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.
The Geisinger Value Journey, with Dr. Jaewon Ryu
As one of the leading integrated health systems in the country -- serving more than 3 million residents throughout 45 counties in Pennsylvania and New Jersey with 30,000 employees, nine hospitals, 1,600 employed physicians, 13 hospital campuses, 70 primary care sites, two research centers, and a 550,000-member health plan -- Geisinger has become a standard for value-based payment innovation and care delivery transformation.
Geisinger was also an early adopter of value-based payment as a member of the Keystone Accountable Care Organization (ACO), which is a group of nearly 5,000 physicians and advanced practitioners and 9 hospitals who deliver over $800 million annually in coordinated healthcare services to more than 80,000 Medicare patients in Pennsylvania. Additionally, Geisinger has been engaged in Medicare’s Bundled Payment for Care Improvement program since 2014, and currently has more than $140 million in healthcare services delivered as part of Medicare’s Bundled Payment for Care Improvement Advanced (BPCIA) program.
Our guest this week is Dr. Jaewon Ryu, M.D, J.D, President and CEO of Geisinger. Dr. Ryu has led the system with a spirit of innovation and transformation, driving new approaches to some of healthcare’s most complex problems, including primary care redesign, home care and senior-focused, concierge healthcare centers for those 65 and older. His commitment to making health easier by improving outcomes, engagement and affordability are evident in his work and make him an exemplar in the race to value.
05:30 Dr. Ryu describes Geisinger’s Value Journey that has been taking place over the last 35 years
06:30 “Value-based care allows us to innovate around care models by marrying the payment with delivery.”
08:15 Dr. Ryu provides advice to other health systems looking to invest in an infrastructure for population health
11:30 Dr. Ryu discusses how “Primary care is the backbone of the delivery system” and why it is so important in managing chronic disease
13:10 The Abigail Geisinger Scholars Program that offers medical students entering the Geisinger Commonwealth School of Medicine free tuition if entering primary care
14:30 The importance of Geisinger physicians understanding its different care models (e.g. Geisinger 65 Forward, Geisinger At Home, LIFE Geisinger)
17:30 Dr. Ryu discusses the impact of the COVID-19 pandemic on frontline providers and staff and importance of workforce resiliency during challenging times.
19:00 How Geisinger’s Value-Based orientation positioned it favorably during the COVID-19 pandemic (e.g. upstream capabilities and care at home program)
20:00 How strong partnership with employers, school districts, and nursing homes created a pandemic response ecosystem to improve community care
21:00 “Our value-based care orientation provided us with a public health lens to better care for our communities during the pandemic.”
23:30 How the Steel Institute for Health Innovation provided human-centered design thinking, AI/ML, automation, and other innovations to further catalyze VBC at Geisinger
28:30 Dr. Ryu describes the importance of risk stratification and population segmentation in providing better care to seniors with chronic disease
29:30 Geisinger 65 Forward clinics that provide VIP-level personalized care and appointments, longer visits, one-stop shopping, and social and educational activities for seniors
30:45 Unlike other high-touch senior-focused primary care models, Geisinger 65 Forward is fully-integrated with the health system
32:40 How primary care redesign at Geisinger focusing on team-based care improved clinical outcomes
35:20 Dr. Ryu on how we need to move care away from “Field ...
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, with Susan Hassmiller, PhD, RN, FAAN and Janelle Sokolowich, PhD, RN
In this week’s episode, we spotlight the recently released Future of Nursing report, “Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.” The report is a landmark consensus study supported by the National Academy of Medicine and the Robert Wood Johnson Foundation. It charts a 10-year path for the nursing profession, to help our nation create a culture of health, reduce health disparities, and improve the health and wellbeing of the US population in the 21st century.
The COVID-19 pandemic has exposed serious inequities in the nation’s healthcare system, with frontline healthcare workers often lacking the necessary PPE and other equipment to safely and effectively do their jobs, and the murder of George Floyd shined a spotlight on the structural racism that exists in the workplace and society at large. In the wake of these challenges, the Future of Nursing report provides us with a north star to guide the nursing profession over the next 10 years, with a particular focus on reducing health inequities and improving health outcomes in value-based care.
Our guests are both important thought leaders in nursing. Dr. Susan Hassmiller is the Senior Advisor for Nursing at the Robert Wood Johnson Foundation, and Senior Scholar in Residence for the National Academy of Medicine. Dr. Janelle Sokolowich is the academic Vice President and Dean for the College of Health Professions at Western Governors University. Their voices are united in sharing this important message: nurses are key to health, healthcare, and the future success of our healthcare industry, and educational programs that provide equity in access and learning will ensure our nursing workforce has both the cultural humility and clinical competence to address the needs for greater health equity and diversity.
01:40 Introduction to the “Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity”
04:40 The need for diversity in the nursing workforce and how to eliminate bias in teaching and learning
06:55 Historical contrasting between stories of Florence Nightingale and Lillian Wald with occurrences of racism in nursing (e.g. Black Angels)
07:20 Recognizing bias in nursing curriculum through population exclusion (e.g. transgender), stereotypes, colloquialisms, and standardized testing
09:00 The lack of training with nursing faculty on how to have uncomfortable, yet crucial, conversations on race and health equity
10:00 The importance of diversity and cultivating inclusive learning environments
11:00 Holistic recruiting and competency-based learning as an opportunity equalizer for students of color
11:30 “Health equity is our end goal, but in order to even achieve that, we have to create pathways to education.”
12:50 The “Diversity Tax” – dependence on faculty of color to do all of the mentoring for underrepresented minority students
14:20 Raising awareness for health inequities to bring about industry-level commitment to SDOH and health equity
15:20 The importance of holistic admissions, diversity, and cultural humility to build models for culturally-competent care
16:20 “Our goal as educators is to empower our students to have cultural currency in their communication so that they can provide competent care that is enhanced and enlaced with humility.”
17:00 The need for kindness and patience for others to elevate crucial conversations
20:00 Competency-based education in nursing as an opportunity to increase diversity in the workforce and improve health equity for populations
22:00 “Competency-based education is a promising way to integrate equity, social determinants of health, and population health into the nursing curricula all at one time.”
Value-Based Care: A Superior Technology to Create Trusting Relationships, with Dr. Griffin Myers
Oak Street Health has an amazing vision to rebuild Health Care as It Should Be: Personal, Equitable, and Accountable. The business was launched with a belief in value-based care that was patient-centered, evidence-based, and ensured equal opportunity for good health outcomes across populations, despite the economics being unproven. The business model depends on global capitation and allows the best service for patients in some of the poorest and most vulnerable communities. The high touch, relationship-based, tech-enabled primary care model includes support with medications, transportation, social work, home visits, and more – the sickest 10% of patients receive 78% of Oak Street’s dollars.
This week, our guest is Dr. Griffin Myers, CMO and co-founder of Oak Street Health. In his own words, the challenge is not providing treatment but winning patients’ “trust and building relationships,” something Oak Street has demonstrated successfully with its ability to rapidly scale, to a network of 90 centers in 15 states. The Oak Street Platform is redefining Primary Care by bringing technology-enabled, value-based care to the seniors that represent the highest proportion of healthcare spending in the country. Winning the race to value will depend on many more following in the footsteps of these leaders!
05:35 The “insane” journey of starting a company that takes full-risk on very sick populations
05:55 “The downstream microeconomics of fee-for-service reimbursement has created a janky, inequitable, low quality health care system.”
06:30 The importance of segmenting your patient population within a payment model that is better aligned with care outcomes
06:40 “We take care of community-dwelling older adults with multiple chronic conditions and adverse social determinants.”
06:50 Full risk, global capitation enabled the development of the Oak Street Health platform.
07:00 Oak Street platform: 1) Community-Based Primary Care Centers, 2) Proprietary Technologies, 3) Value-Added Services to Primary Care
07:35 Dr. Myers discusses how the culture at Oak Street, coupled with the power of global capitation, drives value-based care results.
08:45 Oak Street’s Results: 50% reduction of hospital admissions, 52% reduction of ED visits, 35% reduction in 30-day readmission rates, 5-star quality ratings, and a 91 NPS
10:40 Dr. Myers discusses the concept of relationship-based care and how it improves outcomes for underserved populations.
11:20 Referencing Viktor Frankl’s “Man Search for Meaning” and how deeply meaningful and trusting relationships provide purpose
12:05 “Trust is the core input to us being able to help patients navigate adverse social determinants.”
12:10 Critical Success Factors: 1) Spending more time with patients with a consistent presence from a longitudinal care team, 2) Deep sense of accountability (“a promise”), 3) Culturally-Competent Care
12:55 “Having people who live in the neighborhoods to which we serve that share a cultural connection with patients helps form trusting relationships.”
13:30 “A value-based model is simply superior technology compared to fee-for-service. Value allows you to incubate and foster relationships to drive outcomes.”
14:40 Inspiration from John Lewis (“Try to be the pilot light not the firecracker.”) when it comes to building a safer, higher quality, more equitable, more affordable health system.
17:35 Referencing the HBS Case Study: “Oak Street Health: A New Model for Primary Care”
17:45 The role of the Clinical Informatics Specialist at Oak Street
18:30 Dr. Myers discusses the evolution of EHR technology at Oak Street and the development of Canopy ...
The Path of Hope for Human-Centered Care Delivery, with Dr. Zeev Neuwirth
Let’s face it - the healthcare system is broken. It will never be fixed unless we fundamentally redesign our industry towards a more consumer-centric model. That will require courageous leadership, and our guest this week provides "the path of hope for human-centered care delivery". Leaders must overcome the cultural malaise that has been formed after years being conditioned by the current model. We know that our healthcare system causes 200-400k avoidable deaths each year (which is like having two or three jumbo jets crashing every single day), however, we’ve become desensitized to the consequences of our flawed model for delivering care. Each and everyone in the system bears responsibility for other people’s lives and has a role to play in reimagining the future of healthcare. We clearly need urgency for change.
Dr. Zeev Neuwirth is the author of “Reframing Healthcare: A Roadmap For Creating Disruptive Change” and produces and hosts the popular podcast series, “Creating a New Healthcare.” He is currently serving as Atrium Health’s Chief Clinical Executive.Dr. Neuwirth is reorienting the way individuals and organizations think about healthcare, to catalyze movement towards an affordable, accessible, effective and safe healthcare system.His ultimate goal is to humanize healthcare for those who serve within the system, and especially for those who are served by the system.
03:15 Referencing Dr. Neuwirth’s book: “Reframing Healthcare: A Roadmap for Creating Disruptive Change”
06:30 The challenges of practicing medicine in the pandemic era and recognition of those on the frontlines of care delivery
08:20 A shift in focus from Internal Medicine to care redesign, human-centered care delivery, and process improvement
08:50 Dr. Neuwirth explains his passion in seeking out people who are making a difference
09:40 “Creating a path of hope for health care delivery” by providing a platform for those transforming healthcare
11:30 “Health care transformation is already happening across the country. It’s just a matter of aligning payment to it.”
12:30 “Are we collectively ready to have the courage to change a system in fundamental ways? The answer is YES or NO – there is no in-between.”
13:00 The catalyst for Dr. Neuwirth’s work in health care transformation started twenty-five years ago (seeing the “inhumane” system).
15:00 “You cannot improve this system. You actually have to reframe it.”
16:00 Dr. Neuwirth explains how his mother died from a completely preventable hospital-acquired infection
18:00 Avoidable deaths due to medical errors happen to over 400,000 families a year!
18:30 Dr. Neuwirth discusses the human tragedy of a close friend and physician colleague who committed suicide
19:45 “I am going to go down fighting against a system that strips the humanity out of every single person who tries to do the best they can to help their fellow man.”
21:00 Dr. Neuwirth’s déjà vu “Groundhog Day” moment realizing that we keep talking about the same answers (but the system never changes)
22:30 “Technology is an enabler – no question about it. But it is not the transformative thing needed to create a new orientation.”
26:30 Courageous leadership to re-instill humanism in health care sometimes requires people to make sacrifices in their career.
27:20 “The people are not the problem in health care…the system is.”
28:00 “If there is an evil in health care, it is the fee-for-service payment model.”
29:00 When piecemeal payment and patient churning ultimately becomes the key performance indicator -- choosing to leave or live with it!
An Old-World Doctor’s Prescription for Health in a New World, with Dr. Tony Dale
We’re excited to share this special edition episode with Dr. Tony Dale, an “Old World” doctor from England who has since become a successful healthcare entrepreneur in the United States. Despite practicing socialized medicine early in his medical career, Dr. Dale has become a champion for free market reforms to our nation’s healthcare system. As the founder and Chairman of The Karis Group and Sedera, he has brought cost transparency and consumerism to the forefront. Dr. Dale’s entrepreneurial vision has directly impacted the lives of millions of patients seeking the best possible care at fair and affordable prices. In this podcast conversation, we discussed his newest book “The Cure For Healthcare: An Old World Doctor’s Prescription for the New World Health System”. This episode was recorded in collaboration with the Point Health podcast and its hosts Steven Cutbirth.
01:20 Intro to Dr. Tony Dale -- from practicing family medicine in London to his work as an American healthcare entrepreneur dedicated to affordable care
02:30 Early experiences with his father, a family doctor in Taiwan, who led him into a career in medicine
04:30 What Dr. Dale learned from his work as a physician in the UK’s NHS within a socialized model of medicine caring for the poor
06:30 Access to care in a socialized model does not necessarily mean access to quality
07:30 Seeing 40-60 patients per day, on top of doing home visits, led to bad medicine
08:15 Relocation to the United States with an inspiration to help doctors treat the “whole person” in a holistic way
10:00 How the British system prevented family medicine doctors from helping their patients who were hospitalized
10:45 Dr. Tony Dale’s new book, The Cure for Healthcare
11:10 Inspiration from “The Price We Pay” by Dr. Marty Makary
12:00 Fascinating examples of the “power of the free market” from his work with Sedera to provide medical cost sharing
12:45 Dr. Dale’s experience in influencing health policy and how that convinced him that a grassroots effort is really the true cure for healthcare
13:45 Albert Einstein’s famous maxim, “The thinking that got us to where we are is not the thinking that will get us to where we want to be”
14:30 The issues of waste, inefficiency, and outright fraud -- how current health policies enrich the very few, at the expense of the “ordinary American”
16:30 “The answer to changing the system isn’t incremental. It is dramatic.”
16:40 Parallels to the disruption of the transportation system from Uber/Lyft (ridesharing) and Priceline (airline and hotel booking)
17:40 How Cristen Dickerson (a radiologist in Houston) and her company Green Imaging is bringing “the Priceline model to Radiology”
19:30 Inspiration from radical change agents who bring a “stroke of genius” to fixing healthcare
20:30 President Obama and the passage of the Affordable Care Act that led to an exemption of Christian healthcare sharing ministries
22:45 Finding a way to make the medical sharing model (a non-insurance solution) mainstream through the founding of Sedera
25:00 The story of his founding of The Karis Group (now Point Health) to help patients shop for cash pay options for healthcare services
27:40 The exploitation of government regulations related to the Medical Loss Ratio in order to drive health insurance profits
28:30 “The system is working perfectly for what it is designed for. It is designed to let the big hospitals consolidate and drive up prices.”
29:20 The “smoke and mirrors” tactic of duping patients to pay more for urgent care by billing as an ER (paying 3X more for the same care!)
Developing Human-Centered Health Systems in Low and Middle Income Countries, with Dr. Chintan Maru
Historically, health systems in low- and middle-income countries (LMICs) have taken a volume-based approach to health rather than a value-based one. The public sector has focused on coverage rates or access, and the private sector profits when it drives quantity of expensive, hospital-based care. Adhering to this path will create long-lasting structural flaws that increase costs without delivering desired results, similar to what we see in the US and many other developed economies.
Our guest this week is Dr. Chintan Maru, founder and executive director of Leapfrog to Value, a health initiative to advance value-based care in lower- and middle-income countries. Dr. Maru is a medical doctor and public health expert who has dedicated his career to maximizing the value of health systems. The race to value is not limited to fixing health care in the US – lessons learned and shared internationally will have world-wide impact, and will help lower- and middle-income countries leapfrog past hurdles and accelerate their own race-to-value. Join us as we learn from Dr. Maru about his efforts to leapfrog to value in Ghana, South Africa, Kenya and India!
01:45 Low- and middle- income countries (LMICs) are at-risk of replicating system flaws from higher-income countries
02:10 The Leapfrog to Value strategy: Building a robust ecosystem for VBC experimentation
04:00 How Dr. Maru’s father dealing with Parkinson’s Disease provided a personal perspective on the work he does in value-based care
06:00 “In low- and middle-incomes countries now, quality has eclipsed access as a prime driver of outcomes.”
08:30 “There is a big focus in low- and middle-incomes countries on primary care and community-based health delivery, often via community health workers.”
09:15 How Value-Based Care differs In LMICs: focus on how to spend more on health to achieve universal health coverage!
09:45 “Instead of volume versus value, you are trying to get both volume and value.”
11:00 Ensuring localization by directing donor-funded programs for health system development with local stakeholders
13:15 Dr. Maru explains how the definition for “value” differs in LMICs when implementing universal healthcare
14:00 “The phrase ‘value-based care’ hasn’t really shaped the dialogue for universal health coverage for places like India or Kenya yet. It’s just coming into the conversation.”
14:15 How can payment models in LMICs prioritize health over healthcare?
15:15 Feasibility versus point of path feasibility in creating value-based care systems
16:30 “There is a ‘leapfrog to value’ opportunity in low- and middle-income countries to build a value-based health care system somewhere between the point of feasibility and the point of path dependency.”
17:00 Building new national health insurance models in Kenya, India, South Africa, and Ghana to experiment in value-based care
18:45 Dr. Maru cites mobile banking penetration in Nairobi as an example of how we can learn from the ingenuity of others when there isn’t already an entrenched ecosystem
20:15 Partnering with USAID Center for Innovation, the Gates Foundation, and the Rockefeller Foundation on the Leapfrog to Value flagship report
21:45 Getting buy-in from local stakeholders in LIMCs for value-based care experimentation and innovation
23:00 “Value-based care is partnership-driven.”
24:00 The role of global health donors in providing risk capital to cover the costs of value-based care pilots in LMICs.
25:00 Comparing climate change and the need for environmental sustainability to the value-based care movement
26:30 Determining appropriate hospital bed capacity in places li...
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.