablement improves patient care outcomes.

14:30 Primary care is the only specialty in medicine that increases life expectancy when community access is enhanced.

16:00 Only 32% of primary care physicians work in a private practice outside of corporatized care delivery business model.

17:00 How independent physician-enablement strategy at SPCP creates whole-person care and improves health equity in underserved communities.

19:30 “The culture, leadership, and long-term strategy of a primary care practice must be oriented towards robust Total Cost of Care revenue models.”

20:00 Can hospital-owned and PE-backed primary care groups effectively pursue a value transformation agenda?

23:00 Investing in FTEs to enhance the population health capabilities of a primary care MSO.

24:45 Creating EHR interoperability and data aggregation to empower population health insights.

25:30 How the SPCP MSO leverages capital to invest in a PCP-led, patient-centered care environment.

26:30 Forming effective payer-provider partnerships through spirited collaboration and demonstration of risk capability.

28:00 The SPCP MSO is differentiated through provider empowerment,

Are you ready to climb the mountain and reach new heights for a transformative future?







In the “race to value”, the mountain climber must not be intimidated by the steep terrain of a broken healthcare system. Instead we must look within ourselves, while also finding inspiration from others, to keep climbing! The ultimate summit of value transformation is what drives us, but the climb itself is what matters.  If you are looking for inspiration in your value journey, look no further than our guest this week, Debbie Welle-Powell. Debbie is a healthcare thought leader, educator, national speaker, and content expert in delivery systems, clinical models of care, population health, and digital care. She is also an avid mountain climber, having attempted three of the Seven Summits while also reaching the summit of all 58 of Colorado’s 14,000 peaks. She has also climbed Mt. Rainer in in Washington and Grand Teton in Wyoming and, she has climbed peaks in Bolivia, Mexico, France, Argentina, and Mt. McKinley in Alaska.  In this podcast, you will learn how taking the path least travelled is when you learn the most about yourself and why value transformation is a most noble journey to undertake in healthcare.







As the former Chief Population Health Officer at Essentia Health – an integrated delivery system with 14 hospitals, and 1,500 provider health system spanning the states of Minnesota, North Dakota, and Wisconsin – Debbie Welle-Powell designed, built, and operationalized Essentia’s $2.5 billion dollar transition from a primarily fee-for-service model of care to one that focused on value.  She oversaw risk-based contracting with payers and care delivery transformation, resulting in forty-five percent of the system’s fee-for-service revenue tied to financial and clinical performance which produced record earnings on shared savings. Debbie’s exceptional experience and background in multi-state, large integrated delivery systems, coupled with industry involvement and insights into emerging opportunities, trends, and challenges, have been valuable to health systems and purchasers seeking to grow, diversity, and promote expertise in the development and implementation of data-driven strategies and solutions in population health and value-based care.















Episode Bookmarks:







01:30 Introduction to Debbie Welle-Powell, a nationally-recognized leader in value-based care transformation.







03:30 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.







04:00 The grim statistics of American healthcare and the moral and economic imperative to reform it!







05:00 Recent article from Don Berwick about the excess profiteering and greed in healthcare: “Salve Lucrum: The Existential Threat of Greed in US Health Care”







06:30 Debbie discusses the current state of the healthcare industry and how she spent her career moving healthcare delivery to full-risk and globally capitated payments.







07:30 A leadership commitment to test models of care that address the moral imperative for improved outcomes.







08:30 Reflections on Dr. Berwick’s article and the need to expand the conversation by focusing on solutions.







11:00 The Innovation Center Strategy Refresh is a stake in the ground for 100% of Medicare beneficiaries to be in an accountable care relationship.







12:00 The need for innovation in specialty care and new risk models that improve health equity.







13:00 “Medicare is a laboratory for change.” (e.g. alignment of quality measures, multi-payer approaches to improvement, expansion of access in rural areas)

One of the most widely known and influential thinkers on management, Peter Drucker, once said, “The entrepreneur always searches for change, responds to it, and exploits it as an opportunity.”  In this movement to value, it’s seems that the new players – innovators and disrupters with unbridled passion for entrepreneurialism – are going to be in the best position to be at the headwaters of a transformation in American healthcare. The financial incentives in the current model of healthcare are simply too entrenched to be overcome by most legacy incumbents worried about how value transformation will create demand destruction in their fee-for-service lines of business. We need a better way forward.  Now is the time to  throw away traditional economic principles to reshape healthcare in our country!

Our promise to build a uniquely new American healthcare system that is patient-centered and economically viable will be realized by innovators like the one you will hear on this week’s episode. We are joined this week by Thompson Aderinkomi, the Co-Founder and CEO of Nice Healthcare. Thompson has the mindset that if it’s broken, you fix it…we as industry leaders shouldn’t wait for someone else to figure out how we are going to win in this Race to Value!  Thompson is a health economist and entrepreneur that you should be listening to.  As the co-founder and CEO of Nice Healthcare, he has created a technology-enabled primary care clinic that delivers all care in the comfort of the patient’s home and contracts directly with small employers. Thompson built this company in response to the economic dysfunction and lack of cost accountability that he observed in our broken healthcare system. According to Thompson, it will be necessary for innovators to lead the way since the legacy model is too entrenched to reform itself.  Listen to this incredible interview to find out why Thompson believes that value-based care (if done right) will ultimately lead to the bankruptcy of legacy companies!

 

Episode Bookmarks:

01:30 Introduction to Thompson Aderinkomi, the Co-Founder and CEO of Nice Healthcare.

02:30 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts!

03:30 In 2017, Thompson co-founded Nice Healthcare – an on-demand, in-home technology-enabled clinic that delivers comprehensive healthcare to employees of small and medium-sized businesses.

04:30 Thompson shares the horrific story of the poor healthcare his one-year old son received and how that shaped his entrepreneurial vision to start his company!

06:45 How the lack of consumer-centric innovation in healthcare harms the spirit and hurts patients financially.

08:00 Thompson’s privilege allowed him and his family to overcome their poor healthcare experience unscathed…how many people do not have that fortune? (The inspiration for Nice Healthcare)

09:00 Referencing the famous article, “It’s the Prices, Stupid,” by the late health economist Uwe Reinhardt where he argued that high prices explain most of why U.S. healthcare costs are so much higher than those in other advanced countries.

09:45 The problem with supplier-induced demand, where a  physician (i.e. the “supplier”) also serves the economic role as a consumer by generating their own demand.

10:15 Nice Healthcare is fully capitated (no fee-for-serve whatsoever) which allows it to offer unlimited virtual care and home visits, along with lab tests, drugs, xrays, and EKGs conducted in the home.

10:45 “The problem with healthcare is the unit price.”

12:00 Thompson explains the pricing inelasticity demand in healthcare and why that creates flawed incentives for consumer price gouging.

13:00 Profit maximization by increasing market share is not necessarily the modus operandi in healthcare when you can get away by charging whatever you want.

Disclaimer: The information provided in this podcast is purely for educational purposes and should not be interpreted as a recommendation for a specific treatment plan, medicinal plant, or course of action for medical treatment. None of the statements or ethnobotanical information in this episode have been evaluated by the Food and Drug Administration (FDA). The purpose of the information conveyed in this podcast is simply to explore the ancient healing practices of indigenous cultures. Please consult a professional if you are considering the use of plant-based medicines.

     In many ways people have become disconnected, dislocated, and dislodged from their place in the world as a result of trauma.  Trauma due to physical, emotional, and sexual abuse, neglect, household dysfunction, or just everyday unmanaged stress as an important social determinant of health. These traumas can actually change the chemical makeup of the brain and increase the risk for developing certain physical ailments, including digestive problems, diabetes, chronic pain, and heart disease. Unfortunately, the American healthcare system is not effective in addressing the root causes of the chronic issues we face at a psycho-emotional level. Western culture is now looking for alternative ways to stem the epidemic of anxiety, depression, and stress we see in the modern world.  Is there an opportunity in health transformation to seek alternative and ancient sources of healing medicine that finds coherence between the mind and heart and the body and the spirit?

     This week we are offering our listeners with a Bonus episode to discuss the healing potential of ayahuasca. Our guest is Kevin Johnson (also known by the Q’ero people of Peru as Puma Blanco). He is a shamanic healer who has become a popular public speaker, giving presentations on consciousness, shamanism, plant medicines and psychedelics. He’s been featured in several magazines and periodicals, and has appeared on many popular podcasts including; “Tangentially Speaking” with Christopher Ryan, “The Duncan Trussell Family Hour”, “The Warrior Poet” with Aubrey Marcus, “Not Just Paleo” with Evan Brand, “Fat Burning Man” with Abel James, and “The Truth Junkie Podcast” with Kevin Bates…just to name a few. This won’t be your typical Race to Value episode.  Not only are we exploring the congruency between ayahuasca and healing and the parallels between shamanism and Western medicine, but we will also be learning about the Q’ero people of Peru who have a special relationship with the planet and an approach to energy balancing that maybe we could all learn from.

     If you have an open mind and an open heart, you will find this conversation to be quite enlightening and informative as people around the world are retracing the ancient pathways of shamanism, the oldest spiritual practice of healing on the planet. So let’s now hear from Kevin Johnson, who is joining us for this special bonus episode of the Race to Value!



Episode Bookmarks:

01:30 Trauma as an overlooked social determinant of health that leads to chronic disease.

02:30 Introduction to Kevin (Puma Blanco) Johnson – a shamanic healer and popular public speaker on the topics of consciousness, shamanism, plant medicines, and psychedelics.

03:00 The healing potential of ayahuasca, parallels between shamanism and Western medicine, and the Q’ero people of Peru.

05:45 Referencing prior episode with Dr. Charles Nemeroff, the Co-Director for the Center for Psychedelic Research & Therapy.

06:00 Inspiration from Hippocrates: “The greatest medicine of all is teaching people how not to need it.” “Foolish the doctor who despises the knowledge acquired by the ancients.”

06:30 Ayahuasca is a very ancient medicine, with archaeological evidence for the consumption of ayahuasca going back at least a thousand years.

07:30 An overview of ayahuasca as a plant medicine and how it ...

Implementing value-based care can help providers improve patient health and reduce care costs, but it also presents the opportunity to explore new and emerging areas of research in breakthrough treatments that can revolutionize healthcare as we know it today. Embracing such a paradigm shift is for the mindful, who acknowledge that certain aspects of medicine are not working as intended.  If we are to truly attain better patient outcomes at a lower cost, we must consider emerging areas of research that can create new knowledge in the practice of medicine. On this week’s podcast, you will learn about some of the research being done to further scientific rigor and expertise in the study of psychedelic therapy. In clinical research settings around the world, renewed investigations are taking place on the use of psychedelic substances for treating illnesses such as addiction, depression, anxiety and posttraumatic stress disorder. Psychedelics fell from medical grace nearly half a century ago, their reputation mired by associations with counterculture drug excesses and Cold War era enhanced interrogation, but now a new wave of research has returned to psychedelics as potential candidates to treat mental health disorders.







We are joined this week by Charles B. Nemeroff, M.D., Ph.D the Co-Director of The Center for Psychedelic Research and Therapy at Dell Medical School at The University of Texas at Austin. Dr. Nemeroff is one of the nation’s most influential psychiatrists and has published more than 1100 research studies, and his research is currently supported by grants by groups such as the Multidisciplinary Association of Psychedelic Studies (MAPS).  His research is focused on the pathophysiology of mood and anxiety disorders with a focus on the role of child abuse and neglect as a major risk factor. He has also conducted research on the role of mood disorders as a risk factor for major medical disorders including heart disease, diabetes and cancer. At the Center for Psychedelic Research and Therapy, he aims to advance the application of psychedelics for the treatment of mental health disorders through impactful clinical research.  Additionally, the center looks to improve the health of those suffering from severe depression, anxiety and PTSD through psychedelic-assisted psychotherapy and research focused heavily on military veterans and adults affected by early childhood trauma.







Episode Bookmarks:







01:30 “If we are to truly attain better patient outcomes at a lower cost, we must consider emerging areas of research that can create new knowledge in the practice of medicine.”







02:45 Introduction to Charles B. Nemeroff, M.D., Ph.D the Co-Director of the Center for Psychedelic Research and Therapy at Dell Medical School at The University of Texas at Austin.







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







05:00 The field of human-based research into psychedelic drugs has in the last ten years become a legitimate field of study, after decades of repression by governments around the world.







05:30 The renaissance of psychedelic research with renewed media and medical interest in LSD, psilocybin, MDMA, ayahuasca, DMT, and ketamine.







05:45 From the Woodstock generation to present day – Dr. Nemeroff provides an overview on this history of psychedelic research.







06:30 Early psychedelic research conducted by Timothy Leary and Ram Dass (formerly Richard Alpert) that created a spiritual awakening and captured a generation.







07:30 A research moratorium that persisted for decades until the Dr. Rick Strassmanundertook human research on N,N-dimethyltryptamine, also known as DMT.