Ep 39 – Overcoming Self-Interest to Build a Social Compact for Health and Equity, with David Smith

What this episode covers

Achieving health value demands the formation of a new social construct, one that puts aside self-interest and builds systems of care for the common good. One that prioritizes health and equity for all, including the underserved and most vulnerable among us. This effort requires stronger leaders and better leadership than ever before. Getting Medicaid right, transforming addiction and substance use disorder treatment, reframing behavioral health, and removing silos – these are a few of the efforts of this week’s guest as his work exemplifies the mission of achieving health as the seminal American institution to drive social connectedness and economic prosperity. Our guest is David Smith, CEO and founder of Third Horizon Strategies (THS), a Chicago-based, boutique advisory firm focused on maximizing human potential through a better health system. David serves on the Health Care Council of Chicago, the Alliance for Addiction Payment Reform, the board of the Sinai Hospital System, the Founder’s Council of United States of Care and as a Senior Advisor at AVIA and a Project Executive for their Medicaid Transformation Project. 04:55 Facts on Medicaid: 75 million Americans covered (1 in 5 Americans), 50% of US births, $600B annual spend 05:40 Medicaid beneficiaries may even approach 100M in the next five years 06:00 Background on the Medicaid Transformation Project (MTP) 08:00 “The Medicaid program is the single most important endeavor in our country, PERIOD. And that’s not just in healthcare, I’m talking about in total.” 09:00 Health is required to serve in the function in the full human capacity. 09:45 The neglect of the Medicaid program over the years and why we need to get it right to improve health in underserved communities 10:18 “Getting Medicaid right improves health, and improving health creates economic development.” 10:30 Disparities in public health are drawn across racial lines 11:00 Transformation Factor #1:  Evolution of payment models and realignment of incentives 11:45 Transformation Factor #2:  An evidence-based approach to Care Model research and implementation 12:15 Transformation Factor #3: Leveraging technology innovation for underserving communities 12:40 Transformation Factor #4: Social impact investments to fuel innovation 13:00 Transformation Factor #5: Social determinants of health 13:30 Transformation Factor #6: Growth in Medicaid enrollment requiring scalable solutions 14:10 Lack of government boldness, states not moving fast enough, MCOs not eager to develop new payment models 14:40 Partnering with health systems in the MTP to look for disruptive solutions that with financial self-sustainability 16:40 Facts about Substance Use Disorder (SUD): 23.4 million Americans affected, 81,000 drug overdose deaths per year, 1 in 5 Medicaid beneficiaries, 46% of the total Medicaid spending 18:40 David shares how he has personally been impacted by drug overdose through the loss of his father, brother, and sister 21:25 The role of Big Pharma in creating the opioid problem and how Addiction (the “dopamine rush”) is the #1 most common human failing 23:00 How the system of care is setup to treat patients with SUD as “bad people” 23:35 “If we think our fee-for-service system is bad for our physical health, it is a dumpster fire for people who struggle with addiction.” 24:15 The total cost of care for a patient with high acuity SUD is $31-32k per year, and how that creates a $17k value gap. 25:20 “There is no “cure” for Substance Use Disorder; there is only reducing a person’s risk to a baseline.” 25:50 The Value Gap due to waste and inefficiency in the ...