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/

In this episode, we welcome Rachel McLaughlin, REBC®, VP of Business Development for a pharmacy benefit manager (PBM). Throughout our conversation, Rachel delves into the complexities of the healthcare system, exploring topics ranging from direct primary care (DPC) to the challenges posed by pharmaceutical costs. With her extensive experience and unique perspective, Rachel sheds light on the intricacies of healthcare delivery and emphasizes the pressing need for innovation and advocacy. Join us as Rachel unravels the nuances of healthcare, offering insights and potential pathways to mitigate cost burdens and enhance patient care.

Key Takeaways from this Episode:

• Direct Primary Care (DPC) offers personalized, holistic healthcare solutions that transcend conventional models.

• Primary care physicians, like Dr. Nikila Schroeder, often possess specialized expertise, allowing for targeted treatment approaches within the realm of primary care.

• Innovative treatments such as sublingual immunotherapy (SLIT) hold promise in addressing chronic conditions like severe allergies.

• Pharmacy Benefit Managers (PBMs) play a crucial role in managing pharmaceutical costs, with transparency and clinical guarantees being key differentiators.

• Policy shifts, such as those post-ACA, have led to unintended consequences, including escalating pharmaceutical costs and accessibility challenges.

• Advocacy efforts are essential in driving systemic change and exploring innovative solutions, such as international drug sourcing, to mitigate healthcare cost burdens.

Rachel McLaughlin can be contacted via Linkedin @rachelmclauchlin/

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

In today's episode of the Off the Rails Podcast, Michelle Bernabe joins me to discuss challenges of providing mental healthcare, including the need for dedicated psychiatric emergency rooms and a collaborative team of medical professionals. Michelle shares her insight on the transformation occurring in psychiatric care, moving towards rapid-acting, neurotherapeutic treatments like ketamine, transcranial magnetic stimulation (TMS), and stellate ganglion blocks. These treatments offer quick relief for various mental health conditions, challenging traditional talk therapies and antidepressants. Our conversation delves into the economics and accessibility of these treatments, highlighting the potential to shift the paradigm in mental health care towards more effective and efficient solutions. This episode emphasizes the importance of patient education and navigating through the existing trust issues within psychiatric care, aiming to provide relief and hope for those suffering from mental illness.

Key takeaways from this episode:

• Shift in Psychiatric Care: There's a notable shift towards rapid-acting neurotherapeutic treatments such as ketamine, TMS, and stellate ganglion blocks.

• Efficacy Challenges Traditional Therapies: These new treatments challenge the efficacy of traditional talk therapies and antidepressants by offering quick relief for various mental health conditions.

• Economic and Accessibility Considerations: There's a discussion around the economics and accessibility of these treatments, highlighting potential barriers to widespread adoption.

• Paradigm Shift in Mental Health Care: The emergence of these treatments signals a potential paradigm shift in mental health care, suggesting more effective and efficient solutions compared to traditional methods.

• Importance of Patient Education: Patient education is crucial in navigating through these new treatment options, ensuring informed decision-making and managing expectations.

• Addressing Trust Issues: There's a need to address existing trust issues within psychiatric care to build confidence in these emerging treatments, offering hope and relief for individuals struggling with mental illness.

Michelle Bernabe can be contacted via email at Michelle@moral.health or on her Substack at moralhealth.com.

In this episode, Sidney and Dr. Demetrio Aguila discussed the challenges and opportunities in the healthcare industry, particularly in peripheral nerve surgery. They emphasized the need for innovation, better understanding of the peripheral nervous system, and patient-centered care. Sidney and Demetrio shared their experiences and perspectives on peripheral nerve surgery, including its effectiveness for chronic pain management. They also discussed the importance of transparency in billing and payment processes and the potential benefits of cryo analgesia for patients with multiple comorbidities.

Learn more about:

• Healthcare innovation and peripheral nerve surgery.

• Peripheral nerve surgery and the path to becoming a specialized surgeon.

• Peripheral nerve surgery for chronic pain, including neurectomy procedure.

• Peripheral nerve surgery for pain relief.

• Peripheral nerve problems causing pain in the index finger, with examples from spine and brain issues.

• And so much more!

To learn more about Dr. Agulla's innovative approach to peripheral nerve surgery and pain management, visit his YouTube channel at https://www.youtube.com/c/TotalPainSolutions. You can also contact his practice directly through the information provided in his YouTube videos. If you are an employer interested in exploring direct contracting options for your employees' healthcare needs, consider partnering with innovative services like those offered by Dr. Agulla and listed on the Off the Rails healthcare network. This type of value-based care model has the potential to improve outcomes and reduce costs for both employers and patients.

The conversation centered around the growing trend of outpatient joint replacements, the increasing number of younger patients requiring joint replacements, and the need for resources and preparation in the healthcare system to accommodate this trend. Benjamin also discussed the importance of managing costs and patient experience in total joint replacement surgeries, as well as the potential of chatbots and AI to provide tailored information and support to patients. Additionally, they highlighted the challenges of integrated care delivery within large health systems, the success of government-sponsored initiatives and value-based care programs, and the difficulties in aligning incentives in value-based care for specialist providers.

Learn more about:

• Joint replacements with an orthopedic surgeon.
• Outpatient joint replacement surgery efficiency and cost-effectiveness.
• Joint replacement surgery for young patients with arthritis.
• Improving patient experience through more engagement and transparency in total joint surgery.

• And so much more!

Clinicians and innovators should work together to address challenges in healthcare delivery and bridge the gap between digital health communities and real-world clinical practice. Interested parties can contact Dr. Benjamin Schwartz to learn more about innovations in orthopedics or to shadow him in the Boston area.

Relevant Links:

• Dr. Benjamin Schwartz's practice: https://www.goodbonesortho.com/

• Dr. Schwartz's blog "Dead Dry Bones": https://dead-dry-bones.substack.com/

The conversation revolved around the relationship between direct care and prospective payment systems.

Learn more about:

• Direct primary care, bundled healthcare, and prospective payment systems.
• Direct primary care and its benefits, including personalized care and upfront pricing.
• Healthcare transparency and patient empowerment.

• And so much more

Employers, providers, and other healthcare stakeholders should work together to implement bundled pricing models, direct care, and streamlined payment processes. This will help reduce administrative waste, lower costs, and improve quality of care.

For more information on these topics:

David Balat's website: https://www.hcfinance.net

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