Episodes

Welcome back for part 2! This episode further explores Klasko’s vision of health assurance, an industry that focuses on consumer’s health, and that is enabled through innovative partnerships between health care and technology organizations. Patient’s expectations are shifting toward a system of care that is empathetic, communicative, creative, and responsive – those providers, policy-makers, payers, and other partners who align with these principles will be the winners in the race to value! Dr....

Dr. Stephen Klasko is the President and CEO of Thomas Jefferson University and Jefferson Health. His newest book, co-authored with venture-capitalist Hemant Teneja, is a manifesto that advocates for bringing consumerism, affordability, and rational economic behavior to the healthcare sector.UnHealthcare: A Manifesto for Health Assurance is a declaration to usher in a new age of digital of mobile consumerism in the healthcare industry and introduces the concept of “health assurance” – a gamechang...

North Carolina seems like an unlikely laboratory for value-based care. It refused to expand Medicaid coverage under the Affordable Care Act and ranks in the bottom third among states in measures of overall health. North Carolinians are experiencing stagnant or worsening population mortality rates and substantial health disparities, with 15% percent of residents living below the poverty line, and over one million (10% – 9th highest in the US) North Carolinians uninsured. Health care costs are ris...

The concept of “accountable care in the safety net” was introduced in a Dartmouth Study published by the Commonwealth Fund back in 2013. In that study, there were 4 critical success factors outlined for a coalition-based Medicaid ACO: 1) aligned leadership through a shared vision, 2) strong governance, 3) a unified strategy for using data, and 4) a sophisticated care coordination infrastructure. MHN ACO has exhibited excellence in all four of those areas. Since 2009, Medical Home Network has se...

Today’s episode follows Austin Regional Clinic (ARC), a large multi-specialty medical group that serves over 500,000 patients in Austin, Texas. Founded in 1980 as an HMO, ARC is coming full-circle on their journey in value-based care as they now serve more than half of their population in value-based contracts. Tyler Willson, VP of Population Health and Clinical Quality talks with us about the tipping point for value, ARC’s strategy during and post-COVID, as well as partnerships with payers. We...

There are over 1,300 Federally Qualified Health Centers (FQHCs) in our country providing a healthcare lifeline for more than 28 million Americans living in underserved areas of the country. The vast majority of these are living with significant health concerns and are extremely vulnerable to economic fluctuations. Community Care Cooperative, C3, epitomizes what the research shows, that despite the inherent challenges of serving as a safety net, FQHCs perform better in caring for the Medicaid pop...

In this virtual panel discussion, Dr. Ernest Grant (President of the American Nurses Association), Dr. Jan Jones-Schenk (Senior Vice President – College of Health Professions, WGU), and Jason Thompson (Vice President – Diversity, Equity and Inclusion, WGU) will discuss how we must eliminate barriers to equity in access and learning in order to reduce racial disparities in care. Progress in advancing diversity in the US health care workforce has been slow. This is evidenced by the low numbers of...

Most people know that 3M as a massive industrial conglomerate, a Fortune 500 company with 60,000 products that include Post-It notes, Scotch tape, sandpaper, hanging hooks, band-aids and more. A lesser-known division, but the one that is paramount to our focus on value-based care, is their Health Information Systems division: a $1billion+ dollar enterprise built over the last 35 years and focused on healthcare data aggregation and analysis. 3M’s Health Information Systems business works with mo...

The importance of Humana’s consumer focus, care in the home, technology, and other strategic imperatives related to value-based care have been amplified by the novel coronavirus (COVID-19) pandemic. As COVID-19 presses onward, this week Race to Value presents an industry perspective from Mike Funk, Vice President for the Office of Health Affairs and Advocacy. Mike Funk believes that the transition to value-based care is inevitable. In his role with Humana, he leads the organization’s commitment ...

Many industry insiders believe that health system-led ACOs are inherently disadvantaged to demonstrate value-based care in an environment where most revenue is still generated in fee-for-service. In moving to value, hospitals must contend with demand destruction on their fee-for-service lines of business as they reduce admissions, emergency department visits, and procedures. Physician-led ACOs, they argue, simply do not have this dichotomy; therefore, they have a clearer pathway to financial ben...

MaineHealth Accountable Care Organization (MHACO) serves a uniquely heterogeneous population that is spread across coastal, rural, and urban communities with multiple different cultural components. And they serve the oldest population of all states in the Union! The organization’s ED utilization in its early years was historically around 775 visits per thousand – a significantly high number when compared to other ACOs in the country which were well below 700. At the same time, the ACO was about ...

Primary care is especially compromised in the ongoing pandemic crisis. PCPs are uniquely vulnerable to the deleterious economic effects of COVID-19, since most of their revenue still comes from in-person visits which have plummeted since March amid widespread stay-at-home orders and fears about in-office virus transmission. The pain has been particularly acute for PCPs who are not backed financially by health systems, private equity or other entities. Roughly half of U.S. doctors still own their...

Quality in health care has been a hot topic for over 20 years, ever since the landmark report, To Err is Human, which declared that up to 100,000 people die each year from preventable medical errors. Since that time, the industry has increased its efforts to incorporate quality principles from Lean, Six Sigma and other models, but only one organization has raised a quality standard for health care organizations and their workforce. The National Association of Healthcare Quality (NAHQ) is leading...

Palliative care, and the role it plays in health value, is difficult for many people to understand because it runs so contra to the linear algorithm that is allopathic medicine. Curative care – played out in the form of surgeries, procedures, therapies, and various other medical interventions – is focused on doing something TO the patient. This becomes problematic when the patient has a terminal illness – eventually the illness will win. Nature always wins. Palliative care shifts the caregiver’s...

In health care, we excel in addressing problems in the human body that are fixable. However, with regard to the two main un-fixables in life — aging and dying— we often inflict therapies on patients that shorten lives or increase suffering before death. These heroic measures result in wasteful costs in the healthcare system: of $700 billion a year spent in Medicare, it’s estimated that about one-quarter of that spending goes to the 5% of Medicare beneficiaries who are in their final year of life...

How does an organization have a banner year in 2019, start 2020 with additional momentum, and then continue to grow despite COVID-19 making them change their whole approach? Because they have something the market needs, because they are able to adapt, because they care about solving their customer’s needs – and the list goes on. Earlier this year, Innovaccer released survey results showing that more than 45 percent of healthcare executives understand value-based care; however, most of those are...

The Rio Grande Valley, located in the southernmost tip of Texas along the US-Mexico border, has become a new epicenter for COVID-19 over the last month. Death rates are also over five times higher than the rest of Texas because more than 60-percent of residents are diabetic or prediabetic and more than 90-percent of the population is Latino. To compound the situation, the Valley was also impacted by the landfall of Hurricane Hanna on July 25th creating mass flooding, infrastructure stress, and h...

Physician groups are becoming the dominant type of new entrant into the ACO space and have been most successful in achieving savings to date. Many in our industry think that physician-led ACOs are at a disadvantage in comparison to hospital-led ACOs because they lack the capital and the administrative firepower to spin up a population health infrastructure. RGV ACO, one of the leading Accountable Care Organizations in the country, has proven that physician leadership is actually the key ingredie...