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The Race to Value Podcast

By: Institute for Advancing Health Value
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  • Summary

  • We are in a race to make health value work. Join Dr. Eric Weaver and Daniel Chipping of the Accountable Care Learning Collaborative as they interview top executives, physicians, and entrepreneurs leading the transformation to health value.
    2020 - Accountable Care Learning Collaborative
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Episodes
  • Ep 201 – Value-Based Change Management: Navigating the Human Side of Healthcare Economics, with Philip Eaves, MBA

    Ep 201 – Value-Based Change Management: Navigating the Human Side of Healthcare Economics, with Philip Eaves, MBA
    Feb 14 2024
    In this episode of the Race to Value podcast, we are sharing inspiration for a more optimistic future in the value transformation of our country. This week’s interview brings a message of hope, compassion, and human connection balanced with the business success of value-based care within a national leading health system. Albert Einstein once said that “Only a life lived for others is a life worthwhile” and no one better captures that spirit of servant leadership than our guest this week. Philip Eaves is the President and CEO of Ascension Seton ACO | Ascension Seton Health Alliance and the Vice President of Population Health at Ascension Texas, and he is a leader in the value movement that you should know about. In this interview we focus on change management, leadership, and the human side of healthcare economics. Overseeing the value-based care strategy and operations for one of the largest clinically integrated networks in Texas, Philip is leading the ACO to outstanding success…and transforming the lives of people along the way. Bookmarks: 01:30 The human side of healthcare economics – compassion is the currency; empathy is the language. 02:00 Introduction to Philip Eaves, President and CEO, Ascension Seton ACO and VP of Population Health, Ascension Texas 02:30 Ascension Seton ACO is the largest clinically integrated network in Texas with 3,600 providers with 300K value-based lives. 04:45 “Only a life lived for others is a life worthwhile” -- Albert Einstein 05:30 Philip shares how a humble, faith-based upbringing fueled his ambition, work ethic, and compassion as a healthcare leader. 07:30 “Healthcare is about serving others.” 08:30 Occupational medicine as a stepping stone to value-based care. 09:45 Team-based care that enables providers so they can build meaningful patient relationships. 11:00 $24M in MSSP Shared Savings for 23,000 Medicare beneficiaries to achieve a top 7% performance ranking of all ACOs in the country (#32 out of #482). 12:45 Valuable partnerships with independent practices (e.g. Austin Regional Clinic, Capital Medical Clinic). 13:00 “Physician engagement is the overall key to ACO success.” 14:00 The impact of Annual Wellness Visits (AWVs) in practice transformation. 15:00 HCC recapture for documentation accuracy as an area of educational focus. 15:45 Centralized versus Embedded Care Management. 16:30 Analytical insights to drive high risk CM interventions. 17:15 Quality campaigns to close care gaps and improve population health outcomes. 18:00 Refining a Post-Acute Care network for optimal transitional care. 18:30 An after hours program as an effective ED diversion strategy. 20:00 Change management to improve team culture and reinvent the business model for VBC. 22:00 Phillip shares his experience leading an inflection point for the ACO business. 23:30 Applying the principles of the Kübler Ross Change Curve in organizational change. 24:30 Inspiration from John Kotter (“Leading Change”) – Leadership versus Management. 25:00 Recognizing the need for change in shifting a new strategic direction. 26:00 Communicating the vision and creating short-term wins. 26:45 New initiatives: a new ACO for early adopters, Medicare Advantage risk, and Direct-to-Employer partnerships. 28:00 Financial toxicity as a driver of Direct Contracting between employers and providers in value-based care. 30:00 Employer frustration with rising medical spend and the lack of solutions from their brokers. 30:45 Designing an ACO value proposition based on employer pain points. 31:00 Leveraging network adequacy and CIN care infrastructure for commercially insured populations. 32:45 PBM transparency to reduce extreme spending on pharmacy drugs. 34:00 Forging a new partnership with Signify/CVS to support practice transformation. 37:00 Accessing capital within a landscape where there is mass provider consolida...
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    52 mins
  • Ep 200 – Belief in the Possible: Navigating the Successful Transition from Volume to Value, with Melanie Matthews

    Ep 200 – Belief in the Possible: Navigating the Successful Transition from Volume to Value, with Melanie Matthews
    Jan 30 2024
    The transformation of healthcare is a seemingly insurmountable challenge, yet overcoming any obstacle in the journey begins with the belief that it is possible to win!  It's not about the magnitude of the task; it is about the collective will to prioritize the wellbeing of every person we serve in our population.  Perhaps when approached with the audacity to imagine a healthier and more equitable future for all, we'll actually get there.  And that is just what the Physicians of Southwest Washington (PSW) is realizing as they navigate a successful transition from volume to value. Our guest on the Race to Value this week is Melanie Matthews, the dynamic, creative, and innovative CEO of PSW. She leads a population health company that has been around for three decades. Melanie is not only leading their ACO and managing their progression in the adoption of full-risk Medicare Advantage delegation; she has become a nationally recognized voice for value-based health policy.  In listening to this interview, you will hear from a leader that has a real personal capacity for leadership and a clear focus on excellence. If you want to hear from someone that is at the absolute forefront of risk-based contracting and innovation, who understands the issues at a granular level, this episode with Melanie is a must-listen! Episode Bookmarks: 01:30 Introduction to Melanie Matthews and the Physicians of Southwest Washington (PSW) 04:30 PSW has evolved over the last three decades from an IPA to a diverse business that includes a national leading ACO and risk-bearing entity for MA. 06:00 "PSW is a story of independent physicians who, in a time of market consolidation, want to remain independent and focus on the patient relationship." 06:45 Achieving success in delegated risk and taking accountability for both quality and total cost of care. 07:00 The impact of MACRA on the long-term value-based care strategy of PSW. 08:30 Building an infrastructure and developing capabilities to move a value-based agenda. 09:00 Developing a business model for agility in responding to new rules ("a kayak in a sea of cruise ships") and engaging all types of physicians in the landscape. 09:30 "The value-based movement is important as the fee-for-service chassis is not realistic, has poor quality and outcomes, and rising costs." 10:00 Taking risk with physician partners and providing them with MSO services, leveraging a technical infrastructure and population health platform. 10:45 The glacial pace of scaling payment model transformation at CMS and CMMI's bold goal for 2030. 12:00 The increasing shift to home-based care delivery and the use of generative AI in reshaping care delivery. 13:00 How the flawed economic design of the fee-for-service system creates industry inertia. 14:00 Diverting to the known (i.e. fee-for-service care delivery) in times of stress is an unsustainable path forward. 15:00 Convincing the Board room on the tenets of VBC when it hasn't historically delivered on its promises. 16:00 Trends in consumer cost-shifting and the challenges of private insurers cross-subsidizing provider losses from public payers. 16:30 Unsustainable economics in employer-based healthcare and the looming insolvency of Medicare. 17:00 What does the CMMI 2030 Goal mean for future of the value movement? 18:30 An overview of the extensive services offered by PSW that empowers success in VBC. 19:30 The explosive growth of strategic transactions of physician groups and how mass consolidation is impacting the landscape. 21:00 Aligned incentives and access to a population health platform as keys to VBC success. 22:00 PE investment impacts on competition in an independent physician ecosystem. 23:00 Generational differences in the approach to the business of practicing medicine. 23:30 "Organizations that are convened with independent physicians are able to show better costs of care." (vs. employed or vertically integrated systems)
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    1 hr and 3 mins
  • Ep 199 – Translating Truth: Overcoming Misunderstanding to Champion Accountable Care, with Mara McDermott

    Ep 199 – Translating Truth: Overcoming Misunderstanding to Champion Accountable Care, with Mara McDermott
    Jan 16 2024
    We have a broken healthcare system. Too often, individuals today experience care that is fragmented, duplicative, wasteful, and confusing.  Through value-based care, we can improve the health care experience by coordinating care, creating care teams that communicate with one another, and supporting individuals in their care journey with services that address their medical and non-medical needs. Accountable for Health is a nonpartisan national advocacy and policy analysis organization accelerating the adoption of effective accountable care. Their members are advocating for value-based care on Capitol Hill so policymakers can understand how best to move American healthcare towards a model that achieves better outcomes, improved care experiences, increased access, and lower costs. Joining us on the podcast this week is Mara McDermott, the Chief Executive Officer for Accountable for Health.  She is an accomplished healthcare executive with deep expertise in federal healthcare law and policy, including delivery system reform, physician payment and payment models. Take this opportunity to learn from a leading expert on accountable care as she translates the truth in building a bridge towards a more broad-based understanding of health value.  And make sure to tune in to Mara's special announcement about Health Care Value Week at the end of the interview so you don't miss out on important educational events occurring January 29th thru February 2nd. Episode Bookmarks: 01:30  The need for accountable care policies that create better health outcomes and patient experiences. 02:00  Introduction to Accountable for Health (A4H) and its Founder/CEO Mara McDermott, JD, MPH 03:00  Interview topics discussed (e.g. the meaning of VBC, MSSP vs. MA, MACRA 2.0, advanced APMs, integrated specialty care, Medicaid transformation, and the upcoming Health Care Value Week event). 06:00  How A4H is translating thought leadership to action in the advocacy arena. 06:30  Accountable care as the solution to fragmented, uncoordinated care. 07:00  Political turnover in D.C. has made VBC a "new" health policy solution. 07:30  Educating the Hill comes down to conveying enthusiasm for health care transformation. 08:00  Accountable for Health Members are shaping the national conversation for payment and delivery system reform. 09:00  The health policy controversy of the Global and Professional Direct Contracting model (the precursor to ACO REACH). 11:30  If Direct Contracting was the natural evolution of a series of advanced ACO options, why was there such strong criticism? 12:00  The need to overcome misunderstandings about what ACOs are trying to achieve. 13:00  Providing education to dispel the myth that ACOs can actually limit services. 14:00  How uninformed policy decisions could potentially create a catastrophic blow to the value movement. 14:45  "Accountable care is integral to care delivery system reform." 15:45  Confusion with the term "value-based care" and why it will fail unless people understand the truest aims of the movement. 17:00  The need for effective storytelling to advance care delivery transformation. 18:00  Prioritizing care experience over cost reforms (delivery innovation will address costs!) 20:00  The topline takeaways from CMS model evaluations and whether or not programs should be expanded. 21:00  What do most people think when they hear the word "value"? (the need to reframe the conversation with more precise language) 22:00  The MSSP and the Medicare Advantage programs as two distinct approaches to healthcare delivery and reimbursement. 24:00  Mara provides a brief comparison between MSSP and MA (e.g. beneficiary assignment, risk adjustment, benchmarking). 25:30  How strong relationships between MA plans and provider networks (underpinned by capitation) drive value. 26:30  Understanding provider compensation in MA value-based payment and the synergies between managing MSSP and MA populations.
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    52 mins
Physical Illness & Disease Hygiene & Healthy Living Economics Political Science
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