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The #HCBiz Show!

The #HCBiz Show!

The podcast dedicated to unraveling the business of healthcare.

Latest From Series

COVID-19 Community Vulnerability Map w/ Dr. John Showalter

There is an urgency to utilize social determinants in healthcare decision making, especially to meet the needs of underserved populations. Jvion launched its new COVID-19 Community Vulnerability Map, a free, publicly available tool that identifies populations — down to the census block level — that are likely to experience severe outcomes requiring hospitalization when they contract the virus. The map integrates the findings of the data analysis project that Jvion conducted last week, which analyzed a representative sample of 2 million patients to understand the social and clinical risk drivers that make populations more vulnerable to viral infections like COVID-19. Joining Don and Shahid on this episode is Chief Product Officer, Dr. John Showalter to talk about the deployment and use cases of the COVID-19 Community Vulnerability Map.

Highlights

  • COVID community vulnerability map – learn how limited datasets can be used to understand which communities are at risk of having high mortality and high hospitalizations.
  • Developed map on Azure and partnered with Microsoft to map the predictors.
  • This map is telling us where we should pay close attention when deploying resources.
  • The best maps for future planning and focusing on prevention.

Helping during the pandemic aligns with our values...our mission is to reduce preventable harm. We're committed to evolve this initiative and bring forward the best insights that we can.

A message from Shantanu Nigam, Jvion’s CEO and Founder

We are tremendously grateful for the thousands of healthcare workers on the frontlines of the battle against COVID. Their courage and rapid mobilization in the face of the greatest public health threat of our time has been incredibly inspiring. We are working around the clock to provide them with data-driven insights to help them protect the most vulnerable members of their communities.

 

Dr. John Showalter, Chief Product Officer

Dr. John Showalter, MD is the Chief Product Officer at Jvion and a board certified internal medicine physician specializing in clinical informatics. He is passionate about quality improvement and the application of AI to improve patient outcomes, and is dedicated to ensuring the Jvion Machine drives value and improves lives. 

Jvion 

Jvion enables healthcare organizations to prevent avoidable patient harm and lower costs through its AI-enabled prescriptive analytics solution. An industry first, the Jvion Machine goes beyond simple predictive analytics and machine learning to identify patients on a trajectory to becoming high risk and for whom intervention will likely be successful. Jvion determines the interventions that will more effectively reduce risk and enable clinical action. And it accelerates time to value by leveraging established patient-level intelligence to drive engagement across hospitals, populations, and patients. 

Links, Resources and Related Episodes

Jvion's COVID Community Vulnerability Map

Jvion Map Press Release

COVIDactNOW Surge Prediction Map

COVID-19 Healthcare Coalition

Dr. John Showalter and Jvion Contact:

Dr. John Showalter

Jvion Twitter

Jvion LinkedIn

Jvion Main Website

 

April 9, 2020

Protecting and Extending the Life of PPE with Engineered Controls

An #HCBiz Brief: Given the shortage of Personal Protective Equipment (PPE) in our hospitals due to COVID-19 and the elevated risks our medical professionals are facing every day, I wanted to share a tool I came across at an infection control conference last year that might help. This is a short PSA about an engineered control that prevents infective aerosols, sprays, and splash-back generated by suctioning. I hope you find it helpful.

https://prodaptivemedical.com/stal-shield/ 

And here's an interview I recorded with them at HITS 2018: 

https://thehcbiz.com/ep77_prodaptivemedical_hits2018/

March 31, 2020

Using Opportunity Zones to Drive Substantial Investment in SDOH w/ John Gorman

The Opportunity Zones incentive is a new community investment tool to encourage long-term investments in low-income urban and rural communities nationwide. Nightingale is accelerating the health care industry’s ability to deploy underfunded SDOH benefits by leveraging the innovative financing mechanisms of Opportunity Zones, to catalyze a new marketplace of social service providers. Joining us today is the Founder of Nightingale Partners, John Gorman, to talk about one solution that is good for society, good for patients, and good for business.

Show Notes

I like to say, social determinants of health are just four fancy words for poverty.

We hacked a Republican billionaire tax shelter to try to improve healthcare for black and brown people in inner cities.

You can never get to compliant patients who are participating in population health activities unless their basic needs get met.

  • Breaking down silos to sign patients up for all available social services.
  • The Community Health Worker is the linchpin of any successful social determinant intervention.
  • Designing a management services organization to facilitate rent and utility subsidies for thousands of people.
  • Cultural competency and the "execution risk" for new interventions.
  • Case Study: Adult Daycare Centers in Puerto Rico

They're dropping $21 million on some big slick analytics package and I was like, " What is that actually going to do for you if you can't stand up an intervention the right way?" That's like putting the greatest scope in the world on a really rusty rifle. If you give me $21 million worth of social workers, I'll change the world.

John Gorman, Founder

John is the Founder and former Executive Chairman of Gorman Health Group, at the time the industry’s leading consulting practice which spawned almost a dozen entrepreneurial ventures in government health programs. John’s work focuses on Medicare, Medicaid, and Affordable Care Act strategy, governance, and turnaround of distressed health plans. Prior to founding the firm, John served as Assistant to the Director of Health Care Financing Administration’s (HCFA, now CMS) Office of Managed Care, where he provided day-to-day management and served as the external liaison for the Medicare and Medicaid managed care programs. During the 1993 debate on national health care reform, John was chief lobbyist on health care financing issues for the National Association of Community Health Centers, an organization of federally-funded primary care clinics for the medically underserved. John’s career in Washington began as Press Secretary and Staff Director for U.S. Representative John Conyers, Jr. (D-MI), then Chairman of the Government Operations Committee. John serves on the Board of Directors of Henry Ford Health System’s Health Alliance Plan in his birthplace of Detroit, MI, and serves as a Senior Advisor to Premier, Inc., the hospital purchasing cooperative, on Medicare Advantage and Medicaid matters.

Nightingale Partners LLC 

Nightingale Partners LLC is a Qualified Opportunity Zone (OZ) fund and advisory firm that identifies, collaborates and invests in market-ready health care initiatives in OZs nationwide. NP focuses on designing evidence-based, targeted, non-clinical interventions addressing Social Determinants of Health (SDOH) for Medicaid and Medicare enrollees through creative partnerships with High-Net Worth Individuals, Institutional Investors, Government Agencies and Strategic Health Plans/Providers.

Resources, Links, and Related Episodes

Nightingale Partners

https://www.linkedin.com/company/nightingale-partners-ll

https://www.nightingalepartners.org/

John Gorman

https://www.linkedin.com/in/john-gorman-098b265

https://twitter.com/johngorman18?lang=en

March 27, 2020

Making Value-Based Care Work in Rural Health

Today’s episode is about how the Rural Risk-Free Solution helps rural hospitals and health systems take on risk faster to achieve value-based care. The methodology is a community / population health approach. By providing analytics on care metrics, nurse-led and team based care, and population health programs, you can improve outcomes for both communities and the hospitals. Today we have Lynn Barr here from Caravan Health to explain how it works. 

Highlights from A Rural Risk-Free Solution

  • The rural challenges of moving from cost-based reimbursement to value-based care.
  • How consolidation is putting rural clinics at risk.

We thought we were very high quality, we were the best. We were leading the country. And guess what happened? We reported our quality results. And we were the worst in the country. It was the first time we knew. Nobody had been gathering our data!

  • The Rural ACO Turn Around Story
  • The payment incentive system that is working against us.
  • Build a support system around your doctors.

It doesn’t really take much time to fix this stuff. We beat the national averages by 2015. This isn’t rocket science. It’s just a bunch of work and it’s hard to change.

  • The ACO numbers game.
  • BONUS: How will the COVID-19 pandemic effect ACOs?

Lynn Barr, Founder and Executive Chairwoman of Caravan Health

Lynn Barr is a recognized leader in the movement to transform and improve our nation’s healthcare systems. While working at a rural hospital as Chief Information Officer, Lynn organized the National Rural Accountable Care Consortium to overcome barriers for rural health providers so they could participate in innovative payment models under healthcare reform. In 2014 Caravan Health was formed to provide turn-key services to providers interested in population health programs in Practice Transformation Networks, Medicare and Commercial Accountable Care Organizations, MACRA, Comprehensive Primary Care, and other payment models.

As founder of Caravan Health, Ms. Barr has led the development and execution of nationwide programs that bring better care to patients and help health care providers achieve financial success. Caravan Health supports more than 13,000 primary care providers and 250 community hospitals making the transformation to value-based payments, with affordable, simple solutions that achieve outstanding results.

Ms. Barr is a popular speaker and a frequent collaborator with government and national organizations looking to improve our healthcare systems.

About Caravan Health

Caravan Health was started by a forward-looking group of community hospital CEOs and physicians who recognized early on the many challenges they would face transforming to a value-based payment model. They were attracted to the emphasis on the patient and the focus on improving overall community health through operational improvements, staff development, community engagement, regional collaboration, and the effective utilization of useful information based on never-before-available data.

Caravan Health is now a national leader of successful accountable care and population health programs for community health systems. Caravan helps physicians and hospitals work together to create, operate and manage successful population health programs that improve patient care, clinician satisfaction and financial performance.

Links and Resources

Check out my new podcast collaboration with The Infection Prevention Strategy (TIPS): https://deepdive.tips/

March 19, 2020

There Are No Drug Prices in the US w/ AJ Loiacono

Drugs are way too expensive. It has got to be from someone in the middle taking up all the money. Blame the pharmacy benefits managers! Right? Not so fast. If you're like me and have gotten derailed by complicated flow charts trying to understand PBMs in the past, this is the episode for you.

AJ Loiacono, CEO of Capital Rx, is a new PBM injecting some much-needed trust back into the system. By starting fresh and denouncing business as usual, AJ is giving control back to self-insured entities while looking after the community and specialty pharmacies that historically haven't had negotiating power. Don is joined by Shahid today and the tough questions are coming in hot! Enjoy!

Highlights

  • What do you mean by, "There are no drug prices in the US"?
  • The dangers of an inefficient market.
  • Does the PBM have an inherent conflict of interest?

If someone is being prescribed a $50,000 medication, my company makes $5. If someone's being prescribed a million dollar medication, my company makes $5. My competitor on a million dollar medication might make $200,000. That incentive is not aligned with both the patient care or the plan, and that's a problem. Personally, I think it should be completely against the law for any pharmacy benefit manager to be taking spread on drug and receiving payments from pharma industry.

  • The abandonment curve: When do groceries matter more than medications?
  • Capital RX is a clearinghouse, just like the New York Stock Exchange.

There's a price to everything. Words and definitions and things to fight about and exclusions and going through a hundred-page contract, that is an artfully constructed pitfall.

  • Proving value and building trust with EDI 835 and EDI 837.
  • Risk assessment and level-funded products.
  • An outcome-based rebate schedule.

Anthony J. Loiacono, CEO

A.J is a successful Entrepreneur and CEO of Capital Rx. He has over 20 years of experience in pharmacy benefits, finance, and software development. As the CEO of Capital Rx, his mission is to change the way pharmacy benefits are priced and administered in the US

Capital Rx

Capital Rx is redefining the way prescriptions are priced and administered in the U.S. Through its Clearinghouse ModelSM, Capital Rx unlocks the pharmacy supply chain and reduces prescription costs for employer groups.  By establishing a competitive marketplace for drug pricing, Capital Rx focuses its resources on deploying actionable strategies that improve plan performance and patient outcomes. The company’s commitment to innovation, technology, and service is why Capital Rx is the fastest-growing pharmacy benefit manager in America.

Links and Related Episodes

February 5, 2020

Interoperability 2.0 with Niko Skievaski

The interoperability promise of a shared, longitudinal medical record has so far focused on connecting health systems to each other. With the growing investment and constant new entrants of SDOH solution vendors, a new wave of interoperability challenges are becoming apparent. How does your health app connect to an EHR? Will new anti-data blocking legislation help or hurt SDOH startups? In this wide-ranging conversation, Don Lee and Shahid Shah talk with Niko Skievaski, President and Co-Founder of Redox, about his team’s solution to interoperability and why health information exchanges (HIEs) are only part of the answer.

Highlights

  • One API to link them all.
  • FHIR is a language, not an API.
  • Redox helps you scale your integration infrastructure without scaling your team.
  • Interop with Epic: Then and Now.
  • B2B relationship building through Interface Analysts.

HIEs are designed to facilitate the movement of data to follow a patient, Redox shares data between health systems and their business associates.

  • The competing interests between Value-Based Care and Consumerism.
  • Where is the government investing in health tech?
  • 2020 will be a big year for interoperability.
  • Implications of the Blue Button Breach.
  • Will the Cambridge Analytica problem come to Healthcare?
  • 21st Century bugs need a 21st Century solution.

Niko Skievaski. President and Co-Founder

As president and co-founder of Redox, Niko Skievaski leads his team in helping healthcare organizations fulfill the promise of digital health with an integration platform that securely and efficiently exchanges data. Prior to co-founding Redox in 2014, he worked at Epic, a multi-billion-dollar healthcare technology company. After Epic, he co-founded 100state, Wisconsin’s largest co-working community. He is also a board member at Prime Health, a Denver-based non-profit designed to accelerate the adoption of emerging healthcare technologies that address community and safety net needs. Niko has an MA degree in economics from Boston University and a BS degree in economics and international business from Arizona State University’s W.P. Carey School of Business. He lives in Boulder, Colorado with his collection of mountain bikes.

Redox

Redox accelerates the development and distribution of healthcare software solutions with a full-service integration platform to securely and efficiently exchange healthcare data. With just one connection, data can be transmitted across a growing network of 600+ healthcare delivery organizations and 250+ independent software vendors. Members of the Redox Network exchange more than 7 million patient records per day, leveraging a single data standard compatible with more than 40 electronic health record systems. Redox exists to make healthcare data useful and every patient experience a little bit better.

Links, Resources, and Related Episodes

LinkedInhttps://www.linkedin.com/in/skievaski/

Twitterhttps://twitter.com/niko_ski

Websitehttps://www.redoxengine.com/

The Redox Podcasthttps://www.redoxengine.com/blog/category/podcast/

Shahid Shah on The Redox Podcast

Trusted Exchange Framework and Common Agreement (TEFCA)

FHIR At Scale Taskforce (FAST) and the DaVinci Project

January 15, 2020

The #HCBiz Show!

The #HCBiz Show! is the podcast dedicated to unraveling the business of healthcare. We help innovators understand the endless list of conflicting priorities and incentives competing for their customer’s attention. Whether you’re launching a product, improving a workflow, or promoting a best practice, we’ll help you align your value proposition and message with the things healthcare leaders need right now.
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Team

Don Lee

Don Lee

Don helps organizations launch new Health IT products and services. He’s a product and business development consultant and accomplished Health IT expert with a 20-year track record of driving value with technology.

Don began his career as a custom software developer and eventually built and led a team of more than 30 engineers. Later, he was the subject matter expert, product manager and head of sales and marketing for a digital health startup that launched a SaaS-platform focused on administrative simplification in healthcare.

Today, Don is President of Glide Health IT, LLC, a consulting firm that helps forward-looking organizations align their Health IT and business strategies. The firm specializes in business and product development with a focus on data aggregation, interop, analytics, and quality measurement.

Don is a co-founder and partner at VBP Forward, an organization that’s building a bridge between community-based organizations and the healthcare system through educational content, workshops and conferences.
Shahid Shah

Shahid Shah

Shahid N. Shah is an internationally recognized and influential healthcare IT thought leader who is known as “The Healthcare IT Guy” across the Internet. He is a technology strategy consultant to many federal agencies and winner of Federal Computer Week’s coveted “Fed 100″ award given to IT experts that have made a big impact in the government. Shahid has architected and built multiple clinical solutions over his almost 24 year career.

He helped design and deploy the American Red Cross’s electronic health record solution across thousands of sites; he’s built several web-based EMRs now in use by hundreds of physicians; he’s designed large groupware and collaboration sites in use by thousands; and, as an ex-CTO for a billion dollar division of CardinalHealth he helped design advanced clinical interfaces for medical devices and hospitals. Shahid also serves as a senior technology strategy advisor to NIH’s and TATRC’s SBIR/STTR program helping small businesses commercialize their healthcare applications.

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