Episodes

  • EP455: A Leadership Blueprint for Measurably Better Care, With Beau Raymond, MD

    EP455: A Leadership Blueprint for Measurably Better Care, With Beau Raymond, MD
    Oct 31 2024
    A rate critical to attain better care for patients, I’m gonna say, is enlightened leadership—maybe dyad leadership—at a clinical organization. I am saying this because without enlightened leaders, it’d be harder to build from the blueprint that Beau Raymond, MD, talks about today on the show. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. I’d say an enlightened leader is someone—and this is my definition, but it’s a term that Tom Lee, MD, brought up first in an earlier episode (EP445)—an enlightened leader really cares about providing better patient care at an affordable price. They have a manifesto to that end, if you will. They also have studied, likely, and understand how change management works because every improvement requires change. They get the bit about people, processes, and technology being intertwined and what operational excellence means. Further, they are probably doing or considering many of the things that Robert Pearl, MD, talked about in episode 412. On the opposite end of the spectrum, there’s a new term floating around called administrative harm. There’s a study. Admin harm refers as much to what administrators—who I refuse to call leaders at this context because I’m talking about the not good administrators, so let’s be clear—but I’d say administrative harm results from what the administrators choose not to do as much as what they choose to do. It is actually a thing to be an enlightened leader, especially in these profit-driven times. It’s really tough, actually, and nothing anyone should take for granted. So, maybe this whole show is kind of a shout-out to the enlightened leaders out there. Thanks for doing what you do. Okay, so this said, and it needed to be said, let’s talk blueprint for better care in the conversation that follows. Dr. Beau Raymond says, step 1, right out of the gate, set clear goals. Then step 2, engage others throughout the organization to together build the framework needed to achieve said goals. Engaging frontline folks and others is really the only way that any proposed framework will actually work in the real world. Listen to the shows with Karen Root (EP381) and Ashleigh Gunter (EP447) for just one proof point after another that what I say is based in fact. Step 3 of the blueprint to better outcomes that Beau Raymond, MD, talks about today is get your data. We talk a lot about plan sponsors and the getting of data, but same thing applies to clinical organizations. For clinical organizations, the getting of data means longitudinal data. The need for longitudinal data has come up in multiple shows, most recently the one with Dan Nardi (Spotlight Episode), and this is just one example of why getting the whole bag of data really matters. Dan said on that earlier show, it’s often a thing that oncologists are unaware of how many of their patients are winding up in the ER for nausea after chemo, which, by the way, is the most common cause for readmission. And the reason for this is lots of patients travel to their oncologist but go to a local ER in a different health system. The show with Brendan Keeler (EP454) about the Particle v Epic lawsuit in general dustup over who gets the data is super relevant here. That’s what I was thinking when I was talking with Dr. Raymond, and maybe it just popped in your head, too. Or just continuing this topic of the importance of longitudinal data, how many specialists, in almost any specialty, see a patient and then don’t know what happened to that patient subsequently? Or even primary care in transactional models? So, step 3 here is get your data and also, as part of that, figure out how to make sure everybody understands the data and also understands that it is fair. Eric Gallagher (EP405), Dr. Raymond’s dyad counterpart over at Ochsner, talked about this some in that episode. So did Kenny Cole, MD (EP431), interestingly, also from Ochsner. Amy Scanlan, MD (EP402) mentions it as well. Step 4 in the blueprint to measurably better outcomes that I discuss with Dr. Beau Raymond, data collection and data management probably need to be system-wide because … yeah, longitudinal and etc. But the “What are you gonna do now with the insights that you derived from the data?” is pretty local. The obstacles and enablers are going to be different depending on the geography. For example, an area with a large Vietnamese population and a big variation in colorectal screening rates as a priority, just logically, is gonna have a program that is in no way suited to roll out in an area with, say, a large Black or African American population with high hypertension rates. Priorities and programs are just different depending on the geography. So, step 4 here is, ask each region, based on the data, what fixes they’re going to own. What will they take ownership on and commit to...
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    39 mins
  • EP454: How the Particle v Epic Lawsuit Impacts Plan Sponsors and Public Health Trying to Get Data, With Brendan Keeler

    EP454: How the Particle v Epic Lawsuit Impacts Plan Sponsors and Public Health Trying to Get Data, With Brendan Keeler
    Oct 24 2024
    You know why I’m interested in the Particle v Epic EHR (electronic health record) systems lawsuit? It’s because … data. Say I’m thinking about this like, say, a plan sponsor and I want data so I can do better population health or do care navigation to help my members avoid downstream bad things or steer and tier to high-quality docs and point solutions and, and, and … For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. To do anything that has anything to do with population health, I need data. And when I say data, we often think claims data as plan sponsors; and we think about getting it from carriers. But where does the claims data originate? Oh, right … the gleam in the eye of a lot of claims data is EHR data. Someone typed something into an EHR system that metamorphosized, ultimately, into a claim that wound up in a carrier’s dataset. Plan sponsors want the claims part of the claims data, obviously, to see prices; but they also want those underlying data elements that indicate the health of their members. Said another way, they want the insights gleaned from some clinician somewhere who typed something into an EHR system that turned into codes that drove claims. So, yeah … Particle v Epic. Particle was getting EHR data and passing it on to other parties, and we get into the what’s and the who’s and the commentary. But bottom line, what I wanted to get into today is this: Will this lawsuit result in more access to data for downstream entities who need it, or less? What are the implications here of Epic shutting down access to its EHR data to Particle and Particle filing an antitrust lawsuit saying Epic did this because Epic wanted to use their monopoly power here to advantage their own payer platform business? Oh, the plot thickens. Payer platform business? For an EHR system. What is that exactly? More intrigue. What’s going on there? Because, yeah, probably a lot of plan sponsors and patients are, I’m gonna say, unaware of this part of the equation as to what data the carriers seem to have and where are they getting it from and what things they may be doing with it that plan sponsors and/or members who are their customers may or may not be aware of. Knowledge is power here, especially in the fight over trying to get data out of carriers who won’t hand it over when the carriers themselves are getting that data through interoperability networks that potentially plan sponsors also qualify for. Chucking that in there as a point to ponder. This whole “I’m intrigued” bit here, though, was not rhetorical. I really am/was intrigued—so intrigued, as a matter of fact, that I called Brendan Keeler to come on the pod and talk this out with me. Brendan, by the way, has written a very detailed account of the Epic/Particle dustup. There is a part one and a part two. Before we kick in here, though, I did just want to make at least one point on background. First, so many, many people want to get their mitts on EHR data for good reasons and maybe not-so-good reasons from the standpoint of the patients whose personal health information is being fought over here. The basic rule is that to get EHR data, you have to be involved in the treatment of the patient. So, this is the current governance as it stands. You have to be involved in the treatment of the patient if you want EHR data. So involved in the treatment, actually, that you have to have your own treatment data to share back. This is called reciprocity, right? Like, how can you say that you’re treating a patient if then you don’t have any data as to that treatment? On-site clinics, by the way, are providing treatment—just saying, in case anybody is thinking the same thing I’m thinking right now. Okay, back to the lawsuit. The real kicker of this whole Particle v Epic and Epic cutting off Particle thing, as far as I’m concerned, is over the secondary use of said treatment data once someone gets it (ie, someone gets EHR data transmitted to them because they are doing something or other to treat the patient, but now they have that data). And at that point, is it a free-for-all what they do with it? Can they, I don’t know, sell it to anyone they want? Said another way, what if I realize I need EHR data for, I don’t know, I’m a lawyer trying to do lawyer things or I’m public health entity or whatever. It doesn’t matter. If I throw a medical professional in a room and cook up something this person is doing, that could be considered treatment if you squint at it. Tricky, right? Now I can get EHR data. So, yeah … there’s that motto “If you ain’t cheatin’, you ain’t tryin’,” which Pryce Ancona said, ironically, on Health Tech Nerds the other day; and I cracked up. But it’s so not funny. Because you have some people—maybe or maybe not—kind of violating, let’s just say, the spirit...
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    35 mins
  • EP453: Running a TPA (Third-Party Administrator) RFP Process That Is Less of a Wild West Fiduciary Shootout, With Claire Brockbank

    EP453: Running a TPA (Third-Party Administrator) RFP Process That Is Less of a Wild West Fiduciary Shootout, With Claire Brockbank
    Oct 17 2024
    In this episode, host Stacey Richter delves into the complexities of the Third Party Administrator (TPA) Request for Proposal (RFP) process with guest Claire Brockbank from 32BJUnion. The discussion highlights the critical role of contracts in managing health plans effectively and the potential pitfalls of accepting contracts crafted by TPAs without thorough review. Drawing from Claire's experience, they explore tactics like starting with your own contract paper in RFP processes to gain negotiation leverage, and the benefits of employer coalitions in navigating health care complexities. To Read the full article which includes mentioned links visit the episode page. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to become a member of the Relentless Tribe. Real-world examples underscore the financial impacts of poorly negotiated contracts and highlight successful strategies for health plan sponsors to optimize costs and services. The episode aims to empower employers with tools and insights to negotiate effectively and ensure their health plan contracts align with their strategic goals, ultimately paving the way for better population health management and cost-effective care delivery. As but one example—and Cora Opshal spoke about this last week and Claire talked about this today—it’s about how allowing upside-down payments, for example, that are in a lot of ASO contracts, this allowing of upside-down payments. I mean, it turns out that 32BJ spent around $10 million paying more than the bill was for one year. If somebody signs that contract as handed to them by the carrier, then the plan is now contractually obligating themselves to pay more than the price the clinical practice was charging. So, doc sends bill for $100, and the carrier pays that practice $200 on behalf of the plan sponsor. So now the plan sponsor is paying $200 for a $100 bill. Is this conflict of interest? Is it imprudent? Is it not reasonable? Said another way, is that a bit of a fiduciary breach on the plan sponsor? So it's understandable why the team at 32BJ pushed back and pushed back hard. We all can see why the leading edge of plan sponsors and more and more C-suites are hotfooting it into conference rooms to plan their RFP process and doing it in the way that Claire Brockbank talks about today. For an open-source contract and some other free tools, please do head over to the 32BJ Insights Web site. 05:36 How does the initial contract writing affect how events in your healthcare plan will go? 06:56 What happens if a plan sponsor or employer doesn’t do the contracting right? 10:42 How much could be saved by doing contracting right? 11:01 EP433 with Justin Leader. 12:22 How do you start an RFP process with your own contract? 14:06 What Claire Brockbank recommends doing to do a TPA RFP process in a way that’s best for you. 19:46 What factors do carriers need to get an ASO or TPA to respond to using your contract? 21:11 Open-source contract available from 32BJ. 21:57 Why it’s important to really probe brokers, despite loyalty to your broker/consultant. 24:30 Who are the reliable agents and experts when carriers are looking to start this process? 26:24 EP428 with Julie Selesnick. 27:56 What’s the silver lining to this effort? 29:17 Why is it important to make it clear why you’re doing what you’re doing for your lawyers and any other support team you need? 31:39 What does “good” look like in this process? 34:15 Why is it important to continue to hold your ASO accountable?
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    37 mins
  • EP452: Fiduciary Duty vs the Healthcare Status Quo, With Cora Opsahl

    EP452: Fiduciary Duty vs the Healthcare Status Quo, With Cora Opsahl
    Oct 10 2024
    In this episode I interview Cora Opsahl from the 32BJ Health Fund to examine the intricate dynamics between fiduciary duties and the entrenched status quo in healthcare. The discussion focuses on the challenges employers face when dealing with anti-competitive contracts and their responsibility to ensure plan expenses are reasonable. Cora Opsahl, my guest today, is the director of the 32BJ Health Fund, serving over 200,000 folks. Their ability to kick NewYork-Presbyterian, a big, consolidated, very expensive hospital, out of their network in 2018 enabled them to offer maternity benefits for $40 in total out-of-pocket for members. And also, employees got their biggest raise ever; employers got a premium holiday and a 3% rate increase for a bunch of years after that; and yeah … this is where we start the conversation today. Furthermore, you will find links to a template health savings calculator for plan sponsors and also a template contract (again for plan sponsors) that 32BJ has made available, in our show notes.

    To Read the Full Show Notes with the Mentioned Links Visit the Episode Page.

    If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.

    06:16 Why is it imperative for employers to do something differently when it comes to being plan sponsors?

    09:22 How analyzing claims data allowed 32BJ Health Fund to reshape their benefit design.

    12:09 What anticompetitive rights did 32BJ run into that limited 32BJ Health Fund from managing their benefit design?

    14:12 How do these anticompetitive rights have quality implications as well as cost implications?

    18:43 How did 32BJ Health Fund remove NewYork-Presbyterian from their network, and how much did it save 32BJ Health Fund per year?

    19:46 What did the healthcare savings allow the unions and employers to do?

    20:46 Study by Zack Cooper, PhD.

    21:26 Why rising healthcare costs has pushed 32BJ Health Fund to move beyond benefit design to manage healthcare spend.

    24:15 Why 32BJ Health Fund wants to control the contracting process.

    26:00 EP419 with Andreas Mang.

    27:18 What are 32BJ Health Fund’s four non-negotiables?

    33:17 Wall Street Journal article on health insurance contract.

    35:30 Upcoming episode with Claire Brockbank.

    36:14 What is the challenge that exists in our current healthcare environment?

    37:43 Cora’s advice on how to get high-quality healthcare at an affordable price.
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    40 mins
  • Spotlight Episode: Oncology Side Effect Management in the Real World, With Dan Nardi From Reimagine Care

    Spotlight Episode: Oncology Side Effect Management in the Real World, With Dan Nardi From Reimagine Care
    Oct 3 2024
    In this Spotlight Episode host Stacey Richter discusses the management of oncology side effects with Dan Nardi, CEO of Reimagine Care. Highlighting the challenges cancer patients face, especially following chemotherapy which often leads to nausea and readmissions, the conversation delves into how Reimagine Care facilitates at-home integrative cancer care. Their services focus on proactive and reactive support via AI-driven tools like 'Remy' to assist patients outside of clinical environments. This approach aims to reduce emergency visits and improve patient outcomes while easing the workload on healthcare providers. The discussion underscores the role of patient reported outcomes and the integration of technology with human care to improve the quality of oncology treatment pathways.

    To Read the Full Article Notes with Mentioned Links, Visit Our Episode Page .

    If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.

    Note from Stacey Richter: Pulling off a show like this one is not cheap, and my Aventria business partner Dave Dierk and I are happy to fund the vast majority of it. But yeah, breath of fresh air, and thanks much to the team over at Reimagine Care for their sponsorship. My one disclaimer is that I have not personally vetted the solution, but there is a white paper available where you will also find some insights from Reimagine Care’s work with Memorial Hermann Health System.

    03:38 Why is it really important to keep track of oncology patients and their side effects?

    04:27 Why is cancer treatment such a complex care journey?

    05:57 Are there outcome and financial issues that compound when an oncology patient is left to navigate their care journey on their own?

    08:53 What is difficult in navigating cancer treatment care pathways, and what does Reimagine Care tackle within that?

    09:55 EP157 with Ethan Basch, MD.

    10:17 How does Reimagine Care proactively check in with oncology patients to help them navigate their care pathways?

    12:41 How does Reimagine Care measure their performance, and how did their work affect patient outcomes?

    13:28 The Reimagine Care white paper.

    14:57 How do providers feel about Reimagine Care services?

    17:37 Where can technology really make a difference in cancer care?
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    19 mins
  • EP451: Hey, Let’s Not Talk About Artificial Intelligence, With Spencer Dorn, MD, MPH, MHA

    EP451: Hey, Let’s Not Talk About Artificial Intelligence, With Spencer Dorn, MD, MPH, MHA
    Sep 26 2024

    In Episode 451 of Relentless Health Value, host Stacey Richter converses with Dr. Spencer Dorn about the implications of AI in healthcare, referencing lessons learned from EHR implementations.

    They discuss Kranzberg's first law of technology, which advises against labeling a technology as inherently good, bad, or neutral, emphasizing instead the importance of its application, configuration, and the human decisions surrounding its use. Dorn and Richter explore both the potential benefits and drawbacks of AI, drawing parallels with past experiences in healthcare digitization.

    To read the full article with links mentioned or to sign up to the newsletter, visit our episode page.

    The first takeaway from this short show focused on artificial intelligence is gonna be the same, really, as it was in episode 446 about EHRs. Do not ascribe any given technology a label of, as good, bad, or even neutral. That is Kranzberg’s First Law of Technology; and it applies here, too.

    Second major takeaway—and again, this is the same as in that earlier show about EHRs, but today we’re talking about AI—if you’re thinking about the ultimate impact of the people and the processes that have some technology in their midst (technology, again, such as AI, artificial intelligence), the ultimate impact will not be a black-and-white binary.

    We talk about some of these nuanced not binaries in the 10 minutes that follow, but for more, I’ve put some links in the show notes on our epsiode page for some newsletters et cetera to check out.

    05:23 What could happen with AI in healthcare if we aren’t thinking about how we’re deploying it?

    05:58 How could the lessons from digitizing healthcare help us with employing AI?

    08:25 How could artificial intelligence make things better and simultaneously worse?

    10:55 Why is it important to look beyond the hype and pessimism and make a clear-eyed assessment?
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    13 mins
  • EP450: When Your Health Plan Is $9 Million in the Hole, Who Are You Going to Call? A CPA. And Tell Them to Bring Their Spreadsheets, With Marilyn Bartlett, CPA, CGMA, CMA, CFM

    EP450: When Your Health Plan Is $9 Million in the Hole, Who Are You Going to Call? A CPA. And Tell Them to Bring Their Spreadsheets, With Marilyn Bartlett, CPA, CGMA, CMA, CFM
    Sep 19 2024

    In Episode 450 I speak with Marilyn Bartlett, a renowned CPA in the healthcare field, about her remarkable achievement of transforming the state of Montana’s employee health plan from $9 million in debt to a surplus of $112 million within three years.

    You can read the full show notes with mentioned links on the epsiode page.

    If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.

    Marilyn discusses the steps she took, including identifying financial inefficiencies, targeting high-cost areas, and implementing data-driven strategies to produce quick wins and sustainable results. The conversation delves into the importance of having the right team, communicating effectively with stakeholders, and staying focused amidst challenges. Listeners will gain valuable insights into strategic change management and actionable advice for improving healthcare plans.

    Yeah, I made a meme for the show with Marilyn Bartlett. My very first meme ever. In this meme, I picture that Olympic silver medalist shooter from Turkey who showed up in a T-shirt and his hand in his pocket versus the others with all their fancy equipment that, turns out, may or may not be necessary, regardless of who might swear up and down that complexity requires even more complexity and plenty of expensive gear to shoot straight.

    Point being, it’s amazing what a dedicated CPA with a spreadsheet and their eye on the target can accomplish in the real world when they just do their thing and follow the dollar.

    And with that, Marilyn Bartlett has entered the chat. Marilyn Bartlett isn’t called the “Queen of Healthcare” for no good reason, and nobody is joking when they say this. She was probably the first person (or one of the first, at a minimum) to truly identify the amount of money getting sucked out of the wallets of taxpayers and employers and plan members and into the pockets of the healthcare and insurance and consulting industries. She is a through and through numbers person but also deeply cares. She is truly a senior stateswoman in our field.

    To read the full article with mentioned links or the transcript, visit our epsiode page.

    06:45 What gave Marilyn the confidence to fix Montana’s state health plan?

    08:11 Why Marilyn knew she would have enough power to make the changes needed in Montana’s state health plan.

    09:11 What Marilyn achieved in her time as the administrator of the Montana State Employee Health Plan.

    10:38 What were the “quick wins” Marilyn was able to achieve when she first took over as administrator?

    17:33 Stay tuned for an upcoming episode that covers RFP in detail.

    17:50 How Marilyn structured her plan for the Montana State Employee Health Plan.

    21:21 What’s the key to setting yourself up for success when doing what Marilyn was able to achieve?

    25:02 Why putting together your own team is so important.

    29:07 What happened when Marilyn left the Montana State Employee Health Plan?

    31:08 Have the costs of the plan gone up since Marilyn’s time working on it?
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    35 mins
  • EP449: For Clinical Leaders, Payers, and Plan Sponsors, Let’s Talk About Blind Spots for Getting Patients or Members Appropriate Care, With Marty Makary, MD, MPH

    EP449: For Clinical Leaders, Payers, and Plan Sponsors, Let’s Talk About Blind Spots for Getting Patients or Members Appropriate Care, With Marty Makary, MD, MPH
    Sep 12 2024
    So, I had a chance to read Dr. Marty Makary’s new book, which is called Blind Spots; and here’s why I wanted to get him to come back on Relentless Health Value and talk to you, people of the healthcare industry. It’s because of something that he said on page 127 and which I’ve been mulling over for probably years, actually. To Read The Full Article Including Links Mentioned, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. It’s this idea of what is appropriate care and how good are we at ensuring that patients/members get said appropriate care. Lots of people are of the same minds because appropriate care has come up in the show with Ben Schwartz, MD, MBA (EP434); John Lee, MD (EP438); Spencer Dorn, MD, MPH, MHA (EP446); Tom Lee, MD (EP445). I mean, an estimated 21% of all medical care is potentially unnecessary. And unnecessary is, of course, one category of things that are not appropriate. This is according to a national survey of physicians: 25% of diagnostic tests, 22% of all medications, and 11% of all procedures are unnecessary/inappropriate. This is billions of wasted dollars doing stuff that shouldn’t be done, and it’s not appropriate care. But think about this: How many visions for how to fix healthcare and how to reduce waste depend upon a broad-stroke assumption that we will materially ensure that patients are getting best-practice (ie, appropriate) care? That we cut down on over-medicalization and surgeries on the back end and add appropriate preventative stuff and optimal medical therapy to the front end? Dr. Makary and I delve into the challenges of ensuring patients receive appropriate care, touching on medical dogma, financial, business, and legal incentives, and the importance of measuring practice patterns. Dr. Makary provides practical advice for clinical leaders, payers, and plan sponsors on promoting transparency, improving health literacy, and steering members towards higher performing providers. To Read The Full Article Including Links Mentioned, click here. 07:32 What is appropriate care? 10:19 Why what we think might be appropriate care might not be appropriate care. 10:34 Why is medical dogma damaging to appropriate care? 12:45 Why we need less absolutism in medical practice. 13:37 How is groupthink prevalent in medicine? 14:02 Why do we resist new ideas? 17:43 How do providers figure out what to believe and what not to believe? 20:59 “If you leave it to the medical profession to fix itself … so far, it’s not going well.” 22:33 How does supporting health literacy affect appropriate care? 30:23 “People need to find their care based on quality and price.” 34:28 What proportion of medical care is deemed unnecessary right now?
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    38 mins