Here’s the thing: All the top-performing Medicare Advantage plans are using, today, right now, some form of advanced analytics and artificial intelligence (AI) to risk-stratify their populations and predict which members will, without intervention, become high cost in the near term. The idea is then to intervene to mitigate risk and stop bad things from happening—bad things that stink if you’re the patient and also cost a lot if you’re the plan. That’s what population health management is all ab...
Mar 05, 2020•37 min•Ep. 263
The World Bank had a revelation a few years back. Some very smart people working there realized that countries that were easy to do business with thrived. Within these countries’ business ecosystem, the best and the brightest entrepreneurs and investors grew not only their own businesses but also positively influenced other businesses and the community around them. Brian Van Winkle and Rishab Shah, both executives at Johns Hopkins, had their own revelation: Health systems who are easy to do busi...
Feb 27, 2020•32 min•Ep. 262
Today I speak with Fred Goldstein. Fred knows a lot about population health. His credentials, in fact, are about as long as my arm, so I’m just going to call him president and founder of Accountable Health, LLC and also co-founder and lead co-host at PopHealth Week —a podcast you should check out. Today Fred and I get into not just what ‘good’ looks like when it comes to population health, but also the six steps to achieve it. If you are looking to deploy some population health or if you are cur...
Feb 20, 2020•31 min•Ep. 261
In this health care podcast, Josh LaRosa from the Wynne Health Group is back to give us an update on the snowball of drug pricing initiatives zigzagging their way around Washington right now. For the details, listen to episode 243 . That’s where we really drill into the details. This conversation is more of a status report. (Note: This episode was recorded on February 6.) You can learn more at wynnehealth.com or reach out to Josh at josh@wynnehealth.com . Josh LaRosa, MPP, is a policy director a...
Feb 18, 2020•15 min
Feb 13, 2020•32 min•Ep. 260
Rahul Dubey is the founder of Percynal Health Innovations. He’s also the former chief innovation officer at AHIP—that’s America’s Health Insurance Plans. AHIP is a trade group for insurance carriers, health systems, best-in-breed solution providers, and others. Rahul has created what he calls strategic working groups, in which he gets together essential stakeholders within a regional geography to collaborate and figure out innovative best-in-class emerging solutions and approaches. The first thi...
Feb 06, 2020•33 min•Ep. 259
In this health care podcast, seven thought leaders talk about the areas of promise they see in health care in 2020. Seven thought leaders include: Kimberly Noel, MD, from Stony Brook Medicine Eric Weaver, from Innovista Health Solutions Suzanne Delbanco, from Catalyst for Payment Reform Sue Schade, from StarBridge Advisors Naomi Fried, from Health Innovation Strategies Joe Grundy, from Grundy Consulting Adrian Rubstein, from Merck Just a couple of comments up front here. I don’t want to further ...
Jan 30, 2020•32 min•Ep. 258
In this health care podcast, I talk with Karl Bilimoria, MD. Dr. Bilimoria is a surgical oncologist and a VP of quality over at Northwestern Medicine. Plus, he is also a John B. Murphy professor of surgery. The second I heard that Dr. Bilimoria and his colleagues had worked on an initiative to “rate the raters” of hospital and physician quality, I reached out to get him on the show. I had just had about four conversations with various people about the difficulties of judging quality. And I had a...
Jan 23, 2020•33 min•Ep. 257
You know how in JAMA recently it said that 25% or more of health care spending is frittered away wastefully? Some of that wasteful spending comes from unnecessary care. And some of that unnecessary care happens when a patient is misdiagnosed and then, based on that misdiagnosis, gets care for the wrong thing. And “wrong thing” care obviously isn’t going to fix the actual problem because its intention is to fix something else. How do some of these misdiagnoses occur? Considering all of the diagno...
Jan 16, 2020•33 min•Ep. 256
Dr. Richard Zane is the chief innovation officer at UCHealth. He’s also the executive director of emergency services there. Besides that, he chairs emergency medicine at the medical school and he’s a professor at the business school and at the medical school. At the recent NODE Digital Medicine Conference, I asked Dr. Zane to talk about the 2019 innovations that he is most proud to have rolled out in their hospital system. We talk about three of these innovations, and then we get into the challe...
Jan 09, 2020•28 min•Ep. 255
Everybody knows about evidence-based medicine, especially evidence-based medicine around the use of pharmaceuticals—and especially in oncology. Provider and payer organizations, many of them, strive to standardize care pathways around that evidence-based medicine. Here is the thing: I’ve heard it said that doctors and patients at the point of care are not particularly interested in evidence-based medicine. What they want right then is medicine-based evidence: If this patient takes this medicine,...
Jan 02, 2020•26 min•Ep. 254
I was asked by a group of students from Michigan University’s Ross School of Business to identify what I would consider companies or areas of promise in health care. It’s a good question. I’m going to take a stab at the answer in this health care podcast, but let me foreshadow coming up next month, there’ll be a second episode of Relentless Health Value dedicated to this same exact topic. I have asked a panel of people from across the industry to weigh in on this same exact question. So, here’s ...
Dec 19, 2019•19 min
Right now, I am in the middle of rereading The Innovator’s Dilemma —that seminal work by Clayton Christensen. I’m at the chapter right now where he talks about resources (human and otherwise), processes, and values. These three things are the trifecta that determines what any organization can manage to achieve—or not achieve, as the case may be with disruptive technologies. Here’s where this is relevant to health IT. You can have the most dedicated team who has built out and proven a digital too...
Dec 12, 2019•30 min
Musculoskeletal issues, otherwise known as MSK issues, account for something like 20% of the cost to any given health plan or employer or anyone else who is paying the bill for health care. That’s like one in every five dollars, which is meaningful when you consider million-dollar drugs and diabetes and all the other things that a purchaser of health care can write checks for. MSK is a big cost kahuna. In this health care podcast, I talk with Chad Gray, who is the CEO of IMC, Integrated Musculos...
Dec 05, 2019•33 min•Ep. 252
I was listening to The #HCBiz Show!, featuring hosts Don Lee and Shahid Shah, earlier this year—specifically, their two-part series entitled “Selling Into Health Systems” [ part 1 and part 2 ]. Besides being co-hosts of The #HCBiz Show!, Don Lee is the founder of Glide Health and VBP Forward [which stands for value-based payments], and Shahid is a serial entrepreneur; one of his companies is Netspective. Shahid can be found doing HIT keynotes all over the country, too. Both of these guys, Don an...
Nov 28, 2019•37 min
In this podcast originally published early last year, Alex Akers and I had a chance to speak with Dr. Robert Pearl about his book Mistreated: Why We Think We’re Getting Good Health Care—And Why We’re Usually Wrong. Besides being an author, Dr. Pearl is former CEO of the Permanente Medical Group; he’s a frequent keynote speaker; and he is also the host of a podcast called Fixing Healthcare. Here’s what Dr. Pearl said at the recent HLTH conference in Vegas, and I’m editorializing a little bit here...
Nov 21, 2019•36 min
There are four pillars that contribute to readmissions: ensuring patients are equipped to self-manage and properly take their medications; follow-up (usually by PCPs); managing transitions of care and care coordination, which might be known as interoperability; plus avoiding medical errors. Dr. Kim Noel and I discuss each of these pillars and how telehealth and other digital tools can close gaps and help patients do what they need to do to stay out of the hospital. Dr. Noel is a clinical researc...
Nov 14, 2019•31 min•Ep. 251
Patients, families, caregivers are generating data outside of the health care setting. They are tracking exercise, symptoms, blood pressure. And they’re coming in for their appointments bearing stacks of printouts or their username and password on a little piece of paper and asking their clinicians to log in to their accounts and check out the goings on. Clinicians, meanwhile, struggle to understand how to bring these data elements into provider environments so that the data can improve engageme...
Nov 07, 2019•33 min•Ep. 250
The North Carolina State Employees Health Plan (SEHP) crafted a proposal called the Clear Pricing Project. The Clear Pricing Project proposed to pay network hospitals based on a transparent price schedule. Considering that SEHP purchases benefits for something like 720,000 people in North Carolina at a cost to taxpayers of billions of dollars, this seems reasonable. When you’re the fiduciary for thousands of dollars, let alone add six more zeros, it would seem to be non-negotiable to actually se...
Oct 31, 2019•34 min•Ep. 249
In this health care podcast, I speak with Mark Blum from America’s Agenda. When I was talking with Mark, I kind of pictured him bearing a flag with a peace sign on it. His point for unions and employers alike is this: Instead of ripping each other into shreds at the bargaining table over health care, maybe work together proactively. Clip the reasons for rising health care costs in the first place. These reasons include, but certainly are not limited to, excess middleman profits that do not contr...
Oct 24, 2019•34 min•Ep. 248
In this health care podcast, I speak with John Gorman, who is a government-sponsored health programs guru. He’s also the founder of a newly minted organization called Nightingale that (spoiler alert) we discuss toward the end of our conversation. I just want to interject right here that I, for one—but I’m sure John would agree—do not believe that Medicare Advantage (MA) is, as is, perfectly terrific and devoid of problems. There are, of course, well-known issues with coding, the whole exaggerate...
Oct 17, 2019•34 min•Ep. 247
In this health care podcast, Pam Arora, SVP and CIO at Children’s Health in Dallas, talks about the work she and her team are doing. Spoiler alert: It’s pretty visionary. They have integrated telemedicine solutions in schools and in patients’ homes. They’ve also been monitoring adherence to vital transplant meds by putting chips on the capsules. They have initiatives happening with voice and GPS technology. I asked Pam what it takes to get all of this done while, at the same time, balancing the ...
Oct 10, 2019•32 min•Ep. 246
I want to talk about the wellness industry today. In the parlance of the famous (or infamous, depending on where your revenue is coming from) Al Lewis, traditional “to employee” types of wellness programs are health care done to employees, not for employees. They’re like forced health care. Generally, these programs tout cost savings to the employer. And also generally, these programs aren’t optional; they may include sticks as well as carrots and sometimes sticks that are dressed up as carrots ...
Oct 03, 2019•33 min•Ep. 245
In this health care podcast, I speak with Lee Lewis, who is the newly minted chief strategy officer at the Health Transformation Alliance, otherwise known as the HTA. The HTA is a group of 50 major corporations that have come together in an alliance to do one thing: fix our broken health care system. Anyone who knows Lee knows he knows a lot about how to improve health care benefits for large employers. He’s pretty much the perfect guy to be the chief strategic officer at the HTA. The most amazi...
Sep 26, 2019•37 min•Ep. 244
Here’s one fact of life that’s always true: It will always be the desire of big vested interests to maintain and stick with the status quo. This applies to all of the various parties in the drug supply chain as much as it does to any other industry. So, here’s the $106-billion-a-year question: In 2019 or 2020, will all of the drug pricing proposals and legislature popping up all over the place in Washington and in some states right now—will they all just simply blow over? Is it the case that Big...
Sep 19, 2019•32 min•Ep. 243
In this health care podcast, I speak with Dr. Marty Makary about his new book, which is entitled The Price We Pay: What Broke American Health Care—and How to Fix It . I could not recommend this book more highly. It’s a page turner for hospital execs trying to do the right thing, employers trying to do right by their employees, insurance carriers looking for better ways to actually drive health care value, and doctors and nurses who are feeling burnout because they see their organizations demandi...
Sep 12, 2019•45 min•Ep. 242
There are 65,000 community pharmacies in the United States today, and the total cost to locate, staff, and operate these pharmacies is about 9% of our total national drug spending. That’s less than 1% of our national health expenditure—and falling. This is despite the fact that about 85% of our nation’s something like 6 billion prescription fills are unbranded generics, and unbranded generics are a staple of community pharmacy business. These stats are courtesy of Troy Trygstad, by the way. Bott...
Sep 05, 2019•36 min•Ep. 241
Are patients consumers? Defining the terms patient and consumer will get us started here and also provide the insight and common understanding that we need to tackle this seemingly elusive question. Patient (adjective): able to accept or tolerate delays, problems, or suffering without becoming annoyed or anxious. Synonyms: forbearing, uncomplaining, tolerant, long-suffering, resigned, and stoical. Definition two (noun): a person receiving or registered to receive medical treatment. I’ll get to t...
Aug 29, 2019•18 min
“If operating on the wrong leg is called a ‘medical error,’ what do we call operating on someone who doesn’t need surgery?” That is a quote I have heard attributed to Jack Wennberg. It also crystalizes a theme I have been hearing a lot lately—the idea that quality metrics in this country today assess care from basically a patient safety standpoint but they don’t consider whether the patient actually needed the surgery or whatever in the first place. Or whether the outcome of the treatment matche...
Aug 22, 2019•32 min•Ep. 240
I am working on a collaborative endeavor right now where the BAA (business associate agreement) signing has literally taken a year. The whole project will likely take 2 weeks. I know I’m likely not going to shock anyone listening, but the legal side of any sale or install or collaboration or proposed interoperability can be a serious impediment when every venture takes literally months or even years. That’s kind of the opposite of a fluid marketplace or fluid collaborative environment and one of...
Aug 15, 2019•31 min•Ep. 239
