Episodes

Equitable and accessible care must ensure appropriate and optimal use of medications since nearly 70 percent of clinician visits involve drug therapies. However, each year there are an estimated 275,000 deaths and $528.4 billion wasted in the US due to suboptimal medication use through inaccurate prescribing, medication errors, adverse drug reactions, skipped doses, or treatment failures. Given that most therapeutic options for the treatment of illness involve pharmaceutical interventions, we m...

The fight over access to gender-affirming medical care for trans youths — like the fight over abortion rights and other issues at the intersection of health, politics, gender, culture and race — is impacting where Americans live, work and raise families. And it’s grown particularly acute over the past year, as conservative governors and legislators have restricted access to medical care for gender dysphoria, a condition that stems from one’s lived experience of gender being different from the se...

The need for physician leaders has never been greater. As the healthcare industry continues to undergo significant change, there is a clear opportunity for physicians with extensive administrative experience to rise up. In order to drive value-based care, physicians will need to assume leadership positions that are all too often filled by executives who do not possess medical training. In the emerging health value economy, a physician leader needs to have both medical expertise and a business ac...

Value-Based Care is at a tipping point. But it’s not just about whether providers adopt alternative payment models (APMs) or ACOs. The real tipping point is whether traditional health systems can get on board fast enough to survive the corporate health care business that is poaching providers and patients. Corporate health care is not only unfazed by downside risk of APMs, but also have built their business models on population-based payments. The pendulum is clearly swinging away from fee-for-s...

How can primary care physicians retain their independence in planning for future success in value-based care? A medical practice must have access to capital to optimize physician workflow and improve patient experience; however, if it chooses the wrong partner, physicians will lose autonomy and compromise their own personal wellbeing. Privia Health is a technology-driven, national physician enablement company that is on a mission to enable doctors and their teams to focus on keeping people healt...

Chronic Obstructive Pulmonary Disease (COPD) afflicts 24 million adult Americans and represents the 3rd leading cause of death. COPD is also the 5th most costly chronic disease in the US with attributable direct healthcare costs estimated at $49 billion! Given the edifice of fee-for-service payment in US healthcare, we have allowed the care of COPD patients to become fragmented and inconsistent. We continue to see care of this chronically ill population wrought with poor clinical outcomes and a ...

As we look around to see what is enduring in our society, it is the work that was accomplished through loving relationships and mutual understanding. The power of love-driven leadership has the potential to change the world; and in healthcare, it can transform the lives of people undergoing immense suffering. Healthcare leaders must collaborate on solutions to overcome barriers in health equity through a deeply rooted commitment to social justice and love to improve the human condition. Leaders ...

In this episode, we are going to discuss the impact of diagnostic errors on health equity. For patients of color, the unequal medical care and quality of the diagnosis received isn’t due to just location, education, or income. It’s also at times due to healthcare professionals’ cognitive biases, along with decades of clinical studies that examined only white, male bodies, and a lack of understanding about the social determinants of biological illnesses. The causes of poor quality diagnosis for ...

When you hear about value-based care, do you get tired of hearing about concepts without tangible best practices? Do you ever wish you could just acquire insights from a leader who navigated a successful value journey? If you want to learn from one of the best in the “value game”, look no further than Dr. Bill Wulf, the CEO of Central Ohio Primary Care (COPC). Dr. Wulf is a respected leader in the value movement and leads the largest physician-owned primary care group in the United States. Durin...

In the uncertainty of today’s healthcare industry, we must continue to persevere towards our true north. The moral imperative to improve the quality of care for patients through better care coordination, including those are underserved, can only be achieved by the realities of the digital age. This transformation will require the medical profession to create a modernized Hippocratic Oath that extends to the broader health ecosystem. The proliferation of interoperable technology and digital healt...

The Institute for Advancing Health Value has recently released two new Intelligence Briefs highlighting two major impactful events in the movement to value-based care. 2021 MSSP Performance Results Analysis: The Institute analyzes 2021 performance data, sharing high-level program performance and examining savings across participation tracks, by the provider type, size and location of ACOs, and their experience in the program, and reflects on the future of the MSSP in light of the recently propo...

Fee-for-service healthcare has destroyed the physician-patient relationship by de-personalizing care delivery. Patient encounters are looked at as transactions, instead of as opportunities to forge long-term healing relationships. Consequently, the healthcare system delivers inexorably bad cost and quality outcomes, and primary care is marginalized in lieu of high cost specialists who perform procedures. This has created a perfect storm for physician burnout and moral injury, and we can only reg...

Many roads will bring us to health value, but some roads will get us there faster than others. As we reimagine our nation’s healthcare system, we must build alternative avenues to value beyond the conventional fee-for-service approaches to transformation. In building a superhighway that fully unleashes the power of independent and accountable physician groups, we will produce faster and better results. Joining us this week on the Race to Value is Susan Dentzer, the President and Chief Executive...

One of the silver linings of the pandemic has, in fact, been, the expansion of telehealth services and virtual care delivery. The pandemic has also accelerated the healthcare industry’s transition from fee-for-service to value-based care. The continued growth of telehealth is fueled by providing incentives for care delivery in the lowest cost settings, identifying and interacting with highest-risk individuals before disease onset, managing care teams with more efficient workflows, and taking adv...

The Gambrell-Fowler family pose for a portrait. From left are Keith Gambrell, Gary Fowler, Cheryl Fowler, Troy Fowler, and Paris Fowler. Oprah Winfrey began her crusade to change the healthcare system when COVID-19 elevated our national awareness of health inequities in our country – a result of exacerbated health outcomes triggered by coronavirus infection across racial lines and the longstanding preexisting disparities that were already there. She launched The Color of Care education campaign...

For anyone following healthcare transformation in our country, you have undoubtedly heard about ChenMed – a family-owned, primary-care physician run organization that serves a challenging patient population under a full-risk global primary care reimbursement model. This is a high touch primary care company that has become the gold standard for how healthcare should be delivered in our country. In a prior episode of Race to Value, “Changing the World through a Full-Risk Value-Based Care Model”, D...

If you are looking for the most egregious profiteering and fleecing of American consumers of healthcare, there is no better example than that of the giant industry of middlemen called pharmacy benefit managers – PBMs for short – that are systematically gouging American businesses. Most people are familiar with the few bad actors in the pharmaceutical industry. For example, we think of the infamous “pharma bro” Martin Shkrelli that jacked up the price of his company’s drugs – and then smirked his...

Creating a value-based healthcare ecosystem with the highest quality outcomes at a reasonable cost for employers and their healthcare consumers requires collaboration. In the state of Connecticut, a grassroots community has formed with the mission to create a value-based healthcare ecosystem. The Moving to Value Alliance is a multi-stakeholder community composed of individuals, practices, and organizations deeply rooted in Connecticut’s healthcare environment. They believe that collaboration is ...

The need to strengthen and empower primary care, like the drive towards health equity, is one of the great causes célèbre of American healthcare. As David Blumenthal and Lovisa Gustafsson recently wrote in the Harvard Business Review: “America’s health care system seems, paradoxically, both endlessly innovative and profoundly dysfunctional. On the one hand, we hear almost daily about flashy new ventures like, most recently, Amazon’s recent purchase of One Medical, a large provider of primary ca...

There is a need for hope and innovation in the delivery of value-based oncology care. Cancer costs are on an alarming trajectory due to the aging and growth of our population. Oncology is currently the 3rd most expensive specialty, but it is growing 3X faster than the top 3 specialties. Unless we find a way to replicate and scale value-based oncology care, it will be soon be the #1 most expensive specialty! Value-based transformation in oncology is especially needed due to the high variability i...

Primary Care in the United States is flawed, especially for our most complex patients in the Medicare program. We have built this incredibly expensive primary care model around a fee-for-service system that is incredibly fragmented and uncoordinated. There is now a need for a new model – one that yields a much better experience for patients and physicians. We now stand at the threshold a great dawning. An era is ending, and we are at the core of creation in reimagining a more idealized, value-ba...

Democratization of value can only happen through the replication of full-risk APM adoption in primary care. As a country, we must accelerate primary care progression towards fully-capitated risk by thoughtful health policy and payment model redesign. Change is underway — primary care is already moving to a capitated model of reimbursement, and ACO REACH is our first real test of realigning financial incentives to improve care of patients living with chronic conditions. Furthermore, this inflecti...

Community-based health transformation can be unleashed by uniting traditional allopathic medicine with lifestyle medicine. To achieve a vision for population health, we will never change things by fighting the existing reality – we must instead innovate to render that old model obsolete. On a mission to flatten the curve of healthcare costs, James Maskell has spent the past decade innovating at the cross section of functional medicine and community. To that end, he created the Functional Forum, ...

The COVID pandemic has taken the lives of 1 million Americans in two years (more than twice the amount of Americans who lost their lives in WWII in four years). This grim statistic came about because of a fundamentally broken, fragmented, expensive, inequitable, and occasionally unsafe healthcare system. If the mission of our $4 trillion healthcare system is to improve health and prevent death from disease, we could look to no greater example of failure than the COVID-19 pandemic. Global pandem...