“Scientists Announce Successful Experiment to Bankrupt Mouse That Can’t Afford Cancer Drug.” That’s a recent  from The Onion, which is, by the way, a funny satire newspaper, if you haven’t heard of it. You could swap out “Cancer Drug” in that headline with “a Trip to the ER”—or pretty much any aspect of health care in this country. No matter what health care service you stick in there as the potential cause for a mouse’s bankruptcy, it’s a pretty LOL headline, right? But the reason why it became a headline is because obviously it’s based on a truth that resonates with your regular citizens in this country. Think about that. A critical mass of people around here believe that health care will bankrupt you. This is one of those sociological signals that has implications to health care leaders. Here’s another signal with implications. In this health care podcast, I’m interviewing the incomparable Marshall Allen. That’s not the signal. His book, , a book with that title being on the New York Times best seller list, is the signal. Marshall’s book is an instruction manual for patients on how to fight back against unfair and/or egregiously inaccurate bills.&nbsp; This interview with Marshall Allen is different from others that you may be hearing. Marshall wrote a book to motivate patients, a critical mass of patients, to get empowered relative to their health care bills. Because listeners of this show are health care executives, I wanted this interview to be relevant to you. What does this book mean for you? Doug Aldeen told me one time, unless something has a direct impact on the CEO or leadership team at a health system or insurance company, they’re just bored. Let me sum up this interview in one sentence: This is not boring. If you want to skip to the exact examples of “not boring,” you can skip ahead to about the 30-minute mark. We go through the ways that health systems can and probably will be hurt by the financial toxicity that they create. Here’s the three-ish ways that Marshall and I talk about:  Doctors who no longer trust their employers (ie, the health systems they work for) leave and then you have to recruit new doctors—#problematicandexpensiveonanumberoflevels, but I don’t need to tell you that. Reputational damage. When the slogan on the door becomes a joke, that’s a problem. Employers and taxpayers reading best-selling books like this one and  (which also is or was just recently on the best seller list) and learning how to not be basically passive suckers anymore.&nbsp;  You can find Marshall’s book, , anywhere that books are sold.   Marshall Allen investigates why we pay so much for health care in the United States and get so little in return. He is the author of the new book, Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win. He is also the founder of Allen Health Academy, which produces a curriculum of short on-demand videos to equip and empower employees to navigate the health care system. Marshall has investigated the health care industry for 15 years, including a decade at ProPublica. He has also spent a decade as an educator at the Craig Newmark Graduate School of Journalism at The City University of New York. His work has been honored with many journalism awards, including some of the top business reporting honors, the Harvard Kennedy School’s Goldsmith Prize for Investigative Reporting, and twice as a finalist for the Pulitzer Prize. Before he was in journalism, Marshall spent 5 years in full-time ministry, including 3 years in Nairobi, Kenya. He has a master’s degree in theology.&nbsp;  03:35 What’s the point of view that Marshall is coming from with his investigative reporting? 04:06 “How does this affect the people who are paying for it and the people who are undergoing the care?” 04:58 “There’s a lot of good people working within this very messed up system.” 05:12 Why are patients considered outsiders in...

EP328: An Interview Specifically for Health Care Executives, With Marshall Allen, Author of the Best Seller Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win

In a recent  in STAT news, TJ Parker, the VP of pharmacy at Amazon and the founder of PillPack, explained that Amazon’s plan to stand out in the pharmacy space is simple: “Better selection, better convenience, and better prices.” He added, “It really is the Amazon playbook.”&nbsp; Better selection, better convenience, better price. The playbook of arguably one of the most successful companies ever, Amazon has decimated and bankrupted anybody standing in its way toward total market dominance. This same better selection, better convenience, better price trio—maybe with “better selection” inferred to mean “getting the right care to the right patient at the right time”—is the vision of many of the virtual-first health care providers starting to pop up. And when I say “pop up,” I mean that in Q1 of this year, , $6.7 billion was invested in digital health companies.&nbsp; In this health care podcast, we’re talking about the proliferation of these “virtual-first” health care solutions. Before we begin, though, let me just clarify that in our conversation, virtual first doesn’t mean virtual only. Most of the time, actually, virtual first means that the connective tissue of the operation is virtual/digitized. In other words, we’re not just talking about some random mobile app here. There are likely human providers involved, and the goal is to offer patients not only a sticky engaging entry point and journey but then also a continuous longitudinal care experience. The patient journey should be clear, and the virtual-first solution is making sure that the patient isn’t getting lost somewhere in their journey from diagnosis to better outcomes. Here’s my main point: The big contrast between these newer virtual-first solutions and traditional health care enterprises is that humans involved in these virtual-first solutions are connected to each other and to their patients with technology designed for that purpose—as opposed to software and systems designed to maximize billing, which, sadly, many software tools and systems used in legacy health care were. The promise of these virtual-first solutions is to fill care gaps for patients who are currently having issues. It sometimes takes 10 years for people to get properly diagnosed. Care for chronic conditions is also abysmal in this country. Now, this all being said, much of the promise of these virtual-first, also called point solutions when someone is not a fan, has yet to be realized. Tune in to my interview with Al Lewis next week for more on that front. One area of concern is that if you have a point solution for MSK (musculoskeletal) care and a point solution for diabetes and a point solution for mental health, you wind up with silos. PCPs have complained that they don’t know what’s going on with some of these solutions, and it makes it harder to manage patients. Here’s my inadequate response to these two criticisms: Well, how many silos currently exist in the health care system? When a specialist gets ahold of a patient, do the specialists talk to one another much less the PCP if we’re talking about an average here? Sometimes patients have multiple PCPs even, who, I’m not exactly sure if they hold regular discussions. So, if the status quo is the benchmark to beat, then at least with some of these virtual-first silos, you have the patient getting longitudinal care within that silo. That’s not the case with many specialists who, at best, manage one episodic or a series of episodic visits. On the other hand, consider that $6.7 billion of investment. Some PE company there is looking for 4x on their investment, so $6.7 billion of PE investment means that they expect to get $28 billion out of health care spend, meaning $28 billion paid for by patients, employers, or taxpayers. On the other other hand, $28 billion is a drop in the bucket compared to the almost $3 trillion that this country spends annually on health care. I talk about...

EP329: Virtual-First Health Care Solutions—Their Promise and a Few Outstanding Questions, With Joe Connolly From Visana Health

In this health care podcast, I’m interviewing John Marchica, who is the CEO at Darwin Research Group. Starting last year in the middle of the worst of the COVID pandemic, Darwin Research Group conducted a study about what was going on at health systems or integrated delivery networks (IDNs), and they’ve updated it every quarter since then. The goal was to try to stay on top of the effects of COVID-19 on care management and the business of care delivery. I loved having this opportunity to quiz John about what health systems are saying about how they are doing and what they are doing, both strategically and reactively, coming out of the pandemic and in response to the pandemic. Now this is a half-hour conversation about an extensive research report, so we’re kind of aggregating all of the health systems in one big bucket. Said another way, we’re obviously not going to play the deep cuts here. No worries—the insights that John lays out are fascinating and give an insider’s look into what’s going on at these really powerful institutions. By the way, when I say powerful institutions, I just was looking at some stats the other day. Something like 50% of all prescriptions these days run through IDNs (that was in 2020). And also in 2020, aggregate IDN market size was $1 trillion. And by 2027, their anticipated combined revenues may exceed $2 trillion. That’s double. (I know, that was some quick math by me. You’re welcome.) We’ll see, though, what the recent Executive Order yields—the one to look into the market power that some of these consolidated IDNs wield. Regardless of who you are, it is tough to deny the mountain of evidence showing that IDN health system consolidation considerably jacks up prices that patients, employers, and taxpayers pay in any geography where consolidated IDNs, otherwise known as monopolies, have destroyed all competition. Probably the most striking takeaway I had from this conversation was how much there is to read between the lines. At the end of the day, IDNs are, and are run, like businesses; and regardless of whether they have a nonprofit on the door or not, that is still true. Before I get into this, let me just clearly say that my heart goes out to the frontline workers—doctors, nurses, everybody else—and all they have done and continue to do for us, and I mean that with three underlines. While I really admire and support some of the rural and urban truly safety net hospitals who are trying to cobble together positive net revenue against all odds, I am far less sympathetic to some of the huge institutions who will engineer an “it’s good for patients, honestly” cover story for any and all endeavors which all seem to have one thing in common: their profitability. Like, nobody mentioned 340B revenue opportunities or how much money there is in specialty pharmacy when explaining the rationale for standing up specialty pharmacies within some health systems’ walls. Maybe it goes without saying. Here’s my conversation with John Marchica, CEO of Darwin Research Group and host of the  podcast, by the way. You should check that out. You can learn more at  or by emailing John at . You can also listen to the podcast  wherever you listen to podcasts.   John Marchica is a veteran health care strategist and CEO of Darwin Research Group, a health care market intelligence firm specializing in health care delivery systems. He’s a two-time health care entrepreneur, and his first company, FaxWatch, was listed twice on the Inc. 500 list of fastest-growing American companies. John is the author of The Accountable Organization and has advised senior management on strategy and organizational change for more than a decade. John did his undergraduate work in economics at Knox College, has an MBA and MA in public policy from the University of Chicago, and completed his PhD coursework at The Dartmouth Institute. He is a faculty associate in the WP Carey School of Business and the College...

EP330: What Is Going On Over at Health Systems? With John Marchica, CEO at Darwin Research Group

My guest in this health care podcast, Al Lewis, was telling me before we hit record that employer customers are vastly worse at evaluating wellness and point-solution vendors today than they ever have been in the past. Let’s break this down. One aspect leading up to the “worse than ever” is the proliferation of point-solutions lately and all the PE (private equity) dollars flowing into the health care space. You pick up any rock and you’ll find 25 health care startups underneath it. A second aspect is this: and this is not going to be a newsflash for many, but employers really trust their brokers and their EBCs (employee benefit consultants) to put together a good benefit package on their behalf. If an EBC says, “buy it,” employers click their heels and buy it a lot of times. And with that great power comes great... opportunity. We see an uptick in brokers and employee benefit consultants, enjoying themselves a little arbitrage-ish money grab by taking money from these startups/vendors under a variety of umbrellas while at the same time they call the employers their customers. This is especially profitable and also slimy when done under the cover of darkness because, as with so many aspects of health care, these backroom deals often happen without the employer customer knowing that there’s a vig involved in the recommendation process. Al Lewis says he works in the “Integrity Segment” of the market. He is well known for outing vendors for basically lies they tell in their marketing. The thing is though, if a vendor comes to Al and asks questions about how to do it right, Al is always happy to help. He has said that he wants people to learn and if you’re asking questions, it means you’re interested in learning. Al has been on the show before, actually multiple times, but one full episode was , and we dig into wellness that’s done “to” employees, not “for” them in that episode. So, check that out after you listen to this one, if you want more Al. Al also founded the Validation Institute and he’s also CEO over at Quizzify. On the show in this health care podcast, Al explains the six major logical fallacies, computational flaws, tricks, if you will, that wellness vendors or point-solution vendors may deploy to inflate their “proven cost savings.” The six “watch outs” I’d guess I say for employers are:  Regression to the mean Participants vs nonparticipants or matched controls or propensity scoring The trend inflation trick Plausibility testing Actuaries and validation Overstating engagement  These six things are all of the different logical fallacies some vendors employ in order to overstate their results or outcomes. The Validation Institute has a PDF write up of each of these flaws which you can find in the show notes. Bottom line? Buyer Beware. And, also, get a broker or an EBC who you know for a fact they’re working for you if you’re an employer because they’ve committed in writing to not taking payola from the vendors that they’re recommending to you. One footnote is that if you haven’t listened to  with Joe Connolly you might want to go back and do so. Joe gets into the trend of some services who could, potentially, start taking on risk. Said another way, if services like these create their own bundles of point solutions and take on the risk of offering said bundle to employers, that could be nice. You can learn more at the . You can connect with Al by emailing , visiting the website at , on , or on Twitter at  and .&nbsp;   Al Lewis wears multiple hats, both professionally and also to cover his bald spot. Hat #1: Employee Health Literacy. He is the founder and “quizmeister-in-chief” of , whose mission is to help companies teach their employees to utilize health care services appropriately, using a format best described as “Jeopardy meets Choosing Wisely meets Comedy Central.” Quizzify is the only vendor authorized to display the Harvard Medical School...

EP331: Employers Buyer Beware! Six Tricks Wellness and Point-solution Vendors Use to Overstate Their Results, With Al Lewis, Cofounder and CEO of Quizzify

In most other industries, it’s the customer who consumes the services and engages with the purveyor of services. In health care, not so much. Legacy health care has evolved to honor the insurance carrier as the customer or, in some cases, the fancy surgeon or other driver of revenue as the customer. Listen to the podcast with  for more on that front, but yeah. And here we are.&nbsp; Health care should be designed so that patients get the best outcomes at a financially not-toxic price point. Otherwise, what are we doing here besides putting profit over patients? In this health care podcast, the conversation is about PCVS, otherwise known as creating a “patient-centered value system,” otherwise known as building a new OS, or operating system, for health care—one that is built around the patient and their experience. The general idea here is to rationalize the patient journey from start to finish: to create a longitudinal flow that guides a patient from here to where they need to be with a minimum of being told you need a follow-up appointment but having no idea with whom or how that’s supposed to happen and when, or getting discharged with no instructions, etc. So, PCVS … let’s talk about this, how this works, real quick before we dive in with Dr. DiGioia. In a nutshell, the first step is to really, really carefully trace the patient journey from beginning—really the very, very beginning of the experience, which might start in the parking lot or with the first digital interaction or at the PCP referral—to the very last interaction, which might be after discharge from the SNF (skilled nursing facility) after their last follow-up appointment. It’s figuring out what matters to the patient at each step in that journey and then documenting that flow map. Then the next step is to compare the current patient journey, the current state, to what the team decides is the ideal patient journey. Then the last task, which may be obvious, is to implement—for implementation teams to devise and implement action plans to get from here to there. Here’s an interesting point to ponder: We often talk about fragmentation and interoperability, and when I said these words, your brain immediately snapped to technology fragmentation and interoperability. But bear this in mind: The patient is the only commonality between all the settings of care that are using all those varied technologies. When you rationalize the patient journey, you also, to some extent, create the foundation to integrate technology. Why a PCVS process, you might ask, if you’re in charge of the P&amp;L and regard patient centeredness as a nice to have if there’s extra cash lying around? Here’s why: If you’re going to successfully roll out a prospective bundle, for example, to employers, you better have gone through a PCVS process. Other things, too, but being intimately aware of the patient journey and where patients fall through the cracks or get disgruntled can easily spell the difference between bundle success and failure. This is probably also true for really almost any sort of risk-based/capitation arrangement. It’s probably also true for great customer satisfaction scores. It’s probably also going to become increasingly true when competing against some of these virtual-first operations that may have been built from the ground up to be sticky and engaging for patients, as well as guide them through a longitudinal journey. For more on the WIIFM (the “what’s in it for me?”) if you are a provider organization and are thinking about patient-centered care, listen to one of our most popular episodes over here at Relentless Health Value—the one with , from PCORI—on this topic. In this health care podcast, I’m talking with Tony DiGioia, MD, about PCVS (patient-centered value systems). Dr. DiGioia is a practicing orthopedic surgeon at the Bone and Joint Center over at UPMC Magee-Womens Hospital and also the medical director of the UPMC...

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