MTVA Unscripted: Empowering the Move to Value Based Healthcare

What does “value” in health care actually mean—and how do we get there? MTVA sat down with a top leader in the value movement who’s put the value philosophy into practice!  Kevin Bozic, MD, MBA [https://dellmed.utexas.edu/directory/kevin-bozic] is Chair of Surgery and Perioperative Care [https://dellmed.utexas.edu/units/department-of-surgery-and-perioperative-care] at Dell Medical School at The University of Texas at Austin. He’s internationally recognized in the field of orthopaedic surgery (a Past President of the American Academy of Orthopaedic Surgeons [https://www.aaos.org/aaos-home/newsroom/press-releases/kevin-j.-bozic-md-mba-faaos-named-president/]) and a leading force in value-based health care.  For Dr. Bozic, value isn’t just about cutting costs or providing better services. It’s about delivering HEALTH.  “You can provide the lowest cost, most efficient, high quality, safe health care, and unless it improves someone's health, you haven't created any value.”  Since joining Dell Med in 2015, Dr. Bozic has built a department from the ground up around one central philosophy: health is the goal, and care is one contributor to achieving it. By recruiting mission-driven clinicians and fostering a team culture grounded in purpose, his department has seen not only improved outcomes, but also provider satisfaction [https://www.fixmoralinjury.org/] and staff retention. In this episode, Dr. Bozic discusses: * Why “health care” should always be 2 words—and what that distinction means * The power of making health our North Star * Why value must be measured by patient-reported health outcomes * What it takes to shift culture in medicine—and how he built a new model from scratch * How turf wars and rigid incentives are holding us back—and what we can do about it He challenges fellow physicians to take ownership of reform: “No one is more responsible for how we deliver and pay for health care than physicians, and we're the people that the rest of the world trusts. Society trusts us. They don't trust the government or health plans or bureaucrats or anyone else to fix these problems.”  Dr. Bozic also reflects on changes in medical education, and his experiences training the next generation of physicians.  If you’ve ever asked what it would take to fix the U.S. health system from the inside out, this conversation offers both vision and proof of concept!  “If we could get the country focused on the whole end game here in health care is health, that would be a step forward.” To learn more about the proposed cuts to Medicaid, check out our episode with Stephanie Noriea [https://www.movingtovalue.org/podcast/episode/284e40cc/whats-up-with-medicaid-proposed-cuts-impact-on-states-and-opportunities-for-value-with-stephanie-noriea].  Sources Referenced: * * “Who Killed Health Care? America's $2 Trillion Medical Problem—and the Consumer-Driven Cure” [https://manhattan.institute/book/who-killed-health-care] (2007) by Regina Herzlinger * Redefining Health Care: Creating Value-Based Competition on Results [https://www.hbs.edu/faculty/Pages/item.aspx?num=21319] (2006) by Michael Porter and Elizabeth Teisberg * “The Innovator's Prescription: A Disruptive Solution for Health Care” [https://accessmedicine.mhmedical.com/book.aspx?bookid=2313] (2009) by Clayton Christensen, Jerome Grossman, MD, and Jason Hwang, MD * Institute for Strategy and Competitiveness [https://www.isc.hbs.edu/health-care/value-based-health-care/Pages/default.aspx] at Harvard Business School  * UT Health Austin’s Musculoskeletal Institute [https://uthealthaustin.org/clinics/musculoskeletal-institute] ———————————— All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠ [https://www.movingtovalue.org/podcast]. | Sign up for our email list here [https://www.movingtovalue.org/community]. Thank you to our MTVA Trade Members and Ally Members whose support helps make this podcast possible! 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. For more information and to join us, visit our website: www.movingtovalue.org/membership [https://www.movingtovalue.org/membership].

“I really do think it's as simple as waking up the buyer, because if the buyer is going to define what they want and hold people accountable, everything else will happen naturally.” One often overlooked stakeholder in the U.S. healthcare system is business leaders. Our guest this week, Darrell Moon [https://darrellmoon.com/], is on a mission to mobilize these decision makers. Darrell is the CEO and Founder of Orriant [https://orriant.com/] and Aspirational Healthcare [https://aspirationalhealthcare.com]. As a hospital administrator, Darrell saw the profound misalignment between the health system and its customers. For the last 30 years, he’s been advocating for a different approach – based on the Nuka [https://scfnuka.com/] System of Care in Alaska and Deming’s [https://deming.org/category/deming-today/healthcare-deming-today/] principles – and coaching executives on how they can too! His recent book “Make Healthcare Work for You [https://makehealthcareworkforyou.com/]” is a pragmatic guide for how CEOs can get better healthcare for HALF the price. Darrell and MTVA discuss his new book and how CEOs can lead the movement to better healthcare! More from MTVA Unscripted: * Webinar Series for Employers [https://www.movingtovalue.org/resources-for-employers] * Wake-up Call: The Johnson & Johnson Prescription Pricing Scandal [https://www.movingtovalue.org/podcast/episode/19a54804/wake-up-call-the-johnson-and-johnson-prescription-pricing-scandal] * From ERISA to CAA: How Has Employer’s Fiduciary Responsibility Changed Over Time? [https://www.movingtovalue.org/podcast/episode/32b0dd5d/from-erisa-to-caa-how-has-employers-fiduciary-responsibility-changed-over-time] * What Employers Need To Do Now to Comply With CAA by End of Year : MTVA Talks to Chris Deacon [https://www.movingtovalue.org/podcast/episode/1f556ca4/what-employers-need-to-do-now-to-comply-with-caa-by-end-of-year-mtva-talks-to-chris-deacon] * PBM Problems (Part 1): Who do Brokers and Consultants Really Work for? Risks for Plan Sponsors 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] * Retail Health Failures: Misaligned Incentives and Misunderstanding Primary Care w/ Brian Klepper [https://www.movingtovalue.org/podcast/episode/2b411baa/retail-health-failures-misaligned-incentives-and-misunderstanding-primary-care-with-brian-klepper] Other Sources Referenced: * Scott Conard, MD blog post re Health Literacy  [https://scottconardmd.com/blog/building-a-health-literate-culture--a-strategic-imperative-for-corporate-and-medical-leaders] * Dr. Marty Makary’s book Blind Spots [https://geni.us/blindspots]   ———————————— All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠ [https://www.movingtovalue.org/podcast]. | Sign up for our email list here [https://www.movingtovalue.org/community]. Thank you to our MTVA Trade Members and Ally Members [https://www.movingtovalue.org/supporters] whose support helps make this podcast possible!   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. For more information and to join us, visit our website: https://www.movingtovalue.org/membership [https://www.movingtovalue.org/membership].

Thinking about Dermatology may bring to mind Botox injections and commercials for anti-aging skincare products, but behind the scenes, it’s one of the most broken specialties in healthcare. Long wait times for short visits, some of the most expensive drugs on the market, and a system that too often overlooks patients with chronic autoimmune skin conditions. In this episode, we sit down with Olivia Deitcher [https://www.linkedin.com/in/oliviadeitcher] – Founder and CEO of Zest Health [https://www.zesthealth.com/about] and one of Slice of Healthcare’s “50 under 50" [https://sliceofhealthcare.com/slice-of-healthcare-50-under-50-2024/#:~:text=Olivia%20Deitcher,Founder%20%26%20CEO%2C%20Zest] leaders transforming our health system. A “patient founder” living with psoriasis and a veteran of the biopharma startup world, Olivia launched Zest to build the dermatology experience she wished for: high-touch, data-driven, and value-based. “I am candidly very optimistic about where dermatology as a field can go if we can put in place value-based care rails.”  Zest is a virtual-first dermatology clinic designed for patients with chronic autoimmune conditions like psoriasis and eczema. Zest patients are seen within days (not months), and get continuous follow-up care with frequent engagement (30-60 minute visits every 4-6 weeks). Through what Olivia calls the “de-prescription paradigm”, Zest helps patients reduce unnecessary medication use and better manage their conditions — saving tens of thousands of dollars per patient. “We bring a very vast toolkit of therapeutic interventions into the analysis of what is appropriate for the patient. It may be that that patient should change their laundry detergent… see if that helps alleviate things. Just moving to a $6 unscented laundry detergent, before we initiate that patient onto a $90,000 therapeutic where they’re going to have to be at home, injecting a drug into themselves, managing the side effects, and feeling like that’s the only answer.” Olivia and her team are serious about the movement to value – Zest only enters value-based arrangements that pay for improving their patients’ quality of life.  Listen to hear why 91% of their patients said Zest is a better approach to dermatology care – and how Zest accomplishes this while saving patients and their employers hundreds of thousands of dollars on unneeded prescriptions.  To learn more about the link between environment, lifestyle and health, check out our episode with Dr. Elizabeth Boham [https://www.movingtovalue.org/podcast/episode/220be4ea/the-promise-of-functional-medicine-with-dr-elizabeth-boham]. Listen to our episode with Pramod John [https://www.movingtovalue.org/podcast/episode/31adca1b/right-drug-right-patient-right-price-using-data-to-deliver-value-with-pramod-john] to learn how his company VIVIO Health helps match patients to the right drug at the right price.  Sources Referenced: * ⁠Episode 458 of Relentless Health Value w/ Komal Bajaj, MD⁠ [https://relentlesshealthvalue.com/episode/ep458-a-really-unexpected-consideration-for-solving-staffing-shortages-that-impact-access-and-care-quality-that-is-based-on-a-ton-of-evidence-with-komal-bajaj-md] * "Biosimilars in the United States 2023–2027,” [https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/biosimilars-in-the-united-states-2023-2027#:~:text=The%20U.S.%20biologics%20market%20has%20grown%2012.5%25%20annually%20on%20average%20over%20the%20last%20five%20years%20on%20an%20invoice%2Dprice%20basis%2C%20faster%20than%20non%2Dbiologics%2C%20and%20now%20comprising%2046%25%20of%20spending] IQVIA (Jan. 31, 2023). ———————————— All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠ [https://www.movingtovalue.org/podcast]. | Sign up for our email list here [https://www.movingtovalue.org/community]. Thank you to the MTVA Trade Members and Ally Members [https://www.movingtovalue.org/supporters] whose support makes this podcast possible!  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. For more information and to join us, visit our website: https://www.movingtovalue.org/membership [https://www.movingtovalue.org/membership].

“Right now, the value-based care reward is coming into the payers far more than it’s coming into the providers.” A primary care provider shortage is on the horizon. Between resolving coverage disputes, trying to get reimbursed for services, and limited time with patients, PCPs are burnt out. But what if we reimagine the primary care payment model to work better for providers and patients?   In this episode, we sit down with Mary Tracy Mock [https://www.linkedin.com/in/mary-tracy-mock-68b6aa31/] to tackle one of the most urgent and complex issues in healthcare today: the state of primary care and the payment arrangements shaping its future. Mary is a seasoned healthcare executive and veteran of value-based arrangements.  We break down the pressing primary care workforce crisis, and how outdated reimbursement systems are contributing to provider burnout and could soon lead to primary care “deserts.” Mary makes a compelling case for a radical reimagining of how we value and pay for primary care — from capitation to Direct Primary Care (DPC) and beyond. Whether you’re a policymaker, provider or patient, this conversation will challenge your assumptions — and offer real solutions! Sources Referenced: * Episode 462 of Relentless Health Value w/ Scott Conard, MD [https://relentlesshealthvalue.com/episode/ep462-managing-populations-of-whole-actual-people-who-are-not-the-sum-of-a-bunch-of-different-body-parts-with-scott-conard-md] * https://pubmed.ncbi.nlm.nih.gov/35029652/ [https://pubmed.ncbi.nlm.nih.gov/35029652/]  * VBC Venn Diagram from Mary Mock [https://drive.google.com/file/d/1SziV6tJrBWF3LQ7UIzufG83a41G_W87-/view?usp=sharing] ———————————— All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠ [https://www.movingtovalue.org/podcast]. | Sign up for our email list here [https://www.movingtovalue.org/community]. Thank you to our MTVA Trade Members and Ally Members [https://www.movingtovalue.org/supporters] whose support helps make this podcast possible!   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. For more information and to join us, visit our website: https://www.movingtovalue.org/membership [https://www.movingtovalue.org/membership].

From geography to network adequacy and endless waitlists, getting seen by a specialist can be tricky. And the challenges are even more pronounced for underserved communities – who may be hours away from the provider they need to see, or whose insurance might not be accepted by specialists. Then, after waiting months for an appointment, it may turn out to be one of the many specialist referrals that are unnecessary [https://pubmed.ncbi.nlm.nih.gov/21418312/].  There’s a better way: eConsults. In this episode, MTVA sits down with Dr. Daren Anderson, the President and Founder of ConferMED [https://www.confermed.com/], a not-for-profit telehealth company that connects primary care practices across the country with specialists through virtual “eConsults”.  “Using an eConsult platform like ConferMED allows you to bring the specialist and the subspecialist into that care team virtually.” Dr. Anderson shares his journey – from primary care provider at a federally qualified health center, to leading the Weitzman Institute [https://www.weitzmaninstitute.org/], and eventually founding ConferMED, which now helps improve access to specialists across 32 states.  With eConsults, primary care providers are empowered to provide better care without unnecessary referrals, specialists can support more patients efficiently, and patients get answers more quickly. Dr. Anderson and his team have also published research showing that eConsults can generate cost savings for the healthcare system.   “We’re seeing more and more primary care practices looking for eConsult solutions because it makes sense for everybody, not just the underserved. And I kind of like that story, because we figured out something for the underserved that actually makes great sense for everybody else as well, and the underserved got it first!” To learn more about the proposed cuts to Medicaid, check out our episode with Stephanie Noriea [https://www.movingtovalue.org/podcast/episode/284e40cc/whats-up-with-medicaid-proposed-cuts-impact-on-states-and-opportunities-for-value-with-stephanie-noriea]. Studies on eConsults referenced by Dr. Anderson: * https://www.mathematica.org/news/econsults-can-lower-costs-and-improve-access-to-specialty-care [https://www.mathematica.org/publications/evaluation-of-parc-econsults-pilot-formative-evaluation-report#] * https://pubmed.ncbi.nlm.nih.gov/26951588/ [https://pubmed.ncbi.nlm.nih.gov/26951588/] * https://pubmed.ncbi.nlm.nih.gov/30633678/ [https://pubmed.ncbi.nlm.nih.gov/30633678/] * https://pubmed.ncbi.nlm.nih.gov/29350511/ [https://pubmed.ncbi.nlm.nih.gov/29350511/] * http://pubmed.ncbi.nlm.nih.gov/33719584/ [http://pubmed.ncbi.nlm.nih.gov/33719584/] * https://pubmed.ncbi.nlm.nih.gov/29061478/ [https://pubmed.ncbi.nlm.nih.gov/29061478/] * https://pubmed.ncbi.nlm.nih.gov/37753619/ [https://pubmed.ncbi.nlm.nih.gov/37753619/] * https://pubmed.ncbi.nlm.nih.gov/37864170/ [https://pubmed.ncbi.nlm.nih.gov/37864170/] ———————————— All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠ [https://www.movingtovalue.org/podcast]. | Sign up for our email list here [https://www.movingtovalue.org/community]. Thank you to our MTVA Trade Members and Ally Members [https://www.movingtovalue.org/supporters] whose support helps make this podcast possible!   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. For more information and to join us, visit our website: https://www.movingtovalue.org/membership [https://www.movingtovalue.org/membership].