MTVA Unscripted: Empowering the Move to Value Based Healthcare

Pharmacists are one of the most trusted professions, yet more and more pharmacies are closing. A recent survey [https://benjaminjolley.substack.com/p/2275-pharmacies-have-closed-so-far?utm_source=post-email-title&publication_id=72487&post_id=148814481&utm_campaign=email-post-title&isFreemail=true&r=21b848&triedRedirect=true&utm_medium=email] found 2275 pharmacies have closed so far this year, and every day independent pharmacies are shuttering their doors – often leaving “pharmacy deserts” in their wake.  Vertically-consolidated Pharmacy Benefit Managers (PBMs) have made it practically impossible for local pharmacies to survive, and we’re all paying the price.  But independent pharmacists are speaking out and pushing back – and they’ve secured wins!  General Counsel for the National Community Pharmacists Association (NCPA) Matt Seiler joins MTVA to discuss the current state of community pharmacy, how “shareholder capitalism” got us here, and what comes next. NCPA [https://ncpa.org/about] is the voice for independent pharmacy, representing the interests of nearly 19,000 community pharmacies across the country.  Despite the challenges facing his industry, Matt is optimistic that desperately-needed PBM reform is on the horizon.  “If there’s one thing that’s brought the political parties together in our country, it’s the dislike for pharmacy benefit managers.”  Listen to learn more about the unique role community pharmacists play in the health system, why PBM consolidation is particularly acute at the local level, and how NCPA has helped secure bipartisan support for reining in PBMs.  Check out the other episodes in our “PBM Problems” series:  Part 1 w/ ERISA Attorney Paul Holmes [https://www.movingtovalue.org/podcast/episode/ee7684d9/pbm-problems-part-1-who-do-brokers-and-consultants-really-work-for-risks-for-plan-sponsors-with-erisa-attorney-paul-holmes] Part 2 w/ Mutual Rx CEO Roy Wilkinson [https://www.movingtovalue.org/podcast/episode/dd2356a4/pbm-problems-part-2-transparency-and-disrupting-the-status-quo-with-mutual-rx-ceo-roy-wilkinson] Part 3 w/ Luke Slindee, PharmD [https://www.movingtovalue.org/podcast/episode/273a1f16/pbm-problems-part-3-monopoly-power-in-prescription-drug-markets-with-luke-slindee] ———————————— We’re excited to welcome like-minded organizations and individuals to join the MTVA Membership program!  As a 501(c)(3) nonprofit, we rely on support from our grassroots network to advance our mission of creating a value-based health system with high-quality patient outcomes at a reasonable cost. We’re proud to offer two membership models, Ally Member and Trade Member. Tax-deductible membership contributions help us enrich the healthcare environment with quality content – including this podcast – and robust platforms to fuel discussion, collaboration, and advocacy that lead to ground-breaking solutions.  For more information and to join us, visit our website ⁠www.movingtovalue.org/trademember⁠ [http://www.movingtovalue.org/trademember]. All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠ [https://www.movingtovalue.org/podcast].

Many successful companies have ventured into the healthcare space and failed.  Why can’t businesses that are household names make it work in our industry? Where do retail investments in health care go wrong? What is missing from their approach to primary care?  Health care reform legend Brian Klepper joins MTVA to explain the pitfalls companies make and why they can’t seem to nail down a sustainable business model.  “There is no such thing in health care as ‘health care lite.’”  Brian Klepper, PhD [https://proven.healthcare/dr-brian-klepper-phd/] is one of the nation’s top voices on realizing the potential of primary care, high-performance healthcare, and management of clinical and financial risk. Brian’s writing has been recognized as among the most influential in healthcare, he led several national healthcare reform efforts favoring patient and healthcare purchaser interests, and last year he was honored with the lifetime achievement “Champions in Transparency Rosie Award” from The Health Rosetta [http://www.healthrosetta.org]. Brian is the CEO of Proven Health and the Founder and Moderator of the Healthcare Benefits Hackers listserv. “We could do it a lot better, but we’ve got to have the incentives aligned. There’s no way around that.” Join the Healthcare Benefits Hackers forum: https://proven.healthcare/healthcare-hackers/ [https://proven.healthcare/healthcare-hackers/]  ———————————— We’re excited to welcome like-minded organizations and individuals to join the new MTVA Membership program!  As a 501(c)(3) nonprofit, we rely on support from our grassroots network to advance our mission of creating a value-based health system with high-quality patient outcomes at a reasonable cost. We’re proud to offer two membership models, Ally Member and Trade Member. Tax-deductible membership contributions help us enrich the healthcare environment with quality content – including this podcast – and robust platforms to fuel discussion, collaboration, and advocacy that lead to ground-breaking solutions.  For more information and to join us, visit our website⁠ ⁠www.movingtovalue.org/trademember⁠⁠ [http://www.movingtovalue.org/trademember%E2%81%A0%E2%81%A0]. We are grateful to our Trade Members and Ally Members [https://www.movingtovalue.org/supporters], who help make this show possible.  All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠ [https://www.movingtovalue.org/podcast].

We all know the cost of prescription drugs in the U.S. is a problem. How did we get here and what can we do about it?   This week, MTVA Board Members Dr. John Rodis and Dr. Steven Schutzer are joined by MTVA Executive Director Laura Wadsten for an engaging discussion with Senior Pharmacy Consultant ⁠Luke Slindee⁠ [https://www.linkedin.com/in/luke-slindee-pharm-d-034946160/], PharmD.  Luke is a second-generation pharmacist who has witnessed first-hand how hidden money flows and increasingly powerful players have hurt his fellow pharmacists, communities, and patients. He’s spent years studying the economics and power dynamics of the pharmacy supply chain, and in this episode he shares some solutions to these problems.  Tune in to learn more about the monopolies and oligopolies influencing drug costs, key differences in generic and brand markets, and how cash-only independent pharmacies can help solve this crisis. Check out the other episodes in our “PBM Problems” series:  * Part 1 w/ ERISA Attorney Paul Holmes [https://www.movingtovalue.org/podcast/episode/ee7684d9/pbm-problems-part-1-who-do-brokers-and-consultants-really-work-for-risks-for-plan-sponsors-with-erisa-attorney-paul-holmes] * Part 2 w/ Mutual Rx CEO Roy Wilkinson [https://www.movingtovalue.org/podcast/episode/dd2356a4/pbm-problems-part-2-transparency-and-disrupting-the-status-quo-with-mutual-rx-ceo-roy-wilkinson] ———————————— We’re excited to welcome like-minded organizations and individuals to join the new MTVA Membership program!  As a 501(c)(3) nonprofit, we rely on support from our grassroots network to advance our mission of creating a value-based health system with high-quality patient outcomes at a reasonable cost. We’re proud to offer two membership models, Ally Member and Trade Member. Tax-deductible membership contributions help us enrich the healthcare environment with quality content – including this podcast – and robust platforms to fuel discussion, collaboration, and advocacy that lead to ground-breaking solutions.  For more information and to join us, visit our website ⁠www.movingtovalue.org/trademember⁠ [http://www.movingtovalue.org/trademember]. All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠ [https://www.movingtovalue.org/podcast].

“There’s a reason that over the last 45 years, the PBM model has been the darling of Wall Street: because it makes a heck of a lot of money for its investors.” – Roy Wilkinson PBMs are in the hot seat: Last week, the House Committee on Oversight and Accountability pressed [https://oversight.house.gov/release/hearing-wrap-up-pharmacy-benefit-managers-push-anticompetitive-drug-pricing-tactics-to-line-their-own-pockets%EF%BF%BC/] the CEOs of United’s Optum Rx, Cigna’s Express Scripts and CVS Caremark (the “Big 3”) on allegations [https://oversight.house.gov/release/comer-releases-report-on-pbms-harmful-pricing-tactics-and-role-in-rising-health-care-costs%EF%BF%BC/] of profiting from unfair practices at the expense of the American people. A recent report [https://www.ftc.gov/news-events/news/press-releases/2024/07/ftc-releases-interim-staff-report-prescription-drug-middlemen] from the FTC also blasted the powerful middlemen for “inflating drug costs and squeezing Main Street pharmacies.”  In a field characterized by deception and greed, we’re excited to share a “carafe is ¾ full” perspective. The MTVA Board spoke with Roy Wilkinson, a disruptor offering an alternative to PBMs.  Roy Wilkinson is the CEO and Founder of Mutual Rx [https://www.mutual-rx.com/] – an innovative approach grounded in trust and transparency. After working as a consultant in the field for many years, Roy and his clients were fed up with the lack of transparency and pricing games offered by conventional PBMs, and believed in a better way.  As Roy explains, “You can’t assess value without knowing what stuff costs.”  Mutual Rx offers self-directed solutions that empower plan sponsors to personalize their pharmacy benefits and reduce costs. The “mutual” represents their equity model, where clients can reap the benefits of managing their drug spend. Roy and his team act as fiduciaries who protect the interest of the plan and its members, not outside financial influencers.  Tune in to learn more about how Roy and Mutual Rx are helping plan sponsors save money – reducing costs by 20% or more!  https://www.movingtovalue.org/podcast/episode/ee7684d9/pbm-problems-part-1-who-do-brokers-and-consultants-really-work-for-risks-for-plan-sponsors-with-erisa-attorney-paul-holmes All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠ [https://www.movingtovalue.org/podcast].

Rollups, takeovers and buyouts. Oh my! With increasing fear about private equity in health care, the MTVA Board is joined by Dr. Marco Fernandez and Jack Dillon of the Association for Independent Medicine to discuss their perspectives on private equity and best practices for maintaining or reclaiming an independent practice.  The Association for Independent Medicine (AIM) [https://www.associationforindependentmedicine.org/] believes that maintaining physician control of healthcare decision-making results in the highest quality care for patients and the most efficient use of healthcare resources. The organization supports independent medical practices through education, practice management support and advocacy. “There’s no better advocate for a patient than an independent physician.” – Dr. Fernandez Marco Fernandez, MD is President of AIM. He is a cardiac anesthesiologist and President of Midwest Anesthesia Partners, a physician-owned group serving the greater Chicago area. Jack Dillon, MSHR, MBA is Executive Director of AIM. He’s the CEO of Anesthesia Practice Consultants, an independent group providing anesthesia and sedation services across Western Michigan.  Though our guests come from anesthesiology, AIM supports practices across diverse specialties who want to be independent – from primary care to cardiology, even veterinary and dental!  Follow AIM on social media for association news and upcoming events like the virtual AIM Toolkit Series discussions about independent medicine issues - Facebook [https://www.facebook.com/AssociationforIndependentMedicine/], Instagram [https://www.instagram.com/associationindependentmedicine/]  and LinkedIn [https://www.linkedin.com/company/association-for-independent-medicine/].  All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠ [https://www.movingtovalue.org/podcast].