The Race to Value Podcast Institute for Advancing Health Value

In this episode of the Race to Value podcast, we are sharing inspiration for a more optimistic future in the value transformation of our country. This week’s interview brings a message of hope, compassion, and human connection balanced with the business success of value-based care within a national leading health system.

Albert Einstein once said that “Only a life lived for others is a life worthwhile” and no one better captures that spirit of servant leadership than our guest this week. Philip Eaves is the President and CEO of Ascension Seton ACO | Ascension Seton Health Alliance and the Vice President of Population Health at Ascension Texas, and he is a leader in the value movement that you should know about. In this interview we focus on change management, leadership, and the human side of healthcare economics. Overseeing the value-based care strategy and operations for one of the largest clinically integrated networks in Texas, Philip is leading the ACO to outstanding success…and transforming the lives of people along the way.

Bookmarks:

01:30    The human side of healthcare economics – compassion is the currency; empathy is the language.

02:00    Introduction to Philip Eaves, President and CEO, Ascension Seton ACO and VP of Population Health, Ascension Texas

02:30    Ascension Seton ACO is the largest clinically integrated network in Texas with 3,600 providers with 300K value-based lives.

04:45    “Only a life lived for others is a life worthwhile” -- Albert Einstein

05:30    Philip shares how a humble, faith-based upbringing fueled his ambition, work ethic, and compassion as a healthcare leader.

07:30    “Healthcare is about serving others.”

08:30    Occupational medicine as a stepping stone to value-based care.

09:45    Team-based care that enables providers so they can build meaningful patient relationships.

11:00    $24M in MSSP Shared Savings for 23,000 Medicare beneficiaries to achieve a top 7% performance ranking of all ACOs in the country (#32 out of #482).

12:45    Valuable partnerships with independent practices (e.g. Austin Regional Clinic, Capital Medical Clinic).

13:00    “Physician engagement is the overall key to ACO success.”

14:00    The impact of Annual Wellness Visits (AWVs) in practice transformation.

15:00    HCC recapture for documentation accuracy as an area of educational focus.

15:45    Centralized versus Embedded Care Management.

16:30    Analytical insights to drive high risk CM interventions.

17:15    Quality campaigns to close care gaps and improve population health outcomes.

18:00    Refining a Post-Acute Care network for optimal transitional care.

18:30    An after hours program as an effective ED diversion strategy.

20:00    Change management to improve team culture and reinvent the business model for VBC.

22:00    Phillip shares his experience leading an inflection point for the ACO business.

23:30    Applying the principles of the Kübler Ross Change Curve in organizational change.

24:30    Inspiration from John Kotter (“Leading Change”) – Leadership versus Management.

25:00    Recognizing the need for change in shifting a new strategic direction.

26:00    Communicating the vision and creating short-term wins.

26:45    New initiatives: a new ACO for early adopters, Medicare Advantage risk, and Direct-to-Employer partnerships.

28:00    Financial toxicity as a driver of Direct Contracting between employers and providers in value-based care.

30:00    Employer frustration with rising medical spend and the lack of solutions from their brokers.

30:45    Designing an ACO value proposition based on employer pain points.

31:00    Leveraging network adequacy and CIN care infrastructure for commercially insured populations.

32:45    PBM transparency to reduce extreme spending o...

The transformation of healthcare is a seemingly insurmountable challenge, yet overcoming any obstacle in the journey begins with the belief that it is possible to win!  It's not about the magnitude of the task; it is about the collective will to prioritize the wellbeing of every person we serve in our population.  Perhaps when approached with the audacity to imagine a healthier and more equitable future for all, we'll actually get there.  And that is just what the Physicians of Southwest Washington (PSW) is realizing as they navigate a successful transition from volume to value.



Our guest on the Race to Value this week is Melanie Matthews, the dynamic, creative, and innovative CEO of PSW. She leads a population health company that has been around for three decades. Melanie is not only leading their ACO and managing their progression in the adoption of full-risk Medicare Advantage delegation; she has become a nationally recognized voice for value-based health policy.  In listening to this interview, you will hear from a leader that has a real personal capacity for leadership and a clear focus on excellence. If you want to hear from someone that is at the absolute forefront of risk-based contracting and innovation, who understands the issues at a granular level, this episode with Melanie is a must-listen!



Episode Bookmarks:

01:30 Introduction to Melanie Matthews and the Physicians of Southwest Washington (PSW)

04:30 PSW has evolved over the last three decades from an IPA to a diverse business that includes a national leading ACO and risk-bearing entity for MA.

06:00 "PSW is a story of independent physicians who, in a time of market consolidation, want to remain independent and focus on the patient relationship."

06:45 Achieving success in delegated risk and taking accountability for both quality and total cost of care.

07:00 The impact of MACRA on the long-term value-based care strategy of PSW.

08:30 Building an infrastructure and developing capabilities to move a value-based agenda.

09:00 Developing a business model for agility in responding to new rules ("a kayak in a sea of cruise ships") and engaging all types of physicians in the landscape.

09:30 "The value-based movement is important as the fee-for-service chassis is not realistic, has poor quality and outcomes, and rising costs."

10:00 Taking risk with physician partners and providing them with MSO services, leveraging a technical infrastructure and population health platform.

10:45 The glacial pace of scaling payment model transformation at CMS and CMMI's bold goal for 2030.

12:00 The increasing shift to home-based care delivery and the use of generative AI in reshaping care delivery.

13:00 How the flawed economic design of the fee-for-service system creates industry inertia.

14:00 Diverting to the known (i.e. fee-for-service care delivery) in times of stress is an unsustainable path forward.

15:00 Convincing the Board room on the tenets of VBC when it hasn't historically delivered on its promises.

16:00 Trends in consumer cost-shifting and the challenges of private insurers cross-subsidizing provider losses from public payers.

16:30 Unsustainable economics in employer-based healthcare and the looming insolvency of Medicare.

17:00 What does the CMMI 2030 Goal mean for future of the value movement?

18:30 An overview of the extensive services offered by PSW that empowers success in VBC.

19:30 The explosive growth of strategic transactions of physician groups and how mass consolidation is impacting the landscape.

21:00 Aligned incentives and access to a population health platform as keys to VBC success.

22:00 PE investment impacts on competition in an independent physician ecosystem.

23:00 Generational differences in the approach to the business of practicing medicine.

We have a broken healthcare system. Too often, individuals today experience care that is fragmented, duplicative, wasteful, and confusing.  Through value-based care, we can improve the health care experience by coordinating care, creating care teams that communicate with one another, and supporting individuals in their care journey with services that address their medical and non-medical needs.



Accountable for Health is a nonpartisan national advocacy and policy analysis organization accelerating the adoption of effective accountable care. Their members are advocating for value-based care on Capitol Hill so policymakers can understand how best to move American healthcare towards a model that achieves better outcomes, improved care experiences, increased access, and lower costs. Joining us on the podcast this week is Mara McDermott, the Chief Executive Officer for Accountable for Health.  She is an accomplished healthcare executive with deep expertise in federal healthcare law and policy, including delivery system reform, physician payment and payment models.



Take this opportunity to learn from a leading expert on accountable care as she translates the truth in building a bridge towards a more broad-based understanding of health value.  And make sure to tune in to Mara's special announcement about Health Care Value Week at the end of the interview so you don't miss out on important educational events occurring January 29th thru February 2nd.





Episode Bookmarks:



01:30  The need for accountable care policies that create better health outcomes and patient experiences.

02:00  Introduction to Accountable for Health (A4H) and its Founder/CEO Mara McDermott, JD, MPH

03:00  Interview topics discussed (e.g. the meaning of VBC, MSSP vs. MA, MACRA 2.0, advanced APMs, integrated specialty care, Medicaid transformation, and the upcoming Health Care Value Week event).

06:00  How A4H is translating thought leadership to action in the advocacy arena.

06:30  Accountable care as the solution to fragmented, uncoordinated care.

07:00  Political turnover in D.C. has made VBC a "new" health policy solution.

07:30  Educating the Hill comes down to conveying enthusiasm for health care transformation.

08:00  Accountable for Health Members are shaping the national conversation for payment and delivery system reform.

09:00  The health policy controversy of the Global and Professional Direct Contracting model (the precursor to ACO REACH).

11:30  If Direct Contracting was the natural evolution of a series of advanced ACO options, why was there such strong criticism?

12:00  The need to overcome misunderstandings about what ACOs are trying to achieve.

13:00  Providing education to dispel the myth that ACOs can actually limit services.

14:00  How uninformed policy decisions could potentially create a catastrophic blow to the value movement.

14:45  "Accountable care is integral to care delivery system reform."

15:45  Confusion with the term "value-based care" and why it will fail unless people understand the truest aims of the movement.

17:00  The need for effective storytelling to advance care delivery transformation.

18:00  Prioritizing care experience over cost reforms (delivery innovation will address costs!)

20:00  The topline takeaways from CMS model evaluations and whether or not programs should be expanded.

21:00  What do most people think when they hear the word "value"? (the need to reframe the conversation with more precise language)

22:00  The MSSP and the Medicare Advantage programs as two distinct approaches to healthcare delivery and reimbursement.

24:00  Mara provides a brief comparison between MSSP and MA (e.g. beneficiary assignment, risk adjustment, benchmarking).

25:30  How strong relationships between MA plans and provider net...

The World Health Organization has declared climate change as "the greatest threat to global health in the 21st century." As our planet grapples with the accelerating impacts of climate change, it is crucial that we adopt a climate lens in the value transformation of our healthcare industry. The repercussions of climate change extend far beyond environmental shifts; they manifest in various health issues, including challenges with clean water access, increased allergens, respiratory diseases, heat induced illnesses, and the proliferation of infectious diseases. It's essential to acknowledge that while climate change affects everyone, the burden falls disproportionately on historically marginalized populations, highlighting the interconnectedness of climate impacts and social determinants of health in underserved communities.





In our pursuit of delivering safe, effective, and efficient care amid the climate crisis, we as healthcare leaders also bear the responsibility to address the substantial greenhouse gas emissions generated by the sector. Accounting for nearly one fifth of the U.S. gross domestic product, the healthcare industry possesses considerable purchasing power that can be harnessed to steer the nation toward cleaner energy and a low carbon supply chain. Beyond mitigating environmental harm, embracing preventive models of care and enhancing care quality that lowers excess utilization naturally aligns with lower carbon footprints. Value-based care, therefore, can become a powerful catalyst in propelling us toward a net zero carbon future that will build a sustainable, resilient future for our planet.





This week we are  interviewing Dr. Vivian Lee, a healthcare executive dedicated to the advancement of value-driven transformation in health and tackling climate change. Author of the acclaimed book,The Long Fix: Solving America’s Health Care Crisis with Strategies that Work for Everyone, she is an Executive Fellow at Harvard Business School and Sr Lecturer at Harvard Med School. Prior to her Executive Fellowship at Harvard, she was the founding President of Verily Health Platforms, an Alphabet company combining a data-driven, people-first approach to precision health.  Dr. Lee is also a former health system CEO, medical school Dean and member of the National Academy of Medicine. She is regularly listed among Modern Healthcare's Most Influential Clinical Executives as well as Modern Healthcare’s Most Influential People in Healthcare.

 

Episode Bookmarks:

01:30  The World Health Organization has declared climate change as "the greatest threat to global health in the 21st century."

02:00  Climate change burden falls disproportionately on historically marginalized populations.

02:30  The responsibility to address the substantial greenhouse gas emissions generated by the healthcare sector.

03:00  Introduction to Vivian Lee, M.D.

04:30  One in four deaths can be attributed to preventable environmental causes...and climate change is exacerbating these risks.

06:00  Climate change resilience as a lens for value-based transformation.

06:45  The irrefutable scientific evidence about the unprecedented levels of carbon dioxide in our atmosphere.

07:00  What are health care leaders going to do about this?  (The need to manage the crisis through an empowered workforce.)

08:30  Exposed vulnerabilities in our supply chain as a complication to address climate-related crises.

09:00  The healthcare industry is responsible for 8-10% of the overall carbon footprint of the country (more than twice the #2 country!)

10:00  How do we decarbonize healthcare in order to "do no harm"?

11:45  Pollution from health care–associated energy use results in an estimated 405,000 disability-adjusted life years annually (a burden comparable to that of preventable medical errors).

     A new era in value-based care is emerging where employers are no longer sleeping giants willing to tolerate a broken fee-for-service healthcare system. ‘Poor health' costs employers $575B in lost productivity on top of the $880B they already spend in premium dollars annually. Employers (and their employees) continued to get fleeced by unsustainable double-digit premium increases every year, with hospitals using that excess spend in commercial insurance to their subsidize losses on the public pay side. The paradigm shift to value-based purchasing is underway in employer-based health insurance; however, it will not achieve the aims of population health unless a similar transformation occurs in workforce wellbeing.



     Joining us this week in the Race to Value is Dr. Richard Safeer, the Chief Medical Director of Employee Health and Well-being at Johns Hopkins Medicine, where he leads the Healthy at Hopkins employee health and well-being strategy.  Dr. Safeer is a highly influential thought leader on building a culture of health and is the author of the groundbreaking new book, “A Cure for the Common Company: A Well-Being Prescription for a Hopper, Healthier, and More Resilient Workforce.” In this interview you will hear from one of the leading experts on employee health in our country about what it takes to cultivate a healthy workforce.





Episode Bookmarks:

01:30 Introduction to Richard Safeer, M.D. and “A Cure for the Common Company”

04:45 Developing a holistic view where we look at individuals as both patients and employees.

05:15 “Until we integrate a strategy that includes the workplace, we are not likely to optimize population health."

06:00 The economic and cultural imperatives for workforce well-being.

06:30 A key factor in achieving health goals is the support of people you are closest to at home and at work.

07:45 Connecting the spectrum of employee health from well-being to chronic disease.

08:30 Why have attempts at corporate wellness failed so often in the past?

09:30 “Our health and well-being are greatly influenced by the relationships we have in the workplace.”

10:00 Most employers do not fully leverage the social sciences to optimize the support of their workforce.

10:45 Innovative self-funded health insurance as a requisite component of a corporate wellness strategy.

12:30 How a company benefits from a healthy workforce.

13:45 Innovations to create access to high quality primary care and lifestyle medicine (e.g. Direct Primary Care and onsite clinics).

17:00 Employers must fully leverage all resources (e.g. data from health insurers, EAPs, collaboration with local health systems).

18:30 The 6 Building Blocks of a Wellbeing Culture.

20:45 Making it easier for employees to make healthy choices.

21:30 The influence of social climate in the workplace.

22:30 The plight of healthcare workforce burnout and moral injury.

23:45 We need supportive work environments to produce good health (not paternalism).

25:00 “Employers who demonstrate genuine care and back it up with genuine resources to support health and well-being will be the ones to attract and retain talent.”

25:30 Resiliency does not rest solely on the individual!

26:00 Employees cannot maintain mental health if their work doesn’t align with education and skill set.

27:00 Social connections to team and trust in management improves resiliency.

29:00 70-80% of employees are willing to take a pay cut to get a job that better supports their mental health (see UKG study)

30:00 Balancing the need for social connection with remote work.

31:30 Referencing the new book, “Culture Shock: An Unstoppable Force is Changing How We Work and Live.”

32:00 One-size fits all decisions about onsite work doesn’t make sense for all employees.

The future of health will be shaped by consumer expectations for a mobile-centric experience with personalized insights and care services.  Information is determinant of health, where people already search for health information on Google hundreds of millions of times a day. Additionally people view YouTube videos about health conditions 100 billion times globally in a year. As consumers seek information ubiquity in their online experience, health information will also become more personalized through wearables and other mobile devices.

Our future in health will also be enabled by AI. Artificial Intelligence has the potential to transform the health of people on a planetary scale akin to the discovery of penicillin.  If developed boldly and responsibly, AI will be a powerful for health equity on a global scale.  It will also bring the joy back to practicing medicine by reducing cognitive burden and giving providers more time to spend with patient.

In this week’s episode, we explore health tech consumerism and AI enablement with Dr. Karen DeSalvo, Chief Health Officer at Google. Dr. DeSalvo is an internist and health leader working at the intersection of medicine, public health, and information technology.  She has dedicated her career to improving health outcomes for all with a focus on solutions that address all the determinants of health.  Dr. DeSalvo continues to be a powerful voice and advocate for eliminating inequities and improving the public’s health.  Under her watch, Google has optimized search and YouTube to better answer common health questions, updated its consumer health wearables to function more like medical devices and built artificial intelligence products to meet industry demands.

This episode covers various topics in the realm of healthcare technology innovation from consumerism, Generative AI and LLMs, health equity by design, and various initiatives underway at Google to connect and bring meaning to health information. In the interview, we also discuss the role of technology in mitigating the health impacts of climate change and addressing the epidemic of loneliness and isolation at a global level.

 

Episode Bookmarks:

01:30 Introduction to Karen DeSalvo, Chief Health Officer at Google.

03:30 How Google understands “information as a determinant of health.”

05:00 “We see heavy consumer orientation to the way we see our opportunity to improve the health of everyone everywhere.”

05:30 The evolution of healthcare businesses to meet people in an increasingly virtual world with ever-changing consumer expectations.

06:00 Informing health empowerment through high quality information and personalized insights.

06:30 Personal reflections from clinical practice when the flow of information was not enabled by technology automation.

07:30 Modern-day tools for patient education and personal health tracking and measurement.

08:00 The optimization of Google search results to convey trust in the provision of health information.

08:30 “The conveyance of information through trusted messengers is an important way we address information as a determinant of health.”

09:00 Patients showing up with more knowledge and power – a priority goal for Google Health.

09:30 How AI can improve health for everyone everywhere. (Karen’s recent blog on the future of AI as a transformational path forward in population health.)

10:00 Leveraging AI at Google Health to advance medical research, improve accuracy and efficiency of diagnostic processes, and improve health information quality.

11:00 A future world were everyone has access to the best quality care on their phone (e.g. AI-enabled health agents combined with the human care team).

12:00 Developing health technology for the entire world. (“A billion people on the planet don’t have access to primary care.”)