360° of Healthcare with Dr. Stan

Decoding The World of Pharmacy Benefit Management: The Real Skinny For Employers and Physicians

In this episode, Dr. Jan Berger and I explore the arcane and hardly transparent world of PBMs. Her wisdom deals good advice for employers who purchase healthcare, benefit consultants who work with those employers and providers whose prescriptions may have a profound impact on businesses that pay for healthcare.
Dr. Berger is CEO of Health Intelligence Partners, a global healthcare consulting company.
Links:
Jan Berger MD Biography
The Chicago Network
Re-Engaging in Trust: The Missing Ingredient to Fixing Healthcare
LinkedIn
360° of Healthcare podcast on Dr. Berger's book

The Fiduciary Landmine: The questions you need to ask to avoid costly mistakes and the answers you need to get

Fiduciary! In this episode we sit down with D. Doug Aldeen, a health care and ERISA attorney for some very specific questions. As I’ve learned, not all fiduciary questions have a single correct answer right now and as Doug discusses, pending litigation won’t necessarily yield answers.
‌Doug Aldeen is an Austin, TX based health care and ERISA attorney who recently served as ERISA counsel on behalf of the Berkeley Research Group in New York City to the $7.7 billion May 2016 acquisition of Multiplan and its medical bill repricing product Data Isight by the private equity firm Hellman and Friedman. Since 1997, he currently and has represented reference base pricing organizations, a bundled payment software platform, PPO networks, medium to small self-funded plans, TPA’s and provider sponsored HMO’s in various capacities including Herdrich v. Peagram which was argued before the United States Supreme Court in 2001.
Moreover, he serves as a resource to national news organizations regarding issues on health care and in addition as a consultant with the Governmental Relations Committee at the Self Insured Institute of America in Washington D.C. and as an advisor to RIP Medical Debt which has abolished over $9 billion in medical debt.
Doug received his JD from the University of Illinois.
He can be reached on LinkedIn or doug@health-attorney.net.

Why Your Company Needs Medical Counsel, Not Just Legal Counsel

So most companies have legal counsel, either in-house or readily available. But many don’t counsel from a physician.
Why can physicians in the role of a physician executive help a company through population health initiatives that grow a culture of health and wellness?
How does a company seek a physician executive? What skills and experience should they look for? With the cost of care restraining employee pay and eroding profits, what can a physician executive do?
My guest today is Raymond Fabius MD. Dr Fabius is an experienced physician executive who’s worked with many large America companies, including General Electrics’ Global Health Plan, Walgreens, Thompson Reuters, Cigna, Truven Analytics and others.
He’s also authored 5 textbooks including the leading textbook on population health.
Ray is currently the co-founder and president of HealthNext, an endeavor focused on helping corporations build a culture of health and well-being.
I’ve known Ray for several years as we’ve both served on the Medical Director Advisory Council of the National Alliance of Healthcare Purchaser Coalitions.
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These organizations were mentioned in the broadcast:
HealthNext
National Alliance of Healthcare Purchaser Coalitions
 
This book was mentioned:Population Health : Creating Cultures of Wellness. Now used by over 165 medical schools and universities worldwide. 
Product Catalog or Amazon https://www.amazon.com/Population-Health-Creating-Culture-Wellness/dp/1284166600/ref=sr_1_1
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Contact Dr Fabius: info@healthnext.com

You’ll Be Surprised By The Advancements In Allergy Care — With Notes About Cost For Plan Sponsors

Mention “allergies” and we all think of hay fever, mold and pollen counts and kid and adults lining up in allergy clinics for those weekly shots.
But a lot has changed recently with new treatments for nut allergies, a spate of new and expensive specialty drugs and a continued focus of mold and so-called sick building syndrome. And those weekly shots? Many have gone monthly, a big savings in both time and dollars.
Lynn Wiens MD is a board-certified allergist and is the lead allergist in Allergy and Immunology at Warren Clinic, the largest private multispecialty clinic in Oklahoma with over 375 providers.
He’s a graduate of University of Kansas School of Medicine and did his residency and allergy fellowship at Children’s Mercy Hospitals and Clinic in Kansas City, MO
Dr Wiens and I talk about these topics and other aspects of allergy important to healthcare purchasers and benefit advisors — and allergy sufferers as well.

Sage Transparency: The Hospital Transparency You Want is Here — If You Know How to Use It.

Stan and Gloria discuss the work that she and her organization, The Employers’ Forum of Indiana, are doing in the realm of hospital transparency, and their mission to improve the value employers and patients receive for their healthcare expenditures. 
Sage has brought together five separate data sources (RAND Corporation, NASHP, Quantros, Turquoise Health and CMS Hospital Compare) into one integrated dashboard. Now it's possible to drill into individual hospital performance in a way not previously available.
Dr. Sachdev talks about how employers and consultants have used Sage and its data source to determine whether they are getting favorable rates.
 
Important Links:
Sage Transparency Home Page
Sage Transparency Dashboard
Employers' Forum of Indiana
National Academy for State Health Policy 
Rand 4.0 (EmployerPTP)
National Alliance of Healthcare Purchaser Coalitions
Houston Business Coalition on Health
RAND Hospital Price Studies are Nationally Recognized
Analysis: Inconsistencies Within Hospital Price Transparency Data Make Cost Comparisons Difficult
 

Frontier Medicine In The USA Today: Yes, Depending On Where You Live

Mention “Frontier Medicine in Colorado” and you might conjure up a vision of TV’s Jane Seymour as Dr. Michaela Quinn in 19th century Colorado Springs.  But you may be surprised to learn that Colorado still has four “Frontier and Rural Area” levels as defined by the federal Health Resources and Services Administration.
These areas vary by degree of remoteness and difficulty in travel for health needs. Indeed, dealing with a major health problem in the middle of a winter storm when the nearest specialty location is across a mountain range isn’t a simple 911 response.
An easily dealt-with injury such as a broken leg or head injury can be fatal when care is impossible to reach.
Today we talk with Dr Clifford Brown, the Director for the Custer County (Colorado) Public Health Agency. Dr Brown is a Doctor of Optometry who gravitated into public health after stints in the United States Air Force and Army. His career brought him to this sparsely populated area nestled between two major mountain ranges and many long miles from the nearest tertiary care. 
Dr Brown and I discuss the imperatives of public health in a frontier area and how technology is providing some solutions. Individualism and self-sufficiency are challenges for public health workers that require not only deft and empathy but also a realization to meet people where they are.

Do you have a primary care strategy...really?

Join Dr. Stan and his guest Scott Conard, MD, as they discuss the pivotal role of primary care in population health.  Employers offering healthcare need to be particularly intention about assuring they have a true primary care strategy to provide covered members with quality care. 
 
That care should be as free as possible from financial and access barriers.
 
The doctors discuss the characteristics of advanced primary care,  the role of non-physician advanced providers and the looming shortage of family and internal medicine physicians.
 
Employers purchasing healthcare also need to understand the payment model of the PCPs their members see. Are those providers paid for the volume of patients they see? Only paid for face-to-face contact?  Paid based on patient outcomes and overall health achievements?
 
With the American population experiencing higher rates of obesity, overweight, diabetes, hypertension and other "diseases of civilization," a primary care strategy must include more than periodic sickness visits. 
 
Dr. Conard offers a template for creating a primary care strategy.
 
Resources:
Primary Care in the United States: a Handbook of Charts and Facts
Advancing Primary Care: a  Purchaser Playbook for Action (National Alliance of Healthcare Purchaser Coalitions)
Primary Care Collaborative
Achieving Value through Advanced Primary Care (National Alliance of Healthcare Purchaser Coalitions)
Converging Health (Dr. Conard)

Minerals and Medicine: Talking Affordable Healthcare To The Mining Industry

Mining has changed a lot from the days of pickaxes and lanterns, and so has the challenge of delivering affordable care to miners and families in rural and underserved areas of Appalachia.
These covered members are a unique population with distinctly different needs from urbanites.
Stan talks with his guest Doug Schram, MD, Alliance Resource's Medical Director, about their comprehensive self-funded, self-administered and very affordable healthcare plan.