Catalyst for Payment Reform

Michelle Zettergren on direct contracting, COEs, and employer compliance with new ERISA regulations

“What’s great about [direct contracting] relationships is they allow for an employer to work directly with a health system in developing a solution that’s specific to their employee base. They can design programs that address their specific needs, such as addressing diabetes issues within their employee population or behavioral health. In return, the health system expects employers to develop benefit plans and contribution strategies that steer their employees to that health system.”

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Scott Doolittle on how an independent health care navigation company builds trust with both patients and providers

“A provider is always going to want to get paid. They’re always going to call to make sure the member’s covered, and if we’re that single point of entry and can provide that expertise and do it in a way that drives satisfaction for them, they’re more likely to leverage us as we talk about care planning on a go-forward basis.” – Scott Doolittle, CFO, Quantum Health

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Nate Freese on how data science can improve health care navigation

Suzanne Delbanco speaks with Nate Freese, MBA, Senior Director of Data Strategy at Grand Rounds Health, a health care quality and navigation solution offering employers a data-driven clinical navigation platform paired with patient advocacy tools. Nate leads data strategy at Grand Rounds Health, where his team is responsible for building algorithms that match patients with the right providers based on billions of historical clinical interactions.

Nate offers a helpful introduction to data science by describing the three types of analyses that data science tackles as well as use-cases that help physicians, pharmaceutical companies, and patients make informed value-oriented choices. He then explores the major challenges that health tech companies face in bringing their data use-cases to life, including the siloed and unstructured nature of health data and the talent shortage of data science professionals across the country. Finally, Nate shares the approach Grand Rounds Health uses to track and improve its ability to reduce health care disparities.

Data science simplifies the unimaginably complex and predicts the future to help us make better decisions. In health care, the difference between the right and wrong decision can result in hundreds of thousands of dollars in spend, hospitalizations, or worse. In this episode, you’ll learn how Grand Rounds Health is using data science to power its clinical navigation platform and patient advocacy tools, with an eye toward health equity and cost containment.

Featured quotes:
“Messy data is another challenge for applying data science in health care. The data often requires a lot further processing to make it useful, and is often inconsistent – you have systems with different definitions of the same concept or information. Ultimately, it takes very specific skills sets and domain expertise to make health care data sets useful. And that gets to the next big challenge, which is talent shortage.”

“There’s a big disconnect between the number of companies out there that have a compelling vision for how they could use data in a health care context, and the number of companies that are actually doing so. A big factor is finding the people they need to realize that vision.”

“Data scientists are not one-size-fits-all. It’s usually not that you need 1 or 5 data scientists at your company to realize your vision for using data. It’s more likely that you need a couple of data engineers, you might need a couple of machine learning experts, a natural language processing expert, a statistician and a couple of epidemiologists. Each of these people are data scientists, but they bring a different skillset to the picture, and you need several of them to suite a particular use-case.”

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Stephen Furia on Mount Sinai’s Principles of Success for Direct to Purchaser Relationships

CPR’s Program Director, Andréa Caballero, chats with Stephen Furia, Senior Vice President, Population Health at Mount Sinai Health System. The Population Health division is the business unit within Mount Sinai that works directly with employers and other health care purchasers, providing an array of services including primary care focused near-site health centers, Centers of Excellence arrangements for specialty care, executive health programs, and, more recently, assisting employers in responding to the COVID-19 pandemic.

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Rick Abbott on lowering costs by focusing on quality

Suzanne Delbanco chats with Rick Abbott, VP of Product and Market Solutions at Premera Blue Cross. Suzanne and Rick discuss if narrow networks, also known as high-performance networks, represent a viable way to lower prices in the employer-sponsored health insurance market.

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Alan Muney, MD, on why large health plans have a total cost of care advantage

Listen in as Suzanne Delbanco connects with Alan Muney, MD, MHA, former Chief Medical Officer of Cigna, former CEO of Equity Healthcare, and current health care advisor to multiple venture equity firms. This interview is part of CPR’s current work to understand whether group purchasing efforts can secure better health care value for employer-purchasers.

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