We have gotten ourselves into this pickle: Americans—all of us as taxpayers, as patients, as employees, as employers—spend exorbitantly for highly variable results. Great work, great health care in some areas by some great physicians and their teams, and then voluminous other areas rife with overtreatment, errors, abysmal chronic care management, predatory pricing by entities owned by private equity or with billing departments gone wild. Who will be our knight in shining armor when it comes to f...
Aug 08, 2019•36 min•Ep. 238
Bad things have a propensity to occur in health care when patients are placed on a trajectory and then simply follow the yellow brick road—to an Oz potentially filled with unnecessary surgeries, MRIs that cost 10 times what they should, low-quality providers chasing RVUs (relative value units) like their paychecks depended on it … I could go on. Today I speak with Derek Winn, cofounder at Distilled Concepts and consultant at the Business Benefits Group. His distilled advice is to recognize that ...
Aug 01, 2019•32 min•Ep. 237
In this podcast, Liliana Petrova, CEO/Founder at The Petrova Experience, translates her experience as director of customer experience at JetBlue to the health care industry. Her advice is practical and designed to actually work in environments as complex and regulated and driven by safety concerns as the airline industry—and also, coincidentally, health care. In the past in health care, some have perhaps underestimated the impact of customer experience. But it’s hard to continue to do so in the ...
Jul 25, 2019•34 min•Ep. 236
Here’s a vital question, “How do you make sure that the physicians your employees or members are seeing are high quality in a given area of focus?” Getting to the right doctor matters when you consider that something like 70% of back surgeries are unnecessary and medical errors are the third leading cause of death in this country. And also because, as Suzanne DelBanco put it in EP224 , if a payer simply cuts out the bottom performing 10% of practices, the returns are outsized from a cost and qua...
Jul 18, 2019•33 min•Ep. 235
Today I speak with Claire Sporton. Claire is SVP of customer experience innovation over at Confirmit. Since we did this interview, the 2019 Edelman Trust Barometer came out. And it showed that trust in US hospitals has nose-dived 8 points. Pharma and biotech held steady since last year, or slight increases, but the bar is pretty low. Same with insurance. In this conversation, Claire and I discuss why this matters—why it matters to hospitals, to Pharma, to insurance carriers, and anyone else who ...
Jul 11, 2019•19 min•Ep. 234
Last week I was invited to attend and present at a Rare Disease Roundtable hosted by Health Catalyst and McDermott Will & Emery in Boston. A colleague from Aventria Health Group and I were there to talk about ways to enlist stakeholder collaboration throughout the rare disease patient journey. When not hosting the show, Stacey is co-president of Aventria Health Group, a marketing agency and consultancy. Aventria specializes in helping pharmaceutical, employer, pharmacy, and health system cli...
Jul 04, 2019•16 min
The Society for Integrative Oncology recently completed a systematic evaluation of peer-reviewed randomized clinical trials for patients with breast cancer. The researchers assigned letter grades to therapies based on the strength of the evidence. Meditation got an A; it had the strongest evidence supporting its use. Music therapy, yoga, and massage received a B grade. Hypnosis got a C. By the way, the letter grade varied depending on the symptoms that were involved. You can go on the website of...
Jun 27, 2019•25 min•Ep. 233
It is pretty much inarguable that happy customers are a prerequisite for business success. And that’s true in health care as much as it’s true in every other industry—although in health care, sometimes the customer is also called a patient. Provider organizations like Cleveland Clinic are really walking the walk when it comes to creating amazing patient/customer experiences; so are other leading provider organizations. But in other segments of the health care industry, maybe they haven’t quite c...
Jun 20, 2019•26 min•Ep. 232
Will the Health and Human Services (HHS) proposal materially impact Pharma’s ability to “pay to play” on pharmacy benefit manager (PBM) formularies? We have that HHS proposal that is now at the stage where they’re trying to figure out how to implement it. What’s at stake right now is that implementation flowchart and who exactly is involved in adjudicating the something like $186 billion in potential charge-backs. Since any middleman who gets himself involved in any flowchart of this sort takes ...
Jun 13, 2019•50 min•Ep. 231
Today I’m talking with John Lynn, founder of Healthcare Scene as well as two conferences, Expo.Health and HITMC. If I was going to frame out an overarching theme, I would suggest that it is this: Organizational culture eats strategy for breakfast, lunch, and dinner. Let’s consider the scope of this statement: Ambulatory patients spend about 84 minutes on average in clinic. Of those, 7-12 minutes are with a physician. Inpatient, I imagine, has probably an even greater ratio. So those 7-12 minutes...
Jun 06, 2019•31 min•Ep. 230
No one denies that it’s a tough world out there for health start-ups. Finding a customer is tough, financial models are tough to figure out, operationalizing is tough. But the same is true for those other health care stakeholders attempting to purchase and implement the innovations start-ups are creating. Here’s another unassailable truth: Everything is just easier within a supportive community. You gain feedback, mentorship, networking opportunities, and maybe just a venue to sob into your beer...
May 30, 2019•28 min•Ep. 229
Let’s talk about the opioid crisis for a moment. When we say the words “opioids crisis,” as a general broad stroke, many people immediately picture somebody who lives under a bridge. But that actually wouldn’t be your average profile of someone with a substance misuse/opioid problem. The average profile of someone with an opioid/substance misuse profile looks exactly like an employee. In fact, 75% of adults up to the age of 64 with a misuse issue are in the workforce. And the cost to an employer...
May 23, 2019•10 min
There’s a great video of Steve Jobs responding to an audience question that is, at a minimum, let’s just say strident. Jobs kind of ignores the aggressive nature of the query and offers a thoughtful response which is super relevant to health care. He says, “One of the things I’ve always found is that you’ve got to start with the customer experience and work backwards to the technology. You can’t start with the technology and try to figure out where you’re going to try to sell it.” I don’t know a...
May 16, 2019•31 min•Ep. 228
If you don’t know the nuts and bolts of the current Health and Human Services (HHS) proposal to nix Pharma’s ability to pay pharmacy benefit manager (PBM) rebates, then it’s possible you might want to listen to EP216 with Chris Sloan first. In this episode, we don’t talk much about the impact of the HHS proposal on patient premiums or drug costs. That’s EP216 . What we do talk about today is the impact on pharmaceutical companies. We also discuss the drug-buying transaction. Kuo Tong is my guest...
May 09, 2019•31 min•Ep. 227
Today I speak with Devon Herrick, PhD, who is an expert in surprise billing. Devon is a health care economist and public policy analyst who has authored many articles on surprise billing. You’ll find some links in the show notes. Devon is also an adviser to the Heartland Institute, which is a free-market think tank. I find it incredibly thought provoking that a free-market think tank, for reasons we discuss in this podcast, finds unfettered market-driven surprise billing as egregious as the most...
May 02, 2019•33 min•Ep. 226
It turns out, patient-centric care that produces outcomes patients care about is usually less expensive than care that is not. The Patient-Centered Outcomes Research Institute (PCORI), an independent nonprofit, nongovernmental organization in Washington, DC, was authorized by Congress in 2010. PCORI was established to fund research that can help patients make better-informed decisions, guided by clinicians, payers, and others. In other words, help nudge health care into a patient-centric place, ...
Apr 25, 2019•31 min•Ep. 225
“Those who say it cannot be done are usually interrupted by others doing it.” That’s a James Baldwin quote to keep in mind while considering employers ginning up real change in the health care industry. Generally speaking, employers who still don’t believe they could have an impact helping their employees get better health care at lower prices, don’t listen to this podcast. But if they did, I’d suggest this James Baldwin quote is apropos. It’s probably also apropos for providers, carriers, Pharm...
Apr 18, 2019•35 min•Ep. 224
Last time I looked this up online, there were more than 5000 companies offering digital medicine tools. Which ones worked? Which ones are less good than others? Which ones have not been tested? How were they tested: apples to apples or a whole fruit basket of standards? If you’re a clinician or the head of population health or an insurance carrier and you’re trying to figure out whether a digital tool could help solve a problem your patients are having … at this juncture, may the force be with y...
Apr 11, 2019•32 min•Ep. 223
Say you’re a provider, an insurance carrier, a pharma company … and you’ve realized that you need to innovate to reduce costs and deliver better care. Or hedge against an upstart showing up on the scene and disrupting your good thing. Or ensure that your risk-based contracts go well. It’s one thing to cerebrally decide to be innovative and another thing to get your organization to actually do innovation and, arguably just as importantly, cross the “o-gap” or the “operationalization gap,” as my g...
Apr 04, 2019•30 min•Ep. 222
“Dr. Google” has a bad rap in some health care circles. If you doubt my words, go on Instagram and do a search for “Doing battle with Dr. Google.” But let me give you a tip: Pretending Dr. Google doesn’t exist or telling patients to quit it with the internet—these are tactics that are always followed by #doomed. The best way to help your health care brand, organization, and clinicians and patients is to ensure that patients can find credible, accurate content on the internet, which they will be ...
Mar 28, 2019•32 min•Ep. 221
Today we’re talking episodes of care payment models, otherwise known as bundled payments. Just to catch you up if you’re unfamiliar, this type of payment model means that a health care provider packaging together all the services needed during an episode and charges a guaranteed price for guaranteed quality of care. If we’re talking about government payments, about 50% of, for example, knee surgeries are paid for right now in an episode of care fashion. In the private pay landscape, that number ...
Mar 21, 2019•28 min•Ep. 220
Arshad Rahim, MD, MBA, FACP, is a practicing physician and a health economist at his core. He enjoys a track record of building innovative health care businesses, including Mount Sinai Health Partners, Healthgrades, and Sg2. As the senior medical director for population health at Mount Sinai Health System, Dr. Rahim is responsible for driving physician performance for 3000 physicians within the Mount Sinai Clinically Integrated Network, focusing on key utilization, cost, and quality metrics. Dr....
Mar 14, 2019•29 min•Ep. 219
Ram Raju, MD, brings vast executive leadership experience and a keen understanding of New York’s health care delivery system to Northwell Health. As senior vice president and community health investment officer, he evaluates the needs of Northwell’s most vulnerable communities and provides solutions for them by collaborating with community-based organizations. He’s responsible for promoting, sustaining, and advancing an environment that supports equity and diversity, and helping the health syste...
Mar 07, 2019•33 min•Ep. 218
Steve Watson, CPA, SHRM-SCPAs a CFO/CHRO, Steve was frustrated each year with rising health care costs for his employer and employees. In 2012, he decided to make a change. First, he decided to fix the misaligned incentive that he had with his broker. Then he and his broker moved on to fixing the way his insurance was purchased from the insurance carriers. Now Steve is sharing this process with other employers through his consulting company Summit Path Group, whose mission is to lower employee b...
Feb 28, 2019•35 min•Ep. 217
Chris Sloan is an associate principal at Avalere Health, a Washington, DC–based nonpartisan consulting firm. He advises a number of clients—including pharmaceutical manufacturers, health plans, providers, and patient groups—on key policy issues facing the health care industry. His particular areas of expertise include drug pricing, the Affordable Care Act, generics, and biosimilars. Additionally, Chris is a recognized expert in the health care policy issues facing people living with HIV/AIDS and...
Feb 21, 2019•34 min•Ep. 216
Tom Kottler is co-founder and chief executive officer of HealthPrize Technologies, the leading cloud-based patient experience and adherence platform for life science companies. In collaboration with CEEK Enterprises, HealthPrize recently released a new report, “The Pharmaceutical Triple Aim,” showing how 21 of the world’s top pharmaceutical companies can increase revenue and boost earnings per share with improved adherence. Tom has led multiple high-growth organizations during his career, includ...
Feb 19, 2019•6 min
Caroline Znaniec, MBA, MS-HCA, is the founder and principal of Luna Healthcare Advisors LLC. Her boutique consulting group provides revenue integrity advisory services to other consultancies and large advisory firms, software companies and developers, and health system and physician providers. Caroline writes and speaks regularly on topics of revenue integrity for many nationally recognized professional associations, including the Association of Healthcare Internal Auditors (AHIA), American Heal...
Feb 14, 2019•32 min•Ep. 215
Don helps organizations launch new health IT products and services. He’s a product and business development consultant and accomplished health IT expert with a 20-year track record of driving value with technology. Don began his career as a custom software developer and eventually built and led a team of more than 30 engineers. Later, he was the subject matter expert, product manager, and head of sales and marketing for a digital health start-up that launched a software as a service (SaaS) platf...
Feb 12, 2019•9 min
Katie D. McMillan, MPH, has dedicated her career to imagining and building technology to improve health care for patients and providers. Her experience spans multinational global health organizations, lean software start-up companies, and large academic medical centers. Katie’s latest venture is the creation of the Mobile App Gateway (MAG) at Duke University Health System. The MAG serves as the hub for digital health at Duke and provides product consulting services to clinicians and researchers,...
Feb 07, 2019•28 min•Ep. 214
Louis Morrow is regional director of sales for Intelligent Retinal Imaging Systems (IRIS), the leading comprehensive solution provider of diagnostic telemedicine services committed to ending preventable blindness due to diabetic eye disease. Louis was one of the earliest builders at IRIS and has played a major role in saving the eyesight of over 55,000 patients (so far) through the partnerships built with major health systems and integrated delivery networks across the country. He’s an award-win...
Jan 31, 2019•18 min•Ep. 213
