Moving to Value Unscripted

In Ohio's rural Ashtabula County, employers and patients struggled with rising costs and accessing services until a community coalition built a localized healthcare ecosystem. The results? A transparent financial structure that cuts out middlemen, direct primary care and community contracting, zero-dollar copays for many services and improved trust, satisfaction and population health outcomes.Bryce Heinbaugh, the man behind this coalition, joins us to discuss the transformative power of community owned health plans, and how his work in Ashtabula provides a roadmap for communities around the country to reclaim control from national insurance giants.Find the transcript of this episode at movingtovalue.org/transcript/heinbaughMentioned in this episode: our May 2024 episode with Dr. Scott Conard, our June 2025 episode with Darrell Moon, our November 2025 episode with April Kyle and Dr. Doug Eby of Southcentral Foundation's Nuka system.________Sign up for our email list.Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/membership.

ER visits account for roughly six percent of health plan spend, with costs rising faster than almost any other hospital service. Why is ER spending is spiraling out of control? And what should we do about it?Al Lewis, founder of The Validation Institute and the gamified health literacy platform Quizzify, has built a career exposing the financial sleights-of-hand many healthcare programs use to drain employer budgets.Lewis joins us to break down how hospitals have transformed federal mandates like the Emergency Medical Treatment and Labor Act (EMTALA) into high-margin profit centers through aggressive pricing and "up-coding" tactics. Lewis also shares strategies for individuals and employers to challenge the lack of transparency that often characterizes emergency department charges.Find the transcript of this episode at movingtovalue.org/transcript/lewis________Sign up for our email list.Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/membership.

Tired of muddled pitches, point solution fatigue and hours of endless meetings? You're not the only one. Chris Fisher is on a mission to fix one of the biggest bottlenecks in the employee benefits industry — the noise. As the founder of BenefitsAlly, Fisher created the 3x3x3 Challenge, which asks vendors to explain what they do, how they’re different and who they’re for in three minutes.This format levels the playing field for vendors while giving brokers, consultants and business leaders a faster, clearer way to evaluate new ideas.Fisher joins us to discuss the virtues of radical brevity.________Sign up for our email list.Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/membership.

The American healthcare system is facing market failure driven by consolidation by industry profiteers. Perhaps no one has a clearer view of how this took place — and what to do about it — than Wendell Potter.Called ‘the ideal whistleblower’ by Time magazine, Potter was a senior executive at insurance giants like Humana and Cigna until a crisis of conscience in 2008.As the Editor-In-Chief of the HEALTH CARE un-covered newsletter, President of the Center for Health and Democracy and bestselling author of Deadly Spin and Nation on the Take, Potter has since dedicated his career to exposing the tactics insurers use to prioritize shareholder returns over patient outcomes.He joins us to discuss the strategies employers, clinicians, policymakers and patients can implement to reclaim a system built on actual value.Find the transcript of this episode at movingtovalue.org/transcript/potter________Sign up for our email list.Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/membership.

"We could probably think of dozens of brilliant ideas on this very podcast to improve healthcare," says AJ Loiacono, Co-Founder & CEO of Judi Health. "Good luck implementing any of them on our aging infrastructure."Loiacono founded Capital Rx, transforming the pharmacy benefit manager (PBM) industry by introducing a transparent, flat-fee model. Now, that mission has evolved into something even more ambitious.With the launch of Judi Health, Loiacono and his team are tackling the trillion dollar problem of administrative waste in healthcare. They’ve built the industry’s first unified claims processing platform, a system that puts medical, pharmacy, dental and vision claims onto a single ledger.Modernizing healthcare's technology infrastructure, Loiacono believes, will empower solutions that improve value for patients.Find the transcript of this episode at movingtovalue.org/transcript/loiacono________Sign up for our email list.Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/membership.

"Now is the time to strike when the iron is hot. People need healthcare."Join us in the halls of the Connecticut General Assembly, where lawmakers are considering a bill to authorize Association Health Plans in the state. This would let small employers pool risk and receive health insurance as one group, boosting their power to negotiate better value for employees.Grace Brangwynne, Policy Director for Healthcare, Insurance and Housing at the Connecticut Business and Industry Association, describes the "breaking point" of double-digit premium hikes facing small employers across the state. She talks us through the guardrails built into the current Association Health Plan proposal, the tension between market innovation and state regulation and why the survival of Connecticut’s mom-and-pop shops depends on a fundamental shift in healthcare purchasing.Find the transcript of this episode at movingtovalue.org/transcript/brangwynne________Sign up for our email list.Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/membership.

Why do savvy business leaders track every penny of office spend but ignore the "black box" of what's often their second-largest expense? With renowned healthcare advisor Ann Lewandowski, we dive into the systemic blind spots that make it difficult for even the most sophisticated plan sponsors to manage healthcare with the same fiduciary rigor they apply to other parts of their business. Lewandowski breaks down how to navigate the Consolidated Appropriations Act (CAA) as a North Star for transparency, the hidden pitfalls of high-deductible plans and how to build a 21st-century healthcare system with trust, accountability and patient-centered care at the core.Find the transcript of this episode at movingtovalue.org/transcript/lewandowski________Sign up for our email list.Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/membership.

From the ball park to the operating room, Michael LaFauci spots solutions with an innovator's eye. The idea for his current venture, Midas Healthcare Solutions, began with a lint roller.LaFauci discusses the "innovator’s DNA" that led him from pharmacy assistant to serial entrepreneur. He developed technology that allowed sports fans to order refreshments from their seats. He created a device to prevent fetal lacerations during C-sections. Now, his team's MidasVIEW system is increasing transparency and safety in drug diversion within health systems, integrating digital connectivity, 360-degree cameras and artificial intelligence to create a verifiable chain of custody and make medication disposal feel cool.Beyond the technology, LaFauci touches on the grit required for innovation — the blood, sweat and tears of a years-long journey from a lint roller prototype to a commercialized pilot, as well as the courage to "fall forward" and trust his vision.________Sign up for our email list.Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/membership.

Are we approaching the "401(k) moment" of health insurance? We're joined by Chris Ellis, co-founder and CEO of Thatch, a platform that helps employers offer personalized healthcare experiences to employees using Individual Coverage Health Reimbursement Arrangements (ICHRAs) .Ellis explains how his team of fintech veterans is leveraging ICHRAs to decouple benefits from the employer-chosen model, allowing employees to use tax-free stipends to purchase plans that fit their lives. By making coverage personal rather than corporate, Thatch is shifting the industry's focus from short-term ROI to long-term prevention and healthcare portability.When individuals have the power to choose, Ellis notes, local health systems can finally compete on quality and efficiency through curated care pathways, finally creating a substrate for the high-value, cost-effective healthcare outcomes the industry has long promised.________Sign up for our email list.Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/membership.

What does healthcare look like when a community-centered approach takes the lead? New York State Assembly Member Chantel Jackson, a licensed social worker representing New York’s 79th District, joins us to discuss increasing access to and trust in healthcare services.With a background in New York City public schools, Assembly Member Jackson brings a unique, holistic perspective to the legislature, recognizing that health is inextricably linked to social and emotional well-being. She advocates for an "all of the above" approach to reform, addressing everything from noise pollution to neighborhood safety to food insecurity to financial literacy.Together, we unpack the stark realities of health disparities in the Bronx and around the country, and discuss how legislators and industry leaders can create meaningful change.________Sign up for our email list.Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/membership.

Healthcare is the second or third largest expense of most employers. As costs continue to rise, hidden incentives, legacy brokerage models and lack of transparency keep employers stuck in the same expensive cycle.Donovan Pyle, CEO of Health Compass Consulting, offers a sharp diagnosis of the barriers employers face in reforming this system, as well as the strategies employers can put in play to get more value from their healthcare spending.Drawing on insights from his new book, Fixing Healthcare: How Executives Can Save Their People, Their Business, and the Economy, Donovan maps out what it takes to flip the script: building a value-driven benefits strategy, eliminating waste and improving outcomes.Join us for a candid, practical conversation on how employers can drive real change in healthcare.———————————— Find all episodes of Moving to Value Unscripted here⁠⁠. | Sign up for our email list here.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. Get involved at movingtovalue.org/membership.  

Rural healthcare is in crisis, and few people understand the stakes better than the National Rural Health Association’s Brock Slabach. In this episode, Slabach cuts through the noise to explain why many rural hospitals are struggling and where real solutions are taking shape.He breaks down the core pressures facing rural providers — thin margins, stretched workforce, volatile policy — and makes a compelling case for why value-based care isn’t optional anymore. Slabach highlights the programs that are moving the needle, the partnerships that matter and the operational shifts leaders can make now to help their organizations thrive.The conversation also surfaces a bigger truth — rural health isn’t a side issue. It’s a systemwide warning sign. Join us as we pull rural healthcare from the margins into the center of the value based care conversation.————————————Find all episodes of Moving to Value Unscripted here⁠⁠. | Sign up for our email list here.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 movingtovalue.org/membership.  

This is part two of our Health Systems at a Crossroads webinar. Click here to catch part one, or find it earlier in our podcast feed.Join us as we discuss a vision for value-based care and practical steps to challenge the status quo. With special guests:Mark Gwynne, Chief Value Officer, UNC HealthJeffrey Hogan, President, Upside Health AdvisorsBlair Childs, President and CEO, Childs Associates LLCModerated by Marion Couch, IntoValue Inc. Co-Founder and CEO, Guidehealth Executive Advisory Board Chair and CMO and Duke University School of Medicine Adjunct Professor.————————————All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠. | Sign up for our email list here.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: https://www.movingtovalue.org/membership.  

This is part one of our Health Systems at a Crossroads webinar. Part two will take place on Friday, November 14 at 12 ET. Click here to register.Join us as we survey the structural, financial and cultural forces shaping hospital behavior. Our expert guests unpack where hospitals truly make money, how consolidation impacts access and what stands in the way of a systemic shift toward value-based care. With featured speakers:Erin Hurlburt, Chief Medical Officer, Population Health Services, LumerisChris Deacon, Author and Founder, Versan ConsultingGe Bai, Professor of Accounting, Johns Hopkins Carey Business School and Professor of Health Policy and Management, Johns Hopkins Bloomberg School of Public HealthModerated by John Rodis, Moving to Value Alliance President and Arista Health LLC Founder and President.Join us on Friday, November 14 at 12 ET for part two of our Health Systems at a Crossroads webinar, when we'll dig deeper into how health systems can work toward creating high-value care models. Click here to register.————————————All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠. | Sign up for our email list here.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: https://www.movingtovalue.org/membership.  

This is part two of a two-part episode. Click here to catch part one, or find it in our podcast feed.What would healthcare look like if it were truly built around the people it serves? In this episode, we take a closer look at Alaska’s Southcentral Foundation and its internationally acclaimed Nuka System of Care — a model that has redefined what value-based care can mean when relationships, trust and community ownership are at the center.Joining us are April Kyle, President and CEO of Southcentral Foundation, and Dr. Doug Eby, the system’s founding medical director and one of Nuka’s chief architects. Together, we explore how an Alaska Native–owned health system transformed itself from a federal bureaucracy into one of the world’s most respected models of integrated, relationship-based care. April and Doug share the principles and practices that have led to dramatically improved outcomes and high patient and employee satisfaction at significantly lower costs.Through the story of Nuka, we consider what’s possible when healthcare shifts from doing things to patients to partnering with people — and how lessons from Alaska might chart a course toward more human, more effective value-based systems around the country (and the world).————————————Don't miss our upcoming 'Health Systems at a Crossroads' webinar series, which will take place Friday, November 7 and Friday, November 14 at 12 p.m. ET. Click here to register.————————————All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠. | Sign up for our email list here.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: https://www.movingtovalue.org/membership. 

What would healthcare look like if it were truly built around the people it serves? In this episode, we take a closer look at Alaska’s Southcentral Foundation and its internationally acclaimed Nuka System of Care — a model that has redefined what value-based care can mean when relationships, trust and community ownership are at the center.Joining us are April Kyle, President and CEO of Southcentral Foundation, and Dr. Doug Eby, the system’s founding medical director and one of Nuka’s chief architects. Together, we explore how an Alaska Native–owned health system transformed itself from a federal bureaucracy into one of the world’s most respected models of integrated, relationship-based care. April and Doug share the principles and practices that have led to dramatically improved outcomes and high patient and employee satisfaction at significantly lower costs.Through the story of Nuka, we consider what’s possible when healthcare shifts from doing things to patients to partnering with people — and how lessons from Alaska might chart a course toward more human, more effective value-based systems around the country (and the world).This is part one of a two-part episode. Click here to catch part two, or find it in our podcast feed.————————————Don't miss our upcoming 'Health Systems at a Crossroads' webinar series, which will take place Friday, November 7 and Friday, November 14 at 12 p.m. ET. Click here to register.————————————All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠. | Sign up for our email list here.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: https://www.movingtovalue.org/membership.  

Convenience, flexibility, value. Subscription-based models could disrupt the paradigm of accessing (and paying for) healthcare. But can they build buy-in and consumer trust? We discuss with special guest Christina Farr.As a health tech investor, general partner at Scrub Capital and author of the industry-leading Second Opinion newsletter, Christina offers her perspective on how business model innovation can drive real value in healthcare.We touch on her recent piece, "Subscription-based healthcare just got a big tailwind," which examines how emerging policy and payment reforms could be a leg up for membership-based and direct care models, and what that might mean for employers and innovators pursuing value-based care.Join our conversation about how the next generation of healthcare leaders can think differently about impact, incentives, and the real meaning of value.————————————All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠. | Sign up for our email list here.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: https://www.movingtovalue.org/membership.  

Surgeons getting sticker shock? MTVA discusses transparency in health system spending and optimizing for better long-term patient outcomes with special guest Derek Haas.Derek is the CEO and founder of Avant-garde Health, which provides surgeons, health systems, and ASCs with comprehensive insight into their surgical care and empowers them to improve their profitability and care quality. "We help health systems and physicians understand the opportunities to deliver their care with the same or higher quality but in a more financially-optimal fashion."Avant-garde's work has been featured on the front page of The Wall Street Journal. Derek has co-authored twelve Harvard Business Review articles, as well as articles in NEJM and JAMA. He holds a BA and MBA from Harvard.Our conversation with Derek is particularly timely as hospitals and health systems navigate how changes in federal policy will impact their business models. ————————————All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠. | Sign up for our email list here.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: https://www.movingtovalue.org/membership.  

Are your bags packed for Denver? Gear up for RosettaFest 2025 by listening to this conversation between MTVA and Dave Chase! If you don’t yet know the pioneering disruptor Dave Chase, he’s on a mission to restore hope, health and economic prosperity to communities through healthcare transformation.Dave is a Co-Founder and CEO of Health Rosetta, a blueprint for high-performing health benefits using simple, practical fixes. Health Rosetta helps employers and unions provide better care for their members, while reducing benefits spending by 20-40%. We discuss driving transformation within our multibillion dollar healthcare industry, navigating political headwinds, and scaling healthcare fixes from the local level with Health Rosetta. “Healthcare was systematically extracting wealth from communities and families, all while delivering mediocre outcomes. And honestly it’s the largest wealth transfer in American history, from the working and middle class – who’ve had 30 years of wage gain stolen – to Wall Street and their water carriers. That was the cold hard truth that I found.” Watch Dave’s TEDxTalk or read his books: The CEO’s Guide to Restoring the American Dream, Opioid Crisis Wake-up Call, and Relocalizing HealthFurther Listening from MTVA Unscripted:Employer Series - Part 1: The Critical Importance of Getting and Owning Your Claims DataWhat Employers Need To Do Now to Comply With CAA by End of Year : MTVA Talks to Chris DeaconFrom ERISA to CAA: How Has Employer’s Fiduciary Responsibility Changed Over Time?“YOU Are the Customer”: Fixing Healthcare from the CEO’s Desk w/ Darrell MoonOther Sources Referenced:Dr. Michael Fine’s book On Medicine as Colonialism Nautilus Health Institute SoNE Health's Crushing Healthcare “Healthcare is Local” ————————————All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠. | Sign up for our email list here.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: https://www.movingtovalue.org/membership.  

“The only thing that actually reduces mortality and morbidity in primary care is a long-term relationship with a PCP.”In this conversation, MTVA explores the fast-growing movement of direct primary care (DPC) with special guest Peter Lazzopina, MD - Founder of Frontier Direct Care in Texas. Based in the Rio Grande Valley, Frontier has grown organically from a single-man operation to a thriving network that’s redefining access, cost, and outcomes.Dr. Lazzopina describes how relationship-based medicine works better for patients, employers and providers. The model keeps physician panel sizes small, visits long, and incentives fully aligned—resulting in high provider morale, better health outcomes, and big savings for employers.By partnering with Frontier, the city of McAllen, TX reduced ER visits by 74% in just one year. In two years, Frontier saved the city $8 million! Dr. Lazzopina and Frontier are proving that DPC can help solve our primary care crisis! This is a grassroots movement with real momentum—and one that can’t be ignored!NOTE: Frontier Direct Care has a business relationship with MTVA Board Member Dr. Steve Schutzer’s company Upswing Health. This episode is NOT sponsored by Upswing nor Frontier. ————————————All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠. | Sign up for our email list here.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: https://www.movingtovalue.org/membership. 

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 is Chair 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) 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 and staff retention.In this episode, Dr. Bozic discusses:Why “health care” should always be 2 words—and what that distinction meansThe power of making health our North StarWhy value must be measured by patient-reported health outcomesWhat it takes to shift culture in medicine—and how he built a new model from scratchHow turf wars and rigid incentives are holding us back—and what we can do about itHe 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. Sources Referenced:“Who Killed Health Care? America's $2 Trillion Medical Problem—and the Consumer-Driven Cure” (2007) by Regina HerzlingerRedefining Health Care: Creating Value-Based Competition on Results (2006) by Michael Porter and Elizabeth Teisberg“The Innovator's Prescription: A Disruptive Solution for Health Care” (2009) by Clayton Christensen, Jerome Grossman, MD, and Jason Hwang, MDInstitute for Strategy and Competitiveness at Harvard Business School UT Health Austin’s Musculoskeletal Institute————————————All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠. | Sign up for our email list here.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.

“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, is on a mission to mobilize these decision makers.Darrell is the CEO and Founder of Orriant and Aspirational Healthcare. 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 System of Care in Alaska and Deming’s principles – and coaching executives on how they can too!His recent book “Make Healthcare Work for You” 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​Wake-up Call: The Johnson & Johnson Prescription Pricing Scandal​From ERISA to CAA: How Has Employer’s Fiduciary Responsibility Changed Over Time?​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​Retail Health Failures: Misaligned Incentives and Misunderstanding Primary Care w/ Brian KlepperOther Sources Referenced:​Scott Conard, MD blog post re Health Literacy ​Dr. Marty Makary’s book Blind Spots  ————————————All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠. | Sign up for our email list here.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: 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 – Founder and CEO of Zest Health and one of Slice of Healthcare’s “50 under 50" 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. Listen to our episode 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"Biosimilars in the United States 2023–2027,” IQVIA (Jan. 31, 2023).————————————All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠. | Sign up for our email list here.Thank you to the MTVA Trade Members and Ally Members 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. 

“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 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, MDhttps://pubmed.ncbi.nlm.nih.gov/35029652/ VBC Venn Diagram from Mary Mock————————————All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠. | Sign up for our email list here.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: 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. There’s a better way: eConsults.In this episode, MTVA sits down with Dr. Daren Anderson, the President and Founder of ConferMED, 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, 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.Studies on eConsults referenced by Dr. Anderson:https://www.mathematica.org/news/econsults-can-lower-costs-and-improve-access-to-specialty-carehttps://pubmed.ncbi.nlm.nih.gov/26951588/https://pubmed.ncbi.nlm.nih.gov/30633678/https://pubmed.ncbi.nlm.nih.gov/29350511/http://pubmed.ncbi.nlm.nih.gov/33719584/https://pubmed.ncbi.nlm.nih.gov/29061478/https://pubmed.ncbi.nlm.nih.gov/37753619/https://pubmed.ncbi.nlm.nih.gov/37864170/————————————All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠. | Sign up for our email list here.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: https://www.movingtovalue.org/membership.  

We’re just a couple months into the second Trump administration, and already we’re seeing a massive push to reduce federal spending. One program that seems to be on the chopping block: Medicaid. In late February, House Republicans passed a budget resolution that would drastically reduce federal funding for Medicaid. What’s really going on in Washington? How would proposed cuts impact states – and the millions of Americans who are covered by Medicaid? How can we harness this attention on Medicaid to advance solutions that cut costs AND improve outcomes? In this episode, Stephanie Noriea joins MTVA to help us make sense of the current situation with Medicaid. Stephanie is an attorney and Managing Director at Mercury LLC who has spent the past 9 years working at the intersection of Medicaid and value-based care. She shares her experience working with startups to bring innovative solutions to Medicaid, breaking down how to navigate the complex landscape and enact meaningful change. “I have never met a single legislator or governor who says ‘I hate medicaid.’ That’s not what I hear. What I hear is how do we effectuate change? How do we do this better? How do we engage better? And they don't know. And it’s up to us, the practitioners on the ground, the thought leaders, etc to bring these solutions.”MTVA and Stephanie agree: NOW is the time to bring value-based solutions to Medicaid! It is possible to generate cost savings while simultaneously improving access and quality of care. Tune in to learn what’s on the horizon for Medicaid, and how we can leverage ideas from the value movement to help transform the program! ————————————Sign up for our email list here.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. 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 https://www.movingtovalue.org/membership.  All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

Managing chronic diseases like diabetes and hypertension is one of the most pressing challenges facing our health system. And Dr. Bill Bestermann has a solution: Optimal Medical Therapy. Optimal Medical Therapy is a comprehensive, evidence-based approach with the power to prevent adverse events, improve patient outcomes, and dramatically reduce healthcare costs. A board-certified internist and expert in preventive cardiology, Dr. Bestermann has been singing the praises of Optimal Medical Therapy for decades. In this episode, Dr. Bestermann and the MTVA Board discuss what Optimal Medical Therapy is, the data supporting its effectiveness, and how a “high-tech, high-touch” system can ensure more patients receive the care they need.“Optimal medical therapy is a product. And if you set up your systems to produce that product, you do much better.” Dr. Bestermann writes extensively about Optimal Medical Therapy on his substack. He is also Chief Medical Officer of Epigenex Health and Chief Medical Advisor for Congruity Health. References:Read the article “How Our Current Medical Care System Fails People With Diabetes” View the CDC’s map of heart disease mortality by state, showing Minnesota has the lowest rateFor more on GLP-1s, listen to our episode with Al Lewis and our episode with Sloan Saunders. Check out our episode with Dr. Scott Conard about his WHY? ————————————Sign up for our email list here. 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. 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 https://www.movingtovalue.org/membership.  All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

“I’d like to leave an infrastructure behind that is better than the one I encountered when I came in, because we're stifling innovation, we're stifling creativity, we’re stifling advance.”How can decentralization and transparent pricing reshape American healthcare? In this episode of Moving to Value, the MTVA Board sits down with Steve Wiggins, a healthcare entrepreneur with 40 years of experience at the intersection of healthcare and technology. Steve has founded and led multiple companies driving innovations in payment models and care management—and today, he’s on a mission to transform the system with his latest ventures: Oxbridge Health and OpenNetworks.Steve’s involvement in healthcare began in college, when his best friend suffered a life-changing injury that left him paralyzed. Since then, he has dedicated his career to creating solutions that improve access, affordability, and outcomes. Steve shares how innovative plan designs and payment models based on episodes of care can break the cycle of rising costs and realign payment with how patients experience healthcare. He also explores how policies like the Transparency in Coverage Rule and the No Surprises Act are pushing the industry toward greater transparency.“To me, if you’ve been in my seat, you look at this and you say, ‘This is the beginning of a profound change. It’s all going to be different.’” With Oxbridge Health, he introduces “Episode Benefit Plans,” which use bundled payments to lower costs while preserving broad provider choice. Open Networks is pioneering America’s first health network cooperative—leveraging pricing transparency and data to offer patients predictability on their out-of-pocket costs.————————————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. 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 https://www.movingtovalue.org/membership.  All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

Drug spending continues to escalate, accounting for an even bigger portion of total U.S. healthcare spend each year.Why do we pay so much for medications? Are the drugs we buy truly worth the price we pay? How can we figure out the real value of a medication? Pramod John joins the MTVA Board to help answer these questions and more. Guided by cold, hard data, Pramod expertly demystifies the drug market and pharmacy benefit ecosystem. His straightforward approach to pharmaceuticals is a stark departure from the overcomplicated acronyms and jargon common in the PBM space – in this episode, Pramod proves that you reallyCAN explain health care value in a straightforward way! “It’s not the drug that you’re paying for, it’s the outcome.” Pramod John is the Chairman and CEO ofVIVIO Health, a public benefit corporation using data to disrupt the typical PBM model. VIVIO’s mission is simple: to deliver the right drug for the right patient at the right price. We discuss what drug data really mean, why Americans are overpaying for prescriptions, and how to move beyond our current broken system. ————————————To learn more about topics discussed including the J&J lawsuit, PBMs and GLP-1 weight loss drugs, check out these other episodes of MTVA Unscripted:J&J lawsuitWake-up Call: The Johnson & Johnson Prescription Pricing ScandalFrom ERISA to CAA: How Has Employer’s Fiduciary Responsibility Changed Over Time?PBMsPBM Problems (Part 1): Who do Brokers and Consultants Really Work for? Risks for Plan Sponsors w/ ERISA attorney Paul HolmesPBM Problems (Part 2): Transparency and Disrupting the Status Quo w/ Mutual Rx CEO Roy WilkinsonPBM Problems (Part 3): Monopoly Power in Prescription Drug Markets w/ Luke SlindeePBM Problems (Part 4): Challenges & Solutions for Independent Pharmacies w/ National Community Pharmacists AssociationMarket Forces Created Our Dysfunctional Health System. Now We Must Harness Them to Drive Change with Ge Bai, PhD, CPAGLP-1sGLP-1s Aren't Right for Everyone: Wiser Healthcare Consumption w/ Al LewisGLP-1 RA’s - Treating Obesity, the Potential, the Cost, and Coverage————————————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. 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 websitehttps://www.movingtovalue.org/membership.  All episodes of MTVA Unscripted can be found⁠⁠here⁠⁠.

“There are medical schools whose mission is to build the researchers of the future, we all know who those are. There are other medical schools to build the community clinician of the future, great. And I’m about: let’s build the scholars and leaders in quality and in population health for the future.” Professor David Nash, MD, MBA joins MTVA for a conversation about his trailblazing career and the past, present, and future of population health. Dr. Nash shares how he found himself as the Founding Dean of the first college of population health in the country, and the trials and tribulations of starting this school from scratch.  We discuss the roles of mentorship and medical school curriculum in building the physician leaders of the future, the importance of aligning economics with outcomes, and Dr. Nash shares hopes for fixing our broken health system in the coming years.  “I’ll work with anybody who’s aligned with the no outcome, no income theory.” Check out Dr. Nash’s recent bestseller “How Covid Crashed the System: A Guide to Fixing American Health Care”.  ———————————— 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 https://www.movingtovalue.org/membership.   All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

“We are incentivized to practice medicine based on reimbursement, so that has resulted in more procedures, more pharmaceuticals, and less time with our patients. That has to change.” MTVA is joined by Elizabeth Boham, MD to discuss functional medicine. Dr. Boham uses her background in nutrition to help patients improve their health, and manage diseases including insulin resistance, Metabolic Syndrome, Diabetes, autoimmune conditions, and obesity. We discuss steps providers can take to integrate functional medicine principles into their practice, how lifestyle can impact gene expression, and the the critical role diet plays in health. Dr. Boham is Medical Director of the UltraWellness Center in Lenox, Massachusetts, Board Certified in Family Medicine, and also a registered dietitian. She is on the faculty of The Institute for Functional Medicine, and developed a Functional Nutrition course being used to educate physicians and other health professionals worldwide.  You can read two studies on the benefits of functional medicine Dr. Boham referenced here: https://pmc.ncbi.nlm.nih.gov/articles/PMC9173848/ https://www.ifm.org/news/cleveland-clinic-functional-medicine-improves-outcomes For more on nutrition, check out our episode with Al Lewis. ———————————— 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 https://www.movingtovalue.org/membership.   All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

“Just because it’s healthcare, doesn’t mean it’s good for you.”  Al Lewis joins MTVA for a lively discussion on patient education, nutrition, and overconsumption of healthcare. After a doctor’s visit for hoarseness where he was recommended unnecessary testing, Al decided to use his background in Trivia and create a new tool for patient health literacy. Quizzify was born!  Quizzify is designed to promote health literacy in an engaging, user-friendly format – helping make patients better consumers of healthcare.  The conversation centers on Quizzify’s program for GLP-1 weight loss drugs, which aims to “dissuade the curious, and educate the serious.” This dual goal can help reduce unnecessary spend on expensive medications, and equip those who start GLP-1s to have a higher chance of success in transitioning off.  Al and MTVA also discuss the importance of lifestyle change, which is made more challenging by deceiving nutrition labels and the relatively higher cost of more nutritious foods.  “Bad calories have become vastly less expensive, and good calories have become vastly more expensive.” ———————————— 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 https://www.movingtovalue.org/membership.   All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

The Moving to Value Alliance (MTVA) has been promoting value in health care for over 7 years. Though we’ve seen some progress, spending is steadily rising, many health outcomes remain unchanged, and burnout is a real problem for healthcare professionals. It can be easy to feel discouraged, but that’s not what MTVA – nor our special guest this week – stand for.  “I feel like it’s a choice in a way to be pessimistic or optimistic. You know that change is slow until it’s really fast, that’s how it always works.” Who better to discuss the state of the movement to value in healthcare than Stacey Richter?! As host of the top healthcare podcast Relentless Health Value, Stacey is usually the one asking questions – she’s interviewed hundreds of experts from all corners of the industry. We’re honored she let us turn the tables for this conversation with MTVA Board Members.  Stacey is tuned into the healthcare landscape. In this episode, we learn about her “why” and  discuss the role of technology and operational excellence, the importance of primary care, and how the term “value” has been coopted. Stacey is hopeful for the future, and she points to the local level for sources of inspiration.  “I firmly believe that when enough people begin to push in the same direction, when the reputational damage starts to happen from people who are overly putting profits over patients in really obvious and unpalatable ways, that's when things start to change.”  In addition to hosting Relentless Health Value, Stacey is co-president of QC Health – a public benefit corporation finding cost-effective ways to improve the health of Americans. MTVA Board Member John Rodis, MD works with Stacey as the Benefit Director of QC Health.   Stacey is also co-president of Aventria Health Group, a consultancy working with clients who endeavor to form collaborations with payers, providers, pharma, employer organizations or patient advocacy groups. Episodes mentioned, from MTVA Unscripted and Relentless Health Value: MTVA Unscripted episode with Ge Bai MTVA Unscripted episode with Brian Klepper  Relentless Health Value episode with Dr. Marty Makary Relentless Health Value episode with Dr. Will Shrank ———————————— 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 ⁠https://www.movingtovalue.org/membership.  All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

Pharmacists are one of the most trusted professions, yet more and more pharmacies are closing. A recent survey 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 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 Part 2 w/ Mutual Rx CEO Roy Wilkinson Part 3 w/ Luke Slindee, PharmD ———————————— 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 https://www.movingtovalue.org/membership. All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

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 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. 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/ ———————————— 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 https://www.movingtovalue.org/membership. We are grateful to our Trade Members and Ally Members, who help make this show possible.  All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

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, 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 Part 2 w/ 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 https://www.movingtovalue.org/membership. All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

“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 the CEOs of United’s Optum Rx, Cigna’s Express Scripts and CVS Caremark (the “Big 3”) on allegations of profiting from unfair practices at the expense of the American people. A recent report 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 – 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! All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

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) 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, Instagram  and LinkedIn.  All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

Though ERISA is often thought of as an issue for retirement plans, the law has always applied to employer-sponsored health benefit plans. The Consolidated Appropriations Act of 2021 (CAA) sought to put a spotlight on the issue by clarifying responsibilities of health benefit plan fiduciaries and the third-party service providers they contract with. Yet, 3 years after its passage, many plan sponsors still can’t get their vendors or advisors to provide the required fee disclosures.  “I’m baffled. I’ve never seen such wholesale noncompliance that seems to be just tolerated indefinitely. Something’s got to move there.” — Alden Bianchi In this conversation with MTVA, attorneys Sarah Raaii and Alden Bianchi of McDermott, Will & Emery’s Employee Benefits & Executive Compensation Group share how to comply with the CAA’s new requirements, and what health plan fiduciaries can do to ensure they fulfill their responsibilities to beneficiaries.  As attorneys who focus on health and welfare plan issues, Sarah and Alden discuss the history of ERISA, steps that employers and health plan fiduciaries should take, and what it might take to boost compliance.  ————————————————————————— Check out our other episodes on health plan fiduciary responsibility:  MTVA Unscripted episode on the Johnson&Johnson lawsuit MTVA Unscripted episode on what employers need to do to comply with CAA All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

“We have to cherish the opportunity in front of us. We’re at a point that public awareness of the current system failure is unprecedented.”  American health care is in crisis, but this expert says there’s reason for hope. MTVA spoke with renowned scholar Ge Bai, PhD, CPA about the dynamics underlying problems in our system, and how middlemen keep taking a bigger piece of the pie. She makes the case for removing the confusing layers that separate patients and physicians. Placing power back in the hands of health care consumers will give providers and insurers a strong incentive to innovate – a much-needed course correction.  Ge Bai is a Professor of Accounting at the Johns Hopkins Carey Business School and a Professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.  A leading voice in health care finance and policy, Professor Bai’s expansive expertise and extensive body of work is influential. In this episode, she shares insights gleaned from testifying before Congress and explains how to break through the bureaucratic gridlock in Washington, D.C. and transform our system.  ———————————— We’re grateful to our Trade Member sponsor Connecticut Joint Replacement Surgeons LLC for their continued partnership and support of the Moving to Value Alliance. We’re also excited to introduce 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. All episodes of MTVA Unscripted can be found ⁠here⁠.

This episode is a must-listen for all plan sponsors and employers!  “In American business you don’t expect your major vendors to be profit-gouging you, and you don’t expect these major consulting firms to be taking their side instead of yours.” – Paul Holmes  As Pharmacy Benefit Managers (PBMs) face mounting scrutiny from policymakers and the public, health plan fiduciaries can’t ignore the money flows and potential conflicts-of-interest that may be hiding in the pharmacy benefit contracting process.  In this episode, the MTVA Board talks with ERISA attorney Paul Holmes of Williams, Barber, Morel about the perverse incentives and lack of transparency in PBM contracts. Tune in to learn what plan sponsors need to ask their brokers and consultants and how to comply with new requirements in the Consolidated Appropriations Act (CAA). Holmes also discusses some innovative approaches – like carve-outs for specialty pharmacy and prior authorization – for plan sponsors to consider.  This is the first episode in a new series from the “MTVA Unscripted” podcast called “PBM Problems” – exploring the middlemen who drive wasteful drug spending and pocket the profits.  Resources mentioned in the episode: Dr. Eric Bricker’s videos on PBMs: PBMs Explained - Learn how the money flows and 5 PBM Tricks in 1 Training Session MTVA Unscripted episode on the Johnson&Johnson lawsuit MTVA Unscripted episode w/ Dr. Scott Conard All episodes of MTVA Unscripted can be found ⁠here⁠. We’re grateful to Southern New England Healthcare Organization (SoNE Health) for their continued partnership and support as a sponsor of the Moving to Value Alliance. You can help advance our mission with a tax-deductible contribution at https://www.movingtovalue.org/jointhemovetovalue.

Join MTVA for a conversation with Dr. Scott Conard, MD, as we delve into the transformative power of purpose-driven healthcare. From fee-for-service models to data-driven initiatives, we explore improving healthcare outcomes, challenges in elder care, and the importance of a social model of care. Discover how autonomy, mastery, and purpose shape healthcare success and the need for a shift toward prevention and value-based care. Tune in for key insights and meaningful discussions shaping the healthcare landscape and learn how the power of purpose is driving change. NOTE: MTVA encountered some technical issues with our audio early in the recording. You may notice some scratchy audio in the first few minutes, but the rest of the episode was not impacted. We apologize for this issue, and hope you still enjoy this conversation with Dr. Scott Conard as much as we did!  Read more of Dr. Scott Conard’s work: The Seven Numbers The Art of Medical Leadership   Amazon author page - ALL BOOKS by Dr. Scott Conard All episodes of MTVA Unscripted can be found ⁠here⁠.

In this episode, the MTVA team delves into the challenges and obstacles faced by a leading healthcare system in its transition into a patient-centered care model. Joined by Mount Sinai Health System's CMO and Senior VP of Population Health, Dr. Arshad Rahim, we discuss the complexities of aligning financial incentives with outcomes-based care principles, leveraging data-driven insights to drive behavioral change among providers, and reshaping patient care delivery through early-stage behavior modification. Most importantly, we explore the critical need for integrating population health and value-based care into medical education and residency training programs. All episodes of MTVA Unscripted can be found ⁠here⁠.

The gig is up. Wake up and smell the coffee. It’s finally happened. After years of speculating what an employee complaint against an employer for breach of fiduciary duty would look like, it has arrived. And this one doesn’t disappoint. Johnson & Johnson is being sued by its employees, alleging that their health plan overpaid for prescription drugs, costing workers money. This suit touches on ALL the many issues that we’ve been focusing on, including the fiduciary duty to act only in the best interest of plan beneficiaries, the adequacy of and potential bias involving the way health services are procured, agent/broker responsibilities and conflicts, the games that are played by PBMs to heavily markup drugs … and the glaring lack of diligence and accountability around these prices.   This isn't just about one company's missteps — it's a wake-up call, folks. Countless similar cases are queuing up in its wake. It’s time to pay attention and it’s time to have a plan. This episode features:  Guest: Josh Golden, Senior Vice President, Strategy, Capital RX Jeffrey Hogan, MTVA Founding Board Member & President, Upside Health Advisors John Rodis, MD, President, MTVA and Founder and President, Arista Health, LLC Lisa Trumble, MTVA Board Member & President and Chief Executive Officer, SoNE HEALTH  Steve Schutzer, MD, MTVA Founding Board Member & Co-Founder, Upswing Health All episodes of MTVA Unscripted can be found ⁠here⁠.

In the last episode of 2023, MTVA team leaders Jeff Hogan, John Rodis, MD, and Lisa Trumble dish out candid insights into the state of value-based healthcare and take a glimpse into 2024. They unpack the trend of primary care physicians shifting gears from employment to independence, delve into the pivotal role of employers in healthcare plan buying and management —hint: data analytics is STILL the key—and navigate a rollercoaster of complexities and strategies, seasoned with a dash of optimism for the year ahead! This episode features: Jeffrey Hogan, MTVA Founding Board Member & President, Upside Health Advisors John Rodis, MD, President, MTVA and Founder and President, Arista Health, LLC Lisa Trumble, MTVA Board Member & President and Chief Executive Officer, SoNE HEALTH All episodes of MTVA Unscripted can be found ⁠here⁠.

Buckle up, folks. Things are changing. We’re seeing influencers out there in the healthcare marketplace cause the behemoths to change their behaviors. We're also seeing some of the biggest companies in the country invest in solutions…to give better access to care, create predictability around outcomes, and get their data so they have better insight into their unique populations. Is it too early to celebrate the exponential curve? This episode features: Jeffrey Hogan, MTVA Founding Board Member & President, Upside Health Advisors John Rodis, MD, President, MTVA and Founder and President, Arista Health, LLC Steve Schutzer, MD, MTVA Founding Board Member & Co-Founder, Upswing Health All episodes of MTVA Unscripted can be found ⁠here⁠.

The MTVA team engages in a thought-provoking conversation with AJ Loiacono, CEO and Founder of Capital Rx, delving into the intricacies of pharmacy benefits and the challenges faced by employers in navigating the healthcare landscape. Loiacono provides insights into the complexities of drug pricing, the far-reaching effects of the Consolidated Appropriations Act (CAA), high-cost drugs, and the importance of data in optimizing valuable health plans.  This episode features:  AJ Loiacono, CEO and Founder of Capital Rx Lisa Trumble, MTVA Board Member & President and Chief Executive Officer, SoNE HEALTH  John Rodis, MD, President, MTVA and Founder and President, Arista Health, LLC  Steve Schutzer, MD, MTVA Founding Board Member & Co-Founder, Upswing Health  All episodes of MTVA Unscripted can be found ⁠here⁠.

The MTVA team talks to Dr. James Caillouette, the visionary behind Hoag Orthopedic Institute, a joint venture orthopedic specialty hospital in Irvine, California, about the path to the establishment of a groundbreaking healthcare institution that prioritizes shared ownership and governance between hospitals and physicians. Jamie discusses the factors that drove the need for this innovative model, from the impact of the Affordable Care Act to the competitive landscape of Southern California. He gives us an inside look at the specialized surgical protocols and bundled payment offerings, highlighting the commitment to data-driven decision-making and the importance of maintaining a strong focus on patient experience, satisfaction, safety, and quality.  This episode features:  Dr. James Caillouette (retired), Board Certified Orthopedic Surgeon who specializes in Adult Reconstructive Surgery; Chairman of Newport Orthopedic Institute; founding Surgeon in Chief/Chief of Staff for Hoag Orthopedic Institute, a joint venture orthopedic specialty hospital in Irvine, California Jeffrey Hogan, MTVA Founding Board Member & President, Upside Health Advisors  John Rodis, MD, President, MTVA and Founder and President, Arista Health, LLC  Steve Schutzer, MD, MTVA Founding Board Member & Co-Founder, Upswing Health  Lisa Trumble, MTVA Board Member & President and Chief Executive Officer, SoNE HEALTH  All episodes of MTVA Unscripted can be found ⁠here⁠.

Jeff Hogan, Dr. Steven Shutzer, and Dr. John Rodis discuss Connecticut's evolving healthcare landscape -- how Connecticut serves as a national testbed for healthcare change, focusing on payment reform, care transformation, and the move toward value-based healthcare. The conversation touches on the influx of advanced primary care organizations, the role of data and transparency, the potential impact on hospitals and health systems in the state, and the role of policy and politics in shaping Connecticut ... and the nation's ... healthcare future.This episode features: Jeffrey Hogan, MTVA Founding Board Member & President, Upside Health AdvisorsJohn Rodis, MD, President, MTVA and Founder and President, Arista Health, LLCSteve Schutzer, MD, MTVA Founding Board Member & Co-Founder, Upswing Health All episodes of MTVA Unscripted can be found ⁠here⁠.

Healthcare’s end users, better known as patients, rely on physicians to listen, care, and solve their healthcare problems. However, what might not be widely appreciated is the value physician leaders bring to large-scale successful strategies around care transformation and payment reform. In this episode from May 2023, Dr. Steve Shutzer talks to two physician leaders, one a primary care physician and the other an orthopedic specialist, with a track record of success in creating patient-centered sustainable healthcare value. This episode features: Steve Schutzer, MD, MTVA Founding Board Member & Co-Founder, Upswing Health John Rodis, MD, President, MTVA and Founder and President, Arista Health, LLC Frederic Liss, MD, - President, Physician-Led Healthcare for America - Board Member, TruNorth.Tech - Medical Director, TEMPUS Work Environment & Risk Solutions, LLC - Clinical Associate Professor of Orthopedic Surgery, Thomas Jefferson University, Rothman Institute - Associate Surgeon, Division of Hand Surgery The Rothman Orthopedic Institute - Co-Founder, Member Board of Directors and Past Medical Director Physicians Care Surgical Hospital Joe Quaranta, MD, - Market President, Privia Health CT - President, Community Medical Group, Inc. - Primary Care Physician, Quinnipiac Medical of Branford *This episode originally aired in a video/webinar format on May 19, 2023 All episodes of MTVA Unscripted can be found ⁠here⁠.