Amy Scanlan's guest appearances

Amy Scanlan

Relentless Health Value™

OwlTail

Doug Pohl

Justina Lehman

Thanks for joining me as we kick off the summer season. Here’s what we’re gonna talk about today in our 10-ish-minute conversation. Keeping it short and sweet. First up, we got three super interesting voice messages left by your fellow members of the Relentless Tribe that I wanted to share with you. Next up, I will cover plans for the summer, because this summer, we have plans. And then after that, just wanted to chat a little bit about what I am up to right now. Agenda item #1: Episodes 399 and 400 of Relentless Health Value were me sharing my manifesto as it were. At the end of the show, I said that if you have a manifesto of your own, to share it by going to relentlesshealthvalue.com and hitting the orange leave a voice mail button. Doug Pohl, CEO of HealthTech Content, did so; and here is what he had to say: “My name is Doug Pohl. I’m the founder and CEO of HealthTech Content, and I'm pretty frustrated by the lack of progress toward making the improvements we need for healthcare. So, I put this out there to sort of be a bat signal for anyone else who feels the same way I do but to also hold myself accountable to be congruent outwardly with how I feel inwardly. No longer will I accept healthcare’s prioritization of the bottom line. No more will I ignore the flagrant victimization of our society. I won’t sit silently while shortsighted greed ruins families. I don’t accept a profit-first model that kills people daily. I can’t let complacency keep me from taking action. I won’t let my voice wither away in fear. I can’t—and I won’t—remain quiet. I believe in the potential of regular people. I know how powerful we can be working together. Every one of us is affected by healthcare eventually, and it will take all of us to create the healthcare we deserve. The first step is rejecting the status quo. I’m tossing it out the window. How about you?” And now let me share two more voice mail messages, and here’s why they both are meaningful. We know that this journey to transform the healthcare industry in this country can be long and slow and, at times, lonely. But together we are stronger and more able to help patients receive the care that they need and deserve at a price that we all can afford. So, thank you for being part of our community, and here’s two perspectives on why you being here matters. Here’s a voice mail from Justina Lehman from the Infinite Health Collaborative (iHealth): “When you are in the work of creating change in healthcare and really working to align with value for the patient, value for the physician, the clinician so they have an environment that they can thrive in, the work can feel hard. And it can feel lonely, and you can feel on an island. And Relentless Health Value podcast is your people. We often say this in our team of … when you look to that podcast, you’re reminded of all the amazing people across this country doing incredibly meaningful work. And linking up with one another can create that strength and help you with your resiliency, especially on those days where you’re feeling down and that the work is hard and that you’re doing it alone. And sometimes you may even question: Is this work of value? Will it be valued of others? The Relentless Health Value podcast, Stacey, all of her guests have really been those people for us. Not uncommon for us to share podcasts amongst each other during the work of reminding each other of the people out there doing great things. So, so incredibly grateful for what Stacey’s built and for all the guests that have been on her show and the value it’s adding and the support it’s giving to those of us who are out in the trenches trying to make this happen. So, thank you, Stacey.” And here’s a message from Amy Scanlan, MD, who was also a guest on episode 402: “Hi, Stacey. It’s Amy Scanlan. Wanted to say thank you for your latest episode. It’s so helpful to be reminded that, even though we’re making little steps, we are making progress and we’re part of a greater movement. Thanks so much for the inspiration and for always doing the good work. Bottom line, here’s my point and call to action: Share this show, especially with colleagues, with anybody trying to find a path forward who may be helped by a little companionship along the way. I just got a note, in fact, from Rajiv Patel, MD, MBA, FACP, from Bluestone Physician Services, and he wrote, “I am only a six-month listener and pretty upset to have not found this podcast earlier.” So, help spread the word and there are some people out there—not everybody, but some people—who you would be doing, frankly, a great service to. It sucks to feel alone. Agenda item #2: Let’s talk about our summer plans here at Relentless Health Value. These plans are made possible because I am a collector. I grew up in Pennsylvania Dutch country. What can I say? We don’t throw things away. We get a recycled jar and start throwing, I don’t know, old keys into it until—it’s like a magic trick, really—suddenly we have a collection of old keys. You know you’re a collector when you have to buy a Brother P-Touch label maker because you have so many collections you require fancy labels to keep track of them all. Here’s why this is relevant to you: Over the past year or so, I started collecting the sound bites that we had to cut from our episodes. I’m not talking about bloopers. I’m talking about really good insights and information but on a topic that maybe was slightly off-topic from the main thrust of the episode or sometimes just a little too long. I try to keep our shows around the 32-ish-minute mark because … yeah, you people are busy. At a certain point, though, I realized I had maybe half a dozen of these 5- to 10-minute clips. So, that’s what we’re doing this summer. We’re going to play a drawer of, I’ll call them, “Summer Shorts.” Get it? Summer shorts? These shorts are all with previous guests, and each short shares one or two very concise insights. I have about seven shorts in this drawer, so this will take us through most of the summer. There will be an episode or two sprinkled in. We have one on deck from Larry Bauer, who goes through some really heartwarming bright spots in the delivery of healthcare, and another one from Dan Serrano talking about CKD (chronic kidney disease) from a financial modeling standpoint. We’ll see how it goes. Feedback is welcome. Speaking of bloopers, though, after 400 or whatever shows, I have to say I’m very blasé about bloopers as you will discover if you ask me about them, which many people do. I’ve heard them all what feels like a thousand times each: the ambulances, the helicopters, the lawn guys, the kids screaming about not wanting to give their germs to the dog (come to think of it, I should have saved that one), squirrels in the mini blinds, dogs barking, obviously the cat on the keyboard, the ice machine, the doorbells, things beeping, an occasional rooster. I always just delete them because guests get embarrassed. But yeah, I probably have enough audio to put together a game show entitled Where Is the Guest Working From— Home, Hospital, Office? Answer correctly and win prizes. That was a detour. Back on track now. One of the other reasons for doing summer shorts is because … wow, I am really busy. QC-Health®, the benefit corp that I’m co-president of, is working really hard in the CKD space. Right now, we are collaborating with several provider organizations—amazing ones, if you ask me—trying to co-design with PCPs in a very helpful way (ie, a way that is intrinsically motivating) to diagnose CKD earlier, slow disease progression, and help their colleagues do so, too. Considering that 50% (five-oh percent!) of patients who go into dialysis crash into dialysis in the ER (ie, they go to the emergency room for something or other and, while there, they are told that the root cause of their problem is “Oh yeah, you have end-stage renal disease [ESRD] and need to be on dialysis,” which costs, what, a quarter million dollars a year [according to a study in JAMA Network Open]). Oh, and also, two out of five of those patients who crash into dialysis—this is sad—had no idea they even had CKD, meaning they had no chance to slow their disease progression even if they wanted to. So, lots of work to be done there. This said, if you are working on anything that has to do with CKD, hit me up. There may be some alignments that we could explore. The process that we are using here to address and try to level up CKD outcomes is the same process that we used in the chronic liver disease (CLD) space, in which we improved the use of clinical guidelines for end-stage liver disease by 23% in about six months nationwide. Yeah, I know. I actually have a day job and do real work. Now, I will say that if you have a drug in the CKD space or a device or you are an ESRD value-based provider … yeah, call me kinda quick. It’s humbling and nice validation the number of folks who are interested in working with us, but we don’t want to bite off more than we can chew. Moving on, here’s some more news about me. Thanks so much to the Validation Institute for awarding me Healthcare Influencer of the Year. That was a really cool surprise, and I am looking forward to picking up the award in DC at thINc360. So, that happened. I’m also looking forward to giving the keynote at the Pittsburgh Business Group on Health Symposium in September. Please come and see me there. I would love to meet you.    For more information, go to aventriahealth.com.   Each week on Relentless Health Value, Stacey uses her voice and thought leadership to provide insights for healthcare industry decision makers trying to do the right thing. Each show features expert guests who break down the twists and tricks in the medical field to help improve outcomes and lower costs across the care continuum. Relentless Health Value is a top 100 podcast on iTunes in the medicine category and reaches tens of thousands of engaged listeners across the healthcare industry. In addition to hosting Relentless Health Value, Stacey is co-president of QC-Health, a benefit corporation finding cost-effective ways to improve the health of Americans. She 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.   01:14 Doug Pohl’s manifesto. 02:43 Justina Lehman’s thoughts on why our podcast listeners are important. 04:05 Dr. Amy Scanlan’s voice mail. 04:39 Note from Rajiv Patel, MD, MBA, FACP. 05:01 Relentless Health Value’s plans for the summer. 09:18 Stacey’s plans for the summer.    For more information, go to aventriahealth.com.   Our host, Stacey, discusses our #healthcarepodcast plans for the summer. #healthcare #podcast   Recent past interviews: Click a guest’s name for their latest RHV episode! Scott Haas, Chris Deacon, Dr Vivek Garg, Lauren Vela, Dale Folwell (Encore! EP249), Eric Gallagher, Dr Suhas Gondi, Dr Rachel Reid, Dr Amy Scanlan, Peter J. Neumann

Thanks for joining me as we kick off the summer season. Here’s what we’re gonna talk about today in our 10-ish-minute conversation. Keeping it short and sweet. First up, we got three super interesting voice messages left by your fellow members of the Relentless Tribe that I wanted to share with you. Next up, I will cover plans for the summer, because this summer, we have plans. And then after that, just wanted to chat a little bit about what I am up to right now. Agenda item #1: <a href="https://relentlesshealthvalue.com/episode/ep399-my-manifesto-part-1-the-relentless-health-value-tribe-i-salute-you" rel="noopener nofollow" target="_blank">Episodes 399</a> and <a href="https://relentlesshealthvalue.com/episode/ep400-my-manifesto-part-2-where-the-rubber-hits-the-road" rel="noopener nofollow" target="_blank">400</a> of Relentless Health Value were me sharing my manifesto as it were. At the end of the show, I said that if you have a manifesto of your own, to share it by going to <a href="http://relentlesshealthvalue.com" rel="nofollow" target="_blank">relentlesshealthvalue.com</a> and hitting the orange leave a voice mail button. Doug Pohl, CEO of HealthTech Content, did so; and here is what he had to say: “My name is Doug Pohl. I’m the founder and CEO of HealthTech Content, and I'm pretty frustrated by the lack of progress toward making the improvements we need for healthcare. So, I put this out there to sort of be a bat signal for anyone else who feels the same way I do but to also hold myself accountable to be congruent outwardly with how I feel inwardly. No longer will I accept healthcare’s prioritization of the bottom line. No more will I ignore the flagrant victimization of our society. I won’t sit silently while shortsighted greed ruins families. I don’t accept a profit-first model that kills people daily. I can’t let complacency keep me from taking action. I won’t let my voice wither away in fear. I can’t—and I won’t—remain quiet. I believe in the potential of regular people. I know how powerful we can be working together. Every one of us is affected by healthcare eventually, and it will take all of us to create the healthcare we deserve. The first step is rejecting the status quo. I’m tossing it out the window. How about you?” And now let me share two more voice mail messages, and here’s why they both are meaningful. We know that this journey to transform the healthcare industry in this country can be long and slow and, at times, lonely. But together we are stronger and more able to help patients receive the care that they need and deserve at a price that we all can afford. So, thank you for being part of our community, and here’s two perspectives on why you being here matters. Here’s a voice mail from Justina Lehman from the Infinite Health Collaborative (iHealth): “When you are in the work of creating change in healthcare and really working to align with value for the patient, value for the physician, the clinician so they have an environment that they can thrive in, the work can feel hard. And it can feel lonely, and you can feel on an island. And Relentless Health Value podcast is your people. We often say this in our team of … when you look to that podcast, you’re reminded of all the amazing people across this country doing incredibly meaningful work. And linking up with one another can create that strength and help you with your resiliency, especially on those days where you’re feeling down and that the work is hard and that you’re doing it alone. And sometimes you may even question: Is this work of value? Will it be valued of others? The Relentless Health Value podcast, Stacey, all of her guests have really been those people for us. Not uncommon for us to share podcasts amongst each other during the work of reminding each other of the people out there doing great things. So, so incredibly grateful for what Stacey’s built and for all the guests that have been on her show and the value it’s adding and the support it’s giving to those of us who are out in the trenches trying to make this happen. So, thank you, Stacey.” And here’s a message from Amy Scanlan, MD, who was also a guest on <a href="https://relentlesshealthvalue.com/episode/ep402-what-physicians-trying-to-clinically-integrate-care-in-the-real-world-need-to-know-with-amy-scanlan-md" rel="noopener nofollow" target="_blank">episode 402</a>: “Hi, Stacey. It’s Amy Scanlan. Wanted to say thank you for your latest episode. It’s so helpful to be reminded that, even though we’re making little steps, we are making progress and we’re part of a greater movement. Thanks so much for the inspiration and for always doing the good work. Bottom line, here’s my point and call to action: Share this show, especially with colleagues, with anybody trying to find a path forward who may be helped by a little companionship along the way. I just got a note, in fact, from Rajiv Patel, MD, MBA, FACP, from Bluestone Physician Services, and he wrote, “I am only a six-month listener and pretty upset to have not found this podcast earlier.” So, help spread the word and there are some people out there—not everybody, but some people—who you would be doing, frankly, a great service to. It sucks to feel alone. Agenda item #2: Let’s talk about our summer plans here at Relentless Health Value. These plans are made possible because I am a collector. I grew up in Pennsylvania Dutch country. What can I say? We don’t throw things away. We get a recycled jar and start throwing, I don’t know, old keys into it until—it’s like a magic trick, really—suddenly we have a collection of old keys. You know you’re a collector when you have to buy a Brother P-Touch label maker because you have so many collections you require fancy labels to keep track of them all. Here’s why this is relevant to you: Over the past year or so, I started collecting the sound bites that we had to cut from our episodes. I’m not talking about bloopers. I’m talking about really good insights and information but on a topic that maybe was slightly off-topic from the main thrust of the episode or sometimes just a little too long. I try to keep our shows around the 32-ish-minute mark because … yeah, you people are busy. At a certain point, though, I realized I had maybe half a dozen of these 5- to 10-minute clips. So, that’s what we’re doing this summer. We’re going to play a drawer of, I’ll call them, “Summer Shorts.” Get it? Summer shorts? These shorts are all with previous guests, and each short shares one or two very concise insights. I have about seven shorts in this drawer, so this will take us through most of the summer. There will be an episode or two sprinkled in. We have one on deck from Larry Bauer, who goes through some really heartwarming bright spots in the delivery of healthcare, and another one from Dan Serrano talking about CKD (chronic kidney disease) from a financial modeling standpoint. We’ll see how it goes. Feedback is welcome. Speaking of bloopers, though, after 400 or whatever shows, I have to say I’m very blasé about bloopers as you will discover if you ask me about them, which many people do. I’ve heard them all what feels like a thousand times each: the ambulances, the helicopters, the lawn guys, the kids screaming about not wanting to give their germs to the dog (come to think of it, I should have saved that one), squirrels in the mini blinds, dogs barking, obviously the cat on the keyboard, the ice machine, the doorbells, things beeping, an occasional rooster. I always just delete them because guests get embarrassed. But yeah, I probably have enough audio to put together a game show entitled Where Is the Guest Working From— Home, Hospital, Office? Answer correctly and win prizes. That was a detour. Back on track now. One of the other reasons for doing summer shorts is because … wow, I am really busy. QC-Health®, the benefit corp that I’m co-president of, is working really hard in the CKD space. Right now, we are collaborating with several provider organizations—amazing ones, if you ask me—trying to co-design with PCPs in a very helpful way (ie, a way that is intrinsically motivating) to diagnose CKD earlier, slow disease progression, and help their colleagues do so, too. Considering that 50% (five-oh percent!) of patients who go into dialysis crash into dialysis in the ER (ie, they go to the emergency room for something or other and, while there, they are told that the root cause of their problem is “Oh yeah, you have end-stage renal disease [ESRD] and need to be on dialysis,” which costs, what, a quarter million dollars a year [according to a <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797907?widget=personalizedcontent&amp;previousarticle=0" rel="noopener nofollow" target="_blank">study</a> in JAMA Network Open]). Oh, and also, two out of five of those patients who crash into dialysis—this is sad—had no idea they even had CKD, meaning they had no chance to slow their disease progression even if they wanted to. So, lots of work to be done there. This said, if you are working on anything that has to do with CKD, hit me up. There may be some alignments that we could explore. The process that we are using here to address and try to level up CKD outcomes is the same process that we used in the chronic liver disease (CLD) space, in which we improved the use of clinical guidelines for end-stage liver disease by 23% in about six months nationwide. Yeah, I know. I actually have a day job and do real work. Now, I will say that if you have a drug in the CKD space or a device or you are an ESRD value-based provider … yeah, call me kinda quick. It’s humbling and nice validation the number of folks who are interested in working with us, but we don’t want to bite off more than we can chew. Moving on, here’s some more news about me. Thanks so much to the Validation Institute for awarding me Healthcare Influencer of the Year. That was a really cool surprise, and I am looking forward to picking up the award in DC at thINc360. So, that happened. I’m also looking forward to giving the keynote at the Pittsburgh Business Group on Health Symposium in September. Please come and see me there. I would love to meet you. For more information, go to <a href="https://www.aventriahealth.com/" rel="noopener nofollow" target="_blank">aventriahealth.com</a>. Each week on Relentless Health Value, Stacey uses her voice and thought leadership to provide insights for healthcare industry decision makers trying to do the right thing. Each show features expert guests who break down the twists and tricks in the medical field to help improve outcomes and lower costs across the care continuum. Relentless Health Value is a top 100 podcast on iTunes in the medicine category and reaches tens of thousands of engaged listeners across the healthcare industry. In addition to hosting Relentless Health Value, Stacey is co-president of QC-Health, a benefit corporation finding cost-effective ways to improve the health of Americans. She 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. 01:14 Doug Pohl’s manifesto. 02:43 Justina Lehman’s thoughts on why our podcast listeners are important. 04:05 Dr. Amy Scanlan’s voice mail. 04:39 Note from Rajiv Patel, MD, MBA, FACP. 05:01 Relentless Health Value’s plans for the summer. 09:18 Stacey’s plans for the summer. For more information, go to <a href="https://www.aventriahealth.com/" rel="noopener nofollow" target="_blank">aventriahealth.com</a>. Our host, Stacey, discusses our #healthcarepodcast plans for the summer. #healthcare #podcast Recent past interviews: Click a guest’s name for their latest RHV episode! <a href="https://relentlesshealthvalue.com/episode/encore-ep365-the-real-deal-with-pbm-contracts-and-drug-rebates-with-scott-haas" rel="noopener nofollow" target="_blank">Scott Haas</a>, <a href="https://relentlesshealthvalue.com/episode/ep408-whos-suing-who-an-overview-of-healthcare-legal-goings-on-with-chris-deacon" rel="noopener nofollow" target="_blank">Chris Deacon</a>, <a href="https://relentlesshealthvalue.com/episode/ep407-considering-comprehensive-primary-care-at-humana-with-vivek-garg-md-mba" rel="noopener nofollow" target="_blank">Dr Vivek Garg</a>, <a href="https://relentlesshealthvalue.com/episode/ep406-the-inertia-show-5-excellent-reasons-for-the-why-with-the-inertia-in-benefits-departments-with-lauren-vela" rel="noopener nofollow" target="_blank">Lauren Vela</a>, <a href="https://relentlesshealthvalue.com/episode/encore-ep249-the-war-on-financial-toxicity-in-north-carolina-as-a-case-study-everybody-should-be-keeping-their-eye-on-with-dale-folwell-north-carolina-state-treasurer" rel="noopener nofollow" target="_blank">Dale Folwell (Encore! EP249)</a>, <a href="https://relentlesshealthvalue.com/episode/ep405-what-else-physicians-trying-to-clinically-integrate-in-the-real-world-really-need-to-know-with-eric-gallagher" rel="noopener nofollow" target="_blank">Eric Gallagher</a>, <a href="https://relentlesshealthvalue.com/episode/ep404-what-now-whos-on-the-board-of-those-big-hospitals-with-suhas-gondi-md-mba" rel="noopener nofollow" target="_blank">Dr Suhas Gondi</a>, <a href="https://relentlesshealthvalue.com/episode/ep403-the-mix-match-with-the-how-doctors-get-paid-with-rachel-reid-md-ms" rel="noopener nofollow" target="_blank">Dr Rachel Reid</a>, <a href="https://relentlesshealthvalue.com/episode/ep402-what-physicians-trying-to-clinically-integrate-care-in-the-real-world-need-to-know-with-amy-scanlan-md" rel="noopener nofollow" target="_blank">Dr Amy Scanlan</a>, <a href="https://relentlesshealthvalue.com/episode/ep401-the-most-interesting-questions-about-the-ira-drug-price-negotiations-with-peter-j-neumann-scd" rel="noopener nofollow" target="_blank">Peter J. Neumann</a>

INBW38: What I’m Up to Right Now, Big RHV Plans for the Summer—Also Doug Pohl, Justina Lehman, and Dr. Amy Scanlan

So, let me just cut to the chase here with very little preamble, and all of this is a setup to the interview that follows, although it is not really what the interview that follows is all about. A mentor of mine used to say, you can’t legislate the heart. Let me also suggest you can’t give someone in finance financial incentives and then expect them to not prioritize financial incentives. It stands to reason that if the healthcare industry is found to be quite attractive to those who are money focused, then do I need to say this? The money focused amongst us will, of course, do the whatever to the extent that they can make money. They aren’t gonna be throwing their backs into quality or cost effectiveness or taking care of patients. They are throwing their backs into making money. Is anyone shocked? Now, don’t get me wrong; I’m not a Pollyanna. And in this country, in order to run a healthcare business, you have to make money; otherwise, you’ll go out of business. So, do well by doing good and all of that. But how much money is too much money? This is an important line to figure out because that’s where you are doing well but you’ve stopped doing good—you’ve tipped into financial toxicity. You are taking more than the good you are doing, and the net positive becomes a net negative. But complicating fact of current life, it’s becoming increasingly obvious that in order to stand up a practice that can take advantage of value-based care payments—payments where primary care docs mainly at this time can get paid more and likely more fairly to care for patients well—you need a lot of infrastructure. You need data, you need tech, you need a team. Translation: You need money, maybe a lot of money, to invest in all of this. And let me ask you this: Who has a lot of money in this country? Here’s the point of everything I just said: These are the external realities that hit anyone trying to do right by patients from every direction. But on the other hand (or maybe different fingers on the same hand), as Amy Scanlan, MD, says in this healthcare podcast, physicians are the backbone of this system. Dr. Scanlan talks in the interview today about the opportunity, and maybe the responsibility, that physicians have here for patients; but also the Eric Reinhart article comes up again about rampant physician moral injury (unpaywalled link with my compliments). Right now might be a great time to read something from Denver Sallee, MD. He wrote to me the other day. He wrote, “Like many physicians, I did not have much understanding of the business side of medicine, as I mistakenly thought as long as I helped take great care of patients that I was doing my job. More recently, it became apparent to me that by ceding the management of medicine to nonclinical administrators and to companies interested primarily in value extraction for the benefit of shareholders that I needed more education in order to truly help patients.” Today as aforementioned, I’m talking with Amy Scanlan, MD, who is chief medical officer of the clinically integrated network (CIN) that is the new joint venture between Intermountain Health and UCHealth in Colorado. We talk about what it’s like to be in the kind of messy middle of transformation to integrated care in a clinically integrated network, trying to figure out how to help physician practices and the CIN itself navigate the external environment in a way that empowers different kinds of practices at different points in their transformation journey that empowers physicians to be in charge, and considering clinical and financial outcomes (ie, the business of healthcare). Dr. Scanlan brings up four main factors to consider when plotting strategy from here to there: 1. Give practices the tools that they need to succeed—not what you think they need but what you’ve discerned they actually need because you’ve listened to them. 2. Many times, these tools will consist of some combination of data, tech, and also offering the team behind the scenes to help doctors and other clinicians help patients through what Dr. Scanlan calls the “in-between spaces”—the times between appointments. 3. Medical culture really has to change, and in two ways: doctors learning how to be part of and/or leading functional teams and building functional teams. Because there are teams, and then there are teams. Well-functioning teams can produce great results. Nonfunctioning teams, however, are, as Dr. Scanlan puts it, just a series of handoffs. And don’t forget, handoffs are the most dangerous times for patients. The DNA of team-based care—real team-based care—for better or worse, are the relationships between team members, between physicians who work together, between doctors and patients, between clinicians and clinicians. So, fostering relationships, creating opportunities to collaborate and talk, is not to be underestimated. How do you re-create the doctors’ lounge in 2023? 4. Getting out from underneath the long shadow of fee-for-service incentives, specifically the paradigm that only patients who get mindshare are the ones in the exam room. Value-based care, integrated care is as much contemplating the patients who don’t show up as the ones who do. This is a really big mind shift, much bigger than many realize.    You can learn more by reaching out to Dr. Scanlan on LinkedIn.      Amy Scanlan, MD, serves as chief medical officer for the new joint venture CIN between UCHealth and Intermountain Health—a physician-led, clinically integrated network of more than 700 primary care providers from UCHealth, Intermountain Health Peaks Region, the University of Colorado School of Medicine, and multiple independent practices along the Front Range. Dr. Scanlan trained as a family practice physician and has continued to practice for the past 25 years. She has worked as a physician-owner in a small independent practice and has held multiple leadership positions as part of large health systems. She has served on numerous health system committees spanning quality, innovation, recruitment, and credentialing. She is very familiar with value-based care models, having been part of an accountable care organization (ACO) practice for the past 15 years, as well as participating on an ACO Practice Performance and Standards Committee and serving on a local ACO board. She received a bachelor’s degree with honors from Wesleyan University in Connecticut. She obtained her medical degree from Case Western Reserve University in Cleveland, where she received the Kiwala Award for Research in Family Medicine. Her residency was completed at St. Anthony’s Family Medicine Residency program in Denver. She is currently board certified by the American Board of Family Medicine and NCQA (National Committee for Quality Assurance) certified in diabetes.   06:33 How is Dr. Scanlan thinking about the transformation process and the shift to value? 09:14 “It is really trying to think about, how do we help practices get there?” 11:46 “The hard part is the in-between spaces.” 14:10 “Team-based care done badly is really just a series of handoffs.” 15:50 “We have to get to that point where the culture of collaboration is more pervasive.” 19:57 “How do we as healthcare providers step in and solve this problem?” 20:04 Why do providers have a responsibility to step in and try to fix the healthcare system? 20:20 Article (unpaywalled) by Eric Reinhart, MD, PhD. 21:50 Why do physicians need to be accountable for the cost of care as well as outcomes? 23:37 Why does physician burnout give Dr. Scanlan hope? 24:25 What is the solution to changing fee-for-service incentives? 25:42 What are some of the challenges facing changing incentives? 27:14 Why is data so important? 28:53 EP393 with David Muhlestein, PhD, JD. 30:11 “It’s important to understand that we are in the middle of this change.” 31:16 Dr. Scanlan’s advice for those trying to stand up a CIN.    You can learn more by reaching out to Dr. Scanlan on LinkedIn.   Amy Scanlan, MD, of @uchealth discusses real-world #clinicalintegration on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest’s name for their latest RHV episode! Peter J. Neumann, Stacey Richter (EP400), Dawn Cornelis (Encore! EP285), Stacey Richter (EP399), Dr Jacob Asher, Paul Holmes, Anna Hyde, Dea Belazi (Encore! EP293), Brennan Bilberry, Dr Vikas Saini and Judith Garber

So, let me just cut to the chase here with very little preamble, and all of this is a setup to the interview that follows, although it is not really what the interview that follows is all about. A mentor of mine used to say, you can’t legislate the heart. Let me also suggest you can’t give someone in finance financial incentives and then expect them to not prioritize financial incentives. It stands to reason that if the healthcare industry is found to be quite attractive to those who are money focused, then do I need to say this? The money focused amongst us will, of course, do the whatever to the extent that they can make money. They aren’t gonna be throwing their backs into quality or cost effectiveness or taking care of patients. They are throwing their backs into making money. Is anyone shocked? Now, don’t get me wrong; I’m not a Pollyanna. And in this country, in order to run a healthcare business, you have to make money; otherwise, you’ll go out of business. So, do well by doing good and all of that. But how much money is too much money? This is an important line to figure out because that’s where you are doing well but you’ve stopped doing good—you’ve tipped into financial toxicity. You are taking more than the good you are doing, and the net positive becomes a net negative. But complicating fact of current life, it’s becoming increasingly obvious that in order to stand up a practice that can take advantage of value-based care payments—payments where primary care docs mainly at this time can get paid more and likely more fairly to care for patients well—you need a lot of infrastructure. You need data, you need tech, you need a team. Translation: You need money, maybe a lot of money, to invest in all of this. And let me ask you this: Who has a lot of money in this country? Here’s the point of everything I just said: These are the external realities that hit anyone trying to do right by patients from every direction. But on the other hand (or maybe different fingers on the same hand), as Amy Scanlan, MD, says in this healthcare podcast, physicians are the backbone of this system. Dr. Scanlan talks in the interview today about the opportunity, and maybe the responsibility, that physicians have here for patients; but also the Eric Reinhart <a href="https://www.nytimes.com/2023/02/05/opinion/doctors-universal-health-care.html?unlocked_article_code=JTSk52EZLrQAIql5fJVB_6Q_3iwWVSMMNr2TjX9vCG9m-W0kPmj1pRrtkSGt5NKw5jJszEcb-nRVlPp0xJAHD8oym1jC_HqaawmFqhwmb5bHu_RBHeMY5dy6yrDUrSKM29c0T-g_ZyV_d-MEGiUbjTD5UVD3XqBLV4j4r2N_deUmKlIf3mgg6dBTdQ2z1yu_VhMI7ebOV8X09WwOVuavL1qR9TARDMFQ-91_zg_QN-gukaqTdzgeEFiDyGKk3MEVo68I876tOKpdSTimjJgaksU56gFHRud7CxrpNaEAxkZkkkci1bIv-Ew4T2mcDz4euGjIPMqsKO6T_MoemeiEwN_TOfTvAME&amp;giftCopy=0_NoCopy&amp;smid=url-share" rel="noopener nofollow" target="_blank">article</a> comes up again about rampant physician moral injury (unpaywalled link with my compliments). Right now might be a great time to read something from Denver Sallee, MD. He wrote to me the other day. He wrote, “Like many physicians, I did not have much understanding of the business side of medicine, as I mistakenly thought as long as I helped take great care of patients that I was doing my job. More recently, it became apparent to me that by ceding the management of medicine to nonclinical administrators and to companies interested primarily in value extraction for the benefit of shareholders that I needed more education in order to truly help patients.” Today as aforementioned, I’m talking with Amy Scanlan, MD, who is chief medical officer of the clinically integrated network (CIN) that is the new joint venture between Intermountain Health and UCHealth in Colorado. We talk about what it’s like to be in the kind of messy middle of transformation to integrated care in a clinically integrated network, trying to figure out how to help physician practices and the CIN itself navigate the external environment in a way that empowers different kinds of practices at different points in their transformation journey that empowers physicians to be in charge, and considering clinical and financial outcomes (ie, the business of healthcare). Dr. Scanlan brings up four main factors to consider when plotting strategy from here to there: 1. Give practices the tools that they need to succeed—not what you think they need but what you’ve discerned they actually need because you’ve listened to them. 2. Many times, these tools will consist of some combination of data, tech, and also offering the team behind the scenes to help doctors and other clinicians help patients through what Dr. Scanlan calls the “in-between spaces”—the times between appointments. 3. Medical culture really has to change, and in two ways: doctors learning how to be part of and/or leading functional teams and building functional teams. Because there are teams, and then there are teams. Well-functioning teams can produce great results. Nonfunctioning teams, however, are, as Dr. Scanlan puts it, just a series of handoffs. And don’t forget, handoffs are the most dangerous times for patients. The DNA of team-based care—real team-based care—for better or worse, are the relationships between team members, between physicians who work together, between doctors and patients, between clinicians and clinicians. So, fostering relationships, creating opportunities to collaborate and talk, is not to be underestimated. How do you re-create the doctors’ lounge in 2023? 4. Getting out from underneath the long shadow of fee-for-service incentives, specifically the paradigm that only patients who get mindshare are the ones in the exam room. Value-based care, integrated care is as much contemplating the patients who don’t show up as the ones who do. This is a really big mind shift, much bigger than many realize. You can learn more by reaching out to Dr. Scanlan on <a href="https://www.linkedin.com/in/amy-scanlan-b343a82a/" rel="noopener nofollow" target="_blank">LinkedIn</a>. Amy Scanlan, MD, serves as chief medical officer for the new joint venture CIN between UCHealth and Intermountain Health—a physician-led, clinically integrated network of more than 700 primary care providers from UCHealth, Intermountain Health Peaks Region, the University of Colorado School of Medicine, and multiple independent practices along the Front Range. Dr. Scanlan trained as a family practice physician and has continued to practice for the past 25 years. She has worked as a physician-owner in a small independent practice and has held multiple leadership positions as part of large health systems. She has served on numerous health system committees spanning quality, innovation, recruitment, and credentialing. She is very familiar with value-based care models, having been part of an accountable care organization (ACO) practice for the past 15 years, as well as participating on an ACO Practice Performance and Standards Committee and serving on a local ACO board. She received a bachelor’s degree with honors from Wesleyan University in Connecticut. She obtained her medical degree from Case Western Reserve University in Cleveland, where she received the Kiwala Award for Research in Family Medicine. Her residency was completed at St. Anthony’s Family Medicine Residency program in Denver. She is currently board certified by the American Board of Family Medicine and NCQA (National Committee for Quality Assurance) certified in diabetes. 06:33 How is Dr. Scanlan thinking about the transformation process and the shift to value? 09:14 “It is really trying to think about, how do we help practices get there?” 11:46 “The hard part is the in-between spaces.” 14:10 “Team-based care done badly is really just a series of handoffs.” 15:50 “We have to get to that point where the culture of collaboration is more pervasive.” 19:57 “How do we as healthcare providers step in and solve this problem?” 20:04 Why do providers have a responsibility to step in and try to fix the healthcare system? 20:20 <a href="https://www.nytimes.com/2023/02/05/opinion/doctors-universal-health-care.html?unlocked_article_code=JTSk52EZLrQAIql5fJVB_6Q_3iwWVSMMNr2TjX9vCG9m-W0kPmj1pRrtkSGt5NKw5jJszEcb-nRVlPp0xJAHD8oym1jC_HqaawmFqhwmb5bHu_RBHeMY5dy6yrDUrSKM29c0T-g_ZyV_d-MEGiUbjTD5UVD3XqBLV4j4r2N_deUmKlIf3mgg6dBTdQ2z1yu_VhMI7ebOV8X09WwOVuavL1qR9TARDMFQ-91_zg_QN-gukaqTdzgeEFiDyGKk3MEVo68I876tOKpdSTimjJgaksU56gFHRud7CxrpNaEAxkZkkkci1bIv-Ew4T2mcDz4euGjIPMqsKO6T_MoemeiEwN_TOfTvAME&amp;giftCopy=0_NoCopy&amp;smid=url-share" rel="noopener nofollow" target="_blank">Article</a> (unpaywalled) by Eric Reinhart, MD, PhD. 21:50 Why do physicians need to be accountable for the cost of care as well as outcomes? 23:37 Why does physician burnout give Dr. Scanlan hope? 24:25 What is the solution to changing fee-for-service incentives? 25:42 What are some of the challenges facing changing incentives? 27:14 Why is data so important? 28:53 <a href="https://relentlesshealthvalue.com/episode/ep393-how-do-you-know-if-a-practice-or-a-cin-clinically-integrated-network-is-actually-clinically-integrated-with-david-muhlestein-phd-jd" rel="noopener nofollow" target="_blank">EP393</a> with David Muhlestein, PhD, JD. 30:11 “It’s important to understand that we are in the middle of this change.” 31:16 Dr. Scanlan’s advice for those trying to stand up a CIN. You can learn more by reaching out to Dr. Scanlan on <a href="https://www.linkedin.com/in/amy-scanlan-b343a82a/" rel="noopener nofollow" target="_blank">LinkedIn</a>. Amy Scanlan, MD, of @uchealth discusses real-world #clinicalintegration on our #healthcarepodcast. #healthcare #podcast Recent past interviews: Click a guest’s name for their latest RHV episode! <a href="https://relentlesshealthvalue.com/episode/ep401-the-most-interesting-questions-about-the-ira-drug-price-negotiations-with-peter-j-neumann-scd" rel="noopener nofollow" target="_blank">Peter J. Neumann</a>, <a href="https://relentlesshealthvalue.com/episode/ep400-my-manifesto-part-2-where-the-rubber-hits-the-road" rel="noopener nofollow" target="_blank">Stacey Richter (EP400)</a>, <a href="https://relentlesshealthvalue.com/episode/encore-ep285-who-is-auditing-these-healthcare-bills-also-that-cigna-lawsuit-with-dawn-cornelis-cofounder-and-director-of-transparency-at-claiminformatics" rel="noopener nofollow" target="_blank">Dawn Cornelis (Encore! EP285)</a>, <a href="https://relentlesshealthvalue.com/episode/ep399-my-manifesto-part-1-the-relentless-health-value-tribe-i-salute-you" rel="noopener nofollow" target="_blank">Stacey Richter (EP399)</a>, <a href="https://relentlesshealthvalue.com/episode/ep398-why-is-the-commercial-payer-marketplace-in-california-completely-boring-with-jacob-asher-md" rel="noopener nofollow" target="_blank">Dr Jacob Asher</a>, <a href="https://relentlesshealthvalue.com/episode/ep397-the-minefield-that-is-a-pbm-contract-and-also-some-advice-for-ebcs-who-are-taking-money-under-the-table-with-paul-holmes" rel="noopener nofollow" target="_blank">Paul Holmes</a>, <a href="https://relentlesshealthvalue.com/episode/ep396-how-to-answer-this-question-will-humirar-biosimilars-reduce-drug-spend-with-anna-hyde" rel="noopener nofollow" target="_blank">Anna Hyde</a>, <a href="https://relentlesshealthvalue.com/episode/encore-ep293-game-theory-gone-wild-co-pay-cards-co-pay-accumulators-and-co-pay-maximizers-with-dea-belazi-pharmd-mph-president-and-ceo-of-ascellahealth" rel="noopener nofollow" target="_blank">Dea Belazi (Encore! EP293)</a>, <a href="https://relentlesshealthvalue.com/episode/ep395-consolidated-hospital-systems-and-cunning-anticompetitive-contracts-with-brennan-bilberry" rel="noopener nofollow" target="_blank">Brennan Bilberry</a>, <a href="https://relentlesshealthvalue.com/episode/ep394-spoiler-alert-it-is-counterintuitive-which-hospitals-offer-the-most-charity-care-with-vikas-saini-md-and-judith-garber" rel="noopener nofollow" target="_blank">Dr Vikas Saini and Judith Garber</a>