LUMINA Podcasts

From its humble origins as an academic gathering of a few attendees, the Population Health Colloquium has evolved into a diverse gathering of brilliant minds in the field of population health and value-based care. In this episode of Value-Based Care Insights, we sit down with Dr. David B. Nash as he discusses the Population Health Colloquium taking place September 18-20^th in Philadelphia. We dive into the colloquium’s focus on value-based care, health equity and AI’s innovation within population health.  Speakers will discuss the crucial link between delivering value and transforming the future of healthcare.

KEY TAKEAWAYS: 

• An exceptional panel of transformational leaders will explore the role of the population health officer.
• Speakers will explore social determinants of health, health equity, and delivery value through community-based population health initiatives.
• AI (artificial intelligence) can be used as a powerful tool to improve healthcare, reduce care variation, improve quality, and address complex patient challenges.

LISTEN TO THE EPISODE:

 

 Transcript:

Daniel J. Marino: 

Welcome to Value Based Care Insights. I am your host, Daniel Marino. We have a very special program today where we're devoted to talking about the 23rd Population Health Colloquium in Philadelphia, September 18th through the 20th. If you've never been to the Colloquium before, it's a fascinating event.I had the opportunity to attend the Colloquium back in 2017. And one of the things that really impressed me was the ability to gather folks together who havereally at different places in their journey in population health. Some folks were very experienced and been doing it for a number of years.Others had just sort of gotten involved in it in the last couple of years. And the ability to create a networking type of an event with experts that you feel comfortable having conversations with and really learning a lot of the lessons and hearing a lot of the bumps and the bruises that folks have had along the way.It was justfascinating to me.

Well, I am really pleased today to have on the program. Dr. David Nash. Dr. Nash is the founding dean emeritus of Jefferson College of Population Health. He's faculty professor of health policy at the Jefferson College of Population Health. And believe it or not, he’s led the coordination of now 23 population health colloquiums, Dr. Nash, welcome to the program. 

Dr. David Nash:

Thank you, Dan. Great to be together. And I'm smirking because I'mprobably the only person on the planet who's been to all 23 events.

Daniel J. Marino: 

I venture to say so,that's amazing. You know, so 23 and clearly, you know, you you've been involved in population health, you probably started a lot of the you know, the principles of population health over the years. How has the colloquium changed over the years to where it is today?

Dr. David Nash:

Yeah. Wow. What a great question. So 23 years ago we had50, 60 people in an auditorium on our campus. And you know, I remember it vividly there was a large number of people.And they were the only people who could, first of all, spell colloquium that was one prerequisite for attending. And back then, of course, it was disease management, then chronic care management, and then population health colloquium. So we changed the name over the two and a half decades. And then the heterogeneity of the audience increased back then. It was only academics because nobody else knew what we were talking about. Uh, then I became editor in chief of the only scholarly journal in the field, population, health managementand so that got expanded. And then by the time our 1st textbook in population health came out, we're now in the 4th edition.Sothe overtime we left the campus, we went to a small hotel on the riverfront. And then finally, we ended up at the Lowe's hotel right downtown, a big, wonderful place. That's been good to us over a long period of time. But yes, I mean, we went from 50 to at one point over 700 people attending right before Covid. 

Daniel J. Marino:

Well, you definitely have. Influenced and I would probably venture say, led a lot of the population health initiatives. And, you know, when you look at the agenda I'm really impressed by the speakers, the topics that are there, you know, it seems to me, there's 3 overarching themes that are really as key takeaways from the colloquium I think one is really value-based care and equity, right? And I think social determinants of health play into that. But health equity, something everybody in population health is very attuned to. I think the 2nd thing is around value-based performance, right?And delivering value-based care. And then the third area, which I'm really interested in, is innovation, and in particular, how artificial intelligence is really driving a lot of the population health models, outcomes, and a lot of, I think, our ability to be more proactive. Thoughts around those themes.

Dr. David Nash:

Well, that's really great that you could discern that from the agenda. That means we've done a good job organizing it. Look, the colloquium, historically, especially in the last five years, Dan, is very deliberately a newsworthy event. Meaning, there is not a single theme that ties it all together. And the reasons are, we start the planning nearly ten months in advance, so it's hard to know you know, what will be on top of people's minds. So we try to keep it as newsy as possible. And certainly the three themes you elucidated are on everybody's mind. And we'll get into it today, of course, but you know, value-based care, the social determinants, artificial intelligence, chat GPT, innovation. I mean, these are the drivers in our field today. 

And per your previous question, of course, none of this existed 23 years ago, right?  

Daniel J. Marino:

None. These are the top-of-mind issues that are driving every individual, every organization that's involved in population health.

Dr. David Nash:

Right. So this vocabulary is completely different. And, you know, speaking personally, to give you some insight. 

When we opened the doors to the College of Population Health, which wasn't until 2009, in fact, 9-9-09. So it's got a certain, you know, fen shui, easy to remember. I spent two years on campus, on my own campus, explaining to people what the heck is population health, right? And a little history lesson attached to that. Of course, it wasn't until March of 2010 and the launch of Obamacare I was at AHA meeting in Chicago giving a plenary talk and Congress voted to approve Obamacare and off we went. 

I mean, it was a celebratory day in many levels, but selfishly super important. Because people then started to say, okay, you know, I get this.

Daniel J. Marino:

Well they started to think about care differently, right? Less episodic care, more around the populations, more around driving change on an outcome basis, as opposed to, like I said, an encounter or an episode basis.

Dr. David Nash:

That's right. And it wasn't until USA Today. 2017 story, right? So, seven years after Obamacare, front page story, USA Today, the most important journal in medicine, had a whole article about, wow, keeping people out of the hospital is a good idea. Good thing,

Daniel J. Marino:

Right? Good thing. Amazing. I'm excited to talk about the speakers and in full transparency I'm very fortunate and really excited to be speaking at the colloquium myself. 

My presentation is on, September 19th. But 1 of the things that I want to dive into, you know, you've got 2 really interesting panels and the 1st panel, which is on Tuesday, it's Insights of the C Suite Chief Population Health Officer panel. I have to tell you, Dr. Nash, population health officers didn't exist a few years ago.

Dr. David Nash:

That's correct. So, give you the thumbnail history here. So, first of all, thanks for pointing that out and kudos to our faculty leader, Dr. Mitch Kaminsky - wonderful. He's the chief of our population health programming and he'll be moderating the panel. And you're right, the CPHO sounds like C3PO from Star Wars. 

The CPHO is a really, you know, new term, a new member of the C suite, and it's called different things in different places, but pretty much people understand now what that is. I want to give credit to my longtime colleague and good friend, Dr. Rita Numeroff at Numeroff and Associates in St. Louis. She and I have collaborated on probably the most comprehensive annual survey that's been published in Modern Healthcare and referred to in multiple places where we really sort of said, Whoa, wait a minute. 

There's a new sheriff in town, and she's called the CPHO, and we started that discussion, gosh, six, seven years ago, and then having it come full circle to the colloquium and bringing these leaders people like, you know, Dr. Jamie Reedy, and others. I mean, it's going to be spectacular. 

Daniel J. Marino:

and it's going to be fascinating because when you look at this, you have four chief population health officers coming from different segments, so Dr. Reedy, who I had the opportunity to work with her, you know, a number of years ago. You know, she's the CPHOfor horizon blue cross. And then, you know, Dr. Walker is with the Children's Hospital. Soyou've got such a great diverse group. I can't wait to hear that conversation. 

Dr. David Nash:

And the good news for both of those leaders is that, they could practically walk to the event. They can commute. That's for sure.

Daniel J. Marino:

Yeah. They could. The other one that, is definitely, it's a little bit different and I think the focus, is something that's near and dear to my heart. It's on the, I believe it's on Tuesday. 

It's the Chief Quality Officer panel, where you actually have brought together a number of Chief Quality Officers. You know, Dr. Dean from the Emergency Department of Mount Sinai, but you also have Dana Steiner, who's from the Nebraska Health Hospital Association.

Dr. David Nash:

You bet. So a little history here. 

And again, special kudos to our faculty, Dr. Mary Cooper, who leads our entire, quality programming. Remember, too, that the college was the second such school in the country to have a master's degree in quality and safety. And we created that from the get go, our partnership with the American Association of Physician Leaders. 

Mary. is a former Connecticut Hospital Association executive. She's the real deal, MDJD. She's amazing. She's on the editorial board of our journal, American Journal of Medical Quality. So, you know, Dan, quality and pop health, those have been our two core competencies at the college.

Daniel J. Marino:

Oh, absolutely.

And, I would venture to say it's really the foundation for any organization that truly wants to succeed in population health. You know, we work with many of the organizations around the country, a lot of physician groups, a lot of hospitals, looking at outcomes, looking at quality. And I would say that is the key driver in any prospective care model.

Dr. David Nash:

Well, for sure, we take that real seriously. I mean, our listeners. Appreciate here we are in 2023, and all the major national quality measures post-covid are all in the wrong direction, as you are most likely aware, and depending on who you read, sadly. Medical error remains the fourth leading cause of death in America, right? 

Heart disease, cancer, covid and medical error. That's where we are today. Pretty sad.

Daniel J. Marino:

Well, if you're just turning in today, I am Daniel Marino and you were listening to Value Based Care Insights. I am here. Talking with Dr. David Nash, and we're going over the upcoming 23rd population health colloquium that's in Philadelphia, September 18th through the 20th. 

Dr. Nash, I want to dive into a little bit of some of the other speakers that you have, because again, I'm pretty impressed with the level. Tom Lawry, wrote a great book, on hacking healthcare and looking forward to hearing his perspective on artificial intelligence. Thoughts?

Dr. David Nash:

Sure. I got to know Tom very well over this past summer.I read his book, Hacking Healthcare, and I thought, we got to have this guy present. Now, what I didn't appreciate is that he was Microsoft's number one AI guy, so it's a little hard to wrangle, but now with his book tour, literally he is all over the world. I don't think I've ever talked to him when he's in the US. But he's coming to Philly. We're really excited.He'sa down to earth. The book is easy to understand. It really is clear AI machine learning wherewe're going. And what I really like about Tom is that he links AI to reducing variation in care, improving quality, all the things we just talked about.

Daniel J. Marino:

Yeah, well, and that is so key and especially, you know, as many providers, many physicians struggle with just getting their arms around managing all of the data and the elements there, a tool like artificial intelligence could just be an unbelievable asset to physicians as they really start to think about conquering these challenges with the complex patients and understanding the impacts of social determinants of health, all of those things.So I'm really excited about hearing him.

Dr. David Nash

And Tom is a real optimist as am I and he believes like, I do that it's a tool that will help reduce burnout. Improve outcomes, improve safety. I hope I'm around long enough to see it all happen. That's my current wish. Yeah, but Tom is going to be one of the stars of the show about hearing him.

Daniel J. Marino:

Yeah, I'm excited about that. Another speaker you have and he's really opening up the conference as the keynote is Dr. Jeffrey Brenner his keynote address. Are we there yet? Detours on the road to better care at lower costs. I had the opportunity to meet Dr.Brenner probably about seven, eight years ago, but the article, that he was a part of with Atul Gawande back in 2011 was so influential to me on my career. It was really the first time back in 2011 where I realized the importance of data and how data and information could really change healthcare delivery outside of the clinic, right?It's all social determinants stuff, which wasn't called social determinants

Dr. David Nash:

Certainly not. Well, you press the button. So I'm going to tell the audience a very quick story. Okay. So, Jeff Brenner, what a great guy, of course, McArthur genius awardee. Let's not forget that. Right. So, Jeff Brenner is probably now, you know, he's almost 15 years younger than me. 

Made an appointment to see me a number of years ago. We had a deep connection that we both went to Vassar College in Poughkeepsie, New York. I was in the second co-educational class. That's a separate story, but Jeffrey came to see me as a fellow alum and I'll never forget. It looked like a typical family doctor, you know? Had kind of a shirt that wasn't exactly pressed and shoes that were scuffed. He literally was a storefront family doctor. And in his briefcase, Dan, were the initial data set showing that these people, certain key patients, the recidivist patients in Camden, New Jersey, We're clogging every ER, and it was a small number of patients responsible for the vast number of ER days and subsequent spending. And he said to me, what should I do with this data? I mean, and I said, my goodness, this is red hot stuff and you've gotta take it and run with it. And boy, I really am grateful that he showed up at my doorstep. Of course, I take no credit for Jeff other than saying to him, go home and get busy. 

Daniel J. Marino:

Well, way back they had to just be fascinatingto have that conversation.I mean, here you have a young doctor and it's like, okay, we have something. What do we do with it?

Dr. David Nash:

Right. It was like my conference room table was on fire. That's what I remember. And then I talked to Atul who I know pretty well. And got them connected.And the rest is history. All I did was make the connection.

Daniel J. Marino:

You had a part to play. Wow. I'll tell you, that was a fascinating article. One that definitely was a major influence on my career. And that is really what kind of got me started in population health

Dr. David Nash:

It’sthe term hot spotting,

Daniel J. Marino:

Absolutely. The other speaker that really comes to mind is Nwando Olayiwola

Dr. David Nash:

Yeah, Dr. O.

Daniel J. Marino:

Don’t know if I got her last name right, but yeah, Dr. Nwando.

Dr. David Nash:

Yeah, so we call her Dr. O. That's her nickname. She's amazing. Her ethnicity is from Nigeria. Parents are from Nigeria. She, of course, lives in Columbus, Ohio. So she's the top Humana national key health equity person. 

She's the face. She's the brains. She's the energy. I mean, she's pretty amazing. I won't tell you how young she is because it's embarrassing for me, but Dr. O is a powerhouse, and we're very fortunate. Of course, Humana recently gave Jefferson a staggering $15 million gift In the form of three endowed chairs. 

And we have the Dean of our college the Humana health equity officer and another title. And so Dr. O is coming to acknowledge in part, this amazing close relationship between the College of Population Health and Humana, and to talk about Humana's national strategy. The punchline of which is you can't have value-based care without health equity.

Daniel J. Marino:

Oh, absolutely. I'll tell you, you know, I'm based in the Chicago area. I've done a lot of work with different health systems, different, you know, community facilities and the health equity issues and just bringing care to the community is something that, you know, we've been passionate about for years. So I am really excited about you know, hearing her speak and just some of the things that she's looking to do. Andalso tied in with the direction of Humana, I think that'll be fascinating to hear.

Dr. David Nash:

Yes, it will.

Daniel J. Marino:

So, Dr. Nash, the agenda jam pack looks great. I think the speakers are phenomenal that the topics look really, really good. 

If there were, you know, one or two key takeaways that, you know, it would be important for the attendees to kind of think through or to walk away with. Anything come to mind? 

Dr. David Nash:

Wow. Sure. I mean, it's chock full as we've been talking about, but I guess from my perspective, you can't have value without equity. 

That's a major take home message I think. 2nd message is while cataloging the social determinants is certainly a great idea. We darn well better be able to do something about them. Otherwise, we're just going to frustrate patients and providers. And I guess my third take home is, buckle your seatbelt with, CHAT GPT and AI, you know, as you probably have heard, CHAT GPT got an 85% on the USMLE licensing exam. That's better than I did. So, you know, I think that's something to really pay attention to. And we got to harness that, you got to get that horse before it bolts out of the barn. So value-based care, social determinants, innovation, those are the take home themes I hope that everybody will take away. The 3 weeks from now. 

Daniel J. Marino:

Yeah, I agree with you. And just to kind of layer on top of that, the ability to network with these experts to network with the other attendees the takeaway is just the lessons learned and all of that just huge value add. I know that 

Dr. David Nash:

I'm glad you said that too Dan, because, as you know, this is not hymns, this is not your father's Oldsmobile. 

And we do it that way on purpose because it's small enough and intimate enough that you could actually speak to the speakers when they're done. So be prepared to be surrounded when your presentation is over. I think that's a fair warning. 

Daniel J. Marino:

Yeah, well, I am excited about it. And Dr. Nash, if any of our listeners, and I'm sure many of them are interested, where can they go to register? 

Where can they go to to learn a little bit more about the colloquium?  

Dr. David Nash:

Great. It couldn't be any easier. Just go to, you know, populationhealthcolloquium.com. And all the details are there. The agenda is final, all the registration information. It's at the Lowe's Hotel, beautiful downtown center city, Philadelphia. 

And we're really looking forward to seeing everybody and kickoff time is Monday, September 18th at 1 PM. So you could travel on a Monday and then we'll wrap it up noon on the 20th.

Daniel J. Marino:

Yeah, well, jam packed and just an exciting 3 days. I'm really personally looking forward to it.I'm looking forward to seeing you and then the many other guests that are going to be there.

Again, that is, populationhealthcolloquium.com for more information to register. Dr. Nash, loved having you on the program. Great conversation. thanks again for joining! 

Dr. David Nash:

Thank you for the opportunity and look forward to seeing everybody in person in our great city.

Daniel J. Marino:

Yeah, likewise. 

Likewise. I want to thank all of you for listening until our next infocyte. I am Daniel Marino bringing you 30 minutes of value to your day. Take care. 

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners

When it comes to making big decisions, strategic plans often overshadow the critical aspect of leadership culture. This episode of Value-Based Care Insights welcomes Keith Hadley, whose expertise lies in building healthy organizations and improving organizational decision-making through building high-performing teams. Discover the roots of misalignments in leadership teams and the significance of transparent communication in creating a unified voice to advance the culture of the organization.

KEY TAKEAWAYS: 

• Leadership growth is as vital as having a strategic plan.
• Healthy organizations prioritize clarity and minimize confusion.
• Stronger leadership alignment leads to faster and smarter decisions.

LISTEN TO THE EPISODE:

 

 Transcript:

Daniel J. Marino: 

Welcome to another episode of Value-Based Care Insights. I'm your host, Daniel Marino. As we've talked about on the program many times, as healthcare providers, as health systems, hospitals start to engage in their strategic plans, not only is it important to consider all of the elements that will drive the success for growth of the organization or alignment or partnerships, if you will. 

You also have to really give some consideration to development of the leadership team. And as we said, it's a growth piece. And where we see a lot of organizations struggle is they focus all this attention on the strategic plan, but don't focus a lot of attention on their own strategic growth, developing the leaders, thinking about how we need to change as a team becoming more cohesive because it's difficult sometimes as you're engaging in a lot of decisions or discussions, how to keep the team moving forward as the organization moves forward.  

Well, I am very pleased today to have a colleague, Keith Hadley join the conversation. 

Keith brings about 25 years of operational leadership and management experience to the consulting world and works with an organization called table group, which its principal is Patrick Lencioni. Keith, very happy to have you as part of the program today.

Keith Hadley:

Thank you, Dan. It'sgreat to be here and excited for our conversation.

Daniel J. Marino: 

So Keith, before we jump into the topic, let's talk a little bit about you. You've got a fascinating background. How did you first get into developing leadership teams and aligning with Patrick?

Keith Hadley:

Yeah, well, I have a very predictable path. You know, I studied French and history in college because I think I wanted to teach at a high school or a college level but then very quickly realized that that wasn't my dream. But you know, but growing up, my family was all, you know, farmers, doctors, nurses, therapists, and educators. And so I had nobody in the business world.

Daniel J. Marino:

It’s fascinating how you sort of grew into it from this other area so how did you make the jump?

Keith Hadley:

Yeah. So, when right out of college, I got an internship with a small consulting firm that did international business development. It was at a time when, you know, NAFTA had just been signed. The wall had just come down and my boss said he hired me because he said as a history major, he figured I could write. 

And they needed, another foreign language on their team as they were expanding into Europe and beyond. But long story short, that small firm got bought by a big firm. And suddenly I found myself, you know, at a big firm doing business development, strategic planning, and feeling very out of sorts because I was the only one without a business degree and felt super unqualified to be there. 

But I worked there for eight years and loved it. And somewhere along that line, I discovered Pat's books. And, and it was like, opening up a whole new world of things that I felt like I should have been aware of when when I was doing that kind of client work.

Daniel J. Marino:

Well, and I've read many of his books. I think I've read all of them to tell you truth. And he just brings such a practical approach to a lot of, aspects of developing the development leaders and especially in healthcare, there are so many hospitals that are struggling with not only the financial performance of their organization, but meeting the needs of their communities. 

And, you know, as I mentioned in my opening remarks, organizations constantly and leadership teams constantly spend a lot of money on their strategies, which is good investing in new markets, new providers, new relationships, and new partnerships. Which is good, but I don't feel like they spend enough time developing their own teams. What do you see? where do you see some of that misalignment or some of the struggles?

Keith Hadley:

Yeah, I would even go further with it, you know, in my experience, my mother worked at Loyola University Medical Center. My brother went to med school there, and became a physician. My wife worked in home health care and in the nursing home environment, as well as in a different hospital in Chicagoland. 

And I think it's broader in healthcare that we don't develop leaders at all. And just the idea of organizational effectiveness, organizational leadership, for many has just been overlooked. And so it's got to start at the top. And that's all the work that we do at table group is we start with the CEO and the executive team really helping that team become cohesive and focused and clear and aligned, which is, probably just as much about behavioral alignment as it is intellectual alignment or strategic alignment. So that's where we put a heavy emphasis. And in almost every case, we're treading into new territory that these teams have really not explored. And I'm excited to talk about what some of those avenues are, but, you know, I've done this work at very large hospital systems. 

I've done it in small clinics. I've done it with healthcare, technology, creators, you know, diagnostics, you know, all across the board and we see the same issues and you're right, they're dealing with tremendous change, tremendous uncertainty, and we need to have teams that are ready and are equipped to deal with the kind of complexity and changes they're seeing. 

Daniel J. Marino:

Well and especially when you think how they really have to focus on the alignment with their physicians. They have to focus on meeting the needs of the patients. There's a lot of new regulatory challenges that come through. So maybe we can dive into this a little bit when you're working with the leadership team, particularly the CEO.How do you engage them in such a way that they start to understand that this development is really critical to their success? That they really have to focus on thinking differently, thinking outside the box, which could be a little bit humbling for the CEO, right? A lot of times they don't realize that they're the ones that have to change. So how do you, where do you start? How do you really move that along?

Keith Hadley:

Yeah, it all starts with making a very clear distinction between the two sides of the organization that need to be mastered. So we talk about the smart side of running an organization, and everybody resonates with that right away. Havinggood operations, good technology, good finance, good marketing, good programs, good safety, all of the, what we call the decision sciences and, and all of these teams resonate with that side because that's what they went to school for.That's what they studied.

Daniel J. Marino:

Sure. That's their training. 

Keith Hadley:

Yep. And, and it's absolutely critical. We don't minimize the importance of that at all. But the problem is it's only half the equation, but it tends to get 90% of leaders time and attention. The other side is the healthy side, which ironically, since we're talking to healthcare providers, they also resonate with this. 

But when you think about the healthy side, healthy organizations are known for having minimal confusion, minimal politics. And as a result have maximum levels or they've maximized their level of productivity and morale. And if you think about productivity and morale in the typical healthcare system today, it's at an all time low. 

Even though the work they're doing is so important and that the purpose of the organization is so obvious. And yet we have people frustrated. We have people confused. We have conflicting priorities, you know, limited resources against massive goals and objectives that have been established, incredible pressure for talent to retain our best talent. So these are stressed out environments. So we ask, you know, what are people confused about around here? And it's the same list. Goals, priorities, decision rights. you know, “what's my job?”  

Daniel J. Marino:

Yeah, you can see thatalignment necessarily isn't there. The clarity isn't there. How much does communication transparency fit in the equation?

Particularly when you talk about the senior leaders and maybe then their junior leaders underneath that, is it that the goal hasn't been clearly defined or is it more so around the goal, the vision, etcetera, has not been communicated. 

Keith Hadley:

I think it's both. And I think one of the reasons leaders don't communicate clearly is because they really haven't gotten clear themselves, right? 

So if we haven't really put in the time to get crystal clear. It puts tremendous pressure on our messaging to come up with something that sounds good, but it really isn't communicating very clearly at all. And so, when we think about a healthy organization, that's minimize confusion. That means we have to maximize clarity. 

And it also means we have to maximize or minimize politics and politics in organizations can be very damaging and we're not talking about things like sabotage. We're thinking of things like the meeting before the meeting, the meeting after meeting, saying one thing in one room and another thing in a different room or changing what you're going to say based on who's in the room. 

And so the communication from the top gets very muddy, very quickly. Just one layer out from that executive team Let’s say team two levels. We talk about team one is the team at the top team two that's where you immediately get into functional leadership. And already at team two, we're getting slightly different versions of messages. 

And it's because we haven't put in the time to get clear at the top. And often we haven't put it in that time because we're dealing with some politics, some internal, you know, just some misalignment between functions at the top.  

Daniel J. Marino:

Yeah, if you're just tuning in, I'm Daniel Marino. You're listening to value-based care insights. 

I'm talking today with Keith Hadley around developing strong leadership, cohesive teams, aligning that with strategic plans. So Keith, when you think about those key elements. That really drive a cohesive team, aligning them to align with their strategies, manage some of the challenges that they have so forth. What are some of those key elements that you focus on with the teams? 

Keith Hadley:

Yeah. So we talk about four disciplines and the first discipline and they're truly discipline. Like physical health is a function of disciplines. You got to eat right. You got to exercise, get good sleep. It's not that we don't know that we just don't do it as a discipline. 

So organizational health discip lines, by the way, we asked that one of my colleagues was at Mayo clinic and ask, you know, a room of about a hundred physicians, like, you know, Hey, how many of you in the last 24 hours have like done all three of those and like, not a single hand stayed up. So, you know, when we're talking even to physicians, they realize that physical health is harder than it looks. 

So organizational health, though, is four disciplines. It's really simple, but it's just really hard to do. So the first discipline is about building a cohesive team. And that's, you know, a cohesive team is one in which we can trust each other enough to have really honest, good conversations leading to stronger decisions that we can hold each other accountable to all focused on the shared results of the organization. 

And that's Pat launch he only wrote about that in his book, the five dysfunctions of a team, trust, conflict, commitment, accountability, results. That's the first discipline and. Dan, you know how hard it is to stay cohesive and aligned with just one other person. I think of like a marriage, just staying cohesive. 

You have good days and bad days, and now you have maybe a team of eight or 10 people. And to try to help that team stay and maintain their cohesion is hard. So it's active work.  

Second discipline is all around creating clarity. So the organization needs answers to six critical questions and every time we've done this work in hospitals or in healthcare systems, everybody has an answer. 

That's not the problem. And the answers are right. That's not the problem. You know, everybody at that table is too well informed to have wrong answers. The problem is they just don't have the same answer. And so six critical questions, Pat wrote about that in the book, the advantage and it's, why do we exist? How do we behave? That's our core values and our core purpose, clarity.

Daniel J. Marino:

Right, so that of the team becomes really critical to drive into that cohesiveness as well as in your decision making, I would assume. 

Keith Hadley:

Totally, totally. So we need to be clear to top two. Why do we exist as an organization? How do we behave for most hospitals and healthcare providers? That's a pretty easy set of statements, but even as easy as this to understand, you know, we need the same answer.  

The next two get pretty tricky though. What do we actually do? And how will we succeed? And this gets into the choices that we make around what's included in the scope of our work. 

And there's a lot of changes happening there. Are we going to do local community clinics? Are we going to do research? You know, all kinds of, you know, we call that our business definition. We have to make choices. And then how will we succeed? That gets into our strategy. How are we going to differentiate ourselves? What's going to be the pattern of decision making that we teach people to make sure that we're strategically aligned and consistent?  

And then the last two questions are really hard to get the same answers on. And that's what's most important right now. 

We call that our rally cry and who's doing what? So it's a lot of work to get totally clear, focused and aligned. From a team and then the 3rd and 4th disciplines are we got to over communicate the heck out of it and we have to reinforce it through all of our human systems, which I don't want to minimize the importance of those disciplines. 

We could talk more about those.  

Daniel J. Marino:

No, that's critical. So when you think of where in healthcare leadership is going and talk a little bit about the growing physician leader that is occurring right now in the hospital or the health system, or even the medical group for that matter. 

More and more physicians are assuming leadership roles. Sometimes what we see is the, I don't want to say the interest, but the strategic focus is slightly different where you may have a CEO that's not a physician leader. You'll have the chief medical officer, which is, maybe a few other clinical folks who are on that leadership team. 

How much does that the background, the training of the leaders, I'm thinking more so the physician leaders versus the administrative leaders. How much does that come into play to really design where they want to go or even breaking down some of these barriers to align around a cohesive team. 

Keith Hadley:

Yeah, it can be critical, but here's the problem that we see. On an executive team, the leaders need to decide which  team is their number one team, what's their first team. So if that physician has been selected to represent the interests or the needs of a particular constituency within the system, then they are there like a member of Congress advocating for their primary team, which is outside of that executive team. 

On the other hand, if they're there representing the system, representing the entire organization and making that executive team, their number one team, then it's great to have them at the table because they can be a good strategic advisor. They can bring all that context and perspective, but they need to bring that as with where their primary loyalty or their primary drive is the shared collective result of the organization. 

And then we like to say that. Physicians would represent the executive team out to their constituency, not the other way around, or they're representing that constituency on the executive team.

Daniel J. Marino:

Right. But I also feel like you have to land on that vision, right? So that whole team, that leadership team does have to agree on where we're going to go. 

Right. I think that has to be the first step. And then maybe you might have a couple of different paths to get there. But if you don't have that North star, right, I think you're really challenged in terms of where to go. And then it's a matter of perceptions that come into play, which I would think would definitely tear the team apart.

Keith Hadley:

Right. And I would change one word that you said. You said they need to agree on where we're going. And I would say they don't need to agree. They need to commit. And so the, the CEO, their job is to be the decision maker, to build enough trust on the team, to get all the issues and perspectives on the table. 

Yes. From all the different functions, all the expertise that people are bringing, but often executive teams aren't going to agree. The goal is not consensus. The goal is clarity. So we need to agree on, Hey, what's our North star? Where’s our vision for the future? Or what's our strategy or how are we going to make these trade offs and the allocation of limited resources? 

And we need to debate it with good, honest debate. And then we need to decide. And often that the leader, you know, that's their job is to decide. My dad was a high school principal and I learned a lot of lessons from his leadership. And one of the things I'll never forget that he said is, the hardest part about being the principal at the high school, is that the only decisions he gets to make are the impossible ones.  

So if you're the CEO of a system. They recognize like, hey, I only get to decide when it's impossible. And I'll tell you what's impossible is that when you have a team of highly trained, highly skilled, well meaning leaders around the table and they do not agree, your job is to get all the issues on the table, listen to the various points of view, and then make a decision and then ask the team for, and expect their commitment. And that's really where that team one comes into play is that we need to be able to represent that decision out there at our team, team two, team three   four levels so that we can speak with one voice focused on one thing. And I think that's what breaks down most in executive teams is that people show up expecting it to be like Congress they leave with. You know, not having gotten their way, they leave with a lackluster, you know, lukewarm commitment, no matter how hard they try, they communicate through their nonverbals, their lackluster support. 

And now two, three, four layers out, you see these little gaps emerging between functions and people are left to fight as Pat says, bloody unwinnable battles between functions because their leaders are not clear. Their leaders are not aligned.  

Daniel J. Marino:

Yeah, it breaks down the organization. If you don't have that commitment and that alignment, I agree with you wholeheartedly. 

How much does agility come into play when within the leadership team,  

particularly aligning with the strategy? How agile do you have to be, you know, when do you need to pivot, if you will? 

Keith Hadley:

Yeah. The military has this great rule of thumb. It's called 70%. and it's when you get about 70% of the information that you think you need, it's probably time to make a decision. 

So before you have agility, you have decisiveness. And the idea being that as a leadership team, we need to make some decisions and let's make faster, better decisions by being clear and aligned. If we're making a fast high quality decision. We have to build in our ability to pivot and be agile. Meaning some of the decisions that we make, we're going to very quickly realize, Oh, that maybe wasn't the right decision. 

We need to come back to the table and make a new decision. And so agility comes in with, from a qualitative perspective, with things like humility. You know, leaders who are humble enough to say, like, hey, my job is to make a decision here, but I'm not always going to make the right decision. And hopefully these are decisions that if they're the wrong ones, we can walk back and make a new decision. 

And then they need to have the cadence or the rhythm to know that, like, on a daily weekly basis, we're checking in with people to know, like. Are you seeing signs that we should pivot. 

Daniel J. Marino:

In our industry you're seeing that constantly. I mean, we did a strategic plan in the beginning of the year for an organization and they had a direction they wanted to go with some of their payer strategy, particularly for Medical advantage. Well, lo and behold, in the beginning of March, CMS released some new regulations, right? Now it was technical in nature, but it affected the strategic plan and the growth that they wanted to have. And to a certain extent, some of the leaders were a little bit upset about that, right?Because they had a direction, they weren't sure where to go. But what we tried to say was, you know, you need to be agile. That's part of you as a leader is understanding how things are changing and feeling comfortable to pivot. But I think one point that you made, which is criticalis you have to be able to communicate that to you know, youtnext set of leaders, right? To agee and so forth. 

Keith Hadley:

Yeah. I think a lot of leaders make a pivotal mistake and the mistake they make is that we have to be consistent. We don't have to be consistent. Because the world isn't consistent, but we have to be as clear. I worked with a client once that we worked in the context of an offsite to determine what is their rally car, their thematic goal. 

They announced it at their all hands meeting. And then the next week, something changed. And I was talking to the leader and he's like, Oh, but we just announced that last thematic goal. Like we can't announce a new one. And I was like, no, this is the perfect time to announce the new one. Cause you have everybody's attention. 

You know, just get right back out there and say, Hey guys, Hey, last Friday, we said this. Here's what changed. Here's the new direction. Yeah. Here's the new priority.

Daniel J. Marino:

For a lot of folks, they probably are, you know, they watch the industry and I think for the leadership team to quickly be able to pivot and pivot in a comfortable way is refreshing and reassuring to tell you the truth. 

Keith Hadley:

Yeah. That's why you know, my background is strategic planning, but I am not a fan of the formal strategic planning, especially if it has like the five year or 10 year aspect. I mean, we like to have a really simple focused approach and say, hey, let's look three years down the road. 

Like if three years, there's a mountain peak, let's call that Everest. We're trying to get there. What's the base camp I need to get to now? Like, let's think in terms of, you know, quarterly or six months increments. In light of where we want to get to in three years, but knowing that every quarter we need to review this thing. 

So whenever I see a strategic plan, I always ask like, who's the audience? Is this something you need to present to the board? Is this something you're trying to teach your director level vice president level folks that they can make better decisions? Like let's, let's keep our plans agile and flexible. 

Not our North star. We need that North star. That's our vision, but. The reality, it's just like climbing up a mountain. Yeah, we're just trying to get to base camp, we reassess the weather, the terrain, our supplies, the health of the team. And then we get to the next camp and we reassess. 

Yeah, 

Daniel J. Marino:

Okay. This has been fantastic. I know, a lot of our listeners definitely interested in all aspects of developing leaders and certainly alignment with leadership teams and strategy and so forth. Ifour listeners want to hear a little bit more, how can they get in touch with you?Or what are the resources that you have available?

Keith Hadley:

Yeah. So there's, you know, if you're a podcast listener, Pat Lencioni has an amazing podcast. It's an award winning, it's called, At the Table with Patrick Lencioni, and he's also rolled out recently a new tool called the working genius, which is a terrific tool about productivity, the six activities that we have to go through to get any work done, and that's at the working genius podcast. 

And then one of my colleagues, James Felton and I are doing a podcast called the Organizational Health Advantage with Keith Hadley and James Felton. And that's available on any of the podcast forums. And, if you're interested in learning more about organizational health, of course, we just invite you to go to tablegroup.com. If you want to learn a little bit more about me, keithhadley.com.

Daniel J. Marino:

Keith. That's great. Well, again, this is a topic near and dear to my heart. We work with many organizations on their strategic development and the leadership aspect of it is justabsolutely critical. But I want to thank you for your time today.

This has been fantastic. I really appreciate it. We'd love to have you back again to maybe deep dive in one or two of these topics. I think, you know, particularly around the four aspects that you had described the four disciplines. I think you touched on some great information, but thanks again for your time. This has been wonderful. 

Keith Hadley:

Thank you, Dan. I really appreciate your time.  

Daniel J. Marino:

And I want to thank our listeners today for tuning in until our next insight. I am Daniel Marino bringing you 30 minutes of value to your day. Take care.

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners

Risk-based contracts are revolutionizing the healthcare industry, prompting a transition to value-based care. In this episode of Value-Based Care Insights, guests Cliff Frank and Dr. George Mayzell explore the key aspects of risk-based contracts and provide actionable insights for physicians and practitioners navigating this transformative shift.

KEY TAKEAWAYS: 

• Internal communication is vital in risk-based contracts.
• Data can be utilized for proactive patient interventions, aligning primary and specialty care.
• Clinicians must promote appropriate care settings, strengthen patient relationships, and build trust in value-based models.

LISTEN TO THE EPISODE:

 

 Transcript:

Daniel J. Marino: 

Welcome to Value Based Care Insights. I'm your host, Daniel Marino. On the show, we've spent quite a bit of time talking about different aspects of risk based contracts. And, you know, we focused a lot of the attention on how to engage in a strong risk based contract. What are some of the things that we need to think about as we're preparing for either discussions with payers or thinking about the data that's going to prepare us for some of those discussions and even some of the contract elements. It's been great discussions and even the last 1 that we had with our partners, Q.R.C. We talked about these risk based models and quality, which is extremely important to looking at the performance of these contracts. 

But an equally important element of the contract is what happens once the contract is signed, and frankly, that's really where the work starts. Well, I am pleased to have today, two great gentlemen. Cliff Frank, Dr. George Mayzell, join me in the conversation about that. And just as a little precursor, George and Dr. Mayzell wrote this great article for HFM. It's in HFM magazine. It was just released in the summer 2023 edition. It's entitled Six Actions for Physician Practices on Signing Risk Based Contracts. We'll put the link in some of the liner notes so you can get it. It's a great article. So, here to discuss this is Cliff and George Mayzell.  

Gentlemen, welcome to the program.  

Cliff Frank:

Thanks.

Dr. George Mayzell:

It's good to be here.

Daniel J. Marino: 

So, George, maybe we could start with you whenwhen we negotiate these contracts. Obviously, they're different than fee for service. There's typically a fee for service element in here, but we're focusing on different things. And hopefully, by the time we get to risk based contracts some of the providers are at least used to tracking their outcomes are capturing a few things. But what do you see is a sort of the real culture differentiators that need to occur with physicians and their practice as we engage in a risk based contract.  

Dr. George Mayzell:

Yeah, I think you sort of summed it up in the question. It is a cultural difference. And some of it is making sure everybody's on board. So there's a lot of internal communication that has to happen. All the physicians and administrators have to understand this is going to be different. And so it's not just about, you know, seeing as many patients as you can and running from room to room as fast as you can. All of a sudden, you have to take a different approach. And you have to understand that approach is looking at not just maximizing RVU's, but maximize the care they give patients. So, all of a sudden you using data to drive decisions. You're looking outside the office. You're thinking about the patients that don't come in the office, not just the ones that come in the office. So, all of a sudden you're thinking is not insurance based when you're thinking insurance based, " It's okay. If I have to give lab results, I have the patient come back because otherwise there's no reimbursement." So, all of a sudden you're thinking, "Okay, what's best for everybody? What's efficient?"  

So, by phone calls, by telehealth, you can start to do what makes sense to maximize revenue at the same time you're maximizing care. But the thinking is different. It has to be data driven and a lot of it, you just have to get everybody on the same page. Otherwise, if you start having folks that are still trying to practice themselves under the old fee for service model, they can really disrupt things. So, everybody has to be engaged. Everybody has to be on the same page. And the key is communication and information flow. 

Daniel J. Marino:

Right. Well, I think the one thing you mentioned, which I fully agree with is physicians in a fee for service world, you're really used to managing that patient, that encounter, right? And we need to think broader than that. You have to think about the population that you're managing and not just the patients that are coming into the office. But the patients that you don't necessarily see that you'restill responsible for. Cliff, when you've worked with different practice leaders per se, and you're focusing on these contracts, and we're looking at some of the, you know the populations that were really responsible for those attributed lives, what are some of the indicators? What are some of the things that you've been able to get across to the providers to help them understand, maybe where to focus some of their attention?  

Cliff Frank:

Well, George said it best. It's not just the patients who are in the office, it's the ones who have a high risk score and they're not seeing a specialist and they're just a ticking time bomb. You know, if you're a fee for service, you could just wait around with a catcher's minute. When somebody gets in trouble, you're there to help them out. The name of the game here is to get ahead of that. So, identify patients who have chronic conditions who aren't getting optimal care either the patient's not engaged or the patient's care is fragmented.  

Find the patients who are going to the ER for a whole lot of treatment that really could be done elsewhere. Change your scheduling algorithms so you can see these patients quickly when something hot occurs rather than have it kind of spiral out of control. And then you've got a mess on your hand. It's simply, it's the difference between reacting and playing heads up ball.

Daniel J. Marino:

Well, you have to get the data, right?You have to get the data.You have to understand what's occurring with that population. Do you feel that is this sort of the practice manager's responsibility? Is it a sort of a new capability of these practice managers that we should be incorporating into their job descriptions, or is it somebody else within the network that should be providing that information to the practice on the attributed lives. The number of patients that are being seen in the office versus that aren't being seen and and those that we have to see in schedule management, Cliff, like you said.

Cliff Frank:

It depends. I've seen it work both ways. I mean, if you have a care manager in the group, usually a nurse care manager or, or at least someone who is a data savvy, a lot of that stuff can be done in the practice. In many cases, though, that doesn't exist. And so, some sort of central support organization has to do that through an IPA or an ACO or some other collaborative organization. And in some cases, the plans do it in support. Part of that gets to timeliness of data, how granular the data is.  

And most importantly, is the data actionable?  

Daniel J. Marino:

Right.

Cliff Frank:

Just because I know something's out there that doesn't tell me what I got to do. And, you know, there are lots of things that are going on that, you know, the doctor or the office really can't bend the trajectory of that disease process and in other situations, they can't. And sopicking and choosing your spots as to where you're going to provide these prospective interventions really becomes important. The other piece I'll just mention is all this is happening, not in a vacuum. It's happening amidst a regular fee for service world, right?

Daniel J. Marino:

Soit's all intertwined, right? Soyou're sort of...

Cliff Frank:

These patients are not tattooed. You know, on their forehead they're an A. C. O. Patient or an I. P. A. patient or you know, whatever. So, a lot of what the doctors end up doing since they don't really practice in a bifurcated way is they develop these new practices and new sensitivities and awareness and interventions and they apply it across the whole practice, which lifts the quality of care for everybody. It's a good thing. 

Daniel J. Marino:

All right. So, George, one of the things you mentioned in your article is you talk about the rising risk score, and you say that early identification of patients who are undergoing a significant shift in health status can enable primary care physicians to positively affect patient outcomes. I don't think anybody would argue with that. How do we get that data? So, are we relying on the systems to risk score the patients? Are there protocols that we should be having built in terms of how we identify patients and put them in these cohorts? What would be a bestpractice that that helps to achieve what you put in there?

Dr. George Mayzell:

Yeah, great question. Let me take a step back into because the data stuff is just such an important element of this. And it's something that hasn't been traditionally inside the medical practice. And so, when you look at data, one of the things you have to do is you have to get external data because what happens is traditionally you have EMR based data from inside the practice. 

That is not good enough. Because that only tells you, you know, who's there. So, you have to get claims data and integrate it with that EMR based data so that you can get a full look at the patient. When you look at that, that's when you start breaking down to what Cliff talked about was the acute care, which is our kind of our current model. Then Cliff also talked about the chronic care model, which is still kind of part of our care model we're not very good at but we try as well as diabetics and hypertensives and hyperlipidemics and you're trying to be more preventive. But what this does, it lets you reward you for being more preventive because you're getting early and you lower long term medical costs.  

But the biggest issue which you brought up, which is not something physicians are used to thinking about is what you called rising risk. Because that's really the thing that we've not done a great job at intervening on and so what we know is that patients that spend a lot of health care resources this year are not predictably the ones that are always going to spend health care resources next year. So, what you have to do is go back and say, "Okay, who are the ones are going to have issues?" And so, you start looking at that and you can predict them to predictive modeling. You can look at things in lab work. Maybe someone has a cancer diagnosis that pops up or a kidney, you know, something acute that's going to be turned into a chronic problem. Those are where you really want to focus your resources, because that's really where you can be most effective. So, identifying those rising risk folks is really, it's a challenge, but it's so, so important. And again, as Cliff said, how do you then move that information into actionable items? And that's tough because, you know, the care managers, in my experience it's a whole new skill set to take that predictive modeling and predictive algorithms and then intervene in a way that lowers the risk. And that's really, that's 1 of the biggest challenges, but also 1 of the most important, but it's also the most rewarding because you're taking someone who was going to have a very difficult year medically and you're hopefully preventing or at least mitigating it. 

Daniel J. Marino:

Yeah, absolutely right. Well, if you're just joining us, or you're just tuning in, I'm Daniel Marino. You listen to value based care insights. I'm here today with Cliff Frank, Dr. George Mayzell. We're talking about an article that great article that they wrote. It was recently released in HFM magazine, which is part of HFM for May.  

Cliff, let's talk a little bit about the risk component, some of the cost drivers, right? Because at the end of the day, when you look at these risk based contracts, it really comes down to how cost efficient we are in managing the population, right? So we have to manage utilization efficiently. We have to make sure we're providing care to the patient, the right care to the patient at the right time. All of those things that we talk about, how do we align that risk element with costs in a way that it really does integrate well with the physician practice so we can achieve those goals that really drive the performance of the contracts.

Dr. George Mayzell

This is where the two worlds collide, the fee for service world and the value based world. For example, you might have a set of specialists that you really like and use a lot, but they're very aggressive and you know, they view the clinical indicators for doing a particular procedure. Very broadly. Whereas, some other providers are much more conservative, thoughtful, careful, whatever adjectives you want to use. And in the fee for service world, you really don't care, you know. 

You're happy to have it. You just want the patient to come back. You want them to be in better health by the time they come back. And you know, the problem that was driving the patient resolved. But in many cases, there are multiple ways of resolving a patient, whether it's surgical, medical, You know, some sort of psycho-social support and it could be any number of things. 

Suddenly as a primary care doc in a value based panel, you care a whole lot more about which specialists are doing what to your patients and frankly, a lot of primary care docs are not really comfortable or built to have conflict with their downstream specialist.  

Daniel J. Marino:

But I think building on that, that's critical because if you look at the real cost drivers, obviously the specialty care, which is needed, I don't think anybody's arguing with that. It's the most expensive component of the care, right? So, that integration between the primary cares and the specialists. It's not a matter of how do we do it. It's a matter of of it just needing to be done, right? You have to be in to communicate.You have to collaborate.We have to be on the same page in terms of working behalf of the outcomes.

Cliff Frank:

I would just start with data. George said the doctors don't have that data. It's in the claims database and it's in broader databases that speak to clinical proclivities of your downstream network and understanding what they are is kind of basic to being successful in these value based programs. And if your specialty network goes crazy. You're still upside down.

Dr. George Mayzell:

Yeah, I was basically going to say the exact same thing. Most primary care docs really don't know the quality of their specialist care. They know, you know, the one off quality, they know how they treat the individual patient but I know there's a lot of surprises when they actually look at the data and they see kind of what's going on and it really does change behavior a lot when they see that information. So, it's not something we don't share a lot of outcomes and quality data across the different specialist and primary care. Traditionally, these new models are forcing that to happen. And that leads to things happening. 

Daniel J. Marino:

So how much does access come into play here. You know, we all have heard we got a lot of access challenges. You know, wecan't get in to see a specialist for 3 months. Our primary care is booked out 4 or 5 weeks. You put in your article, which I think is great. You have to establish systems for after hours coverage. Obviously, you're talking about urging care. How does the access management come in as you become, you know, as a tool, so to speak, to drive that performance, George? 

Dr. George Mayzell:

Well, yeah. I think we all know that if you get somebody in quickly, you can resolve a problem before it becomes a big problem. The last thing you want is to someone go to the ER for a non-urgent issue. It's very expensive. ERs are not efficient places to take care of non-emergencies. So that access gets patients in a quick fashion and you know, potentially preventive or stopping a big problem. So, it could be in the office. It could be after hours. It's a relationship with an urgent care facility that you trust as good outcomes and we'll share records with you. So you can see the patient back and follow up. It's using the ER appropriately. I mean, there are certain things that you need in the ER. So, it's really about appropriate usage but allowing access to the lowest level of care that is appropriate. And so, we're not good at that because right now it's hard to get into practices. 

And so, that's we're using models that use team based care and other things that that allow that to happen efficiently with the appropriate scheduling and maybe telehealth, all those things play into what's the right thing for the patient at that moment and the best way to get care.  

Daniel J. Marino:

And so, Cliff, let me build on that for a second. I'vespoketime and time again. I think, you know, the 3 of us agree with this that you have toprovide the right level of incentives to get the behavior that you want. Should we be incentivizing our urgent care providers? 

Cliff Frank:

Well, I think for them, the fact that they're in the referral stream is the incentive. What I think is more important is the comp model for the doctors. If they're still on churn and burn RVUs and there isn'tkind of a quality or a relationship or a direct percent of savings model that hits their income stream, you're not, you know, they're going to do what they're comfortable with, which is what they've always done. 

Daniel J. Marino:

Sure.

Cliff Frank:

So, it's really hard to just kind of layer on a value based deal and expect some significant clinical changes without it flowing all the way through the incentive system.  

Daniel J. Marino:

You need to have that and I couldn't agree with you more. We need to create the alignment of the compensation model has to align with the contracts. I've spoke with many organizations who are still have their providers on a straight RVU model, which frankly aligned well a few years ago with fee for service, but works against you in risk based contracts, right? So I absolutely agree. Let's switch the topic a little bit though. Oftentimes, when I talk to physicians about this and, you know, we talk about risk based contracts and we talk about what the providers need to do and you need to, you know, talk with them about all of these protocols and be a little proactive. 

A few of the physicians will come back and say, you know, look, there's a certain level, certain group of patients who doesn't matter what I say, they're going to do their own thing, right? They're, you know, they have choices. They can go to whoever they want to. They're going to throw their hands up. You mentioned in the article that you need to build stronger relationships with patients. Is this the way that you're working through to try to get better alignment with the patients to have them follow what that clinical protocol is? Hopefully get the outcomes that you want.  

Cliff Frank:

Well, let me take a macro approach to this before we get to the micro. This whole leakage issue where the pay you send the patient to your preferred set of specialists and the patient says, "Nah, I'm going over here to this other one or this other neurologist or what, whatever it is." That happens a lot, especially in PPO type benefits like Medicare or a regular Blue Cross product and you're still somehow at risk for all this. The good news in all of that is you don't have to fix it. You just have to make it a little bit better than it was because that leakage is already in the base year, 

Daniel J. Marino:

Right. Well, it's in the base. It's a basic cost in the base cost of care, right? 

Cliff Frank:

All you got to do, you don't have to beat the bear. You just got to meet the other guy who's running from the bear. So, you just have to be a little bit better than you were last year. Now, that's not easy, but it is a point. II'll let George kind of speak to the to the individual physician patient kind of section relationship and dialogue that that has to happen but from a from a macro standpoint... 

Daniel J. Marino:

That's a good point.

Cliff Frank:

We can be 5% better than what we were last year. That's a lot.

Daniel J. Marino:

Yeah, you don't have to boil the ocean. You just have to chip away. So, George, you undoubtedly have had to hear that. Complaint or that issue coming from physicians.

Dr. George Mayzell:

I have and here's, you know, there's no perfect system, but the advantages of a value based care. It let's the doc slow down. It's not, you don't have to see as many patients as, you know, you're not, you're not trying to hit RVU numbers. You can spend more time form relationships, build that trust. And we know that when that trust is built and better patients are more compliant and outcomes are better. So you do get that compliance. Now, you know, the other piece I always hear is, oh, I always got this non compliant patient. Yeah, you're always going to have some non compliant patients on the end of the bell curve. You know, and you do your best, but they're going to be there, but they're not going to drive really the main numbers. 

You know, if you think about statistics, most of your patients, if you spend the time, you know, we'll be compliant with what's best for them. Good communication and some trust building and all those things. So this lets the doc. Slow down the model. It frankly takes the insurance payer a little bit out of the process. So, all of a sudden it allows you to, if it's the right thing to make a phone call, it's best for everybody. It's the right thing to come in. And so everybody feels more comfortable when that trust is built. So, you know, I always encourage stocks, don't worry about the folks that are way outside. They're going to be non compliant in any situation. They're not going to be driving your practice patterns, you do your best you can with them. You know, sometimes you can win, sometimes you can't. But with the majority of your patients, they're going to do better in this model.  

Daniel J. Marino:

Yeah, no, you're absolutely right. So real quick, because we're running to our end of our show here and Cliff, we'll start with you real quick, 30 seconds. As physicians are entering into these contracts or as organizations are entering these contracts. What's the one piece of advice you'd give to practice managers or leaders or physicians that would drive the success of the contracts?

Cliff Frank:

Data, data, data. If you have good data, good things can happen. Not necessarily well, but you got a shot. If you have no data, you're done. 

Daniel J. Marino:

Perfect. I agree with you wholeheartedly and having that data translate in a way that physicians could do something with it and really make an impact with that patient. That's the Holy Grail. That's where you need to aspire to. How about you, George?

Dr. George Mayzell:

Okay, nice. Cliff stole my thunder. 

Daniel J. Marino:

He usually does but we won't talk about that. 

Dr. George Mayzell:

He does. I would add to that, "Go slow this is not easy when you're transitioning from fee for service and you're in that middle ground where you have some fee for service some value base. It's hard. Don't think about this is is just same old business is as usual. Go slow build the infrastructure, which includes the data piece, but also includes operational infrastructure. And take it 1 step at a time so that, you know, as you increase your financial risk, you know, you're going to be successful because you've gone slow." 

You've done the modeling. You've changed the behavior. You've changed the culture and, you know, you're going to be, you won't have any doubts you're going to be successful because you've already, you've already run the process and numbers.

Daniel J. Marino:

Yeah, you're already on it, worked it through. Well, gentlemen, this was fantastic is, you know, as usual. I love having you both on. We have a lot of fun with these these conversations. George, any of our listeners want to get in touch with you have an email or LinkedIn or how can they reach out?

Dr. George Mayzell:

I'm on LinkedIn. Happy to talk to you. My email is GMayzell@gmail.com. It's my personal email. That's easiest. That's what I check. So happy to have a chat with anybody. 

Daniel J. Marino:

Great. How about you, Cliff? 

Cliff Frank:

Mine is cap help, C. A. P., as in Paul H.E. L. P. like help me Rhonda caphelp@msn.com. That's my personal email as well and both George and I are both kind of sick guys because we love talking about...

Daniel J. Marino:

Youdo and I love having you both on it was always makes for a great conversations and I'm sure my listeners enjoy it as well. So, thanks again to both of you for coming on today. And I definitely want to thank our listeners for tuning in. Hopefully you got out a lot out of today's conversation until the next insight. I am Daniel Marino bringing you 30 minutes of value to your day. Take care.

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners

Rising prices and sky-high interest rates are posing significant operational and care delivery challenges for hospitals. In our latest episode of Value-Based Care Insights, Nillie Djassemi, CFO of Houston Physician’s Hospital, shares valuable insights on navigating these challenges. Together, Dan and Nillie explore the importance of investing in vendor management and capital expansion to thrive in today’s economy.

KEY TAKEAWAYS: 

• Health care providers can mitigate financial challenges by creating operational efficiencies, partnering with their physicians, and building a culture of employee engagement.
• Given the inflationary pressures, finance leaders must engage with  payers and adjust their payer contracts.
• To manage financial strain effectively, finance leaders must think creatively about supply costs and non-labor expenses, then structure purchase agreements with their vendors.

LISTEN TO THE EPISODE:

 

 Transcript:

Daniel J. Marino: 

Welcome to Value-Based Care Insights. I am your host, Daniel Marino. There is a recent survey that came out by Kaufman Hall, their hospital, national Hospital Flash reports. It is actually really good. I have looked at it many times both on the hospital side, in the physician side, and in the recent report that they put out, they mentioned that, five takeaways that were interesting observations from the hospital perspective.  

One is that hospitals are still operating in a negative margin, although that margins is decreasing actually in April, with all the hospitals that they surveyed. There was actually a 0% operating margin, but that also takes into consideration the larger hospitals. 

Many of the smaller hospitals, particularly the community hospitals or specialty hospitals still are operating at a loss. Volumes within the hospitals are decreasing, but interestingly enough, length of stay is increasing and we all know that certainly affects the star ratings. And a lot of the performance around value-based purchasing. 

Medicaid disenrollment is also occurring, but the biggest one that I saw that again, is still an issue that we are seeing with many hospitals, many physician practices, is inflation continues to really be a significant challenge with hospital finances. Well, I am pleased today to have as my guest, a long-term colleague and friend. 

Nillie Djassemi. Nillie, is the Chief Financial officer of Houston Physician Hospital down in Houston, Texas. Nillie, welcome to the program.  

Nillie Djassemi:

Good morning. How are you Dan? 

Daniel J. Marino:

Doing great. Doing great. Thank you. So Nillie, given those above challenges that I mentioned and some of the things that are identified in the Kauffman Hall National Hospital Flash Report, what are you seeing as some of the major issues affecting Houston Physician's Hospital financial performance? 

Nillie Djassemi:

I Think the two major drivers for Houston Visits hospital is the reimbursement pressures from the payers. We are, in the last 18 to 24 months, we have had to go into renegotiations with a few payers and, we got beat up, Dan, we got

Daniel J. Marino:

Yeah. 

Nillie Djassemi:

knockout actually on one of them. We just got knocked out. 

And the other one is supply costs. Which is not, I mean, we are seeing that everywhere, every hospital is dealing with that. And so we are doing some things that are helping us offset those increases in supply costs that we can talk about later.

Daniel J. Marino:

Well, and as you know, revenue is one side of the equation, but your expenses and how you structure those are the other. 

And if your expenses are going up, You cannot just automatically increase your revenues. Your revenues are fixed and tied into the payers.

Nillie Djassemi:

That is correct, yes. And so we have definitely started increasing the revenue and not through rates, but through volume.

Daniel J. Marino:

Right.

Nillie Djassemi:

And the volume growth is helping us help offset the rate impact. 

Daniel J. Marino:

Have you focused more on surgeries or is there an ambulatory component either through the A S C or maybe through some of your therapies that are figuring into your volume expansion? 

Nillie Djassemi:

Yeah, so we have definitely brought in different types of surgeons. So we have opened up a, not opened up, but we have definitely expanded.

Daniel J. Marino:

Mm-hmm.

Nillie Djassemi:

Our robotics services through the GYN and general surgeries. And so we bought a DaVinci last year and

Daniel J. Marino:

Oh, great.

Nillie Djassemi:

Yeah, so just because, you know, I mean that is definitely for GYN and general surgeons, that is definitely something they want and we have not really focused on that, those service lines before. 

So we invested in one again, that was in play probably three years ago when we made that decision. And it just took a long time to get that here because of all the supply chain issues. So we actually were not able to launch it till mid last year, and it was supposed to be launched much sooner than that. 

So those were things that we had already. We knew that we had to prior to the reimbursement pressures coming down the pipeline.  

Daniel J. Marino:

Right. So you needed to do something in terms of volume.

Nillie Djassemi:

Yes.

Daniel J. Marino:

You know, I guess the supply chain challenges that you had a couple years ago essentially worked in your favor. 

Right? Because now you are able to get that and add additional surgeries based on some of the robotics to support it, which, I think that is certainly key. How about some of the turnover and the staffing challenges that you have had? Are you seeing a lot of turnover? Is it stabilizing? Are you particularly in the nursing arena, are you able to recruit or are you still see this a challenge in your organization?

Nillie Djassemi:

I cannot say it is a huge issue. Our turnover rates are much lower than what I see around the market, but it is still a problem. Right, because every time someone leaves the cost of bringing them back is so much more, plus the training cost and everything. 

Daniel J. Marino:

Sure.

Nillie Djassemi:

Right. I want to say our people, our nurses and our non-clinical staff are happier here. 

Our turnover rate is lower. But we still the challenges. Of course we do because the nurses and especially on the inpatient and in the surgery world, that is where our nurses are. Right. Yes, they all talk, they know the market. So yes, we have had to deal with increases in looking at the market rates. 

We are doing market analysis every six months now. We used to never have to do that. Right, 

Daniel J. Marino:

Right.

Nillie Djassemi:

So, HR has processes now where they actually have to look at market rates and market analysis every six months. Dan, you know, that is crazy.

Daniel J. Marino:

You gotta do it.

Nillie Djassemi:

But you have to, because we do not want to be caught off guard if our CSTs are coming to us and like, Hey, someone down the street is paying me X dollar more an hour. 

We do not want to be caught off guard. We want to be able to have that knowledge in our back pockets to be able to give them, no, that is actually not true. Or, yes, that this is what we can do. And it is very difficult. It is very, very difficult. But that is the process that we put in place to help for us to be knowledgeable.

Daniel J. Marino:

Well, you have to be competitive, right? I mean, getting that insight, that is the only way to be competitive and to be totally transparent to our listeners. I have had the wonderful opportunity to work with Houston Physician Hospitals for a number of years, and nearly your leadership team has built a great culture down there. 

And I have felt time and time again, I have spoke about this with many folks across the country. You have to be competitive on rates, but in order to really manage a lot of the turnover challenges, the financial challenges related to our workforce, you have to create a strong culture, right? You have to create the culture that makes people want to work there. 

And as you have said, and I agree with you, I think people are happy working in your organization, and we see that a lot of times with smaller community hospitals or with specialty hospitals.

Nillie Djassemi:

Right. Yeah, we definitely, I think I have told you this, Dan, before I came to H p H, I came from a more corporate healthcare background and so, The employee engagement here is something I have never experienced anywhere else. 

And I am not just saying that cause I work here, but we put in a lot of effort to have that high employee engagement. And it takes resources and it takes a lot of time, but it does pay off because our turnover rates are so much lower. We still have to deal with the pressures right, the external pressures of inflation with salary rates. 

But, I really do think that is a huge piece of the puzzle is that we put so much into employee engagement. And look, when I first started here, our ceo, I would be like, wait, we are spending how much on t-shirts? We give out, we are known for our t-shirts here

Daniel J. Marino:

so little things make a difference,

Nillie Djassemi:

It is a little things. It really is. We, every month, in my department, there is one thing we focus on every month in the departments. And for example, last month, we focused on integrity. And each person had a banner. And it give me what your integrity motto is for you as a person. 

Right? And so everyone, it was not all across the hospital, but for all my departments, they did the individual one. But across the hospital, what we did was every department made their own banner. And then we were able to hang it up in our cafeteria area, and everyone could see what everyone's motto was in terms of integrity. 

That is one of our mission statements that we believe in. And so it is just, we really do focus on that. And this month we have something else that we are doing.

Daniel J. Marino:

And the culture piece is huge. If you are just tuned, again, I am Daniel Marino. You are listening to Value-Based Care Insights. 

I am here talking to Nillie Djassemi, she is a Chief Operating Officer. I am sorry, chief Financial Officer of Houston Physician Hospital. Nillie. I want to get back to one other thing that you mentioned, and I would like to dive into this a little bit with where interest rates are right now. It is, of course putting a lot of pressure on hospitals to fund some capital expansion, some new equipment and so forth. 

How have you responded to that?

Nillie Djassemi:

So last year, I was approved for X amount of capital purchases through my main bank and I actually had not used majority of it cause we had slowed down the purchasing. Right. Capital purchasing. But I had the ability to actually pull all of it and put it in basically in an escrow account. 

I would have to pay interest and principal on it, but the interest rate on it was only 3%.

Daniel J. Marino:

Oh, wow. Right.

Nillie Djassemi:

Because I was approved for that loan back in 2021 and so you do not ever want to pull money out when you are not using it. Right. I mean, to me, I am like, God, I am not

Daniel J. Marino:

The arbitrage factor just makes sense, right? 

Because if you have got that line that is paying 3% as opposed to funding something else through an equipment vendor that is 8%. I mean that interest arbitrage is key. That makes a lot of sense.

Nillie Djassemi:

Yeah, I think it actually was three and a half percent. So we ended up back actually, it was late fall, we ended up pulling it and I have been using that for the capital funding that we have needed for 2023. 

Now, obviously that is going to run out in 2023, so then we will have to revisit all of that again. But it was a huge, huge, decision, a great decision that we made. And it definitely helped us out for this year. Now I have some different things I am thinking through for 2024. 

Which is related to what I was mentioning earlier, related to working with the vendors on potential placement agreements or usage agreements, or even one of our large vendors, we are doing a conversion project with them, they are trying to gain market share in one of our Orthopedic subspecialties. And so we are going to have to buy a bunch of equipment. And so what we are going to do is do a conversion project. If we convert so much, so many supplies to them, we will actually get some capital credit back if we purchase with them. If that makes sense.  

Daniel J. Marino:

So, then it sounds like you are definitely have had to become a lot more innovative. As to how you have structured these relations with the vendors. And so are you seeing the vendors being a lot more willing to structure deals differently?

Nillie Djassemi:

Yes, for sure. Because if you know your landscape of what you have in the hospital. Like for example, if you have 70% Medtronic or 70% Stryker, Boston Scientific, whatever your vendor landscape is, and you can maybe talk to the vendors that want to gain market share and see, hey, look, I am going to need X, Y, Z. These capital items, what are some things that you can work with me around capital? 

Cause they want you to buy capital and they want to get that supply cost.

Daniel J. Marino:

Well they want to keep that long-term relationship right?

Nillie Djassemi:

Yes.

Daniel J. Marino:

And I mean they are seeing the challenges as well too when you are talking about all the foundationary pressures that are occurring.

Nillie Djassemi:

Exactly.

Daniel J. Marino:

If you do not have the relation with the hospitals, you are not going to get anything through.

Nillie Djassemi:

Yeah, so I have had to really get into supply chain. I have had to get my hands real, real deep into supply chain, negotiations, contract modeling with them. And again, we are a smaller hospital, but I think one of the things for CFOs out there is really getting your hand into supply chain and not, 

Daniel J. Marino:

I agree with you.

Nillie Djassemi:

being consistent with it, but really getting in there, looking at it. 

You know, another thing that the hos, the way we positioned this hospital, we did not want to go into contracting because we got better rates of local contracts.

Daniel J. Marino:

Right.

Nillie Djassemi:

Well that is coming back on us. And so I amactually having to really look at, do I want to go into the G P O pricing? 

Daniel J. Marino:

Yeah. Well many hospitals have gone into G P O and there is a lot to be said for a lot of participating in a national rate negotiation. 

Through a gpo. Right. So, I give you credit for looking at that. I think that is great.  

Nillie Djassemi:

Yeah. And before, we were actually better off not being, and not everything was off gpo, just some of the, especially high dollar implants, but we are looking at it now with our vendors. But I have to have meetings with them quarterly. 

I am with them, you have to have that relationship with them to start having those conversations.  

Daniel J. Marino:

Yeah, you do. Absolutely. So, Nillie, when you think about the financial performance and the financial pressures that your hospital is under, have you had to look and make any tough decisions on services? 

Have you refocused a lot of your attention on maybe some of those services that are not? You know, it is a shame, but they are just not making any money. Or you have no choice but to either reduce those or maybe you have made the decision the other way. Hey, we know we are going to lose money, but this is the right thing to do for our patients, for our physicians, so it is going to be a loss leader for us. 

Have you dove into those types of services and those discussions?  

Nillie Djassemi:

So since we are so focused on our primary source of revenue does come from surgeries, right? And so we do not typically do cases that are under. 

Daniel J. Marino:

Sure.

Nillie Djassemi:

And so I cannot say that. 

The reason why we have actually grown the volume just not in orthopedics or sinus, and those are high. Those are our bread and butter. Right? Those are the high volume.  

Daniel J. Marino:

Sure. The high continu margin services. 

Nillie Djassemi:

Right. But, you know, we have had to really look at expanding to other service lines because we cannot just depend on that. 

And so the margin, so no, we have not for what you are saying is, have we had to stop the service? No. We have actually grown services that are not as high margin as the other service lines have been, and like PT is another, physical therapy is another example of resources that we have put a lot of resources in the growing our physical therapy service line. 

We are going to hopefully hit a hundred thousand visits in 2023. Is it high margin? It is not. It is high volume and it carries itself and so we think from a quality perspective, keeping those. The types of surgeries that we are doing, the post care of going into physical therapy within our clinics, that we know that we are, we train those therapists. 

We know their outcomes. It is a huge satisfy for our patients.  

Daniel J. Marino:

Well, it is a big value add, right? Not only, like you said, for your patients, but, also for your physicians, and it is part of what you need to do if you are going to create a strong, comprehensive services in support of, say, orthopedics or some of the other service lines. 

I know that as and I, we do this in our own business, right? You are constantly looking at where you can become more efficient. You are constantly looking at where you could maximize your financial opportunities, but sometimes you just have to do it because it is the right thing to do.

Nillie Djassemi:

Yes, that is right. 

Daniel J. Marino:

So in looking at some of the activities happening around, Houston area, there has been a lot of collaboration in other markets where, The physicians in the hospitals have just to head form a tighter relationship, whether it has been in an integrated network or just to do some collaboration of services. 

Are you having any of those discussions? Are you seeing collaboration is kind of a key as it picked up a little bit? Or do you feel like the relationship that you have right now with your physicians have really been good and has been strong? 

Nillie Djassemi:

No, we have definitely had to reach out to different practices around the market. We are looking into that for sure. There are recruitment efforts into going out and creating those relationships with large practices, especially since we are the high quality, low costoption. In the market. 

Daniel J. Marino:

Well, and I think in working with your organization, you have been extremely physician friendly, right? 

Your level of collaboration with physicians I think is really something that has carried you, and that is just embedded in your culture, right? That is the fabric of what you do. So I could see that is really a big value driver for your team, for your physicians and so forth. 

Well, Nellie, this has been great. I really appreciate the conversation. For our listeners, particularly those on the finance side, any pieces of advice that you might be willing to share or can offer to some of our listeners?  

Nillie Djassemi:

I think the couple things that I would focus on is revenue cycle technology. 

I think the payers are way ahead of us, and we, as the hospitals have to get on board with revenue cycle technology. And like, for example, Dan, you know, we are working on this 8 55 project with you. Yep. And really digging into our 8 55. What are the trends? That is just one, something very simple 

but I am actually looking at several different revenue cycle technologies to come in through the intake process, through the billing process, the collection. It is tough, right? Because margins, I do not have a lot of resources to put into it, but we have to get smarter with revenue cycle technology.

Daniel J. Marino:

Well, and I will tell you, that is an area that I think every finance person, every cfo. Focuses on revenue cycle. They all think and they all believe that the revenue cycle has to improve. And I fully agree. Well Nillie, this has been great. I really appreciate your time. 

You know, if any of our listeners want to reach out to you or network with you, any thoughts, how can they get ahold of you?

Nillie Djassemi:

Sure. LinkedIn is great. That is very easy. My name is and Nillie just send me, I think Daniel have it in the detail. And so yeah, just definitely look me up on LinkedIn.

Daniel J. Marino:

Great. Well again, thanks again for your time, Nillie. This has been fantastic. Love to have you back some time down the road. Hopefully things will kind of improve a little bit and sounds like certainly within, with what you are doing within your organization. You guys have made some real strides, so I commend you for that.

But thanks again for your time today. This has been great.  

Nillie Djassemi:

Thank you so much. I appreciate you having me on. 

Daniel J. Marino:

And I want to thank our listeners for joining in today and until our next insight, I am Daniel Marino, bringing you 30 minutes of value to your day. Thanks and take care. 

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners

To provide value-based care, providers need to address their process, their technology, and their people. But stakeholder priorities don’t always align. Knowing where and how to start can be the difference between a successful implementation and one that falls short.  

Tune into the latest episode of Value-Based Care Insights featuring host Daniel J. Marino as he welcomes Sarah Hartley and Dr. Purvi Shah, whose expertise in ambulatory clinical documentation improvement (CDI) will help illustrate the need to improve clinical workflows.  In addition, they discuss the risks, challenges and obstacles providers need to navigate in order to better deliver meaningful patient outcomes. 

KEY TAKEAWAYS: 

• Coding and clinical guidelines don’t always align with documentation guidelines 
• To start a CDI program, peer-to-peer education is a critical key to success 
• Providers need to advance clinical workflow and documentation in order to meet the needs of patient populations 

LISTEN TO THE EPISODE:

 

 Transcript:

Daniel J. Marino: 

Welcome to value-based care insights. I'm your host, Daniel Marino. As we have talked about on the program many, many times. There is such a transition that has to occur as we enter into value-based contracts. And in particularly as we enter into risk-based contracts.  

You know, as we all know, value base really allows us to manage the population. We are focused on many different outcomes, many different changes that support our physicians, and whether it be their clinical workflow or changes in the care model. All of that becomes important, especially if we want to take care of patients beyond just the care that is being done within their clinics. The documentation, the care model, the support that we give to our patients, critically important, that drives the success of our value-based contracts.  

But when we think about that, there has been so much attention that it's been given to changes in the care model and the level of outcomes that we need to focus on. Only now are we starting to see the importance of modifications of enhancements to our clinical documentation. So in today's episode, we are going to spend some time talking about the new initiative. And it is not really new, because it has been happening for quite a while, particularly on the hospital side. But the need to really advance the ambulatory clinical documentation improvement. I am excited about today's discussion. 

We've got 2 ladies joining us that have done a great job within their health systems within their programs on building a real strong clinical documentation improvement program on the ambulatory side. First joining us today is Dr. Purvi Shah. 

 Dr. Shah is a primary care intern as a medical director of population health for a large health system here in Chicago, also joined by her colleague, the administrator System director, ambulatory risk adjustment and clinical documentation in Tyler, gritty, Sarah Hartley. 

Sarah and Dr. Shah. Welcome to the program. 

Sarah Hartley:

Thank you. Glad to be here.

Daniel J. Marino:

So Sarah, let us start with you. You know, as I mentioned, and we have done quite a bit of work helping organizations move into value-based care everything from strategies to the managed care contracting, lot of folks have focused on their clinical programs, looking at the outcomes, maybe enhancing some of their systems. Let us focus on the documentation. 

Why, all of a sudden, in your opinion, has this been a focus? Why has it not been a focus sooner as organization started to get involved in value-based care.

Sarah Hartley:

Sovalue-based care has been around for a while. But it has been focused on the hospital side, right? And so as we see the industry shift and wanting to treat our patients on the outpatient basis, keeping them out of the hospital, keeping our costs lower. We are shifting that model to our ambulatory settingand the goal is to keep the patients out of the hospital, and we do that for quality care. Our medical records tell a story. They tell the story for each position, looking at the record so that patient can have an appropriate continuity of care as they go through the health care system and the only way that ourinsurance companies know how we are doing, how we are performing is through the documentation and the coding. That is our communication tool to our providers and to our payers. And so, as we move away from E. And M. And P for service. We go into this value-based approach, where we are showing the quality of care that we are providing how sick our patients are, and really justifying the costand the the amount of money that we take care of.

Daniel J. Marino:

Really and really tracking all the activities of really what has occurred with that patient, not just within that particular encounter, but really from a comprehensive standpoint, everything that's happened to them over, say the the duration of their care, if you will. 

Dr. Shah, how have physicians reacted to this? Do they see? that the improvement to some of their documentation. Not just improvement to some of their coding. But you know, with, Sarah said, being able to tell the full story, has this been something that they have been open to? Or has this been a challenge that they really needed to overcome? 

Dr. Shah:

Yeah, I think this is a really hard shift, you know, when you think about the ambulatory setting, you are talking about limited amount of time with patients who may be coming in for a multitude of illnesses. 

 Maybe that really needs some special attention to one or 2, and you are being tasked with capturing and documenting on all of their chronic illnesses. You couple that with the ambulatory space. We are really still focused on E. And M. Coding fee for volume and not really fee for value. I think it is a hard hurdle to overcome. 

I think what is really important, though, is when we are talking to our providers is, this is really the next phase of how we deliver care to our patients. It is really how we keep the lights on and get the equipment that we need to take care of them. And so, just as if there was a new drug for a chronic disease management that was having really good outcomes. We would all be excited to start prescribing that medication. We should be excited about the opportunity to really convey the quality of care that we are providing through our documentation. 

Daniel J. Marino:

Yeah, I agree. That is a great point and I cannot help (inaudible) you have been practicing for 25-35 years, right? Because they are used to really (inaudible) And now, all of a sudden, we are taking in these other elements into consideration. And so when you started your program and you started to really introduce this where did you start? Did you start with a couple of, say, disease categories like the chronic diseases? Or did you start with a segment of the population? you know, Dr. Shah! from your perspective what made the most sense for the physicians. 

Dr. Shah:

I think what really is helpful was starting with the why and really laying the groundwork. For here is why HCCs are important in our population health strategy. Here is what an HCCis. Here is how it impacts the reflection of the quality of care that we provide.By the way, it also impacts reimbursementand then we coupled that with some very basic tools in our EMR, and then from that, from that kind of just foundational understanding, we have added educational modules. We have added the ambulatory CDI process that you alluded to. And so that is really sort of been an iterative process of starting from a foundation of understanding why something is important, and then providingmore and more tools and support and feedback to our clinicians about how they are doing and how they can improve.

Daniel J. Marino:

So, Sarah, when you started to consider some of the tools. And again, I am a huge proponent of technology, right? We have talked on this program many times that in order to really create efficiencies, you know we have to help our physicians work smarter, help them, not work harder, but become more efficient. Obviously, the technology and the tools help with that. 

 Where did you start? What are the tools that are out there that help support them in improving a lot of their documentation?

Sarah Hartley:

This is still a difficult thing, because tools are limited with the. 

Daniel J. Marino:

It is in the early stages of this. 

Sarah Hartley:

Right. So, we look to our Ehr, that is the main tool that our providers use, and the goal is to make it as easy as possible, reduce the number of clicks and the number of steps they have to take, and really embed our process into their day to day workflow. And then what can we help? What is the benefit that they are getting from us.So we looked at how the alerts fire in the Vpa. Can we make sure that those are accurate and we can add information in there for them to address the Hdcs with their patients. We have separated out thequeries that we send to our positions because they get jumbled up in the rest of the messages. And what are the templates looking like? Do we have that phrases? Are there other tools in the Ehr that can be very easily accessible. That kind of help, the provider drive the elements of that documentation.

Daniel J. Marino:

Yeah. And really help them become more proactive. Right? I mean, you see this all the time. One of the reasons why physicians I think it's so frustrated is becausethere's just so much work that they have to do, and it is a lot of redundancy that certainly that they donot need to do, or somebody else could do, or they have already done it. So they are in baskets are huge, I think, as you start to put in place. What I'm hearing you say, is kind of those activities to help support the documentation activity will help them become a little bit more proactive and hopefully less inthe burden. Dr. Shah,Is that been kind of a benefit that you have seen from the program?

Dr. Shah:

I think absolutely. And I think one of the really important parts of our program is that we are going to our clinic business meetings on a regular basis, and hearing feedback and sharing opportunities for improvement in many of the times we do are able to take that feedback back to our team and think about, how can we make something better? How can we make something easier for a clinician. 

How can we educate in a different way? are there ways to make this sort of come alive for our clinicians in a way that they are going to remember what we are saying to them. But I think that engagement is key. You cannot just set it and forget it with any improvement effort in quality, any quality, improvement effort. But I think, especially when it comes to documentation, which is added work on top of the work of caring for a (24:47) you have to be able to go back and provide feedback and say, Hey, I listen to you, and here is something cool that I can offer you, or Hey, I completely hear where you are coming from. I'm practicing clinician as well. And here is how I navigate this space, and how I am able to be successful.

Daniel J. Marino:

But what I am hearing you say though, is under the clinical documentation improvement program that you have in place. This is not just enhanced coding right? But it's really enhancing what is being documented being proactive and aligning it with the right level of coding. But understanding sort of what else has to occur right? Even outside that clinic visit. Is that correct?

Dr. Shah:

I would say it is really less about the coding and more about the documentation we can get to the codes. If the documentation is there. Physicians are not coders. We should not be. We end up, you know. That is not where our brain space, should be spent. 

 But we are experts at taking care of our patients, and we are experts at communicating to our patients how we are going to take care of them where the work needs to happen is translating the into the electronic medical record so that others can see how we are taking care of our patients. And then as positions. We get the credit for the work that we have done.

Daniel J. Marino:

Yeah, yeah, what has been the adaptability on this? I can imagine that this had to be really tough. When you first to introducethis right?I'm sure you have gota few scars and a few bruises. You probably both do. What was the adaptability of this? I mean, Did you find that physicians understood it, and that they were able to, you know, they sort of embraced it, or did they come to the meetings, little kicking and screaming, and saying, Oh, not really sure what we are doing. Or maybe this is just one more thing we have to do.

Sarah Hartley:

I think it's a mixed back.At the end of the day,our physicians are human, and it's hard, right? And so you have to speak to where they are at, and that in person, presence, and having those ongoing conversations has really helped taken the program to another level, where we have much more engagement.

Dr. Shah:

and I would say, the other part is that there are going to be people who are excited about it. There are going to be people who are able to see why this is important. And I would grab on to those people. Cultivate your excitement, you know. Bring them formally into the program. You know we have a team of physician advisors who are all very passionate about this. And I think it's something that sets our program apart. But if you find someone who is asking great questions, or sharing great ideas. Cultivate that enthusiasm as much as possible.

Daniel J. Marino:

Oh, yeah. Well, excitement like that, I mean, that's contagious, right? I mean, that's what kind of takes off. 

 If you're just tuning in on I am Daniel Marino, you're listening to value-based care insights. I am here with Dr. Shah and Sarah Hartley. We are talking about ambulatory clinical decision programs, key to navigating through value-based contracts. And Dr. Shah, as you were talking about that. I guess a couple of other thoughts came to mind. As you were thinking about the adaptability here. Did you incorporate this, or have you incorporated this in any type of financial incentive? In other words, if you have been able to achieve better performance on your contracts, have you included this within your incentive distribution model or rewarded physicians for higher adaptability, or something of that nature?

Dr. Shah:

We have included this as a part of our bonus metrics in primary care as well as in our medical group and some of our specialties as well. We understand that this is more work for all of our clinicians, and we want to reward them. 

 We want to make sure we are doing so in a compliant way, though. So that is why our program exists. We are really focused on the I in the clinical documentation integrity, you know, acronym. And so we are not just rewarding people for clicks and for adding diagnosis. We are doing it for adding accurate diagnosis and supporting the documentation. 

Daniel J. Marino:

Well, at the end of the day, I mean, those are the key drivers, because sometimes you can see, this is just like you said, adding more clicks or adding more codes or more diagnoses, or what have you and that have some impact to risk, and the wrap, score and all that stuff, which is, I guess, all good. But the end of the day. That is not going to get you where you want to go. We need to make sure that the risk score is accurate. We need to make sure that the patients that we are seeing and how we are seeing them either with the in the clinic or the referrals is efficient because it affects the cost of care. We also have to make sure that utilization is as efficient as possible. So I agree with you. I think the integrity piece is really key. and I think wrapping that within the incentive program. That is how you really really create some strong momentum. 

Sarah, when you have all started to align this or thought about this with the contracts. have you been able to see that the performance of the contracts, the connection between what the physicians have done, improvement in the documentation, so forth. Have you seen greater performance or alignment with the contracts and with the payers in a way that it's helped. Maybe the discussions you are having with the payers or something in that regard. 

Sarah Hartley:

Yeah, so I think the key one of the keys to being successful in this space is having those relationships with the payers, and we have monthly meetings with each of our payers, and we are seeing improvement. We are seeing our raft score increase. We are seeing a recapture rate increase year over year. you know, we are seeing our annual wellness visits increase. And so there is definitely an improvement as we move forward.

Daniel J. Marino:

Yeah, yeah, I can see that. So what about the challenges? I mean, I imagine this cannot be easy.Right? This is, you know, cannot be easy at all. It'sa paradigm shift, like we talked about. We are introducing new things. Sarah, from your perspective. What has been the biggest challenge that you've had introduced the program and now have worked through the program. over theselast period of time.

Sarah Hartley:

Oh, we are boiling the ocean here, I mean, we are just kind of scratching the surface. and you know primary care is a great place to start. But our specialistsreally have that knowledge to get us to that next level code that is really specific. So how do we get them engaged. We cannot put everything on primary care. How do we please? Every pay or all of the contracts are different. The report is different. We do not even get the same information from each payer. Do we have all of the claims data, right? And sothere'sall of this lag and these nuanceswith our metrics. With the data we receive. We have limitations with the technology. It’s every aspect, I will tell you. We have a challenge. It's with dapping. We firmly believe in trainingfrom the ground up because we are not going to find seasoned ambulatory Cdi staff. And so we bring in people, and we train them from the ground up. And we have been very successful with that as well.

Daniel J. Marino:

Yeah, that's great. How about from your perspective, Dr. Shah whathas been some of the biggest challenges that you have seen?

Dr. Shah:

I think the biggest challenge is that it is very hard to show the value of the work that is done in a way that feels immediate to a provider. It is really easy to say I treated your diabetes, and now your A1c is under better control. That's good for you as a patient, and it's good for me for my quality metrics. 

 When we talk about the reimbursement or the benefit that comes from Hcc. Capture and documentation. There is a huge lag like, Sarah said. It depends on what the contract is, how much it does. It depends on where the patient was seen and how that money gets distributed, and then at the end of the day it does not necessarily come back to an individual physician, so I think it is hard to convey to a provider. 

 Please trust me, this will have a benefit for us in the long run. and we have been lucky that we have a lot of folks who just kind of take us at our word, and we have to prove to them now that all of this effort is worth it 

Daniel J. Marino:

Yeah. Connecting the dots I think is always the hardest, especially in value-based care. When you are thinking about what your performance looks like. A lot of times you do not see that financial reward until after that performance here, and in most cases it is even 4 or 5 months after that because you are still going through all of the reconciliation. So you know, and in a lot of cases we are asking physicians to trust the process to get us to where we need to go. 

How has physician leadership come into play? You have mentioned that You had rolled this out to a number of physicians, and Sara had mentioned primary care and kind of rolling this out to the specialists. 

 Have you relied on more of the rank of file physicians within your network to drive this? Or have you really focused on creating? maybe working this through the leadership of your network. 

Dr. Shah:

I think we have really gone at it from both ways. You know, leadership engagement is so important for sure. And so we want to make sure that across the board that our leadership understands why this is important. But a leader alone is not going to get us where we need to be to support individuals. We need to support folks who are in the trenches and doing this every day. And so, while it is important to rally the troops when it comes to leadership and make sure that they can spread the messagesupporting and kind of cultivating. success really comes from our physicians who are doing this on a day to day basis. 

Daniel J. Marino:

Yeah, absolutely. Well, I can only imagine, this is a (inaudible) in terms of how we are dealing this thinking about changing the care model, as well as enhancing the documentation and being able to modify that culture, you have to relyon your leaders. But you also have to rely on good performance outcomes. Right? You have to measure your success as you go along. Sarah, have you? You know I would assume you have come up with some pretty good reporting, or at least some data, at least some information as a feedback tool, right that you can provide to your physician, your leadership?

Sarah Hartley:

Yeah, yeah, we do. We have very manual reporting at this point.

Daniel J. Marino:

the annual reporting. My goodness.

Sarah Hartley:

Yeah, yeah, I mean, we are. This I'm telling you in the industry. And we were just yet, we are not alone in this space. So, but using industry best practices like Http recapturing or query response rate is showing our providers that they are doing the right thing. We do measure wrap internally our risk adjustment factors for. And really, that is just directionally, because as you said earlier at the end, you know that 18 months ago, Today we are getting our raft score from 18 months ago. So you know, you cannot really see that. But it is directionally showing up.

Daniel J. Marino:

Yeah, yeah, I can see that. And you know I was kind of joking when you were saying Manual. You recaptureate the awv percentage. All of that, I think, becomes really key.  

But I think the system still are quite antique, right? As you start to really look at how, what the physicians are documenting, and is it accurate? Right?

Sarah Hartley:

And the population that you are measuring is very important.It is a subset of your overall. You know patient population that is just in these value-based care contracts. So you have to be very careful.

Daniel J. Marino:

Well, ladies, this has been great, I tell you, and I give you a lot of credit for embarking on this in a way that it sounds like you have built some good collaboration. And you know, understanding that it is a journey. And it is not going to happen quick. But it is something that is extremely important. 

Doc Shah, for any of our listeners, and I'm sure there's quite a few that are really giving consideration to putting an ambulatory clinical decision, improving the program in place. What advice would you give them? 

Dr. Shah:

So there is a quote from Wayne Gretzky that often gets thrown around when we talk about value-based care. You probably said it on this program before, but you have to get to where the Puck is going. You are not going to be successful if you skate to where it's been. And so I think you have to start talking about Hcc. Capture and documentation as part of your population health strategy.As soon as you identify the need to have a population health strategy, I think it's also really important to cultivate expertise amongst the folks who are going to be talking about this. I think on the surface of it. Hccs can seemreally easy, and it's really easy to understand. I capture this condition, and I put down some documentation, and I'm good to go but once you really delve into it, there is a lot of nuance, and, as we know, increasing scrutiny as well, and so you donot want to be in a position where you havenot enough depth of expertise to back up the work that you are doing.

Daniel J. Marino:

And I that is so critical and helping physicians particular understand why this is important and what the value is.Sarah how about from you? Any thoughts? Any piece of advice you can give to our listeners?

Sarah Hartley:

Do not be afraid to take a chance, you know a pilot is where you begin, and that is how you know,You just gotta get your couple of physicians to buy in and work with them and the pilot is the way to go. But have no fear.

Daniel J. Marino:

Yep, got to start somewhere. Right? Because I've said time and time again small and impactful. So you are right. Well, this has been fantastic. If any of our listeners are interested in, maybe reaching out to you.Have a few questions. Sarah, any thoughts on how they can get a hold of you?

Sarah Hartley:

Yeah, you can reach out to me. I am on Linkedin. So, Sarah Hartley,search for me, and I am out there. Please feel free to send me a message. Happy to chat.

Daniel J. Marino:

Good Doctor Shah. 

Dr. Shah:

Same thing. I'm on Linkedin. Purv Shah. Happy to connect with anyone out there. 

Daniel J. Marino:

Good! Well, thanks, guys, I really appreciate it. Good luck to you as you embark on this. I would love to have you back, and maybe another, you know, 6 months or so to see how your how you're doing, and I'm sure you're going to have quite a bit of success. So thank you for joining the program today.

Sarah Hartley:

Thanks for having me.

Daniel J. Marino:

and for our listeners. I want to thank you all for listening in until our next insight. I am Daniel Marino, bringing you 30 min of value to your day, Take care.

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners

Many issues are impacting today’s clinical service lines, especially cardiovascular services. Health systems, hospitals, and physician groups are focusing on growing their cardiovascular service lines to address shifts in site-of-service, improve patient access, and position themselves for enhanced financial performance under value-based contracts. 

In this episode of Value-Based Care Insights, Daniel J. Marino talks with Dr. Hani Salti, a clinical cardiologist and Clinical Assistant Professor at a large academic-based health system.  Dr. Salti shares his insights on the growth of cardiovascular service lines, the need to develop strong physician leadership, and the growing impact of cardiovascular services on population health.  

KEY TAKEAWAYS: 

• The cardiovascular service line drives tremendous clinical value by creating a comprehensive longitudinal care model that includes general cardiology, invasive, and non-invasive services.
• New financial models will align incentives and modify behaviors of cardiovascular physicians, providers, and payers.
• Value-based performance will have a sizable impact on cardiovascular services creating financial opportunities.

LISTEN TO THE EPISODE:

 

 Transcript:

Daniel J. Marino: 

Welcome to Value-Based Care Insights. I'm your host, Daniel Marino. In today's episode, we're going to spend some time talking about cardiovascular service lines. As I've mentioned in previous episodes, hospitals have focused a lot of attention, on expanding their capabilities in different service lines. 

Some hospitals and health systems and even some physician groups have spent a lot of time expanding primary care, service line, orthopedic service line. But cardiovascular service line is interesting in the fact that it touches a lot of different subspecialties and incorporates a lot of different areas of needs within the patient populations, if you will. 

And there's been a couple of real drivers for that. I think one is that as our population starts to age, cardiovascular services is an important element that patients are looking for to continue to, allow for a healthy lifestyle. What we're also starting to see is that, as we start to advance into population health and we track our outcomes and we look at social determinant factors, cardiovascular care is a natural progression that patients are looking to really begin to manage around. 

Payers are looking for it in terms of being able to track a lot of our outcomes, and it does provide a pretty strong economic opportunity. Four hospitals, four health systems, and frankly, for physician groups. Well, to continue the discussion today, I am really pleased. To have a great guest joining me today, Dr. Hani Salti, he is a physician with a very prominent cardiovascular group, has worked in obviously cardiovascular services in in all of his career, but he brings a very interesting perspective to our conversation today. Not only is he involved. In the growth and the direction of cardiovascular services of his group. 

But he's also very involved in a lot of the population health and value-based components related to cardiovascular care as well. Dr. Salti, welcome to the program.  

Dr. Salti:

Thank you for having me. Please to be here. 

Daniel J. Marino:

So, Dr. Salti, when you think about where cardiology, where cardiovascular care has gone, boy, it's madetremendousamount of leaps over the years. Reflecting back, what do you see are some of the biggest changes that has affected you, your colleagues? I guess the specialty in total.

Dr. Salti:

There have been a lot of changes over the years and it, this is an ever-changing, service line and product. 

And I look back to even my medical school and my early training years. I was in Michigan Medical School in University of Michigan and, Northwestern for training. And if you think about those times, these were hubs, tertiary care hubs where patients would come to from all over the state and sometimes from all over the country to see a particular specialist, whether it's in cardiovascular care or any other specialty. 

And they come, they get their service there. They may stay for a period of time, even in the local geography, and then they go back to their locales. And over the years, some of the earliest changes is where institutions are bringing the care more to where patients are and so the geography has become different in terms of where the care is offered what the patients have to do to access that care. 

And that's just to begin with.

Daniel J. Marino:

right. I agree with you. You know, I've had the opportunity early in my career, I've worked with a pretty large integrated cardiovascular group and it's always been a specialty that's been near and dear to my heart. I provided a lot of practice administration for the group, and you are right, we set ourselves up for a destination center. 

And now it seems like. Through a lot of the advancements of technologies, through a lot of the advancements of therapies and so forth, care has become a lot more localized. But what I'm also seeing, and I would be interested in hearing your thoughts on this, it used to be that cardiovascular services, the interventional side was very transactional based, right? 

So a patient became a candidate for surgery, we immediately put them in surgery, and then they transitioned out. Now within cardio with cardiovascular care, it's very integrated, it's managed, it's focused, so as a patient becomes a candidate for cardiovascular care. They're monitored. There's a lot of therapies. 

The interventional side almost becomes, I don't want to say a last resort, but it's certainly not the first resort of treatment as we begin to think about that. And, and so it's really expanded the whole dynamics of what cardiovascular services really is. How has your group really responded to that? 

Dr. Salti:

It’s absolutely a reality and a challenge that every group has to deal with and it's actually every group has to embrace and this actually speaks to the comprehensive care of the patient. The patient does not come and see you just to get a procedure and to go through the procedure well. The patient wants to be healthy, to have good outcomes to live life the way, the way they desire. And so this is not simply taking care of them, it is not simply about performing a procedure and having a good outcome of the procedure.  

So even our outcomes are not measured based on procedure complication rates or success or failure, our outcomes based on how are patients doing overall. Are they even satisfied with the care just in terms of patient satisfaction and so it's a com and then the services we have to offer them are not have to be comprehensive. They cannot be a successful service line, you need to be able to offer the patient the full scope of what needs to be offered to them in various situations, whether it's procedures, including surgeries, whether it's cardiac, rehab, preventative care, devices for electrophysiology colleagues. And so you have to take them and be able to take them through the entire journey as they seek care from you and you deliver it.

Daniel J. Marino:

That is such an important point, and I would even go so far as to say that is a really a primary critical success factor of building a successful cardiovascular service line. You need to have all of the subspecialties integrated, right? So, they're working together and managing the patient where they are as the patient's risk, condition and complexity needs change. 

And, you know, when you think about it from a value-based care population health perspective. You're measuring really the outcomes over that of that patient over time. But if you do this well and you have clinical pathways and protocols that you're able to measure, you will significantly impact the overall cost of care, and at the same time provide an incredible experience to the patient.

Dr. Salti:

That's very true. And for somebody delivering the care you need to understand the patient as they come to you. What is their risk? What are their comorbidities? What other diseases interact with each other? So, population health, tremendously valuable. To be able to understand it, utilize it in, in all your decisions, so that you understand the person the patient as they come to you in their entirety. 

And of course, that's tied to outcomes, payments, reimbursement, which in turn feeds back to your, to your experience as a provider delivering that care. Yeah I absolutely agree. You know, one of the challenges that I often see as I work with A number of different service lines not just cardiovascular services, but access is an issue. 

Access is an issue all over healthcare, whether it's primary care, it's, you know, cardiology, cardiovascular services, whether it's orthopedics, it seems like, you know, there continues to, to not be enough physicians, not enough providers, and yet the needs are certainly there in delivering that care to the patients. 

How your group responded to some of the access changes and really the needs of the patients? One response is what I was touching upon earlier, which is you have to expand your geography. You have to meet patients where they're at geographically. You, you should not expect them anymore to come to you. 

And this is not just in cardiology, I mean patients. Patients press a button and expect a car to come pick them up, right? Or, or press a button and expect the food to come to them. And it should be no different in healthcare. They, they want the healthcare to be where they're at and to meet them where they're at. 

And so, to make yourself available where the patients are available is very important and then you have to make, you have to understand your referral patterns. Some of them are their traditional, you mee the primary care doctors. You have to build relationships with them or other specialties. 

But also sometimes, we we're seeing more and more self-referrals, right? Study the various entities that are supplying care in their area. And they're choosy. They may choose a primary care doctor in one institution and see a specialist in another institution simply because of either reputation or what they offer or where they're at. 

Daniel J. Marino:

Right. Or convenience for that matter.

Dr. Salti:

Convenience. And you have to remember, a lot of patients are not even seeing the traditionalprimary care.They’re getting their services in alternate locales, whether it's at the pharmacy even. So how they come to you is different and you need to meet them where they're at. You should not expect them to adapt to what you want, how you want them to behave. You need to, you know, be available for them.

Daniel J. Marino:

That is such an interesting point. You know, an important point too, the paradigm shift I think is we are, we all are, are going through right now to provide more convenience based healthcare services is something that is, is critical and patients are asking for that, you know, and, and some of the subspecialties, I think we tend to focus more on that traditional way of delivering care where we want the patient to actually make the appointment and come to see the physician. 

But you are spot on. You need to have a lot of different types of opportunities to connect with the patient, whether it's through telehealth or it's through other types of conversations, or be open to the fact that, you know, patients may be self-referring and, and so that relationship with the patient versus the relationship with their PCP.  

Frankly, maybe a little bit different  

If you're just tuning in. I'm Daniel Marino and you're listening to Value-Based Care Insights. I am here talking to Dr. Hani Salti. We're discussing the advancement of cardiovascular service lines and Dr. Salti's perspective on what makes for a successful service line. 

Great discussion. Dr. Salti, as I think about the value-based care component of this an area that I think is always a little bit of a challenge is as we start to think about really aligning the patient with their primary care. Many patients that are within cardiovascular services see their cardiologist as their primary care physician. Right. And cardiologists are internal medicine trained and many of them do a fantastic job of providing primary care services. How do you manage that within your group? Do you assume some of that primary care responsibilities for the patient helping you to kind of manage the total complexity and needs of that patient? Or is your preference to send them back to the primary care physician and maybe have that collaborative working relationship with the pcp? 

Dr. Salti:

I think as a group, our preference is to have a collaborative relationship. Having said that, we have seen all the whole breadth of how patients perceive cardiology.

Daniel J. Marino:

Yeah, I can imagine. Sure. 

Dr. Salti:

Yeah. And, and some of our maybe older cardiologists who have been in practice decades and still may function like that in certain situations. But then generally, and I think that's true for most is we try to encourage them to have a relationship with to keep the relationship with their primary care doctors. 

And if they don't have it because they saw you primarily without a referral, we definitely encourage them to establish the relationship with the primary care doctor. 

Daniel J. Marino:

Yeah. And I do think that'sprobably the preferred approach, right. You know, to really create that alignment and, and from a value-based contracting standpoint, you know we're constantly looking at who the patient is attributed to and really putting together a very collaborative, very comprehensiveapproach to managing that care, not just for cardiovascular services, but if the patient has say, you know, a GI issue or orthopedic issue or whatever the case may be, it's, it's coordinated through the primary care.So that makes a lot of sense. 

Dr. Salti:

Yeah, absolutely. And, and, you know, population health is not an individual effort. You can expect Exactly A particular specialist to capture the entire popul risk of your patient and let alone the whole population. So, it is a team collaborative effort with multiple, of course, primary care, but all the specialists have to participate in capturing their respective, you know, conditions of the patients and documenting on it. 

And so, it has to be a collaborative effort for it to be successful.

Daniel J. Marino:

Yeah, great point, great point. I absolutely agree. You know, when you, when you look at cardiovascular care over the last couple of years we're seeing a lot of pressures to shift a lot of the care that's being delivered. Mostly the interventionalists or procedural type care. 

You know, a couple years ago, a vast majority of it was done in the hospital, on an acute basis. More and more now is being shifted to the ambulatory setting or the outpatient setting. How has your group dealt with that? How have you managed that transitions that that undoubtedly have occurred?

Dr. Salti:

So, it's a challenge. It's a and again, challenges have to be embraced. Absolutely. But it's, it's a challenge and so it's about number one access. So again, you have to shift some of the services to ambulator, which enhances access to the patient, but also you need to be able to deliver the same quality of care in all these settings that you're, that you're at. 

So, and that's true. Not just on the provider side, but even. A patient may come and have an, have an echocardiogram performed in an offsite versus in the hospital, the quality of that echocardiogram needs to be the same, right? And, so you need to train your sonographers, you need to train the, the support staff to, to be able to deliver the same quality and the same experience with the patient wherever they meet you.  

Right. And that is a challenge. You know, we talk about practice variability among providers and physicians, but there could be practice variability in how even our support staff is able to support that care.  

Daniel J. Marino:

Oh, absolutely. And I think that level of training, at least initially, is different, right? 

I mean, there is some training that has to occur more on the outpatient arena. And just making sure that the investments in the equipment are there and you know, just the overall focus and attention is really given to the ambulatory arena. I think it's easier to accommodate that in the hospital because it's more just the philosophy, the mentality is

Dr. Salti:

Yes. And, and even administrative staff are present. Yeah, mostly in the hospitals. They see what's happening. They can see what's on the ground, what's needed, but to have a fully functioning Offsitethat's able to deliver the same quality and you know that that site needs to be function independently and  

Daniel J. Marino:

No, I agree with you. So, if you, you know, given where your group has gone and some of the, the upcoming challenges or changes that are undoubtedly occur, we talked about many of them here today. 

You know, the, um, Let's say the impacts of population health and value-based care shifts in the site of care from acute to ambulatory. Um, you know, managing, working with the different providers and managing the care more, you know, collaboratively. So forth. Where do you see the big growth opportunities occurring for cardiovascular services as you sort of, you know, look at your crystal ball and think about where things might go in the next couple of years?

Dr. Salti:

So, first of all, the opportunities are always there. The patients are living longer.  the cardiovascular disease still remains, you know, the number one prevalence. And so the population, the opportunity for growth is there. You need to be able to meet it with access, comprehensive care, quality care. 

The scope of care that you deliver and you need to be able to build all those elements that can support, your care. Whether it’s, the interventional side, the structural side, the heart failure side, the EP side, preventative, weight management, cardiac rehab. And so the growth will be there as you support those services, but you need to be able to invest, in those services and ensure that you deliver that you have access. The patients have access to them and you deliver it with good quality.

Daniel J. Marino:

Yeah. And all those elements tied together, like you said, taking advantage of. Where the, you know, the environment is going and the reimbursement elements and so forth. You know, as you're thinking, as you were kind of describing that we've had an opportunity to work with a number of different service lines at cardiovascular service lines, has been one that we've worked with quite a bit, and we've done a lot of strategic development, a lot of areas where we've developed strategic plans and so forth. 

And you really do have to think about cardiovascular services and the service line as its own separate business, right? Where are we going to grow? How are we going to be able to take the care out to the community? And even how we're going to market ourselves, right? Creating ourselves, branding ourselves around high performing cardiovascular services. That recognition and connection with the patient becomes really powerful. And as you kind of think through all the elements that you just talked about, building that into a strategy that really allows you to gain a lot of momentum and really see a lot of opportunity for growth.

Dr. Salti:

And once you acquire a patient and allow them access into your system, there's a big trickledown effect into multiple divisions within your organization. Be, you know, a cardiac patient will touch multiple, aspects of your division, whether it's radiology. Cardiovascular surgery and vascular are of course almost automatic, but renal, endocrine and diabetes,  support, whether it's oncology and hematology and coagulation issues, vascular medicine, pulmonary and critical care. 

So, you are supporting the services then offered by all these other specialties and so a successful cardiology service line is, In instrumental in the success of an entire organization.

Daniel J. Marino:

Yeah. Boy, that is an absolute great point. So, any of our listeners today, you know, that are tuning in, that are interested in expanding their cardiovascular service line maybe kind of reaching out and connecting with some of their community providers.Is there a couple piece of advice that you may offer some of our listeners today in terms of where they are and maybe where they need to go?

Dr. Salti:

You know, I think it boils down to the basic access quality, scope of care delivered, be able to be, be available, do-good work, and be able to, to provide what the patient needs. 

And once you work with these three elements, You can scale them up to your capability and time allow, but that's where, yeah, any, anybody can start.

Daniel J. Marino:

Well, I agree with you and the, you know, one of the things that's always fascinated me about cardiovascular services is, you know, it touches so many different areas of the healthcare continuum, right? Not just in terms of what happens in the hospital and the ambulatory, but certainly expanding to post-acute and care in the home, which there's a lot of focus on, but it also integrates a lot of the providers and the providers’ support. So, I think reflecting back on those three elements, access, quality, the scope of care. 

For an organization that really focuses a lot of attention on this, there is a, there, there's a tremendous opportunity for you to expand the amount of services, expand your breadth of reach to the community, as well as then be able to contract around it. 

Dr. Salti:

Correct? Correct. And, and, and you'll be able to lift up other aspects of your, of the organization you're working with as you do it successfully. 

Yeah, absolutely. Well, Dr. Salti, I want to thank you for coming on the program today. You know, it's been a great discussion as I mentioned, cardiovascular services. I'm doing a lot of work in this area right now. It's always an area that has been near and dear to my heart, and sounds like you've done fantastic in your group. 

So I'm very excited for your direction and I'm particularly excited about how you're taking a population health. Value-based care approach to it because again, as you know, on value-based care insights, that's an important element that we try to share with the group. So, I commend you for, for really thinking through that a lot. You're doing a nice job.

Thank you very much. Pleasure to be here. And yes those are all things we cannot forget about and more to come. This is the beginning of our journey. Not the end yet.  

Daniel J. Marino:

Yeah, absolutely. Well, for our listeners today, I want to thank everyone for tuning in. Great discussion on cardiovascular services. And as Dr. Salti mentioned, you know, it really comes down to thinking through what the strategy is. Thinking through what the approach is, dealing with access, dealing with your collaboration with your physicians, so on and so forth. I want to thank all of our listeners again for tuning in until the next insight. 

I am Daniel Marino, bringing you 30 minutes of value to your day. Take care.

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners

As more and more provider organizations engage in risk-based contracts, including Medicare Advantage, understanding  quality and performance along with clinical workflow integration  is critical to contract success. On our third episode of our three-part series focusing on risk-based contract and performance, we invited two special guests from qrcAnalytics to join the show and dive deeper into Risk Adjustment Factor (RAF) scores and the impact of Hierarchical condition category codes (HCCs).  

Tune into the latest episode of Value-Based Care Insights, as our host Daniel J. Marino speaks with Gene Rondenet and Paula Gallagher on how data and information critical to proactively build a prospective risk model is key to to manage the potential risks of health care cost increases and prepare the organization for the future. 

KEY TAKEAWAYS: 

• A prospective model provides the organization with a forward look into actionable data to affect change in the organization for better care outcomes.
• All key stakeholders, including providers, must be aligned to attain the goals of better care, lower cost, and improved care outcomes.
• Provider organizations must prepare for new, evolving payment models and learn how to navigate the intersection of quality, risk, and cost.

LISTEN TO THE EPISODE:

 

 Transcript:

Daniel J. Marino: 

Welcome to Value-Based Care Insights. I'm your host, Daniel Marino. We are very excited about today's episode. If you've been listening to the last couple episodes this is a third part series where we've dove into discussions around risk-based contracting. The first episode was a replay that we did with my colleague, Cliff Frank. It was initially recorded last October, and we spent some time talking about the foundation of risk-based contracting. Episode two is where we brought Cliff back. And due to the fact that there's been a lot of changes with regards to risk contracting, particularly in the MA space CMS made some new announcements. Cliff and I spent a little bit of time talking about what some of those changes are and how providers need to reposition themselves for success within risk. And a big element coming out of that conversation was the need to really create sound models, really moving from retrospective to prospective models and understanding data, the performance outcomes, all of those things that are going to drive change for providers in the clinical setting.

Well, in today's episode, we're going to dive into what that data means, what the models really should look like, moving to a prospective risk model. At the end of our conversation today, I have a really exciting announcement to share with everybody that I am really looking forward to, to making some real changes and, and support with a lot of providers within the industry. So, with that being said I have great guests today. qrcAnalytics is an analytics firm. We at Lumina have done quite a bit of work with them over the years. They have lot of expertise in in extracting a lot of clinical data, claims data helping organizations prepare for risk monitoring, the performance of risk-based contract. Here today to talk with me is Gene Rondenet. Gene is the founder and president of qrcAnalytics and his partner in crime, Paula Gallagher, vice President of Sales and marketing. Paula and Gene, welcome to the program.

Paula Gallagher:

Thank you. Hey. Hi, Dan. We're excited to be on.

Daniel J. Marino:

Paula, let's start with you. You know as we've talked about, risk-based contracting has really changed. A lot of providers have started to really build their capabilities on understanding RAF scores, understanding quality, understanding HCCs, understanding where they need to, what their information needs to look like as they're optimizing some of these contracts. What are some of the things that you've seen as real challenges to providers to ensure their success as they've engaged in these risk-based contracts?

Paula Gallagher:

From my perspective, going into an organization, I'm kind of an early adopter into the organization when they're getting ready to move to more downside risk. And one of the challenges I have as I am prepping an organization to get ready to work with qrcAnalytics is letting the organization understand the data that is needed to take a full holistic look at the organization. We need administration buy-in, we need physician buy-in, we need revenue cycle buy-in, we need h i t buy-in. And working with organizations so that they understand this holistic view of data and how to apply it to the rest. Right.

Daniel J. Marino:

And really plotting that course, right. So exactly. If they're at risk, you know, and again, there's upside risk and there's downside risk. Nobody wants to payback a check. Everybody you're focusing on performing, you really do have to have that full buy-in. But I also feel like you have to have a clear understanding on what informs what, what the information that's needed. And in order to get the information, you have to have the right level of data. So, you know, Gene, I know you've spent a lot of time, you've worked with large health systems around the country. I'm building these models. In your opinion, are providers capturing the right level of either quality data, performance data, claims data or is it that they don't have it, or maybe they just can't extract it and make sense of it?

Gene Rondenet:

I think the biggest challenge is getting the providers to understand the difference between their clinical workflow and what the financial needs of the organization are as far as revenue. And understanding the connection between the two that the physicians are, you know, they're clinicians, so they're looking at things clinically, but they put things into the visit note that represent what they're doing accurately, but then making sure that there's a connection between what's in the visit note versus what is updated in the problem list, what diagnosis codes get captured, and making sure that those things all tie together and making sure the right level of specificity on the diagnosis codes. And that's becoming more and more important as the newer models are coming out, that the CMS is requiring that necessity. If you don't provide it, you won't get reimbursed. Right.

Daniel J. Marino:

And it needs to be presented in a way, I would think that it has to translate to the clinical workflow, right? So as you're getting this level of information, like I said, it needs to be incorporated into the problem is incorporated into the care plan in incorporate it into the conversation that these physicians are having with patients. So you can really make that change. But Gene, I immediately then go to the concept that we've talked about moving from this concept of retrospective information or modeling to being prospective, right? So understanding what we need to do going forward to drive that change. I think moving to that prospective model, that's a necessity in my mind of the success of these contracts,

Gene Rondenet:

Correct? Yeah. The pro prospective model is much more efficient for within the clinical workflow, and it's much more accurate. Everything just works much better. You know, like we said, it requires the entire organization to be bought into the process. And it's really, really important before you take that downside risk that you use a retrospective model to try to train the organization to what is coming. And so right when you look at the visit notes and you have your auditors look through the notes and say, what was missed? You know, what was documented, but not quite close enough that we can't capture properly and use the opportunity before you're taking that downside risk to kind of get the machine well lubricated and functioning properly. And then when you get to the, so when

Daniel J. Marino:

When organizations make this change from retrospective to prospective again, they're extracting their own data. I sort of think about retrospective and I had a conversation with a vice president managed care just not too long ago, and they were almost a hundred percent relying on the payers to give them this information and really understanding what their performances and then trying to apply it going forward. And I said, well by the time the payers give you this information, it's too late, right? Yeah. You need to have these models, you need to put them in place ahead of time. So you're able to drive some of the change in your opinion Gene, what's some of the data that's required, or what's the data that is required in order to build this prospective risk models?

Gene Rondenet:

Really the single most important one is having the ability to see what HCC diagnosis were previously captured for a particular patient. And if they're not acute, making sure that those get captured on an ongoing basis. You know, they have to be captured every year. And one of the best ways to manage that is using the problem with, and making sure the problem with is accurate as all the HCCs diagnoses that are appropriate, and then using that to drive as new visits come along. And then also using algorithms when a patient comes in to see if there's any clinical indicators that there's a potential HCC diagnosis that hasn't been captured yet. Then you also being more prospective if you will, using AWS as an opportunity to capture HCCs preparing for when a visit is scheduled and this about to happen, and making sure you have enough information to support that. But one of the biggest ones is identifying patients that have not been seen. Right?

A lot of times providers are more passive. A patient shows up, but the organization needs to be more active in looking forward and say, okay, I've got patients who were at risk for and we haven't even seen them. So, A. you're not capturing the diagnoses that you should be getting reimbursed for, and B, you're not managing those conditions. And so that is the big win on a on this kind of a contract. If you're managing the patient properly, you're getting paid for the risk. And so if you manage it properly, you're making money.

Daniel J. Marino:

Absolutely. Absolutely. And, and that's such an important point, but it's really comes down to making sure you're extracting that right level of information. And as you said Gene, it's the HCCs, the diagnosis, the problem list, and so forth. Paula thoughts?

Paula Gallagher:

Yeah. You know, the retro Gene is being awfully modest about that, that first step of making sure that the inform the data is accurate, because it can take our organization a while to verify that the information coming out of a health system is accurate. And when we look at the retrospective, it also gives us a little eye into possible training needs and into possible areas where the organization might be needing additional assistance to get where they need to be before they're taken downside risk. And this isn't an easy process by any stretch.

Daniel J. Marino:

Right.

Paula Gallagher:

And making sure that data is accurate.

Daniel J. Marino:

Well, that kind of brings me to my next point. As I was thinking, you were describing this Gene, there's been a lot of focus on the RAF score, right? I think early on a year and a half ago, folks spent a lot of time thinking about how to create accuracies of the RF score. And again, I think good, bad or indifferent, possibly some providers have maybe overemphasize the support or the calculation of the RF score, but it is an important driver as you are thinking about how to create that true care directed support to patients who need it. Paula, as you think about the RAF score, as you think about providing that right level of support, how do you position it appropriately so the AF score is accurate? So you're actually able to drive a lot of change to the patients within the clinical setting?

Paula Gallagher:

The first thing that we would do with an organization is we try to assess where the organization is, and we take a look more at the HCCs than the RF score. You can't really change a RF scores, you can really affect it by the HCC. So that's really where we really pay attention to. As Gene had mentioned, if they're being properly assigned to diagnosis, how they're working with their HCCs to really be able to affect the organization's overall scoring to make sure that it's compliant and that it's accurate and that they're getting the appropriate reimbursements for the population they're caring for.

Daniel J. Marino:

Yeah, absolutely. If you're just tuning in, I'm Daniel Marino, you're listening to Value-Based Insights. I'm having a great conversation today with Gene Rondenet, Paula Gallagher from qrcAnalytics, and we're talking about the data needs, the modeling requirements that are important on driving a lot of these risk-based contracts. So Paula, just kind of building on what you had just said, the capturing and recapturing of the HCCs is critical, having the data elements both I think in terms of the claims data and the quality data is really important. But at the end of the day, we have to create these level of reports, these insights, if you will, to really drive clinical operational change with the practices, right? Because if it can't translate well to the clinical workflow of the physicians, then I, I think many of these providers are going to be challenged in really performing well in these contracts. Would you agree Gene? thoughts?

Gene Rondenet:

Yeah, I think that what Paula mentioned is a really important point that from a clinical perspective, you know, as a clinician mindset, they don't think about RAF scores. It's just a number. It doesn't mean anything to them, but if you tell them they need to recapture diabetes, that makes perfect sense to them. And so we really try to focus more on the actual recapture of the diagnosis code that is the HCC.

Daniel J. Marino:

Right? Absolutely. So let's focus a little bit on some of these audits and things that are coming down from cms. There's been a lot of discussion lately related to the increase in the amount of audits, increase in amount of, of activity that that's going to occur from CMS and possibly OIG and so forth. How are you working with your clients right now on to support some of these audits to ensure that there's a level of compliance?

Gene Rondenet:

Yeah, we try to make sure that they have an internal audit process that predates any kind of RAV audits or any other kind of repair audits, or things like that so that they understand it where they will land if there is an audit, make sure that the organization is well trained to understand the accuracy of coding based on the clinical record. That’s the essence of what an audit is. It’s basically looking at the claim that was submitted and the diagnosis codes, and then the clinical documentation to support that. And so we have a process where they go through and do those, you know, mock audits, if you will. Even though they check type in our audits, because, you know, at the end of the year, you do have to attest that your claims are accurate. And so going through an auditing encounter is a sampling encounter for providers on a periodic basis. It is a really good idea to figure out who needs to be trained and how to code no code, how to write their notes so the coding is appropriate and making sure that the organization follows those guidelines.

Daniel J. Marino:

Well, and I'll tell you, this is a part that has always been important to me. You know, we've done a lot of revenue cycle work over the years and have helped many organizations with their compliance program. And I know you all have done a great job on building these risk model compliance. I'm looking forward to working with you and on really creating a strong risk model compliance program that kind of incorporates the right level of modeling with, as well as a lot of the policies and procedures and the elements that are going to be critical on supporting providers in the event that they are audited. Because I think it's always scary. And as we've talked about before, Gene, it was as long as they've been able to demonstrate that they have the ability to self-monitor and self-governance selves, that goes a long way towards, ensuring that level of compliance. Paula, let's kind of change the discussion a little bit. As we think about where contracting is going, Medicare advantage, some commercial risk-based contracts as hospitals are starting to consider taking on additional risk. Are there two or three things that are top of mind that are really critical that these providers need to think about or really give strong consideration to as they build the right level of modeling, the right level of data, and the right level of reports?

Paula Gallagher:

Absolutely. And when I talk to organizations that are still primarily fee for service moving to valued based contracting and eventually to downside risk, we encourage, the sooner they assess how they're capturing HCCs, the better. If you're not taking downside risk, it, you don't have the compliance issue and the deletes and the returns, you can still work pretty transparently with organizations to make sure you're doing it correctly and accurately. And then from there you can decide what are the best contracts to participate in based on the maturity of your organization and move along an appropriate path so that you have a sustainable model for caring for patients, and that you can continue to get the appropriate revenue again, to care for your patients because you're going to care for them regardless. Right?

Daniel J. Marino:

Right. And these contracts build on one another. As we've negotiated managed care contracts for many, many years, and the fee for service side and the fee for value side, I often say as you're negotiating the first this contract, right, you have to think about the next contract, even though you're not negotiating for it. But how is this contract going to impact the future contract? And typically, when you're managing this fee for value contracts and taking risk, you're only going to be asked to assume more risk. Yep. And, you know, Gene, I guess I'll throw this back to you. As we're thinking about the data, and as we're thinking about where these risk-based contracts are going, from your perspective, what do the payers really have to consider as they're negotiating these contracts that are critical elements on driving this success?

Gene Rondenet:

Well, one of the things the payers would like to get is more clinical information, but that's generally problematic. And that's why it's nice to have an organization that sits between the payer and the provider organization that can have access to the clinical data to run out. Yeah. So that there isn't the privacy issues and we can actually dig a lot deeper than the payer. But then getting the payer to give you the provider organization access to data that they have that you don't have is critically important and the time to do that. And when you're negotiating the contract, one of the things we love to see is if we can get the payer to say, these are the HCCs that we see that you have captured, so that we understand to make sure that everything's in alignment. That, you know, we thought an HTC was submitted, then they didn't recognize it, and we need to know why. And so it's very important to kind of close that loop, and they're generally a little reluctant to do that. And so it's been somewhat challenging, and that's the best time to do that is during contract negotiation.

Daniel J. Marino:

Well, some time ago, it reminds me Gene, of that comment that you just mentioned. I was part of a panel that we were working through manage care contracting, and one of the facilitators asked a question to me and said, when you're talking about collaboration and sharing of information with a payer, what are some of the key things that are important? And as I sat back and thought about it, in my mind it came down to three things. One, the provider has to have good sense of their data, right? They have to have a strong model, they have to believe in their data, and in some cases, the information, in most cases, the information that they get really has to be better than what the payer gives them.

And they should be able to get that because they have access to the clinical data. Correct. Second to that is you're going to get data from the payer. We have to use that data as we get from the payer as a tool to develop our under understanding and drive change, not really as a defense mechanism. And a lot of times, providers will jump to being defensive because oftentimes the information we get from the payers is sort of less in terms of the financial implications than what we as providers think we have. And then third to that, as you're thinking about either the financial reconciliation or the performance going forward, you need to take both the data that you're getting from the payers and your own model and really evolve that for future change, both in terms of the contract that's going to be important going forward, but also in your clinical setting. So really understanding the model, the payer data, operationalizing that, those are really the three key things that I found that have been absolutely critical to performance.

Gene Rondenet:

Agreed. Yeah, just following the entire life cycle of the data provider organizations collect it, they send it to the payers. The payers either deny or pay a claim or set the reimbursement. Then figure out why they set the level at what they set it at and making sure you're all in agreement.

Daniel J. Marino:

Absolutely. And I think if they do that, that's what's really going to allow providers to be successful on these risk-based contract plus allow them to again, mitigate some of their risks going forward. Well, at this time in the show, I'm really excited guys to make this announcement. I know Paula, Gene, this is something that, you know, we've been talking about for quite some time. We've been working alongside each other for quite some time. So to our audience, I'm really pleased to announce that Lumina Health Partners and qrcAnalytics are coming together as a program collaboration. The title of the program is going to be qrcIlluminate. It's an integrated program of data analytics, risk-based modeling combined with clinical and operational change, with the goal of driving true performance improvement and optimization, true success from a lot of these managed care contracts that providers are undertaking. I personally am really excited for this. You know, in Lumina we've done a lot of contract negotiations and have done a lot of clinical redesign. We've not had access to a data partner. Working with qrcAnalytics has been fantastic. And you know, Paula and Gene, I know you've sort of struggled with some of the operational things as well. So any thoughts that you can share? Paula,

Paula Gallagher:

We are super excited about this. I've been wanting to do this for a long time because I was very excited to be able to bring an organization data that they can use to drive change and operationalize, particularly the contracts. It's a tricky lift, and I think it ultimately having better outcomes and better care is of course, that is our goal for anybody working in healthcare for the most part. And I think this will be a really great partnership to be able to deliver on that.

Daniel J. Marino:

Well, and I think the exciting thing is that we're going to be taking a lot of the expertise and the knowledge that we have in, in value-based contracting and really pulling together a strong data engine around that, right? That's coming up. Yeah. You've been doing that for years, but now to really begin to operationalize some of those key elements, not only are going to help organizations really succeed and optimize their contracts, but it's going to help them to kind of think about what's it that they need to do next to ensure that they're going to achieve that success going forward. Gene, any thoughts?

Gene Rondenet:

No, we're very excited to do it too. And just to be able to take kind of our nerdiness and, and mix it with work with organizations is going to be very powerful.

Daniel J. Marino:

Yeah, I agree. I agree. Well, to our listeners, if you're interested in learning a little bit more about qrcAnalytics, their website is qrc-analytics.com. And of course, our website is luminahp.com. Stay tuned for even more information about what our combined integrated program is going to look like. And again, it's called qrcIlluminate. Really excited about this. And of course, if any of our listeners are interested in talking more about it, learning a little bit more, understanding what the value would be, feel free to contact me directly or Gene or Paula as well. Paula, I don't know, maybe if you want to give your email address, it might help some of our listeners.

Paula Gallagher:

Sure. It's Paula.Gallagher@qrc-analytics.com, if anybody has any

Daniel J. Marino:

Sure to our listeners, you're going to be hearing a lot more about this. You know, Gene, I think certainly given your expertise, you're a wealth of information. I think as we start to continue to work together, continue to support providers you know, I certainly want to continue our discussion and even talk about some of these other top of mind issues that will come out related to risk-based contracting.

Gene Rondenet:

Yes.

Daniel J. Marino:

So let me start again. I'm going to build off of that. Gene, I don't know if you have any final comments you want to put in. I was kind of tossing over to you.

Gene Rondenet:

Not really. Paula usually comes up at that <laugh>. Okay.

Daniel J. Marino:

All right. So I'm going to do a signing off then.

Paula Gallagher:

Yeah.

Daniel J. Marino:

To our listeners, I want to thank everybody for listening in today. Again, these three episodes, I think were just great conversations. I would encourage folks to go back and listen to them. And again, if anybody has specific questions on qrcLuminate, happy to answer them. Until the next insight, I am Daniel Marino, bringing you 30 minutes of value to your day. Thanks and take care.

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners

For the second part of our three-part series, we invited Cliff Frank back to discuss the changes among risk-based contracts. Daniel and Cliff explore the pushback with RAF scores, new CMS announcements with potential health equity indicators, and much more.

Listen now to our latest episode of Value-Based Care Insights, as our host Daniel J. Marino and guest, Cliff Frank, dive further into value-based contracts and what has changed over the last few months.

KEY TAKEAWAYS: 

• New regulations are making it harder to risk-adjust certain conditions, particularly diabetes. 
• The old structure of medical management - where there were a large number of primary care providers referring to a few specialists - doesn’t work well anymore.
• To be successful in value-based contracts, providers must dive into their data and create a model that gives them a better idea of what their performance is.

LISTEN TO THE EPISODE:

 

 Transcript:

Daniel J. Marino: 

Welcome to Value-Based Care Insights. I'm your host, Daniel Marino. This is the second of three episodes where we are talking about risk-based contracting. As we all know, risk is becoming even larger part of a lot of our contracts, especially as we move from fee for service to fee for value. Risk-based contracts, especially in the Medicare Advantage world, is really gaining steam. We talked about that on the last episode, and I felt it was important to rerun the episode that we did last October, where we invited my colleague, Cliff Frank, to come in and talk about the basics of risk-based contracts. Well, I have Cliff with us again today, and we're going to spend a little time talking about what has changed.

And I'll tell you in the contracting world, even though that episode ran last October, it seems like an eternity between now and then, given how much has changed in the risk-based contracting world with the information that has come down from CMS and so forth. For instance, there's been a lot of pushback on the raft scores, on the risk modeling. There was some new announcements that had occurred around the potential health equity indicators that will be part of Medicare Advantage down the road, all of which are really impacting providers and not only our ability to manage according to these contracts or be successful and optimize, , our revenue within the contract, but in particular, what we need our physicians, our providers to do, to move from a retrospective point of care to more of a prospective care model. So, to help us kind of talk through this today, Cliff, welcome to the program.

Cliff Frank:

Thanks, Dan. Happy to be here.

Daniel J. Marino:

So, Cliff, help us make sense of this. What are you seeing in terms of some of these changes? There's been a lot going on just in the last month, month and a half or so.

Cliff Frank:

Well, CMS has been taking a lot of heat from congress and from industry observers that they kind of gave away the store for the last 10 years. So on risk a, on basically uncapped risk adjustment. Now they signaled with some of the ACO products, a willingness to change that in they capped the risk score gain. You could get in a, in M S S P ACOs at 3% over multiple years, whereas it's uncapped in Medicare Advantage until 2024, right? With the new regs, they're signaling that that game is going to end in several ways. First, they're making it harder to actually get risk adjustment. A lot of di they went from ICD nine to I ICD 10 or 10 to 11, I forget which. But anyway, they killed a lot of diagnoses that adjust. There were like 2000 diagnoses, particularly in diabetes. Those are gone. They don't get you more risk points. Then the second thing they did was they said, oh, we're going to really start auditing a lot more closely. And it's not the risk scores have to come in through claims, not through some magical home visit that the plan has orchestrated. So they're really kind of making all that much more difficult, right. At the same time, CMS has signaled a rapidly growing interest in measuring and enticing health plans to tackle health equity. And so as if you kind of think of it as a kind of a teeter-totter, as the health equity side goes up, the risk score side goes down in terms of dollars. So the dollars will still be there, but they'll be there for different reasons, right?

Daniel J. Marino:

So there's really two key things that I've seen. I think it's thinking about how we're positioning ourselves for risk within risk, managing risk, identifying risk within the contracts. That's a big one. And then the health equity piece and where that comes into play. Let's start with the risk piece, because I have a few questions here that I'm kind of working through in my mind. I'm kind of thinking that there's two pieces to this, right? We spent a lot of time as providers talking about the fact that we need to capture HCCs and that HCCs are supporting the RF scores and the raft scores give us a better idea on the, the sickness, if you will, of our population, of which then dollars are tied to that, and a lot of providers who spent a lot of time educating their physicians and monitoring it and almost going back and recalculating that, was that in particular, was it wrong? I mean, did we overstate it? Oh, not at all. Too much focus on this.

Cliff Frank:

That's all good stuff for lots of different reasons. , the first is that, , providers like to compare themselves against each other.

Daniel J. Marino:

You're right,

Cliff Frank:

Yes. And, and so if my per member per month spend is 20% higher than you, of course the first thing I'm, you know, I'm gonna whine about it. Well, my patients are sicker.

Daniel J. Marino:

Yeah. My population's sicker.

Cliff Frank:

Right? So, so the raft scores actually level that, that debate, which then moves us to the next level, which is, well, what are you doing that I'm not doing? What are you not doing that I'm doing? Let's have a conversation about clinical pat use utilization patterns. So you can't have that without some sort of severity adjustment, risk adjustment, population standardization. So regardless of what else happens inside c m s in the deal between the payer and the provider, it's really useful information. Then further to have some indicator as to what's changing in your, in a particular patient, the risk score just jped 30%. Well, there's an indicator for some case management intervention, some care support, some further love and attention from the doctor. , it could be, you know, referral to a specialist, could be any number of things, but it's an early indica, it can be an early indicator of a problem that's common, hard and fast at the member and at, at the, at the provider network,

Daniel J. Marino:

Right?

Cliff Frank:

So, all those things still have plenty of value regardless of what else happens. And then the third is, remember, risk scores can go down. So CMS is isn't saying, oh, we'll insulate you from the down as much as we cap you on the up. You know, if, if you, if you fall asleep on risk scores and suddenly you drop two or three points, guess what you're, and you've got a percent of premi deal, your revenue just went down.

Daniel J. Marino:

You just went down. Yeah. So some of the performance model as well, right? So the performance model still has to be there, right? It still has to be sound, you still have to manage that population around cost of care Yes. Around utilization. Yes. And then you have to accurately identify the risk. I think the key to it though is that you have to be able, you have to connect the dots, right? So if there is, I, if the risk is going up, if the cost of care is going up, and, and even, you know, if it is based on over utilization, as you mentioned, some interventions around care, care, , management has to come into play and you have to show that you're taking some responsibility to, to manage that. I think as we start to think about it, the model has to be clean, but we also have to prepare for some type of audit or some type of realization that this may be questioned, right? So we, we've gotta get back to the data, the model and the clinical performance to be able to show that, hey, what we're doing is, is actually the right thing to be done.

Cliff Frank:

I think all that is true. There's, there are plenty of places for c m s to come look. And, and I mean, it starts with rpm, ccm, telehealth. I mean, lots of new areas that are, have, have been exposed already to some pretty significant frauds. So they're looking, and then, , you have their relationships with the plans, which now cut through to the provider because there's the provider providing the claims information. So they're gonna wanna see the docentation that supports that. Yeah. So if you're just submitting diagnoses with no docentation, good luck. That's gonna be a problem. So

Daniel J. Marino:

Do you think that this is, this is sort of generated from the plans complaining that the risk scores have been going up too much, so they're having to pay back or pay out too much? Or is it that c m s is identifying that, hey, all of a sudden the, the risk severity of the Medicare population has increased? Where is this, where's this come from?

Cliff Frank:

Well, I think it's coming from, from two different directions. One is, yeah, cash out. I mean, the, the, and, and where you see that is the benefit plans that, that, , the, , payers are offering are getting insanely rich.

Daniel J. Marino:

Yeah.

Cliff Frank:

I mean, food gyms , travel clubs, I mean, what whatever you want. Yeah. We'll get and, and a $160 credit on your, on your, premi from

Daniel J. Marino:

Oh yes. Social

Cliff Frank:

Security.

Daniel J. Marino:

I mean, well, in a lot of these premis, I mean, lot and, and a lot of markets, they're not even there. It, there's a $0 premi. They're, it's a

Cliff Frank:

Negative premi. It's a

Daniel J. Marino:

Negative premi. It's a negative. Cause you're,

Cliff Frank:

Cause you're, you actually get a rebate from Social Security. So, , and CMS is looking at this saying, how is this? Right?

Daniel J. Marino:

Right.

Cliff Frank:

So, and the, and, and Congress is looking at us saying, how is this right? When Medicare's going bankrupt and we're, we're kind of paying for all this other, other nice to do stuff. , something's outta whack. And then on top of that, you certainly have the, , the pressure that comes from kind of c m s just being embarrassed.

Daniel J. Marino:

Yeah.

Cliff Frank:

They, they took their, they, they kind of got snookered and they know they got snookered, and so now it's payback.

Daniel J. Marino:

Well, they did. They did. And, you know, it's, it was, there was a lot of pressure around risk. They came up with the, the risk adjustment factor. , and I, I think, you know, they, they sort of connected the dots. Here's how you need to position it. And yeah, they tied a payout to it. So I think initially the incentive was good, but I think it came back to haunt him. Abs. Absolutely. If you're, if you're just tuning in, I'm Daniel Marino and you're listening to Value-Based Care Insights. I'm having a great discussion with Cliff Frank. We're talking about, , value-based contracts and, and really tying that to risk and, and really what's changed over the, the last couple of months. So, cliff, and another question. , how are the payers responding to this? Obviously, there's been a lot of lobbying efforts to Congress to, to change this. You know, we, we, we've read about this. C m s has certainly has responded. How are the payers, how are you seeing the payers responding to the providers?

Cliff Frank:

Well, there is a, an emerging sense of interdependency that did not so much exist before. Providers in 2022 were kind of a necessary evil

Daniel J. Marino:

Mm-hmm.

Cliff Frank:

But now with the data being kind of wholly resting on what providers do and the, and therefore the coding and the, , interventions happening at the physician level, if things don't get better for the member,

Daniel J. Marino:

Right?

Cliff Frank:

They can lose, they can pretty e pretty easily lose the member. I mean, one of the things that's really different is that the old H M O Medicare HMO model of a narrow network focused on a system of care those days, like Kaiser, those days are really hard. Those are hard cells now, right? Most of the product selling are p o go anywhere you want. , as long as it's in, in network and very broad networks. And so, and for zero premi. Yeah. So it's, it's really, , much more member centric. And, and the providers feel that because they're really not in a position to say no, like there's no referral authorization. It's more like they can suggest maybe this orthopod or maybe that facility. But, , if the member wants to go to someplace else, just saw a nice billboard on the freeway, you know, they're going and they may not even tell the primary.

Daniel J. Marino:

Yes.

Cliff Frank:

Well. that's a, that's a different world. And, and frankly, the primaries are, are not up to speed about that.

Daniel J. Marino:

Right. They, they know

Cliff Frank:

Command and control world, and it's not,

Daniel J. Marino:

I had a conversation just a couple weeks ago with, , one of the, the vice president of managed care for this large health system. And, you know, he felt like he was in a really difficult position, vulnerable, if you will, because, you know, they've, , to his, you know, he, he's, he fully admitted, they've not done a good job of creating their models that are prospective. They're, they're mostly retrospective, right? So they're look backs in terms of what had happened and what are some of the trends that have occurred. And, you know, then they're kind of, they're trying to apply that to their contract, and particularly in, in some of the risk-based contracts. And they, you know, they're at risk for 8% premi for some of their contracts. So h he feels extremely vulnerable. And just over the last month and a half, their end of their performance year was a calendar year, the payers came to him and said, here's what your model looks like, right? We're seeing that you overshot your risk levels. We're seeing that, you know, your utilization is higher than what you know, you're reporting that it is. And, and frankly, he admitted he didn't have a good model to begin with. , and they're not making the money that they thought they were going to. And to make matters worth the finance people book some of this ahead of time, <laugh> Oh. Which, which kind of made it a bigger, bigger challenge because, you know, as they were running some of their retrospective models on a quarter by quarter basis, they were playing off the model. Right? Yep. So it, it just, it goes back to show that the data and really moving to a prospective model of risk of care of these care plans, , is gonna be critical to the success going forward.

Cliff Frank:

Well, you just bring up something really interesting that's super important for providers who are in risk deals. You gotta learn how to spell I B N R. Incurred, but not reported. Claims liability and prospective models will help you do that. Retrospective models will leave you blind.

Daniel J. Marino:

Yep. That's what I'm seeing. It can be a 30% swing.

Daniel J. Marino:

Yeah.

Cliff Frank:

And, and you've booked it one way and suddenly you come back and get whacked. Yeah. So, I mean, that can be a real career limiting move for, for a CFO F O or for a, for a, an I B N leader. Yeah.

Daniel J. Marino:

Well, and, and it's really hard.

Daniel J. Marino:

The the point, the question that he had is, you know, where's the truth? Right? It's, it's clearly somewhere in between because he doesn't believe, he doesn't quite believe where the payers are coming in at. And, and certainly he thinks maybe his model was, was off. So clearly it was in between. So there, you know, again, i i, with you, and that's what was my response too, you have to move to a prospective model. It gives you much more, a greater ability to begin to understand what's happening and to influence it, I think is really key.

Cliff Frank:

Well, the other thing is that the payers in this new world are loathed to believe anybody else's data.

Daniel J. Marino:

Well, that is true. Yep. So that is true.

Cliff Frank:

So it almost doesn't matter what our clients think is reality. What is reality to the payer is your r what they think your risk scores are, what they think your expenses are, what they think your I B N R is and all the rest of it. So in a sense, the real effort is you have to, and this is hard. You have to get inside their data better than they do.

Daniel J. Marino:

Yeah, absolutely. Well, and, and our next episode, we're gonna spend some time talking about that. That's the third episode in the series. Because I really feel like if providers are going to be successful, they have to begin to dive into their, their nbers, their data, their models, and create a model that's gonna be prospective one to give them a better idea of what their performance is. But also, you know, in the event that there's an audit, you just have a, you have a lot more capability to be able to respond to around that audit than you do if it's retrospective. , so we're gonna spend some time talking about that. One, one thing that, , one thing that came came to mind, cliff, as you were talking about this, is, , you know, a lot of these models, a lot of the activities of course are, are still wrapped around the primaries. How is this affecting the specialists? Are, are you seeing, , any of the, the, the risk contracts, , impacting the specialists different? Are there things that, you know, the cardiovascular group, , or cardiology or, or some of these other, you know, gi other, these other interventional specialty practices? , anything that they need to do or any impacts that you're seeing there?

Cliff Frank:

Yes. , a lot. , but it starts like three premises up. First of all, we don't have enough specialists. I mean, we already know that we don't have enough primaries, but we've been using nurse practitioners and other urgent cares to kind of plug the gap when it comes time to go see a specialist, it can take four to six months to get a new patient in.

Daniel J. Marino:

I know. And that's outrageous. So

Cliff Frank:

Medical specialist, , neuro, , endocrine, , cardiology. Unless, unless they're, you know, gasping for breath, you know, it's gonna be a problem. Then when they see them, they may, you know, do a lot, may do a little, , they don't really care what the primary wants done. They're just gonna do what they want. Yeah. And if you don't like it as a primary fine, send 'em to someplace else. I got 40 more in the hall waiting to come see me. So the old style of, you know, north American Medical Management where you have a few specialists and a big net of primaries feeding those specialists, and that's all they did, I don't think that model works anymore. No.

Daniel J. Marino:

Agree. I just don't, don't

Cliff Frank:

Think it's very prevalent unless you're Kaiser and you employ them. Right. But short of that, the power dynamic has really flipped. And as a result, oh, and remember, a lot of these specialists are part of private equity deals that are strictly churn and burn.

Daniel J. Marino:

Well, they are. And the integration has to be better. I'll, I'll tell you, it has to be better. , and it has to be, you know, we we're, we keep talking about moving to a prospective risk model that has to guide some of the, the referral activity integration with the specialists, you know, even solvent some of these access issues, because that's gonna come into play certainly as you start to, to think about what the financial performance is going to look like for the network as a whole. And frankly, the payers could care less about, you know, they care from a quality standpoint, I guess, but they don't really care that it takes you 30 days to get into see a specialist. What they really care about is what the cost implications are.

Cliff Frank:

Well, so in Medicare, some of that is diminished because, you know, the Medicare fee schedule is the Medicare fee schedule. Sure. So if you go to the academic medical center, or you go to somewhere down matter street, okay, you may have, you know, , what do you call that? , the, , clinic charges, you know, right. The, the provider based payment problem

Daniel J. Marino:

Cancer charge.

Cliff Frank:

Right. But that gets charged back to your expense. But absent that, , the fees are pretty much similar. So then it's gets to use pattern access and patient initiation. Remember, about half the patient visits to a specialist are patient initiated, not referred by primary care doc. Yeah. These are people who just wake up and they got a sore back, they're going to the orthope right away they go. So, you know, how the heck do you control that kind of utilization if you're the primary care doc?

Daniel J. Marino:

Well, absolutely. Yeah. I mean, and really it's care management. It's that integration piece that has to, has to come into play.

Cliff Frank:

Well, you can't say no. So it's a, a process. I mean, you can't, you can, but you can't make it stick, particularly if the patient's just bypassing you, which is why the care support teams early intervention, , and, and this kind of, right, I don't don't wanna call it disease management because that's not really what it is, but

Daniel J. Marino:

No, there's more

Cliff Frank:

Condition management, there's connectedness to that patient outside of the, the, the doctor's treatment room that keeps that patient coming back again and again, and, and having telephone contact and otherwise informa information seeking so that that relationship can remain vibrant and, , curative. Right. That doesn't happen if it's transactional. No. And if we're paying our primary care doc to be transactional, guess what? We get transactions. We don't get managed care. Right.

Daniel J. Marino:

No, it needs to be managed. It needs to be coordinated. , cliff, we just have a couple minutes left and I wanna get your opinion on, on where some of these contract activities are going. , particularly around what c m s announced. A couple, maybe a, a month or so ago, month and a half when they said, Hey, we're gonna start including health equity indicators as, as part of the contracts real quick, , h how is that coming into play? I mean, health equity, social determinants, everybody talks about it, it's a big driver of, of chronic diseases and so on and so forth. We all get that. But h how are we, how is this this gonna be measured? Any insight you could provide?

Cliff Frank:

Yes. , C D C has come out with a social vulnerability index. C m s has published about 50 measures of health equity from, you know, income and transportation barriers and oth other kinds of, of of things that are, that are, , potential, , , interference with, with access to care. , getting good baseline data is important. The hard part. And, and, and there are companies out there that have big data that can, can do that. Here's the hard part, given that you know that, what's the use case for doing something about it?

Daniel J. Marino:

Well, absolutely.

Cliff Frank:

I'll give you a a an example. Real life last year, big heat wave coming to Philadelphia 115 degrees, we need to know in our A C o, we need to know who's living alone in second story building or higher with no air conditioning, who has C O P D or asthma? Cause they're gonna die,

Daniel J. Marino:

Right? We need

Cliff Frank:

To get and, and we need to get them some fans,

Daniel J. Marino:

Right? So those types of indicators have to be included in the care plan, right? And then as you're prospectively managing that, incorporating that in, so I, which takes

Cliff Frank:

A whole different database, it takes a whole different worldview. And it takes, and that's not something that can come right from the primary care office, really a care management organization, be it a plan, or be it an I P A or an a C o central administration. Somebody's gotta take that view and say, you know what? We need to understand not just the patients, but the whole population and, and apply these various use cases. Right? Now here's the problem. Doctors think from the specific to the general population health, people think from the general to the specific. Yeah. So if you just blop a bunch of stats on the table, the doctor's gonna look down and say, what the hell do I do with this?

Daniel J. Marino:

Right. What does it mean? So,

Cliff Frank:

So really, I think the better way to do it is to take a bunch of use cases like the, like the C O P D patients in a heat wave and work it backwards to some sort of generalized, yeah. This is the kind of information we need. That leap has not been made in the industry. It's wide open.

Daniel J. Marino:

That's a good point. Almost to create pathways around what some of those HE health equity issues are. Well, cliff, , you know, we're, we're at the end of the show. I want to thank you. , you know, I, I think talking about health equity, this, , I, I'd love to have you back and dive into it a little bit further and maybe we can get some data folks in here that have had some experience with, , health equity and social determinant indicators. I think that would be a great discussion. But thanks, cliff, for coming on. As usual. I enjoy it my friend

Cliff Frank:

Time wet fast.

Daniel J. Marino:

It certainly did. And I wanna thank our audience for listening today Until our next insight, I'm Daniel Marino, bringing you 30 minutes of value to your day. Take care.

 

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners

Many hospitals are experiencing increasing workflow challenges due to high inflation rates. As a result, government and commercial payers are responding in unique ways.  

On this episode of Value-Based Care Insights, host Daniel J. Marino discusses economic challenges in health care, particularly hospitals and physicians. We’re joined by commercial insurance and government reimbursement expert, Cliff Frank. 

KEY TAKEAWAYS: 

• Hospitals and other health care facilities are facing a number of challenges, and inflation is a key component to internal issues. It’s essential that providers have an understanding on how to navigate an ever-changing infrastructure. 
• Risk contracting has been a common issue for hospitals as payers are making money on empty hospitals and slower ORs. This obviously increases the need for better contracts between payers and providers. 

• The ACO module has changed drastically, impacting how care is coordinated for Medicare patients. 

 

LISTEN TO THE EPISODE:

 

Since the pandemic, many healthcare provider organizations find themselves re-instituting empowerment initiatives initially created pre-COVID, however, the recent circumstances had a vast impact on the workforce culture. Today, organizations must focus on a transformative culture which allows the workforce members to prosper in their current roles while the fundamental needs of the employees are met. How can leaders ensure this? 

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Todd Brook and Danica Wasser from Engagement Multiplier to discuss culture transformation and what it takes to have a thriving workforce.  

Key points include:

• The key to workforce engagement is meeting the three basic needs of the employees: physiological needs, safety needs, and a sense of belonging. 
• There is more to workplace happiness than just giving out raises; pay is no longer the only driving component people desire.  
• Obviously, all humans – and workforce members- are different, therefore, leaders must ask pertinent questions and be prepared to act. 
   

LISTEN TO THE EPISODE: