Relentless Health Value

This conversation starts out talking about the RUC, which is a committee run by the AMA, who has the sole source contract with CMS to figure out how many RVUs any given procedure or service is worth. There are roughly four times as many specialists on this RUC committee as PCPs. You might be able to see where this is going, but let me let our guest in this healthcare podcast, Brian Klepper, explain how primary care got trampled by the goings-on. Brian Klepper is a longtime healthcare analyst and former CEO of the National Business Coalition on Health. You can learn more by emailing Brian at bklepper@worksitehealthadvisors.com. Brian Klepper, PhD, is a healthcare analyst, commentator, and entrepreneur. He is a Principal of Healthcare Performance Inc, a healthcare strategy and business development practice, and CEO/Principal of Worksite Health Advisors, a benefits consultancy focused on linking high-performance/high-impact healthcare organizations with purchasers. He founded and moderates a popular profession

In this healthcare podcast, I’m talking with Brian Klepper. If you haven’t heard of him, Brian’s a longtime healthcare analyst and former CEO of the National Business Coalition on Health. This interview takes off like a shot, as most of my conversations with Brian Klepper do. We’re talking about primary care and its various iterations. We start out with Exhibit A—the HMO version of primary care from the ’90s. This is a great comparator to really get a handle on what’s going on today. During the heyday of HMOs (back in the ’90s), primary care was basically a glorified gatekeeper kind of doing two things. On one hand, they were restricting access. It wasn’t an accident that it was really hard to get an appointment with a PCP.  On the other hand, it also wasn’t an accident that, once you got there, the PCP only had 7 minutes to spend with you, which basically meant that you left with an appointment to see a specialist at, of course, the health system that probably had just bought that PCP practice. Everybody’s h

Let’s discuss price transparency, which isn’t an end unto itself obviously. The great hope of price transparency (or at least one of them) is that it furthers consumerism, which is also not an end unto itself. Obviously. The great hope of consumerism is that it effectively forces the health care industry to straighten up and fly right. Before I dig into this, let me make one critically important point for context. Enabling consumers to find low-cost providers is not the only goal of price transparency. Employers should be hiring companies to do cost analytics and bring them back insights which should, along with quality indicators, be part of network selection or direct contracting or bundle considerations. Add to that something I heard Katy Talento say the other day. She said something along the lines of: Anyone sitting around whiteboarding cockamamie reasons to keep their prices secret ... how is that not corrupt? You’re trying to conceal the prices that your patients will ultimately be responsible to pay,

Recently I was talking to someone, a civilian not in health care, and I mentioned something about how patients don’t always get a treatment plan (a care plan) based on the best evidence or sometimes even any evidence. Here’s how I explained it to him—what this looks like in the real world: Let’s say two patients, patient 1 and patient 2, with the exact same clinical needs and zip code … both these two patients see the exact same doctor. The only difference between these two patients is that they’re two different colors. And let’s add a third patient into this mix: say, ME. Let’s say I have the exact same profile and zip code as those first two patients. I see a different clinician in the same exact practice, though. In all these circumstances, evidence is evidence, right? There should be one care plan that all three of us get when we show up at that same care setting. Until the evidence changes, that is, right? But the reality is that it’s just as likely that those other two patients and I, we all get various

In most other industries, it’s the customer who consumes the services and engages with the purveyor of services. In health care, not so much. Legacy health care has evolved to honor the insurance carrier as the customer or, in some cases, the fancy surgeon or other driver of revenue as the customer. Listen to the podcast with Marshall Allen for more on that front, but yeah. And here we are.  Health care should be designed so that patients get the best outcomes at a financially not-toxic price point. Otherwise, what are we doing here besides putting profit over patients? In this health care podcast, the conversation is about PCVS, otherwise known as creating a “patient-centered value system,” otherwise known as building a new OS, or operating system, for health care—one that is built around the patient and their experience. The general idea here is to rationalize the patient journey from start to finish: to create a longitudinal flow that guides a patient from here to where they need to be with a minimum of be

My guest in this health care podcast, Al Lewis, was telling me before we hit record that employer customers are vastly worse at evaluating wellness and point-solution vendors today than they ever have been in the past. Let’s break this down. One aspect leading up to the “worse than ever” is the proliferation of point-solutions lately and all the PE (private equity) dollars flowing into the health care space. You pick up any rock and you’ll find 25 health care startups underneath it. A second aspect is this: and this is not going to be a newsflash for many, but employers really trust their brokers and their EBCs (employee benefit consultants) to put together a good benefit package on their behalf. If an EBC says, “buy it,” employers click their heels and buy it a lot of times. And with that great power comes great... opportunity. We see an uptick in brokers and employee benefit consultants, enjoying themselves a little arbitrage-ish money grab by taking money from these startups/vendors under a variety of umbr

In this health care podcast, I’m interviewing John Marchica, who is the CEO at Darwin Research Group. Starting last year in the middle of the worst of the COVID pandemic, Darwin Research Group conducted a study about what was going on at health systems or integrated delivery networks (IDNs), and they’ve updated it every quarter since then. The goal was to try to stay on top of the effects of COVID-19 on care management and the business of care delivery. I loved having this opportunity to quiz John about what health systems are saying about how they are doing and what they are doing, both strategically and reactively, coming out of the pandemic and in response to the pandemic. Now this is a half-hour conversation about an extensive research report, so we’re kind of aggregating all of the health systems in one big bucket. Said another way, we’re obviously not going to play the deep cuts here. No worries—the insights that John lays out are fascinating and give an insider’s look into what’s going on at these real

In a recent article in STAT news, TJ Parker, the VP of pharmacy at Amazon and the founder of PillPack, explained that Amazon’s plan to stand out in the pharmacy space is simple: “Better selection, better convenience, and better prices.” He added, “It really is the Amazon playbook.”  Better selection, better convenience, better price. The playbook of arguably one of the most successful companies ever, Amazon has decimated and bankrupted anybody standing in its way toward total market dominance. This same better selection, better convenience, better price trio—maybe with “better selection” inferred to mean “getting the right care to the right patient at the right time”—is the vision of many of the virtual-first health care providers starting to pop up. And when I say “pop up,” I mean that in Q1 of this year, according to data from Rock Health, $6.7 billion was invested in digital health companies.  In this health care podcast, we’re talking about the proliferation of these “virtual-first” health care solutions.

“Scientists Announce Successful Experiment to Bankrupt Mouse That Can’t Afford Cancer Drug.” That’s a recent headline from The Onion, which is, by the way, a funny satire newspaper, if you haven’t heard of it. You could swap out “Cancer Drug” in that headline with “a Trip to the ER”—or pretty much any aspect of health care in this country. No matter what health care service you stick in there as the potential cause for a mouse’s bankruptcy, it’s a pretty LOL headline, right? But the reason why it became a headline is because obviously it’s based on a truth that resonates with your regular citizens in this country. Think about that. A critical mass of people around here believe that health care will bankrupt you. This is one of those sociological signals that has implications to health care leaders. Here’s another signal with implications. In this health care podcast, I’m interviewing the incomparable Marshall Allen. That’s not the signal. His book, Never Pay the First Bill: And Other Ways to Fight the Health

If I had a nickel for every guest on this show who went on to achieve wild success … TJ Parker from PillPack three years before they were bought by Amazon. Anyway, let me introduce this show with a clip from the recent podcast (EP325) with Dr. Mai Pham. We were talking about the rampant and very open secret of excessive upcoding in Medicare Advantage (MA) that is costing American taxpayers a fortune and is very not correlated with actual spend. Here we go with Dr. Mai Pham:  Stacey: Do you have any thoughts relative to how you ensure that these MA plans that are becoming vast are still accountable to not game the system? How do you plug loopholes in a way that doesn’t invite additional and more nefarious gaming? Dr. Pham: My fantasy has always been that CMS can develop, or somebody can develop, a black box machine learning–driven, risk-adjustment algorithm that no one can see into—not even the payer. It would very much level the playing field, assuming that it was developed correctly, appropriately, and you u

You can subscribe to this show two ways. One way is through the iTunes podcast app or your podcast app of choice. That’s a cool way to subscribe because then the show just kind of turns up in your podcast app each week and you can decide to listen to it on the fly. The other way is to subscribe on our Web site. This is more like a newsletter subscription. If you subscribe this way, you get an email each week that transcribes the show introduction, plus includes timed show notes. Many people subscribe both ways, just saying, because each way has different benefits that are pretty complementary. If you subscribe to the newsletter, you only get the newsletter. We are frankly way too busy doing other things to send out other emails. Also, you can easily unsubscribe at any time. I saw a post the other day in Twitter. Someone wrote, “So much can be done to improve community and share lessons to improve outcomes. The trick is making money without selling patient data to Pharma.” Here’s my question for you, and I’m l

Here’s the context, friends: As you may have noticed over the past few episodes, we have been digging into value-based care here at Relentless Health Value corporate work-from-home headquarters. Many lessons have been learned, and it’s important that we sit back and think hard every now and then about how we are going to use these learnings to improve. While this show tackles the Hospital Readmissions Reduction Program (HRRP)—and wow, I was glued to my seat during this interview—the show is really about more than that, which I’ll get into in 30 seconds. But let’s start here: HRRP was originally part of the Affordable Care Act in 2010. In 2012, HRRP began imposing penalties on hospitals with higher-than-expected 30-day readmission rates for three conditions: heart failure, myocardial infarction, and pneumonia. Spoiler alert: More recently, CABG, THA/TKA, and COPD were added to the list. So basically, if a patient is in the hospital for any of these six things and then is readmitted to the hospital for any reas

First of all, a shout-out to all of you listeners who have shared this show with colleagues and LISTSERVs—really appreciate it. It’s because of you and your efforts to share that Relentless Health Value maintains its spot as one of the top podcasts reaching health care executives, executives who take the insights shared by our guests to drive actual change and transformation across our industry. So, thank you. Leaving a rating and/or a review on iTunes is also the bomb and really helps our RHV team stay motivated and keep it going. Weekly shows take a ton of work! Feedback is super appreciated. On to the topic this week: Who has read that white paper put out in February by the University of Pennsylvania, specifically, Penn’s Leonard Davis Institute for Health Economics? It’s called “The Future of Value-Based Payment: A Road Map to 2030.” I mentioned this paper last week, too. So, if you still haven’t read it, go back after this show and take a look. There’s links in show notes.  As with every interesting whit

Recently, the University of Pennsylvania Leonard Davis Institute of Health Economics, or LDI, put out a white paper called “The Future of Value-Based Payment: A Road Map to 2030.” Spoiler alert: Next week’s show is with Dr. Mai Pham, an author of that paper; and it’ll be a great show—so, tune back in next week. But, in the meantime, that paper made some really interesting points about ACOs (accountable care organizations). For example, they say that the average ACO shows a net savings of

This episode seemed particularly relevant right now because it gives insight into how large self-insured employers are prioritizing their efforts to disrupt health care revenue streams that do not provide adequate health outcomes for dollars spent. This episode’s conversation is with Lee Lewis. This is an encore episode. The original was recorded when Lee was the newly minted chief strategy officer at the Health Transformation Alliance, otherwise known as 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. Anybody who knows Lee knows he knows a lot about how to improve health and health care benefits for large employers. The most amazing thing I always find about improving health and health care benefits is that it’s like having your cake and eating it, too. On one hand, both employer and employee save money. On the other hand, employees get better care and spend less time away from work struggling to navigate the health c

One way to spot a flash point is to notice when people are using different words to describe the same concept. Throughput is one example of this. On one side of the table, you have those who grasp that if a provider organization is concerned about patient outcomes, with few exceptions, building relationships with said patients is essential. It’s not entirely clear to anyone anywhere how you manage to build relationships and trust without spending a certain amount of time with patients. These “we need time with patients” people will bring up the Quadruple Aim issues that arise from rigid 7-minute appointments or even 50-minute appointments really. On the other side of the table, you have those who have built practice fiscal models on the backbone of however-many-minute appointments. They use different terminology for this whole concept, however. They call it throughput. How many patients can a physician manage to squeeze into a day? Some of these folks will tell you that throughput success is “more is more.” I

Imagine if innovators in other businesses operated in the way that some health care status quo doomsayers finger wag. So much for failing fast, iterating, and folding learnings into something that might work better. I don’t like to see screeds that seem to advocate an approach of “try it a few times at a minimum half-heartedly, fail, and then just quit, because obviously anything worth doing should be that easy.” Pieces fell into place with me as I was speaking to Monica Lypson, MD, MHPE. Dr. Lypson is an expert in a bunch of things, but one of them is thinking about next-generation primary care and health equity and what that might look like in value-based care (VBC) metrics. I asked her if because of some of the negative potential perverse incentives to these patient populations whether we should throw out the VBC baby with the bathwater. Her response was succinct and amounted to, “And go back to what? FFS? Because that’s worked out so well?” All this being said, there are big issues with value-based care r

If you listen to this show on the regular, you probably have a pretty good bead on a couple of things I’ve been really into lately. One of them is high-value care versus low-value care. These are terms that are really easy to throw around. You also can get pretty much everybody to agree with a plan to deliver only high-value care and quit it with the low-value care … in theory. But the wheels fall right off the bus when it comes to actually doing this. IRL (in real life), what constitutes high-value care and what is low-value care exactly and specifically? This answer is the crucible for value-based care of almost any flavor. How are you supposed to do value-based care successfully when it remains an open question, “What is care that is of value?” Here’s the good news, though. There is a bounty of unmistakably, inarguably low-value things. We can start there. Now, these low-value things may be situational in some respects, so you’ll need to listen to my interview with Dr. Mark Fendrick (EP308) for the scoop o

When I was talking with Dr. David Carmouche from Ochsner in EP316 about the importance of collaboration amongst anybody trying to actually pull off value-based care, we took a little detour, which I wound up cutting out, into the potential and challenges for health systems to collaborate and do value-based contracts with pharmaceutical manufacturers. It’s a really interesting sidebar, though, that I wanted to share with you—especially on the heels of the recent interview with Troy Larsgard from Johns Hopkins (EP318) on how Pharma can better meet the needs of their health system customers.  Here’s an interesting point that Dr. Carmouche makes in the sidebar that I thought was worth highlighting. Chalk this up as one of the challenges when trying to create some kind of risk-share agreement with a pharma company to get the manufacturer to put their money where their mouth is when they say that downstream costs will be saved or complications avoided or better outcomes attained. The challenge comes in assembling e

If you want to hear what my mom and dad, both Medicare Advantage patients in their late 70s, have to say about telehealth (or teleconferencing, as my dad puts it), you’ll have to listen to the episode. They are not and have never been health care professionals, but they fully get that the question “What’s better—telehealth or in-person care?” asked like it’s some kind of winner-takes-all cage fight doesn’t serve anybody’s needs. And by anybody, I mean clinicians or the patient. And by patient, I mean even Medicare Advantage patients in their late 70s. In this health care podcast, I’m speaking with Christian Milaster from Ingenium. Christian worked at Mayo for 12 years before starting his consulting firm specializing in many aspects of telehealth. He has a great newsletter, by the way. I’ve appreciated subscribing to it. It’s called Telehealth Tuesday. I would recommend it.   Christian says telehealth is a clinical tool. That’s why there’s no answer to the question of whether in-person is better than virtual.