In this insightful episode, we sit down with Josh Archambeau, a prominent figure in healthcare policy reform, to explore his significant contributions and the current state of the healthcare system. Josh discusses his role in crafting and promoting legislation that allows patients to apply cash payments toward in-network deductibles, a move aimed at making healthcare more accessible and affordable. He shares his journey into the world of healthcare policy, starting with his work alongside Governor Mitt Romney on Romneycare, providing an insider's perspective on the complexities of healthcare legislation and the differences between Romneycare and the Affordable Care Act (ACA). Listeners will gain a deep understanding of the challenges and opportunities within the healthcare system, the importance of aligning incentives in public programs, and the impact of policy decisions on everyday Americans. Josh also talks about his background, influenced by his father's career as a pharmacist, and his dedication to training the next generation of healthcare reformers through his work with the Cicero Institute and Reformers Academy.

Key Takeaways from this Episode:

• Josh Archambeau has been instrumental in legislation allowing patients to apply cash payments toward in-network deductibles.

• His journey into healthcare policy began with his work on Romneycare alongside Governor Mitt Romney.

• Josh highlights the complexities and differences between Romneycare and the Affordable Care Act (ACA).

• He emphasizes the importance of aligning incentives in public healthcare programs to achieve desired outcomes.

• Josh is dedicated to training future healthcare reformers through his roles at the Cicero Institute and Reformers Academy.

Off the Rails podcast: https://www.offtherails.show/

In this episode, Rohan Kulkarni, a healthcare industry expert from HFS Research. Together, they delve into the current state of the U.S. healthcare system, the critical role of primary care, and the innovative trends reshaping the industry. Rohan shares his unique insights on the failures of value-based care, the potential of direct primary care (DPC), and the importance of a holistic approach to health. They also touch on the broader socio-economic factors impacting healthcare and the need for systemic change.

Key Takeaways from this Episode:

• The U.S. has a critical shortage of primary care physicians, with only about 27% of clinicians in this field compared to 70-80% in other OECD countries.

• Medical school structures and reimbursement models heavily influence the shortage and distribution of primary care versus specialist physicians.

• The concept of value-based care has failed over the past 50 years and needs to be reconsidered for the 21st century.

• Direct Primary Care (DPC) models, which focus on subscription-based, holistic care, offer a promising alternative to traditional fee-for-service systems.

• Socio-economic factors, lifestyle choices, and preventative care are crucial elements that need to be integrated into a reimagined healthcare system.

Off the Rails podcast: https://www.offtherails.show/

In this episode, Craig and I discuss the intricacies of the revenue cycle, the impact of quality measures on healthcare practices, and the challenges faced by providers. From the effectiveness of the Merit-based Incentive Payment System (MIPS) to the real-world implications of healthcare regulations, Craig shares his expert insights and experiences. We also touch on personal anecdotes that highlight the critical issues within our healthcare system.

Key Takeaways from this Episode:

1. Challenges in Revenue Cycle Management: The healthcare revenue cycle is fraught with inefficiencies and challenges, impacting the overall system's functionality and the quality of care provided to patients.

2. MIPS and Quality Measures: The Merit-based Incentive Payment System (MIPS) is designed to improve patient outcomes by incentivizing quality care. However, its effectiveness is limited, and it often fails to drive substantial improvements.

3. Sunsetting of Measures: High reporting rates for specific measures can lead to their eventual discontinuation, as they become standard practice and no longer serve as effective differentiators of quality.

4. Revenue Neutrality: The MIPS program aims to be revenue neutral, meaning the incentives earned by high-performing providers are balanced by penalties on those who underperform or fail to report satisfactorily.

5. Personal Impact of Hospital Practices: Personal experiences, such as Craig Epstein's story of hospital-acquired infections affecting his mother, highlight the critical need for stringent and meaningful quality measures in healthcare.

Off the Rails podcast: https://www.offtherails.show/