Headwinds Impacting the Shift to Value-Based Care with Kyle Swarts and Dr. Matt Lambert
Release Date: 01/09/2020
ChatGPT: Where (and Where Not) to Apply it in Healthcare
The #HCBiz Show!
On this episode, we talk with Matt Hollingsworth, CEO of , about ChatGPT. If you've been reading the headlines, and maybe even experimenting with Chat GPT yourself, but don't quite grasp what's going on, then this episode is for you. Mat gives a not-too-technical, high-level explanation of what's going on under the hood so that you have proper context for the discussion. Then, Matt outlines the potential benefits, and potential harms, of applying ChatGPT in healthcare. Finally, Matt shares his experience launching Carta Healthcare, including how he convinced VCs that software plus...
info_outline
Medicaid Transformation: Past, Present, and Future with Alan Weil of Health Affairs
The #HCBiz Show!
Medicaid Transformation. 1115 waivers. Delivery System Reform Incentive Payment (DSRIP) programs. Expansion. Contraction. We’ve been at this for a long time. Why isn’t Medicaid transformed already? Well… it turns out that this is really difficult work. First off, there are complex political and ideological issues. Even if we all agree that we want the best healthcare for every American – a conceptually easy outcome to rally behind – we don’t all agree on what that looks like, how to get there, or how to pay for it. Second, it takes a long time for policy levers to play out in the...
info_outline
Should Patients Be Charged for Messages to their Doctors?
The #HCBiz Show!
Cleveland Clinic recently announced that they would begin . This flies in the face of everything the industry is talking about when it comes to patient engagement and value-based care. At the same time, it is quite unreasonable to think that a doctor should be available for questions at any time, for free. How can we protect the clinicians' time AND provide the patients with the care and attention they need? And why are we moving away from value-based care? Craig Joseph, MD, Chief Medical Officer of Nordic Consulting Partners, and Matt Lambert, MD, Chief Medical Officer for Curation...
info_outline
Take it All With a Grain of Salt
The #HCBiz Show!
Don and Shahid discuss NCQA's Health Innovation Summit (November 2022) and FHIR Dev Days (June 2022). They explore these events as examples of how to interpret what you hear at conferences, in industry media, and even on podcasts like this. The discussion covers a lot of ground including: What is NCQA? What is HEDIS? What does it mean to move from Electronic Clinical Quality measures (ECQM) to Digital Quality Measures (DQM)? Can FHIR really do all that!? Specified, but not implemented (this is important) Why is it hard to innovate and sell innovations in the quality measure space? How...
info_outline
The State of Blockchain and Web3 in Healthcare with Ray Dogum
The #HCBiz Show!
On this episode, we talk with Ray Dogum, MS, MBA about the state of blockchain and web3 technology in healthcare. Ray is the producer and host of the where he discusses blockchain developments in healthcare with industry experts. There was quite a hype cycle around blockchain in healthcare that has died, but there is still real development being done and plenty of opportunity to create value in the future. We’ll break down the pockets of success that are happening today and talk about where things could be headed in the future. For complete show notes and links visit:
info_outline
Can I Buy You Lunch (and tell you about my product)?
The #HCBiz Show!
Some people tell doctors that anything more than a cup of coffee is a conflict of interest. What about executives? Is it ok to take them out to lunch? What about a trip to the Super Bowl? Is there a line? Where is it? On this episode, Don and Shahid discuss a recent LinkedIn discussion where a healthcare executive called shenanigans on himself and his colleagues for accepting gifts. The gift is a symptom... not the underlying issue. Tune in to find out what the issue is and how to fix it. Plus, learn why Don hates RFPs and how we can do those better too.
info_outline
The Business Case for Being Patient-First with Brian Sanderson
The #HCBiz Show!
There's no business case for doing the right thing in healthcare. Fortunately, being patient-first is the right thing to do and can be good for business too. Today we talk with , national healthcare management leader at and author of the new book, The Patient-First Revolution. In it, Brian provides a blueprint for hospitals to skyrocket net revenue by boosting patient experience (#HCBiz listeners can grab a free copy of the book ). Brian explains it's important to think about more than short-term financials. Yes... you need to operate efficiently and run a sound business… those are...
info_outline
Building an Innovation Lifecycle Ontology
The #HCBiz Show!
It's easy to experiment with new tech and produce products that look and sound innovative. It's much harder to tie your innovation efforts to strategic objectives with measurable outcomes and then scale the solution across your organization. The former leads to "death by pilot". The latter makes a difference in people's lives. We need a more disciplined approach to innovation if we want to make a difference. In this episode (Ep. 201) we introduce the concept of the Healthcare Delivery Organization Innovation Lifecycle Ontology or HDO-ILO. That's a fancy way of saying that we are attempting to...
info_outline
Episode 200!!! What's Next for the show?
The #HCBiz Show!
On this episode, Don Lee and Shahid Shah celebrate 200 episodes of The #HCBiz Show! We discuss what we've done over the past 6 years and tell you where we're headed next. In a nutshell, we're going to work to codify what we've learned about innovation in healthcare over the past 200 episodes and in our decades of deploying digital health solutions. We're steering the effort, but we need your help. There will be plenty of ways to get involved. Thanks for learning with us over the past 200 episodes. Here's to 200 more! Oh... and we're on YouTube now too if you prefer the visuals: ...
info_outline
Putting Ambient Intelligence into the Clinical Workflow at Scale with Peter Durlach
The #HCBiz Show!
There’s no shortage of development when it comes to AI and ML in healthcare. The technology is already powerful and continues to advance. The challenge, as always, is getting things into the clinical workflow. And doing so at scale. Nuance has a plan to help innovators and health delivery organizations find alignment and get the right tools integrated into the clinical workflow quickly. Nuance started with ambient intelligence in the sensory realm. In computing, refers to electronic environments that are sensitive and responsive to the presence of people. Today, Nuance’s Dragon...
info_outlineHealth systems have been working hard to lay the foundation for taking on a larger case mix of value-based contracts. 75% of health systems surveyed said they are ready to accept downside risk in the next two years, up from 42% in 2015. As health systems are discovering, value-based care reimbursement is more complicated and requires a new level of specificity in documentation. The question is, are health systems really ready to take on downside risk while continuing to manage FFS contracts?
Today we have Kyle Swarts, Chief Growth Officer, and Matt Lambert, MD, Chief Medical Officer from TrustHealthcare to help us answer that question. We discuss challenges and opportunities facing health systems as they embrace the shift to value. Enjoy!
Highlights from Headwinds Impacting the Shift to Value-Based Care
- It's time for providers to take on risk.
- Everyone has a population health department but fee-for-service is still driving your overall strategy.
- The threshold for making the jump to VBP.
- Why it's so difficult to get doctors on board with VBP.
"It's not how sick your patients are, it's how well you document how sick your patients are."
- The risk of moving slowly to VBP.
- The promise of 60 minute home visits with a physician finally has a reimbursement model.
- Where we will see new consolidation in response to VBP.
- The two big reasons specificity in documentation is key to successful downside risk contracts.
- Reimagining EHR design to foster VBP.
- AI success is all about physician adoption.
Kyle Swarts, Chief Revenue Officer
Kyle is a growth-minded leader who has overseen sales, marketing, and business development at healthcare consulting, revenue cycle management and information technology companies for the past 12 years.
Matt Lambert, MD, Chief Medical Officer
Matt brings over twenty years of experience as a clinician, CMIO, and change leader to value-based care, ensuring that patients receive more comprehensive care and that payers and providers better capture the value of their services.
TrustHealthcare
Founded in 2018 by a team of healthcare veterans and clinicians with private equity funding from Windrose Health Investors, TrustHealthcare’s mission is to empower healthcare provider organizations and health plans to successfully navigate from fee-for-service to value-based care. The TrustHealthcare platform seamlessly integrates with the electronic health record and leverages more than 500 proven clinical rules – while also connecting CDI specialists, clinicians, and coders in one simplified workflow. With TrustHealthcare, providers and health plans can rest assured that they are capturing the full value of patient care in real-time.
Links and Resources
Unrest Insured by Matt Lambert, MD
A Primer on HCC codes and Risk Adjustment
Related Episodes:
Top 10 Things to Ensure Success in a Value-based Healthcare World
Value-based Payment: Progress, Trends and Direction w/ Jason Helgerson
The Future of Value-Based Payment w/ François de Brantes of Remedy