Health Care Rounds

John discusses our take on health care news in the first half of October, specifically commenting on the recent movements of multiple significant health systems. University Health Network (UHN) and Vanderbilt Health Affiliated Network (VHAN) announced a partnership for value-based health care that reaches throughout the state of Tennessee. Baylor Scott & White Health (BSW) and Memorial Hermann Health System have signed a letter of intent to merge. In a statement, the organizations said their next step is to complete a due diligence and regulatory review prior to signing a definitive agreement, which is expected to occur in 2019. About Darwin Research Group Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers,

What’s it like competing for business as an integrated delivery system—sandwiched eight miles between the University of Maryland Medical System and Johns Hopkins Health System—in a global budget environment within the state of Maryland? Find out this week in John’s conversation with LifeBridge Health CEO Neil Meltzer, a dynamic and inspirational leader serving his community and the stakeholders of LifeBridge with purpose. Interview highlights include: What sets LifeBridge apart from the steep competition in the Baltimore market How LifeBridge hotspots community needs through patient data analysis Where LifeBridge is looking to expand in the future Speaker Bios Neil Meltzer is president and CEO of LifeBridge Health, a position he has held since 2013. Mr. Meltzer joined Sinai Hospital of Baltimore as vice president of operations in 1988, and a decade later became Sinai’s president and chief operating officer. Mr. Meltzer has a background in public health and brings a community-focused approach to every health

John discusses our take on the important health care news that occurred in the second half of September. Our main stories this episode include the creation of OneOncology, a merger of three oncology groups, and a suit on the alleged illegal kickbacks regarding the prescription of Humira. Three large cancer practices have teamed up to create OneOncology. Announced Wednesday, OneOncology includes Tennessee Oncology, New York Cancer & Blood Specialists and Memphis-based West Cancer Center, comprising more than 225 providers and over 60 locations. California Insurance Commissioner Dave Jones filed suit against AbbVie, alleging that the drugmaker gave illegal kickbacks to physicians to prescribe Humira (adalimubab). In court filings, the state alleges that AbbVie “systematically and repeatedly has violated the Insurance Frauds Prevention Act by providing kickbacks to health care providers throughout California.” About Darwin Research Group Darwin Research Group Inc. provides advanced market intelligence and

In this podcast, John Marchica has Dr. Adeel Yang at the table to discuss his newest venture, Medumo. Medumo’s CareTours™ are digital "instructional pathways" that healthcare providers can rapidly customize to guide patients throughout treatments and procedures in the most effective, scalable way possible. Medumo was highlighted at the Connected Health Conference in 2017, looking at “Digital Health Startups Working with Large Health Systems - Lessons Learned.” Here are some of the interview highlights: What is Medumo and how does it help both the patients and their providers? Current key gaps in health care along the patient’s health care journey and how Medumo addresses these through its digital platform. How the Medumo team has managed to succeed in the health start-up world. Speaker Bios Dr. Yang is the co-founder and CEO of Medumo, a PULSE MassChallenge digital health startup offering an intelligent patient navigation platform that creates value for hospitals by improving operational efficienc

John shares a special our take on the trove of changes that occurred in the world of ACOs this past week. In late August, the National Opinion Research Center at the University of Chicago released the results of the first performance year (2016) for CMS’ Next Generation ACO model. Also in late August, CMS released its MSSP ACO public-use data file for 2017, which includes financial performance and quality scores for 472 ACOs, representing nearly 9 million beneficiaries. According to a new study published in The New England Journal of Medicine by Harvard Medical School researchers, physician-group ACOs outperformed hospital-integrated ACOs during the first three years of the MSSP (2013–2015). About Darwin Research Group Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list includes forward-thinking biopharmaceutical and

John shares our take on what happened in health care at the end of August including the NYU at the frontier of offering free tuition to medical students, as well as how a few Republican senators have introduced legislation to protect Affordable Care Act’s provisions for people with pre-existing conditions. The New York University School of Medicine announced that it is now offering free tuition for medical students, becoming the first major medical school in the U.S. to offer tuition-free education. “Our full-tuition scholarships make it possible for aspiring physicians to choose a specialty based on their talent and inclinations to better serve the communities who need it most, and to more easily pursue scientific breakthroughs that improve how we care for patients.” Ten Republican senators have introduced legislation that purports to protect the Affordable Care Act’s provisions for people with pre-existing conditions. The language offering protections would be effected by amending the Health Insurance Port

Happy Labor Day from all of us at Health Care Rounds Podcast! We will be back next week with a new episode. In the meantime, enjoy your week!

In this podcast, John Marchica discusses the intricacies of Canadian health care with his old colleagues, Trafford Crump, PhD and Paul Woods, MD, MS. Canada’s health care system is about 70% federally funded and is experiencing the same health care trends of an aging population and attempts to move towards a value-based care model. Here are some of the interview highlights: How health care is structured in Canada, and its similarities and differences to health care in the U.S. The increasing costs of health care in Canada, and delving into why this is becoming a trend. The reasonings behind looking to the province of Ontario to lead the way to value-based care in Canada. Speaker Bios Trafford Crump, PhD is a health services researcher and assistant professor at the University of Calgary’s Department of Surgery with an interest in patient-centered measures. Dr. Crump's earlier research involved developing the methods for eliciting health care preferences from community-dwelling Medicare beneficiaries in the

John shares our take on what happened in health care at the beginning of August including extended coverage through the Affordable Care Act, as well as a new direct-to-employer contract between Henry Ford Health System and General Motors. The Trump administration issued a final rule concerning short-term health plans. Consumers can now extend coverage for up to a year, with the option to renew for up to three years. Henry Ford Health System announced that it signed its first direct-to-employer contract with General Motors. Starting in 2019, Henry Ford will provide health care management and wellness services to 24,000 salaried GM employees and their families in southeast Michigan. About Darwin Research Group Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list includes forward-thinking biopharmaceutical and medical dev

John shares our take on what happened in health care at the end of July, including how the Centers for Medicare and Medicaid Services is proposing both a rule for site-neutral payments, as well as potentially more 340B cuts. The Centers for Medicare and Medicaid Services (CMS) has proposed a rule to move toward “site neutral” payments for clinic visits, under the 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. Clinic visits are “essentially checkups with a clinician,” CMS said, and are the most common service billed under OPPS. CMS proposed to reduce 340B payments in 2019 to non-excepted off-campus departments of hospitals that are paid under the physician fee schedule. Earlier this year, CMS had already reduced $1.6 billion in Medicare outpatient drug payments to some 340B hospitals. About Darwin Research Group Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, wi

In this podcast, John Marchica has a conversation with Sean Sullivan, JD on the need to address not just physical wellness in the workforce, but also its wellbeing. Sean and John speak on the growing trend of value-based care, not just in the United States, but also internationally. Here are some of the interview highlights: What are the definitions of wellness and wellbeing in the workforce, and where are we currently? How do companies measure and address wellness? How do they tackle the harder task of workforce wellbeing? The changing outlook of seeing employees as human capital, their wellbeing as an investment rather than a cost. Speaker Bios Sean Sullivan is the Co-Founder, President and CEO of the Institute for Health and Productivity Management, as well as the WorkPlace Wellness Alliance which was created by the World Economic Forum, now managed and sustained by the Institute. Founded in 1997, the Institute is a global enterprise that serves as a catalyst and champion for a growing international move

John shares our take on the second half of July, including how the Trump administration continues to take aim at Obamacare, and that Stark and other anti-kickback laws may be obsolete in a value-based world. On July 7, the Trump administration said it was temporarily withholding $10.4 billion in risk adjustment payments to insurers, citing a district court ruling from earlier this year in New Mexico. On Tuesday July 10th, 340B Health released an analysis of a bill introduced by Rep. Joe Barton, R-Texas, that would raise the minimum disproportionate share hospital (DSH) adjustment percentage that hospitals must meet to qualify for the 340B drug discount program. Kathleen Sebelius, Health and Human Services (HHS) secretary under President Barack Obama, and Tommy Thompson, HHS secretary under President George W. Bush, wrote in an op-ed for The Hill that “Stark and anti-kickback laws are a remnant of the fee-for-service world and harm the very patients they are supposed to protect by deterring more comprehensive

In this podcast, John Marchica discusses with Dr. Joshua Lenchus the challenges that come with running a safety net hospital, and the role that social determinants of health play in managing population health initiatives. Topics include: Managing population health in a safety net system Social determinants of health and medical compliance Why we should avoid integrating social determinants of health into the EMR. Speaker Bios Joshua Lenchus, DO, RPh, FACP, SFHM, holds a pharmacy degree from the University of Florida, and graduated from Nova Southeastern University College of Osteopathic Medicine in 2000. He currently works as a hospitalist at Jackson Memorial Hospital for the University of Miami Miller School of Medicine. In 2012, was elected as the youngest and the first osteopathic President of the Jackson Health System medical staff and chairman of its medical executive committee. He was subsequently re-elected in 2014 and 2016. In 2007 he developed a novel curriculum centered about simulation-based inv

John shares our take on the first half of July, including CMS’s decision to green-light a Medicaid value-based drug plan, and how JJMDC added a collaboration with Mercy to its list of partnerships designed to improve patient care. The Centers for Medicare and Medicaid Services (CMS) has approved the nation’s first value-based purchasing agreement for Medicaid, by approving Oklahoma’s request to allow the state to negotiate supplemental rebate agreements with drug manufacturers. Mercy announced a research collaboration with Johnson & Johnson Medical Devices Cos. (JJMDC). In a press release, JJMDC said it would utilize Mercy's data infrastructure to inform and improve regulatory decision making and health outcomes for medical devices. About Darwin Research Group Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list in

Happy 4th of July from all of us at Health Care Rounds Podcast! We will be back next week with a new episode. In the meantime, enjoy your week!

John shares our take on the second half of June, including the decision of a federal appeals court regarding risk corridor payments, and the announcement of the new CEO for the Amazon-Berkshire-JPMorgan health care venture. A federal appeals court Thursday ruled that the Health and Human Services Department is not obligated to pay insurers the more than $12 billion in risk corridor payments that have accrued to date. The U.S. Court of Appeals for the Federal Circuit reversed a previous decision in a suit brought by Moda Health, in which the company argued that it was owed risk corridor payments as stipulated by the Affordable Care Act (ACA). Amazon, Berkshire Hathaway and JPMorgan Chase appointed Dr. Atul Gawande as chief executive officer of their newly formed health care company. In a press release, the companies announced that the new company will be headquartered in Boston and will “operate as an independent entity that is free from profit-making incentives and constraints.” About Darwin Research Group

In this podcast, John Marchica speaks with the CEO and Co-Founder of Teleplus Healthcare, Dr. Suzanne Shugg Teleplus is a medical information technology company that combines comprehensive telemedicine and tele-educational services with the leading treatment technology, focusing on the areas of Sleep Apnea, Congestive Heart Failure, Obesity, Chronic Care, and COPD. Teleplus has an exclusive global partnership with the University of Pennsylvania called the UPENN Sleep Disorder Certificate program that distributes sleep disorder education. Here are some of the interview highlights: What do telehealth and telemedicine mean, and what are their differences? The advantages of bringing telehealth for managing chronic care and rural health. The motivations behind the creation of the telehealth company and its continued success. Speaker Bios Suzanne Shugg, DNP, has over 20 years of experience in multiple healthcare sectors. She has developed a new, innovative health insurance company, implemented and expanded preven

John shares our take on the first half of June which includes how New Jersey recently mandated health insurance starting in 2019, and what the increase in payer-provider partnerships means. New Jersey became the second state to mandate health insurance into law, through the New Jersey Health Insurance Market Preservation Act. The law was signed by Gov. Phil Murphy on May 30 and takes effect Jan. 1, 2019. According to a new report by Oliver Wyman, a health care consulting firm, nearly three-quarters of the 22 payer-provider partnerships reported in the first quarter of this year were co-branded or joint venture insurance products. Wyman reports that the number of payer-provider partnerships was the most the company had seen in the six years it has been tracking them. About Darwin Research Group Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based

In this podcast, John Marchica speaks with Cypress HomeCare Solutions’ Managing Partner, Bob Roth. The Better Business Bureau serving Central, Northern and Western Arizona (BBB) announced on May 16, 2018 that Cypress HomeCare Solutions was the winner of its 2018 BBB Torch Awards for Ethics for companies with more than 150 employees. This is the first time a home care company has been nominated regionally, let alone won this award. Here are some of the highlights we cover: The differences between the terms of home health care, home care, and private duty, and how Cypress HomeCare Solutions fits in with them. The difficulties that Home Care organizations have with partnering with Integrated Delivery Networks (IDN) and Accountable Care Organizations (ACO). Bob’s opinion on how the nation currently scores for caring for the aging, quoting renowned Dr. Ken Dychtwald. Moving forward, how do we both gain more caregivers and integrate technology with caring for the growing aging population? Speaker Bios Bob Roth fo

A century ago, all health issues were tended to in the home, whether by a physician house call or by another family member. Yet, as modern medicine evolved in the early 20th century—along with important economic social changes, such as urbanization, industrialization and immigration—care transferred to hospitals and physician offices. With rising health care costs in mind, by 2050 an estimated 27 million Americans will need some form of long-term care, with the bulk of that care being provided through home health providers and hospice care. Who receives health care in the home is not only a crucial policy question to be addressed but also can be a significant business opportunity for the industry and its suppliers. In this episode, John walks us through how home health care came to be, the differences between home health care, private duty, and hospice, and the impending importance it has for the future as we live longer lives. About Darwin Research Group Darwin Research Group Inc. provides advanced market in