Health Care Rounds

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

To all of our listeners, we hope you had a wonderful Memorial Day Weekend! In this episode, John shares an an abbreviated our take on the second part of May focused on FDA and The Centers for Medicare and Medicaid Services' (CMS) take on lowering drug prices. Steps are being taken to lower drug prices—but which, if any, will work? The FDA posted a list of more than 50 drugs for which generic drugmakers have been unable to obtain samples of certain branded products from the manufacturers. CMS also weighed in last week by announcing enhanced “drug dashboards” that include year-over-year pricing changes for drugs reimbursed by Medicare Part B and Part D and Medicaid. 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

John shares our take on the first half of May which includes the proposal by The Centers for Medicare and Medicaid Services (CMS) to scale back its quality measures for fiscal year 2019 and the current administration’s “blueprint” to tackle soaring prescription drug prices. CMS is looking to reduce the number of quality measures across the five quality and value-based purchasing programs for its FY 2019 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System. President Trump announced his much anticipated proposal to control prescription drug pricing. In his remarks in the White House Rose Garden, Trump said, “The drug lobby is making an absolute fortune at the expense of American consumers.” 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-ba

In this two-part podcast, John Marchica speaks with NCH Healthcare System’s president and CEO, Dr. Allen Weiss. Dr. Weiss breaks down how they have changed the mindset of community health at the health system level with astounding statistics and fruitful outcomes. Here are some of the highlights we cover: Part 1 - 17 min. Present day history of NCH Healthcare System Focus on community health with Blue Zones project Behavioral economics for reducing health care costs Part 2 - 13 min. Health System trends Other health care systems going the same path as NCH Healthcare Advice to new physician residents Speaker Bios Dr. Allen Weiss graduated from Columbia University’s College of Physicians and Surgeons and is board certified in Rheumatology, Internal Medicine, and Geriatrics. He is a Fellow of the American College of Physicians and the American College of Rheumatology. In 2017, Dr. Weiss became an Assistant Professor of Medicine at the Mayo Clinic School of Medicine and was also elected to the American Hospit

In this two-part podcast, John Marchica speaks with NCH Healthcare System’s president and CEO, Dr. Allen Weiss. Dr. Weiss breaks down how they have changed the mindset of community health at the health system level with astounding statistics and fruitful outcomes. Here are some of the highlights we cover: Part 1 - 17 min. Present day history of NCH Healthcare System Focus on community health with Blue Zones project Behavioral economics for reducing health care costs Part 2 - 13 min. Health System trends Other health care systems going the same path as NCH Healthcare Advice to new medical residents Speaker Bios Dr. Allen Weiss graduated from Columbia University’s College of Physicians and Surgeons and is board certified in Rheumatology, Internal Medicine, and Geriatrics. He is a Fellow of the American College of Physicians and the American College of Rheumatology. In 2017, Dr. Weiss became an Assistant Professor of Medicine at the Mayo Clinic School of Medicine and was also elected to the American Hospital

John shares our take on the second half of April highlighting the health of ACA under the current administration and Humana’s statement to acquire and merge Curo Health with Kindred Healthcare. The Centers for Medicare and Medicaid Services provided enrollment statistics for Healthcare.gov and the state-run exchanges created by the Affordable Care Act (ACA). In its last tax package, the Republican-led Congress zeroed out the individual mandate penalty—a cornerstone of the ACA. The Congressional Budget Office (CBO) estimated that 13 million people will lose or drop coverage as a result of this move over the next decade. Reuters reported that Humana, along with two private equity firms, will acquire Mooresville, N.C.-based Curo Health Services for $1.4 billion. Humana will merge Curo Health with the hospice business of Kindred Healthcare, which Humana agreed to acquire in December 2017. Of Note: Our Take Narrations will be twice monthly after these inaugural episodes. About Darwin Research Group Darwin Re

John shares our take on the first half of April highlighting Walmart’s talks to acquire Humana, and California's suit against Sutter Health. Reuters and The Wall Street Journal independently reported that Walmart is considering an acquisition of health insurer Humana. Citing people familiar with the matter, Reuters said the companies are in early talks about developing closer ties, with one possibility being an acquisition. The state of California has filed an antitrust suit against Sutter Health, alleging anticompetitive behavior. Among other complaints, the suit alleges that the Sacramento-based health system imposes gag clauses on prices and in some cases charges “punitively high” amounts for out-of-network services. Of Note: Our Take Narrations will be twice monthly after these inaugural episodes. 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

In this three-part podcast, John Marchica speaks with Commonwealth Primary Care ACO president and CEO, Dr. Curtis Page, and Lance Donkerbrook, chief information officer. Last year, Commonwealth Primary Care ACO was Darwin's Western Region ACO of the Year. Here are some of the highlights we cover: Part 1 - 20 min. (Page) Accountable Care Organizations defined How to deliver high-quality patient care Origins and growth of the Commonwealth Primary Care ACO Part 2 - 20 min. (Donkerbrook) Impact of policy changes on ACOs Lessons from the 2018 HIMMS conference Patient attribution and self-selection Application of quality metrics How to improve physician engagement Part 3 - 18 min. (Page and Donkerbrook) Commonwealth’s use of technology, challenges Partnering with Pharma, other suppliers and providers Strategic priorities Wrap-up Speaker Bios Dr. Curtis Page is quite invested in health care reform and currently serves as the CEO & president of the Commonwealth Primary Care Accountable Care Association, an

In this three-part podcast, John Marchica speaks with Commonwealth Primary Care ACO president and CEO, Dr. Curtis Page, and Lance Donkerbrook, chief information officer. Last year, Commonwealth Primary Care ACO was Darwin's Western Region ACO of the Year. Here are some of the highlights we cover: Part 1 - 20 min. (Page) Accountable Care Organizations defined How to deliver high-quality patient care Origins and growth of the Commonwealth Primary Care ACO Part 2 - 20 min. (Donkerbrook) Impact of policy changes on ACOs Lessons from the 2018 HIMMS conference Patient attribution and self-selection Application of quality metrics How to improve physician engagement Part 3 - 18 min. (Page and Donkerbrook) Commonwealth’s use of technology, challenges Partnering with Pharma, other suppliers and providers Strategic priorities Wrap-up Speaker Bios Dr. Curtis Page is quite invested in health care reform and currently serves as the CEO & president of the Commonwealth Primary Care Accountable Care Association, an