November 19, 2024 • 47 mins
Andrew Molosky, the charismatic President and CEO of Chapters Health System and CareNu, joins us on the Reverse Mullet Healthcare Podcast for a spirited discussion. Andrew shares his journey from a chance encounter with Nikki Sixx of Mötley Crüe to championing patient-centered care. We unravel how viewing patients as unique stories, rather than mere numbers, can revolutionize healthcare delivery. With over two decades in the field, Andrew brings a wealth of insights into innovative risk-bearing programs and addresses the vital role of social determinants in shaping healthcare outcomes.
As we reflect on the future of healthcare, we explore the transformative shift from fee-for-service to value-based care—a shift that prioritizes empathetic treatment over sheer volume. We discuss the need for redesigning health systems to better serve vulnerable populations, such as the elderly and chronically ill. Andrew shares his expertise in integrating Medicare and Medicaid services to create a more unified care model, emphasizing the importance of home and community-based services and exploring innovative care models like PACE and GUIDE.
These care models showcase the significance of holistic, patient-centered approaches that account for both clinical and social environments. Our conversation also highlights the economic alignment necessary for successful value-based care and the challenges different institutions face during this transition. We commend grassroots efforts and legislative support in expanding these programs, acknowledging the Centers for Medicare & Medicaid Innovation's role in driving change.
Join us for a lively talk that imagines a future where healthcare leaves a legacy of superior patient experiences and embraces meaningful transformation.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:08):
Welcome to the Reverse Mullet Healthcare
Podcast from BP2 Health.
Today we're in the studiotalking with Andrew Malosky,
President and CEO of ChaptersHealth System and CareNew, about
seeing patients as stories, notdiagnostic codes.
But first, who are we?
Why are we here?
Why did we name our podcast theReverse Mullet Healthcare
Podcast?
Speaker 2 (00:29):
Well, we want to be relevant, informative and
creative.
We also want to be entertainingand have fun.
So it's like a party in thefront and business in the back,
like a mullet or a horse.
Speaker 3 (00:39):
Here are your hosts, selin Brown.
Speaker 2 (00:40):
Dave.
Speaker 1 (00:40):
Pavlik and Justin Politti.
We are passionate, innovativeand collaborative and are
committed to solving some of ourindustry's most important
issues together with our clients.
We have a combined 90 yearsexperience.
Speaker 2 (00:53):
A bunch of old folks.
Speaker 1 (00:54):
that's what we are, yes with Andrew it's probably at
least it's got to be 120, Iwould say right, there you go,
all right.
So in this episode we're goingto dig into a hot healthcare
topic and dig into each other alittle bit.
Speaker 3 (01:05):
But just please don't dig into me.
Be gentle on me please.
Speaker 1 (01:08):
We never really gentle on her because she's like
our little sister and we willdig, dig and keep digging.
Speaker 2 (01:14):
Well, I'll just dig right back Noogies, noogies,
noogies.
That's what I always say.
Speaker 1 (01:17):
Yes yes, yes, exactly .
Well.
Malosky is the President andChief Executive Officer of
Chapters Health System, one ofthe nation's premier
community-based healthcaredelivery systems.
Chapters Health is aprogressive leader in delivering
innovative risk-bearingprogramming, hospice, palliative
care, home health, durablemedical equipment and pharmacy
services designed to improve thelives of those affected by
(01:40):
advancing age and illness,serving a wide geographic area
including the Southeast andMid-Atlantic regions of the
United States.
He is also CEO of CareNew.
Speaker 3 (01:50):
Yeah, because that wasn't enough.
That other thing isn't enough.
Speaker 1 (01:52):
There's more, there's more.
He's the CEO of CareNew, avalue-based subsidiary of
Chapters Health System,providing predictive analytics,
case management and one of ourfavorite things social
determinants to care delivery.
Andrew served in executiveleadership for more than 20
years, spanning an array ofgeographies.
Speaker 4 (02:10):
You got it.
Speaker 1 (02:11):
20 years, exactly Including publicly traded
organizations, privately heldand not-for-profit.
He led UnityPoint at home, heldleadership positions at Seasons
Hospice and Palliative Care andMedicis Home Health and Hospice
and Heartland Home Health Careand Hospice.
Speaker 3 (02:30):
Okay, but before we jump in, even to the party in
the front we're going to make iteven more party in the front.
So before we recorded, Andrewmight have donned the mullet.
He might not have.
No one will ever know.
It's like a tree falling in theforest.
And as he put it on, you guyssaid Justin said he looked like
Nikki Sixx.
Speaker 1 (02:49):
I mean, it was a spinning image.
Speaker 3 (02:50):
And there was a story and I said wait, but wait,
who's?
Speaker 1 (02:53):
Nikki Sixx.
Some people might not know, whoNikki Sixx is.
Speaker 2 (02:56):
If we have to describe who Nikki Sixx is, I
don't want the listeners.
Speaker 3 (03:00):
No, no, no, no.
You can't say that.
Explain who Nikki is.
We don't want to.
Speaker 2 (03:04):
I want to alienate listeners?
Speaker 4 (03:06):
Well, let me do that, because who.
Nikki Sixx is is fundamental tothe story itself.
Okay.
Speaker 3 (03:10):
All right Perfect.
Speaker 4 (03:12):
Told in a very succinct fashion.
Right, there are people of acertain age and recognition.
Nikki Sixx is a household name.
My wife is not one of them.
So as I'm traveling through anairport a number of years ago,
it was very clearly obvious thatNikki Sixx was about to board
the plane with me, because he isvery clearly Nikki Sixx it's
tattooed on the knuckles, thehair is distinguishable, the
(03:32):
dress is distinguishable and hehad autograph seekers all around
him.
So I had the privilege ofsitting next to Nikki Sixx on a
plane flight right after hisbook had come out, and he was an
exceptionally nice person.
By the way, for those of youalways looking for testaments as
to who is this person, he wasvery kind, very conversational
and wasn't bothered at all by myfandom right.
So in this process, I had justread the book, of course, and
(03:54):
said to him you know, you got totell me what I don't know,
especially about the day youdied twice, and his exact
comment was that was a terribleday, poignant, prescient, right.
Speaker 2 (04:06):
I mean talk about a quotable moment.
You can deliver a line huh,yeah, yeah with emphasis, and so
I text.
Speaker 4 (04:11):
My wife and I said I'm sitting next to Nikki Sixx
and she said she sounds 80s hot.
And I said, well, first it's ahe and you're right.
So that is when someone drops aNikki Sixx reference.
I thought, oh, there's aspecial someone in my life who,
I just have to make it clear, isthe last to know who Nikki Sixx
(04:32):
is.
Speaker 2 (04:33):
But thank you for the reinforcement.
Speaker 1 (04:35):
But after all of that , hold on though.
After all of that, that wasoutstanding.
We still didn't say who he is.
Motley Crue.
Speaker 2 (04:42):
Thank you, drummer.
Kickstart man Tommy Lee.
No, tommy Lee is the drummer.
Oh, that's right.
Speaker 3 (04:47):
Oh, my gosh Bass player Justin's going to disown
you too.
I know man.
This is really disturbing.
Speaker 2 (04:53):
What is going on on that side of the table?
Speaker 1 (04:55):
I made a mistake.
He's the bass player.
But come on See, nobody knowswho bass players are singer.
Speaker 2 (05:01):
All right, there we go.
Speaker 3 (05:02):
I feel like we need to stop now.
All right, I feel like thewhole BP2 partnership could fall
apart right now, like you needto move on from that.
So thank you for that fantasticstory.
Speaker 2 (05:12):
Okay, so after that, that was actually awesome.
Appreciate it.
Speaker 4 (05:16):
I try to bring value where I can.
Speaker 3 (05:18):
Is it going to be?
Speaker 2 (05:18):
awesome.
Speaker 1 (05:19):
Well, everything else is Party in the front to a new
level Wow.
Speaker 3 (05:24):
Maybe you could bring Nikki Sixx next time.
I'll work on it.
That would really take it to anew level.
Speaker 4 (05:27):
Yeah, that would be my takeaway.
Speaker 2 (05:29):
Let's get into your love of water sports and the
saltwater aquarium where youraise corals and reefs.
Can we hear a little bit aboutthat?
Speaker 4 (05:36):
Yeah, certainly.
I mean, people all havepassions and hobbies.
A lot of folks are intogardening, a lot of books turned
to cooking and, you know, alongthe way I picked up this hobby,
if you will, that started off,as many you know, in that space
do you get your first littleaquarium for Christmas and, you
know, killed off a couple ofgoldfish and usually people give
up at that point.
But you know, mine kind of hungaround for a little bit longer.
And so in that process, youknow, as I grew up and lived in
(05:59):
environments where I had accessto those sorts of things, it
became a real passion.
I moved past a hobby and nowinto something that I actually
have the opportunity to giveback a little bit into the world
.
And so, yes, as you indicated,we in our home have a very large
fish tank, but one of thebigger parts of that is where
we're able to have a littlecoral garden and we're able to
raise captive coral fragments totake back out and reseed the
reefs in collaboration with verywell-respected institutions.
(06:21):
I'm not just out therefreelancing on my own but, um,
you know, it is a nice thingwhen your hobby can actually be
taking, giving back to nature,as opposed to purely just taking
from it.
So yeah, how many gallons issaid tank?
Uh, said tank is a little overa thousand gallons, right, so
it's uh.
Speaker 1 (06:36):
I actually had saltwater tanks growing up as
well.
Growing up now as an adult Ishould say, killed the goldfish
growing up but loved saltwaterfish and I don't know.
I guess I eventually killedthem off too, mine was 70
gallons, Yep, Yep.
Speaker 4 (06:51):
And you know it's like many things, right?
The principles remain the sameand it's just how you apply them
.
And, ironically enough, youknow, there comes an analogy
that I draw out to a lot of ourhealthcare pursuits from time to
time, and that's you knownothing.
Nothing good happens fast,right?
You know if the tendency toreact and do things quickly or
on a whim or on a spur usuallybackfires more often than it
succeeds, Right?
(07:11):
And so you know an aquariumhobby, as you firsthand know, is
it takes time, it takes love.
You can't fix things fast, youcan't make them happen fast, and
you just have to be planned andmethodical and patient and
stick to your stick to your gunsand good things happen over
time.
And so that's been a prettypractical lesson to apply to the
health care environment, whichwill eventually come around, I'm
sure yeah, yeah, we will andwe're getting close and you know
(07:31):
what?
Speaker 1 (07:32):
I think, the last guest we had, we had this
conversation and and now withyou here, I I now know more than
ever that ellen we get, we pickguests because they do iron
mans and stuff like that.
So so here we are again withyet another guest that has these
shared interests with Ellenrelated to little things like
(07:52):
Ironmen and Ironmans.
Speaker 3 (07:55):
Is it an Ironman or?
Speaker 1 (07:56):
Ironmans, how do you say?
Speaker 3 (07:58):
I'm a sporty girl.
That's the bottom line.
I'm a sporty girl.
Speaker 4 (08:01):
No arguments from this.
Try to be well-rounded, right.
Yes, pets and musicians, andoutdoor activities.
Speaker 3 (08:06):
I play one on TV, but let me assure you I am rocking
the top knot most of the time ofmy life in sporty clothes.
Speaker 1 (08:13):
I like that.
Yes, tell us about it.
Speaker 3 (08:15):
What is it?
First of all, we had to definewho Nikki Sixx is.
Speaker 4 (08:18):
That's right.
What is an actual Ironman Inthe spirit?
Speaker 3 (08:21):
of Nikki Sixx, I think I know what an.
Speaker 4 (08:22):
Ironman is Complete an Ironman there's got to be
some questions I'm not allowedto weigh in on right.
I think I know what an.
Speaker 1 (08:31):
Ironman is Can I try to guess?
Yes, okay, it's running,swimming and biking.
Speaker 3 (08:36):
Yes.
Speaker 4 (08:37):
Okay, I don't know the distances though Excellent,
that's so much better becauseoftentimes if you hear Robert
Downey Jr's name come in, it'sthe wrong Ironman.
We're not talking about that.
So, yeah, the distances theIronman refers to a specific set
of distances.
Of course, triathlon is thesport itself.
And then when you say tosomeone I ran an Ironman or I'm
training for an Ironman, it's aspecific brand and it's
indicative of certain distances.
(08:58):
Oh, okay, and those distancesin an Ironman are 2.4-mile swim,
112-mile bike and then a fullmarathon which is 26.2 miles of
running or walking or crawling,as it may be more often than not
the case.
So, yeah, to say you do Ironmanis indicative of that's your
level of commitment and again,like the aquarium hobby, like
the healthcare pursuit, it'sfast if you're really doing it.
(09:19):
Well, it's very slow in my case, but it's methodical and it's a
great day out.
No, that's not true.
Speaker 3 (09:24):
I just want to be clear that.
Okay, so I had, as Dave andJustin know, cause we have all
worked together for 20 years offand on.
Yeah, and they truly are mybrothers and um.
So I had my Ironman phase.
Right, we all have our phases,but I was half Ironman phase.
Speaker 4 (09:41):
I just want to be clear.
Speaker 3 (09:42):
But I will tell you, the half is always my distance.
I love a half marathon, whichis 13.1 miles.
I like half distance.
So the half Ironman was likeperfect for me Super competitive
, ended up going to worldchampionships, got my podium
there.
It was amazing.
And Kona.
So I am jealous, though,because Kona is on my list.
(10:03):
But what I've decided is Idon't make good life choices
when I'm training for races.
So now what I do is I trainwith friends who are doing races
so that I can say no, right,they're still on the ball.
But then I say no, but I amsaving for the Ironman until I'm
in my 60s, because then not asmany fast girls show up and I
have a better chance atqualifying for world.
So so when you said, in my caseyou're not telling the truth,
(10:26):
because you also shared with usthat you qualified to go to the
world championships fire and man, and I know race times and I
know your age group and you'renot walking it.
Let me be, clear, so tell us,tell us about your most recent
experiences.
Speaker 4 (10:40):
Yeah, ironically, I think it was this weekend.
It may have very well been, itwas September 10th of last year?
Speaker 3 (10:48):
Did you do Utah?
Speaker 4 (10:49):
No, I did Nice, france, okay, and it was this
weekend last year.
It was a great privilege to goand you know.
Speaker 3 (10:57):
Oh Worlds, I'm sorry, I thought you were talking
about your qualifying.
Speaker 4 (11:00):
Oh my apologies.
No, the last full distance Ironman that I actually did was
Worlds, literally almost a yearago today.
Oh so apologies, no, the lastfull distance Ironman that I
actually did was Worlds,literally almost a year ago
today.
Speaker 3 (11:07):
Oh, so you've just right, exactly.
Speaker 4 (11:08):
And then have been doing a number of things over
the course of the summer and thespring.
Speaker 1 (11:13):
I don't want to say I took the year off.
Speaker 4 (11:14):
That's not even accurate.
But as full distance Ironmangoes, that was a pretty fun day
for me and so we're in a littlespell.
We'll do a half here in Floridain December.
Speaker 2 (11:25):
So, that's the next one on the books, and yeah.
Speaker 4 (11:28):
and then to your point about Kona, I have the
privilege of saying I'm alreadylocked for October of 2026.
Speaker 3 (11:34):
Nice.
So you're re-qualified and youget to go to.
Speaker 4 (11:36):
Kona.
You will be in Kona, yes, andrealizing that dream.
So one of these days, very soon.
Speaker 3 (11:41):
Yes, anyways, all right, I'm geeking out on this.
I learned?
Speaker 1 (11:44):
what I learned here is that a triathlon can be as
long as it's the three eventsswimming, running and bicycling.
It can be different distances.
Exactly so now what I'mwondering is that Justin and I
could do a triathlon we could doa sprint.
Speaker 3 (12:00):
Do a sprint triathlon , or when I get back.
Speaker 1 (12:01):
Absolutely when I get back to my friends.
Maybe that's an event.
Speaker 2 (12:05):
Have you ever seen what these people look like
swimming, like crashing intoeach other?
Speaker 1 (12:09):
I'm talking about swimming 50 yards, biking about
half a mile.
Speaker 3 (12:12):
Well, a sprint is.
I think sprints is a verymanageable distance.
Speaker 2 (12:16):
Absolutely Well.
It's something to.
We'll have a future podcastepisode about our Dave and I
training for it.
Okay, love it about our Daveand I training for it Okay, love
it.
Let's do it All right.
No more triathlon talk for now.
Okay, for now, partying thefronts over.
Speaker 1 (12:29):
Yeah, it is Wah-wah, wah-wah-wah.
Speaker 2 (12:38):
So let's talk about what you think could affect real
change, and that real is incaps, because that's what we ask
all our guests in thisimportant issue, and so I'm
really interested to hear whatyour thoughts are.
Speaker 4 (12:48):
Yeah, you know, and it was kind of queued up in the
introduction and I really likethat.
That was the case, right, Ithink.
Most simplistically put, Ithink real change can happen
independent of your space withinhealthcare, right, Because we
speak of healthcare writ large,but what people fail to capture
is there's so many parts tohealth care, there's so many
segments of health care, focuses, niches, et cetera.
To effect change, though, Ithink, is a universal answer,
(13:11):
and I think when the systemagain the royal we sees patients
as a story, doesn't see them astheir chart, as some of their
medical diagnosis, as a billingcode or part of a sequence of
events, as a billing code orpart of a sequence of events.
When you look at someone and yousee a 56-year-old engineer
who's just trying to get totheir daughter's graduation, if
you see someone as a mother ofthree who wants to make certain
(13:32):
her kids have the most time withthem possible, your approach to
delivering care changes, yourempathy changes, your look at
what is the best care for themchanges, and that follows all
the way down the pathway.
Your views on reimbursementchange, your views on follow-up
and accountability change, andit sounds so simple to do, but
(13:52):
it's the old butterfly effectright, or dropping a stone into
the water and watching theripples take.
That initial approach has suchlong-lasting ramifications to
the entire system that that'sjust kind of the soapbox that I
like to get on, because you saywhat one simple thing can really
hold impact and change.
That's where I always start.
Speaker 3 (14:12):
I will say this I wanted to be a physician when I
was growing up and I couldn'tcut it in college chemistry and
so then I got into the businessside of health care eventually
and I always said I feel like Ican impact people's lives if I
can help bring outcomes-basedpayment transformation,
(14:33):
healthcare delivery intomainstream medicine.
Because if physicians areincented to help people with
their outcomes right which isthis idea of the person as a
person with their story, how tohandle that, as opposed to how
many times they can come see meso I can get more money right?
So I'm totally with you that itis.
I've always believed that thatparadigm shift is absolutely
(14:56):
paramount to shifting and reallyaffecting change.
Speaker 2 (15:00):
So yeah, I think it's needed.
In our system today, the waywe're so fragmented and it's
very easy just to look atsomebody and treat like just
where you are within thespectrum, as opposed to like
looking the person holisticallyand really understanding what it
?
Is Like they're a person, youknow person first.
Speaker 1 (15:18):
That's why you're a perfect guest for this podcast,
because we've literally spentdecades I mean decades on
payment transformation right,shifting from fee-for-service to
value-based care and outcome.
So tell us the good, bad andthe ugly in terms of shifting
from fee-for-service tovalue-based.
Speaker 4 (15:38):
Well, I'm glad I bring more than knowledge of 80s
hair metal.
Speaker 3 (15:41):
Yes, you do, and that's why we always have the
party in the front.
Speaker 4 (15:44):
The layers of the onion right.
Speaker 2 (15:45):
Don't discount the effectiveness of that.
That was very effective.
Speaker 4 (15:50):
You find your in where you can right Justin's
like, let's just wrap it now.
Speaker 1 (15:54):
We're done.
Speaker 4 (15:54):
It's a fantastic podcast.
Yeah, the goods, bads and ugliesof transformational healthcare
delivery.
Right, I'll actually probablyavoid the the ugly I don't know
that ugly is is necessarily acomponent of this to me, but I
think goods and bads are a fairstarting point.
And I think there's an oldadage and I'm not going to give
credit properly, but you knowthere's a saying, and apologies
(16:17):
to whoever coined it.
You know every system isperfectly designed to get what
it gets right.
And and you know it soundssimple when it's said out loud,
but when you really stop tothink about it, you know it's
not the system's fault, it's howa system is applied.
And if you don't like theresults you're getting, you work
on how that system is builtright.
And to that end, we at theorganizations that I had the
(16:38):
privilege of representing, withboth chapters and Care New, had
said okay, our problem is notthe people, our problem is not
the patients, it's not the payermechanisms, the problem is the
system.
And if we don't like that, thenwe should take the bull by the
horns and try to address thesystemic issues.
And in doing so, we focusedfirst on the good.
What is the best part of whatyou do?
It's your mission, it's yourorientation, it's your calling,
(17:00):
and in our specific line of work, which really focuses on care
for the chronic ill, the elderly, the frail, right, as opposed
to you know more the maintainingthe wellness of the youthful
populations, things of thatnature, you know we have a very
specific population that we lookto work with and in that
process we realized we needed avery specific type of employee
base, right, and so you canstart to see where this goes.
Now you have a different groupbeing served than has
(17:23):
historically been served.
You have a different workforcebeing cultivated and nurtured
than has traditionally beencultivated and nurtured and you
start to build a system in itsown right and eventually and
listeners are going to be askingthat sounds great how do you
get paid, right, if you bring avalue proposition to the table
(17:50):
that says, statistically we'redifferent, culturally we are,
know, as care outcomes go, we'redifferent, we're targeting a
population that's different.
You have created a system, oryou have at least embraced a
system, differently than existstoday and that creates audiences
, that creates buy-in and itcreates sort of that cultural
competency and currency of anorganization to say, now we have
enough traction to do thisdifferently than others, right,
the bad is if you don't have thegood fortune of an organization
(18:13):
to be nimble, to be quick tochange, to have stakeholders who
are lined up behind you on thisjourney.
You've got some headwinds right.
It's not a secret.
I'm going to again screw up thenumbers, but the concept is
accurate.
The United States economy isone of the largest in journey.
You've got some headwinds right.
It's not a secret.
I'm going to again screw up thenumbers, but the concept is
accurate.
The United States economy isone of the largest in the world.
Our healthcare spend as aportion of our own economy is
(18:33):
one of the largest parts.
Speaker 3 (18:34):
Four trillion, four trillion.
I thought it was four, six Overfour trillion.
It's like four and a half.
Speaker 1 (18:38):
I didn't want to take a chance on record of getting
it wrong, but I feel that muchbetter, but the per capita
expenditure is twice as much asthe next.
Speaker 3 (18:44):
Yeah, and our outcomes are the worst.
Speaker 1 (18:46):
Bingo.
You finished my statement.
Speaker 2 (18:47):
Sorry, no, no, absolutely.
We're finishing sentences now.
Speaker 4 (18:50):
This is going Very prescient crew, you know, into
that end.
That means there's a lot ofsystem already in place.
There are a lot of stakeholdersor a lot of investors or a lot
of protocols.
If you, as an organization, aregoing to build from the ground
up, you have the good fortune ofsaying yes, we don't have a lot
of traction today, but we getto start this the way we want it
(19:12):
to be.
If you're a very largeinstitution with years of muscle
memory, so to speak, you'regoing to have a different path
to that.
But to your point about goodand bad.
Speaker 3 (19:29):
You know, it's still a system and, like any system,
it starts with moving one brickat a time, one Lego at a time,
one block at a time, howeverthat looks, and you just have to
determine your path.
You said it really well and Iwant to go back to this point.
It is and you didn't say itexactly like this, but it was
the idea that, economically, youhave to align with the outcome.
So, hey, look at the savingsthat I'm generating, look at the
(19:51):
economic value that I bring inthe model of care that I have
created, in the system of caredelivery that I have created,
that I have created in thesystem of care delivery that I
have created.
And you're willing to stand upand say and I'm confident in
that and I'll stand behind thatcommitment and guess what, if I
save that money, it's mine tokeep, but if I lose it, it's
(20:11):
also mine to lose.
Unfortunately, that's where we,again, we have created a system
that doesn't require that, wherewe, again, we have created a
system that doesn't require that.
And so to your point if you'rereporting to a board that's used
to seeing margins on a bed, ona stay, on an admission, on a
(20:36):
DRG basis right, it's verydifficult to think about the
financial risk associated with a$12,000 a year premium versus
an $1,800 daily bed rate.
Do you know what I'm saying?
Absolutely, I think that's areally important aspect of
value-based care that peoplecan't seem to get over.
And then we all point fingersat each other, right, but there
is an absolute that when youcreate the value, they will come
(20:56):
.
That's right.
Speaker 4 (20:57):
Well, you know, and I tend to draw oftentimes bad
metaphors or bad analogies, andI speak in them and my team has
just gotten used to it so theycan decipher what I'm trying to
say.
So I'll be very kind to theaudience and not go down that
path, but I will attempt oneshabby one.
You know, last night, as I waskind of just thinking through
tomorrow, as we often do, I waslike all right, what are what
are going to be my speakingpoints?
How is this going to come outarticulately?
(21:18):
And I kid you not, in the timethat I was just sitting there
with TV running in thebackground, two or three law
firms came on and the same adagewas there you don't pay
anything unless we win right.
And then there was a pizza at alocal pizzeria.
It's like, you know, if you'renot completely satisfied, get
your money back.
(21:41):
And I thought to myselfaccountability and value-based
exists in almost every otherline of work.
Why is healthcare the last andit so often is the last to adopt
what the rest of the worldknows about?
If you have a product andyou're confident in your
delivery, and if you areaccountable to the results and
you're an expert in your space.
The notion shouldn't scare you.
The problem exists as peoplehave gotten comfortable and
people have these well-oiledmachines and expectations.
People have gotten comfortableand people have these well-oiled
(22:03):
machines and expectations.
So oftentimes I would tellpeople you probably have more
competence than you realize.
What you have lacked is apurposeful strategic plan on how
you change other stakeholders'views on this.
I doubt very sincerely you'vehad any guest on this podcast
who doesn't believe they'reproviding top quality care to
their patient or their member orwhomever their population is.
But you probably had more thana couple who said but I wouldn't
(22:24):
be able to convince otherpeople to go a different
direction.
So that's what I usually focusmy conversation.
Speaker 3 (22:29):
Well, I think part of it is.
It's also just a fundamental.
I just want to be clear too istaking insurance risk is very
different than offeringhealthcare delivery, and so it
is a it's a bonus if you'rewilling to do that and and,
quite frankly, there's noincentive to do it and it's much
(22:49):
scarier to do it.
So I, so I get it.
So, justin, you have a lot ofexperience.
I mean you're like the king ofexperience.
We, we have worked with you toimplement a lot of the value
based care care, but I mean youspeak from this experience.
Speaker 2 (23:03):
Yeah, no, absolutely, and a lot of that comes from
you mentioned product right, andthen we're talking insurance
risk.
We have so many differentsystems, right, and when I say
systems, we're talking Medicare,commercial Medicaid that have
different insurance amounts tiedto the individuals right, that
you would be taking risk for Inmy background it was a fully
(23:26):
integrated plan for Medicare andMedicaid right, so you're able
to take both sets of dollarstogether, right, and provide a
more unified bring thosestakeholders together that
you've talked about in a waythat you know when you're siloed
you just can't.
So I guess where I go to is Ifound the value, particularly
(23:47):
for community, home andcommunity-based services.
Can you tell us your thoughtsabout home and community-based
services and what you've worked?
Speaker 4 (23:56):
Yeah, more than pleased to.
It's always one of thesemoments where that's a wide open
door that I kind of run fullspeed through.
And so I tend to also realize,as I've listened to these you
know encounters in my past, Ilike it when people give me an
example, something that's liveto work with they, our PACE
(24:18):
centers not too long ago, andfor those of you to the
uninitiated, pace is the Programfor All-Inclusive Care of the
Elderly.
But to your point, it is aMedicare-driven program with a
Medicaid component, so you havethe federal and state elements
and, to your point, it is afully integrated delivery
focused on that home andcommunity-based approach.
So it's kind of the perfectexample to play with as we speak
(24:40):
.
And you know I had.
If any part of my next statementcomes out as my taking credit
for my team's good work, let meapologize in advance, because
these people are phenomenal, thestaff are phenomenal, the
members are phenomenal, theparticipants are phenomenal and
in this they're engaged in theirown care.
By the very virtue of how PACEis set up, it looks to reward
(25:00):
living right.
It looks to reward experience,it looks to see people as that
story that I spoke of initially.
And yes, there are absolutelymedical components, right, you
know, multi-specialty care,primary care, any unexpected or
unplanned episodes that mightcome through.
But the real magic happens intheir social engagement, it's in
their travel, it's in theirfamily engagement, it's in their
(25:21):
travel, it's in their familystory, it's in coming to the
Pace Center.
And it really is illustrativeof, to me, that perfect Venn
diagram of where great attentionto social determinants, great
attention to the medicalcomponents and great attention
to that psychosocial, spiritual,emotional component intersect.
And that, to me, is value-basedcare.
Value-based care, I know,carries a connotation of
(25:42):
upside-downside risk,sub-delegation, capitation, all
those terms, and that's fine.
That's a part of it, that's thefinancial, that, to me, is the
economics of it, that's not thedelivery of it, it's not the
heart of it.
Right, you pay your check at arestaurant, but the restaurant
is not about the check.
The restaurant is about theexperience, right?
And so, to that end that's whatwe always say we define
value-based care.
The setting is home andcommunity-based.
(26:02):
It's where patients andfamilies want to be, it's where
outcomes can be delivered andit's where the highest level of
engagement in someone's socialand emotional well-being takes
place.
The model is a proven chronicillness model that you know, as
you might expect, is rooted instatistical outcomes and
clinical outcomes, and thesocial side is based in the
health equity components of this.
And we, as an organization Iwon't turn this into a
commercial, but haveaggressively pursued health
(26:24):
equity certifications because webelieve in that three-legged
stool, if you will, of how toapproach true value-based care.
Speaker 2 (26:30):
So these models have been around for decades.
This is what I like to bring upin a lot of the discussion,
because we tend to think likeooh, the latest new idea is the
greatest.
I am super passionate aboutPACE, the fully integrated
programs, but they've beenaround for a really long time.
Why do you think they'regetting more traction,
particularly PACE, at this pointin time?
Speaker 4 (26:49):
You know I don't ever point to one moment, right, you
know, it's almost like askingsomebody how did society get the
way it is?
There's no one moment.
There's certainly aprecipitating set of factors,
but let's lay out a couple ofthose.
One, you know the agingpopulation supply demand curve
is clearly something thateverybody is aware of.
A diminishing workforce, arapidly multiplying population
(27:10):
in need of care and that dynamichas shifted.
You have the you know, adult,the sandwich generation, where
adults caring for children andtheir own parents, right, and so
where often does that happen?
In the home, as opposed to youknow the other piece.
And then it's even very simplebut kind of mind-blowing numbers
.
We built a health careecosystem around the few days a
(27:32):
year that you're in a hospital,a physician's office, a nursing
home, never really fully givingcredit to the fact that you're
probably in your own privateresidence 300, 300, 320, 350, if
it's a great year, 360 days,right, sheer percentages.
Why is more of the healthcareecosystem not driven where
you're at 90, 95% of the time,right.
(27:53):
And if you really think aboutwellness or sickness, or
proactivity over reactivity,that's where that's going to
happen Lowest cost, idealsetting, most engaged patient
population and ultimately givesthe clinical practitioners
themselves that sense offulfillment that many of us
daydreamed about and tried toreally make a difference.
Speaker 2 (28:12):
So how do we get?
Speaker 4 (28:13):
a pace on every corner.
Speaker 1 (28:17):
Well.
Speaker 3 (28:17):
Walgreens has real estate available because Bill
and Jim D is opened up.
I think there's a new businessmodel coming out.
So, do you want to answer that?
Because I have another questionhow do we get a pace on every
quarter?
Do I get any free?
Speaker 4 (28:32):
passes that I can take.
I know I think honestly it's.
You know I hate the wordgrassroots because it has such
an overplayed usage, but thereality is it's to your point.
It's been around a long time.
You don't find anybody who hasexperienced it and not liked it,
which you find more often thannot, as those who have said.
I don't know what that is.
It's like anything in itsorganic state.
You really just need to lookfor every opportunity to promote
(28:54):
and discuss and press, and sothank you for that being here
today.
Secondly, it's as the membersthemselves are engaged.
It's having them tell the story, and then, of course, there are
legislative and politicalcomponents to that too.
Anything that's codependent onbudgets at a state and federal
level has more headwinds than alot of programs do as well.
But whether it's PACE orwhether it's Accountable Care or
(29:14):
whether it's any of the otherprograms that approach this,
you're starting to spread theword.
Speaker 3 (29:18):
So that was going to be my next point programs that
approach this.
You're starting to spread theword, so that was going to be my
next point.
So a lot of people bash CMS and, believe me, there's a lot of
stuff that they do that is, Ithink, a little bit too
aggressive and it aggregatessort of ambiguously and it
shouldn't.
But CMMI, in my opinion, is oneof the really good things that
(29:40):
came from ACA and there havebeen a lot of really good
programs that have come out ofthat, and so the one that I want
to talk about a little bittoday is Guide.
So it's one of the new.
So, just to put this intocontext for the people that are
listening that may not know,this is, cmmi is the innovation
center under the Centers forMedicare and Medicaid right, and
(30:01):
they have, in the first decadeof their existence, they put 50
programs in place and they areall value-based programs and
their goal is that everyMedicare and most Medicaid
people will be under a form ofvalue-based care by 2030.
And that's only six years fromnow.
So that's a very aspirational.
That's their second decade plan.
(30:22):
So this new program, guide, Ithink, is a perfect example of
what we're talking about so, andwe've talked to a number of
clients that have implemented itor are going to implement it as
part of their value-based careportfolio.
But it's those that arelistening.
It stands for it's a newprogram.
This year it's Guiding, anImproved Dementia Experience.
I have to look at that becauseit's a new acronym for me.
(30:42):
Unlike the other ones, I canspit out still at the top.
Speaker 1 (30:46):
CMS never puts out new acronyms.
No, no, no.
Speaker 3 (30:50):
But this one, actually, when you talk about
the sandwich generation, thisone's actually near and dear to
my heart, because my mom wasrecently diagnosed with moderate
to severe vascular dementia,which again, for those that are
listening, that was that isactually a will be her cause of
death from being an uncontrolleddiabetic for 10 years.
(31:11):
That that's it.
And so, like, when we talkabout, you know, cardiometabolic
disease and we talk about allthese things that are happening
in your thirties, your forties,you're setting yourself up for
that dementia right, she setherself on that path, but we are
now finding ourselves as afamily trying to navigate
dementia right, and so I waslike I've got to ask Andrew
after this if he has anythingover on the East Coast, so tell
(31:34):
us.
You guys are one of theinaugural participants in the
guide program beginning thisyear.
Speaker 4 (31:39):
Yes, absolutely correct.
There's about a dozen things inthere I wanted to get to.
Yeah, I figured, I figured, Ijust asked you like a ton, but
this is a really I love talkingabout these value-based programs
.
So on.
I think we got here by theroute of you explaining where
CMS and CMMI sort of motivationslie in that 2030 deadline.
And it's funny you say that.
You know, in our office I havea little countdown clock right
(32:01):
and it's actually set to 2030.
And I don't remember the lastcount.
I think it's a little over 2200days, probably give or take.
But that notion is that that tous, is a bit of the North Star
right.
That is that moment where andthey've not shown any wavering
from that commitment withemerging models and with
recommitment to those models andmaking them move from, you know
, demonstration projects intostatutory projects or programs,
(32:24):
you know.
So we believe fully in the 2030, you know ambition right and
chapters and Care.
New, by its portfolio ofbusiness investments, are all in
on that.
And so the guide model was onethat we pursued with vigor for
several reasons.
One it fits our core audience,our core disease management
platform.
It's certainly something thatmany of us have a personal
connection with.
I do have no problem giving ashameless plug.
(32:46):
I had the privilege of servingon the Gulf Coast chapter of the
Alzheimer's Association boardand those folks do just do
tremendous work.
And for those who have everpersonally experienced it with a
family member, professionallyexperienced it in a clinical
caregiving setting, you know thestress it takes not just on the
patient but on the family aswell.
So when you start to look atCMMI, investing in models that
are equally focused on caringfor a patient but also the
(33:09):
patient's social environment,that to me is a giant leap
forward.
Right, there's lots and lots ofprograms out there, all of which
are exceptional, but they'revery clinically driven.
Right, it's all about a certaintest, it's all about a certain
threshold.
There's not as many models thatare focused on that social
component, the familialcomponent, the societal
component, and you start to seethings like ACO, reach and the
(33:29):
guide program, and I want togive credit to the federal team
for realizing and bringing.
You know it's a big ship, theyalways say.
You know, turning a giant shiptakes time.
So this to me is no small feat.
Right, they're starting to moveinto things that are disease
specific.
But take into account thosethree circles that I say create
the ideal Venn diagram forsuccessful, value-based care.
(33:52):
And this is just yet anotherillustration of it.
Right, and so you know I havenothing, but we haven't seen a
kickoff yet.
Certainly there are bumps orrough edges to any program, no
matter who administers it, sowe'll get through that.
But yeah, we're certainlyexcited about that.
Speaker 3 (34:06):
Yeah, it's good stuff .
Speaker 1 (34:07):
Yeah, got to give them credit 50-plus programs in
the first 10 years.
Speaker 4 (34:12):
Yeah, yeah, I mean I try it.
When we come Friday night We'vegot to figure out where we're
going to have dinner as a family.
Speaker 3 (34:17):
We there's four of- us and we can't settle on one
answer.
I cannot imagine finding aperfect solution for all of
America.
We can't even have family movienight anymore in my house, like
literally, I think we can haveone a year.
That's when everyone has theirphone out staring at something
different, on the couch together, or like you get into a huge
it's either you pick somethingand within five minutes someone
leaves or you get, or you or youget in such an epic fight that
(34:37):
you can't even pick a movie, andthen someone storms off and
then you end up with like two orthree people at best, and then
I end up just going to bed.
You know it's like well, we try.
Speaker 4 (34:46):
I'm going to work on health care, some things I've
given up on.
Speaker 3 (34:50):
Getting a little more serious.
Speaker 2 (34:54):
Like I say serious, no, sorry, go ahead.
Serious about your legacy.
Can you tell us what yourlegacy like your legacy to be in
healthcare?
Speaker 4 (35:06):
That's a great question and there's, you know
there's so many.
I'm going to address it fromkind of an organizational
perspective because certainlywhat I ambition to do is very
different.
Speaker 2 (35:14):
And maybe I'll answer both just to give the listeners
a wider view.
Speaker 4 (35:19):
So, organizationally, if this all happened tomorrow,
if I retired tomorrow andChapters said that's it, we are
just going to freeze everythingwe've ever done and we want to
be remembered for this day.
I hope that people rememberChapters as an organization that
was focused on three thingsFirst and foremost, a superior
experience by not just thepatients but their families, the
volunteers, the patients buttheir families, the volunteers,
(35:41):
the donors, the philanthropists,everything that we support.
We wanted to have changed howour communities viewed the
resource that we were, becausethat does you know ebb and flow,
where some days we're doinglots of things for lots of
people, other days we're morefocused, but we want to always
be able to say we've made a bigdifference.
We weren't a transactional partof someone's life, I would say.
The second piece that would bea great legacy organization to
(36:04):
leave is that little eye rollwhen someone's like man.
They were always on the edge,they were always pushing the
envelope, they weren't afraid totry Bend, don't break.
Be innovators, right.
I would be really sad if wewere ever thought of in the same
sentence as the word status quo.
Speaker 3 (36:21):
That would be a fail to me.
It would be the opposite oflegacy.
Speaker 4 (36:24):
Exactly right, I mean that's certainly a legacy, but
it's not one that we want toleave and I'm not suggesting
there's not a place for that.
There's great parts ofhealthcare that don't need to
evolve as much.
That's just not where we'refocusing our time, and I'll
offer you this one, because ithe made the team his focus and
(36:48):
in doing so, any success he mayhave incurred was done the right
way.
Speaker 1 (36:52):
We have.
Speaker 4 (36:53):
I think we're trademarked.
If not, we're working on beingtrademarked On a phrase that I
believe very passionately about,and there's only two jobs.
No matter what our HR teamwould say, the manual is bigger
than this, but there's only realtwo jobs at our organization,
and that's be caring forpatients or caring for those who
do.
And if you can't look at thestack of work on your desk and
(37:15):
correlate it to either improvingone of our team members
experiences or one of ourpatients experiences, rethink
your priority set, because I dostrongly believe that that is
the.
You know, those are the leadmeasures that ultimately create
the change that you're lookingto implement.
So, as legacies go, personallyI want to have been that kind of
leader in organization.
We want to have left that kindof mark.
Speaker 1 (37:34):
That sounds like a piece of cake, though.
Speaker 4 (37:37):
Done and done.
I mean, all you got to do issay it and will it into
existence, right?
Speaker 1 (37:41):
All right.
No, I mean you talked aboutin-home patient care and all
that, and it's like what did yousay?
Say that one more time Eitherbe caring for a patient or there
are two jobs at ourorganization be caring for
patients or caring for those whodo I love that that's fantastic
.
Speaker 3 (38:00):
So what are some of the key areas that have to be
addressed to move towardsvalue-based care?
For those that are listening,they're like, if I have to do it
by 2030, maybe I do have tostart thinking about this.
I was on a call this morningtalking about this with the
health system that's fullyintegrated with the change
management that they're dealingwith, to try to move more
(38:21):
towards value and away fromfee-for-service transactional.
Speaker 4 (38:25):
That's right, and so you know we've we've had this
laugh.
You know, uh, executive of myteam and she's shy individual,
doesn't like to be called out byname, so I'll avoid that, but
she's listening right now.
She knows I'm talking about her.
You know, she asked me once.
She said so what are we goingto do when we're successful?
Speaker 1 (38:41):
I said that's a great question, right?
Speaker 4 (38:42):
Because if you sell this to your board or to your
investors, or to yourstakeholders, or whomever it is
you need to help convince, comeon this journey there's going to
be a moment where they look atyou and say, that's a good idea,
let's do that, and then it'sgoing to land back in your court
.
You know it's intellectualtennis.
Now the ball is back to me, andwhat am I going to do with it?
So here's what I would suggestYou're going to call BP too.
That's right, there you go,sorry.
Speaker 2 (39:04):
It starts with this.
Now work from our sponsor.
Speaker 4 (39:07):
But wait, there's more.
Yeah, we can have some laughsabout that, but that is not an
inaccurate statement.
There are answers out there.
This is not something that'snever been done.
It's not something that can'tbe done.
It just requires, like wetalked about with an aquarium or
with a 10-hour, 12-hour,15-hour race.
Right, it's one step at a timeand you don't think about a
(39:28):
finish line or finished product.
You think about the next waterstation, you think about the
next waypoint right and, forthose of you who've ever done a
marathon, half floor.
Speaker 3 (39:35):
I'm envisioning the.
I'm literally envisioningputting ice in my cap as I'm
trying to finish the last threemiles of the run.
Speaker 4 (39:42):
Yeah, yeah, a race medal is a long way off.
I need a cup of Gatorade.
It's got to get there next.
And to that end, I would saythat design, or the migration to
value-based care, follows apathway.
Take a look at yourorganization and everything that
you have built.
Check that right.
Is this ready?
And if it's not, then you haveto make sure in your following
kind of a rate limiting or alowest common denominator
(40:02):
approach.
So, is your workforce ready forvalue-based care?
Are their compensationstructures aligned to quality
over quantity?
Are there recruitment, training, development, retention tools?
Are there promotionary pathwaysfor those who perform well,
because it's not aboutnecessarily tenure?
There are some skill sets.
That translates better.
You can follow the workforcepath.
(40:22):
That becomes very real.
What are your capital needs?
If you're going to have to havereserves to take a dual
integrated plan to be in an ACO,right?
Do you need to drive marginsfor a few years in order to put
reserves on the shelf and makethat migration?
Do you have an outside investor?
Do you have to change your realestate portfolio to be less
intensive on acute carestructure and more on home
(40:42):
community based?
So there's that component right, and then you have to look at
your business acumen.
Who is handling your contracts?
How locked into certain thingsare you?
What is your ability to handlea massive switch from revenue
streams based on you know all?
So all these components arethings.
There's not one solution.
You don't wake up one day andhire a value-based care expert
and say now go, do your thing.
(41:03):
In a vacuum.
Value-based care is not a niche.
It's not a single provider orsingle service line.
It has to be kind of anorganizational ethos, and that's
what I would suggest to peopleis.
Value-based care often carriesthis sort of business acumen
connotation.
What I would suggest is is yourcompany or is your organization
ready to move to a quality overquantity approach?
(41:24):
Because that's a little bitdifferent.
You can embrace quality overquantity and still keep a lot of
your traditional businessmodels, but it will change the
whole ethos, which is a nicetransition to when you have to
put your money at risk.
Right, if you're just reallyfocused on quality, you can
still be in a fee-for-serviceenvironment, delivering
exceptional, innovative care andstarting to squirrel away a few
(41:44):
dollars for when you have toput some things at risk in the
more traditional definition ofthe word.
So I'm all over the place.
Speaker 3 (41:49):
But Well, no, I think and I and I appreciated what
you said too about you can'tjust hire a value-based care
expert, because it's true, it's,it is, it is change management
and you have to operationalizesome things.
You have to it's and and like,we have a lot of times where we
(42:09):
literally get the call becauseMcKinsey's come in, or some big
firm has come in and dropped it,and everyone's gone, yes, we're
going to do value-based care,and then they leave and
everyone's like what do we donow?
Speaker 4 (42:22):
You know like.
Speaker 3 (42:23):
I mean, now we have to do all the things that you
just said and we don't.
We don't even know what allthose things are.
And then that's when we get thecalls like, well, can you
actually make us, help us do it,because you know it's like it's
, it's a, it is, it is redesign,it is structural redesign, it
is system, it is really systemredesign, it's engineering,
(42:44):
almost right, it's like how do Ire-engineer my wife and I?
Speaker 4 (42:51):
we like to pick at each other because she's, you
know, also in the healthcarespace, and so our, our, our
dinner talk is quite interesting, but she got chickens not too
long ago and I kind of chuckled.
I said so are we a farmer now?
Speaker 1 (43:02):
Yeah, Actual chickens egg laying chickens.
Speaker 4 (43:04):
They're in, they're in a coop and the whole thing
yeah.
Speaker 1 (43:06):
Yeah.
Speaker 4 (43:06):
And if you ever came to know me as an individual, you
know this is about as far frommy natural tendency as possible
and I said are we farmers?
And she said, oh yeah, causewhen you have a chicken you're
automatically a farmer.
But I kind of laughed because I, you know, the analogy here is
apropos.
You know, so are.
Does a value-based design makeright?
It's a commitment.
You know, if you want to be afarmer, and a good one, you need
(43:33):
the space, you need the acumen,you need someone to teach you,
you need all the equipment, youneed to understand the weather
patterns.
To be in value-based care isnot just a trend or a current
payment model or a singlecontract.
Speaker 3 (43:52):
It's a.
Thing.
So Justin you're trying to jumpin, sorry.
Speaker 2 (43:55):
Well, now I know how he's getting in such good shape,
as he's chasing the chickensaround.
You know they like their eggs.
Speaker 1 (44:03):
So when do you become a farmer?
Do you have to have pigs too,or what's the where's?
Speaker 3 (44:07):
the line.
Oh, you're getting ready forthe last question.
Speaker 2 (44:09):
Yeah, so yeah.
Speaker 3 (44:11):
Wait, yes.
Do you have a definition ofwhen you become a farmer?
Speaker 4 (44:14):
Uh, I think we were done when, when my legacy is
left because I don't havefarming in my future.
Speaker 3 (44:18):
But we have a last question for you.
Speaker 2 (44:24):
We do so.
We ask all our guests whattheir buy a world of Coke or
pigs when pigs fly?
Speaker 1 (44:31):
When pigs fly.
That's where I was going.
Yes, right Segway.
Speaker 2 (44:36):
For fixing the health care system.
So what is yours?
Speaker 4 (44:40):
I kind of gave away my secret a little earlier you
know and I don't know if this isthe technical definition of how
the phrase Occam's razor isused.
But but what I'd like to impartis I do actually believe that
the solutions oftentimes are assimple as they're presented
right.
Healthcare at its core yes,there are, you know, components.
Yes, there are, you know, testsand diagnoses, codes.
(45:01):
Those are all very vital partsof it, but what it really is is
humans caring for humans for themost part.
Now AI takes over and we're allworking for the machines.
We'll revise this podcast then,but until that, day the
machines will revise it for us.
Speaker 3 (45:15):
They'll do it for us.
Speaker 4 (45:17):
I wouldn't even need it for that.
But until then I think we havesome time.
It is humans caring for humans.
It is not humans administeringtests to humans.
Caring is, I think, thecritical word.
So when we at the organizationbelieve you have two jobs, tie
the work on your desk to one oftwo jobs taking care of our
patients and if you're not inthat capacity, then you're
(45:38):
taking care of those who do.
That to me, I believe, wouldfundamentally shift healthcare.
There's a lot of headwinds togetting there.
There's investors who needtheir money back.
There's regulatory statutesthat keep things from getting
done.
There's a lot of red tapeinvolved.
It's what we've built.
We can unwind it, just the waywe wound it.
But I do think it starts withfundamentally recognizing that
(45:58):
health care, when done right,whether it's acute, post-acute,
non-acute, whatever it might be,it is fundamentally humans
caring for humans.
It is fundamentally humanscaring for humans.
And if we can strip all thenoise and all the layers of
nonsense away from thatprinciple and direct our
resources, our time and ourattention to that, I think
things change Well mic drop,that's it and that would be my
(46:23):
Coke, because my wife woulddisown me if that was my Pepsi.
We're a Coca-Cola householdunwaveringly Well sometimes.
Speaker 1 (46:30):
I mean, is that the cue for the song?
Speaker 3 (46:32):
No, oh, come on, we aren't going to sing it today.
Speaker 1 (46:36):
We're going to get a season to sing it.
Do it real quick, do it realquick.
I'd like to teach the worldthat was it.
Never mind Forget it.
Speaker 3 (46:43):
All right.
Speaker 2 (46:44):
It's only a matter of time before Coke suites us
Right, so we've kickstarted myheart If you want to do that, no
.
Speaker 4 (46:52):
They would that I was not.
I'll be a farmer before I'll bea big deal replacement.
You're like thank God youdidn't keep singing because I
wasn't ready for that.
Well, andrew, thank you so muchfor your time today.
We appreciate you coming mypleasure.
Thanks for highlightingsomething so important to us.
Speaker 3 (47:06):
Well, thanks again.
I'm Ellen Brown.
Speaker 1 (47:09):
I'm Dave Pavlik, I'm Justin Politi.
We are the partners at BP2Health your best chance for real
change.
As you can tell, we talk aboutthis stuff all day.
It's on our website at2healthcom.
Welcome to the Reverse Mullet Healthcare
Podcast from BP2 Health.
Today we're in the studiotalking with Andrew Malosky,
President and CEO of ChaptersHealth System and CareNew, about
seeing patients as stories, notdiagnostic codes.
But first, who are we?
Why are we here?
Why did we name our podcast theReverse Mullet Healthcare
Podcast?
Speaker 2 (00:29):
Well, we want to be relevant, informative and
creative.
We also want to be entertainingand have fun.
So it's like a party in thefront and business in the back,
like a mullet or a horse.
Speaker 3 (00:39):
Here are your hosts, selin Brown.
Speaker 2 (00:40):
Dave.
Speaker 1 (00:40):
Pavlik and Justin Politti.
We are passionate, innovativeand collaborative and are
committed to solving some of ourindustry's most important
issues together with our clients.
We have a combined 90 yearsexperience.
Speaker 2 (00:53):
A bunch of old folks.
Speaker 1 (00:54):
that's what we are, yes with Andrew it's probably at
least it's got to be 120, Iwould say right, there you go,
all right.
So in this episode we're goingto dig into a hot healthcare
topic and dig into each other alittle bit.
Speaker 3 (01:05):
But just please don't dig into me.
Be gentle on me please.
Speaker 1 (01:08):
We never really gentle on her because she's like
our little sister and we willdig, dig and keep digging.
Speaker 2 (01:14):
Well, I'll just dig right back Noogies, noogies,
noogies.
That's what I always say.
Speaker 1 (01:17):
Yes yes, yes, exactly .
Well.
Malosky is the President andChief Executive Officer of
Chapters Health System, one ofthe nation's premier
community-based healthcaredelivery systems.
Chapters Health is aprogressive leader in delivering
innovative risk-bearingprogramming, hospice, palliative
care, home health, durablemedical equipment and pharmacy
services designed to improve thelives of those affected by
(01:40):
advancing age and illness,serving a wide geographic area
including the Southeast andMid-Atlantic regions of the
United States.
He is also CEO of CareNew.
Speaker 3 (01:50):
Yeah, because that wasn't enough.
That other thing isn't enough.
Speaker 1 (01:52):
There's more, there's more.
He's the CEO of CareNew, avalue-based subsidiary of
Chapters Health System,providing predictive analytics,
case management and one of ourfavorite things social
determinants to care delivery.
Andrew served in executiveleadership for more than 20
years, spanning an array ofgeographies.
Speaker 4 (02:10):
You got it.
Speaker 1 (02:11):
20 years, exactly Including publicly traded
organizations, privately heldand not-for-profit.
He led UnityPoint at home, heldleadership positions at Seasons
Hospice and Palliative Care andMedicis Home Health and Hospice
and Heartland Home Health Careand Hospice.
Speaker 3 (02:30):
Okay, but before we jump in, even to the party in
the front we're going to make iteven more party in the front.
So before we recorded, Andrewmight have donned the mullet.
He might not have.
No one will ever know.
It's like a tree falling in theforest.
And as he put it on, you guyssaid Justin said he looked like
Nikki Sixx.
Speaker 1 (02:49):
I mean, it was a spinning image.
Speaker 3 (02:50):
And there was a story and I said wait, but wait,
who's?
Speaker 1 (02:53):
Nikki Sixx.
Some people might not know, whoNikki Sixx is.
Speaker 2 (02:56):
If we have to describe who Nikki Sixx is, I
don't want the listeners.
Speaker 3 (03:00):
No, no, no, no.
You can't say that.
Explain who Nikki is.
We don't want to.
Speaker 2 (03:04):
I want to alienate listeners?
Speaker 4 (03:06):
Well, let me do that, because who.
Nikki Sixx is is fundamental tothe story itself.
Okay.
Speaker 3 (03:10):
All right Perfect.
Speaker 4 (03:12):
Told in a very succinct fashion.
Right, there are people of acertain age and recognition.
Nikki Sixx is a household name.
My wife is not one of them.
So as I'm traveling through anairport a number of years ago,
it was very clearly obvious thatNikki Sixx was about to board
the plane with me, because he isvery clearly Nikki Sixx it's
tattooed on the knuckles, thehair is distinguishable, the
(03:32):
dress is distinguishable and hehad autograph seekers all around
him.
So I had the privilege ofsitting next to Nikki Sixx on a
plane flight right after hisbook had come out, and he was an
exceptionally nice person.
By the way, for those of youalways looking for testaments as
to who is this person, he wasvery kind, very conversational
and wasn't bothered at all by myfandom right.
So in this process, I had justread the book, of course, and
(03:54):
said to him you know, you got totell me what I don't know,
especially about the day youdied twice, and his exact
comment was that was a terribleday, poignant, prescient, right.
Speaker 2 (04:06):
I mean talk about a quotable moment.
You can deliver a line huh,yeah, yeah with emphasis, and so
I text.
Speaker 4 (04:11):
My wife and I said I'm sitting next to Nikki Sixx
and she said she sounds 80s hot.
And I said, well, first it's ahe and you're right.
So that is when someone drops aNikki Sixx reference.
I thought, oh, there's aspecial someone in my life who,
I just have to make it clear, isthe last to know who Nikki Sixx
(04:32):
is.
Speaker 2 (04:33):
But thank you for the reinforcement.
Speaker 1 (04:35):
But after all of that , hold on though.
After all of that, that wasoutstanding.
We still didn't say who he is.
Motley Crue.
Speaker 2 (04:42):
Thank you, drummer.
Kickstart man Tommy Lee.
No, tommy Lee is the drummer.
Oh, that's right.
Speaker 3 (04:47):
Oh, my gosh Bass player Justin's going to disown
you too.
I know man.
This is really disturbing.
Speaker 2 (04:53):
What is going on on that side of the table?
Speaker 1 (04:55):
I made a mistake.
He's the bass player.
But come on See, nobody knowswho bass players are singer.
Speaker 2 (05:01):
All right, there we go.
Speaker 3 (05:02):
I feel like we need to stop now.
All right, I feel like thewhole BP2 partnership could fall
apart right now, like you needto move on from that.
So thank you for that fantasticstory.
Speaker 2 (05:12):
Okay, so after that, that was actually awesome.
Appreciate it.
Speaker 4 (05:16):
I try to bring value where I can.
Speaker 3 (05:18):
Is it going to be?
Speaker 2 (05:18):
awesome.
Speaker 1 (05:19):
Well, everything else is Party in the front to a new
level Wow.
Speaker 3 (05:24):
Maybe you could bring Nikki Sixx next time.
I'll work on it.
That would really take it to anew level.
Speaker 4 (05:27):
Yeah, that would be my takeaway.
Speaker 2 (05:29):
Let's get into your love of water sports and the
saltwater aquarium where youraise corals and reefs.
Can we hear a little bit aboutthat?
Speaker 4 (05:36):
Yeah, certainly.
I mean, people all havepassions and hobbies.
A lot of folks are intogardening, a lot of books turned
to cooking and, you know, alongthe way I picked up this hobby,
if you will, that started off,as many you know, in that space
do you get your first littleaquarium for Christmas and, you
know, killed off a couple ofgoldfish and usually people give
up at that point.
But you know, mine kind of hungaround for a little bit longer.
And so in that process, youknow, as I grew up and lived in
(05:59):
environments where I had accessto those sorts of things, it
became a real passion.
I moved past a hobby and nowinto something that I actually
have the opportunity to giveback a little bit into the world
.
And so, yes, as you indicated,we in our home have a very large
fish tank, but one of thebigger parts of that is where
we're able to have a littlecoral garden and we're able to
raise captive coral fragments totake back out and reseed the
reefs in collaboration with verywell-respected institutions.
(06:21):
I'm not just out therefreelancing on my own but, um,
you know, it is a nice thingwhen your hobby can actually be
taking, giving back to nature,as opposed to purely just taking
from it.
So yeah, how many gallons issaid tank?
Uh, said tank is a little overa thousand gallons, right, so
it's uh.
Speaker 1 (06:36):
I actually had saltwater tanks growing up as
well.
Growing up now as an adult Ishould say, killed the goldfish
growing up but loved saltwaterfish and I don't know.
I guess I eventually killedthem off too, mine was 70
gallons, Yep, Yep.
Speaker 4 (06:51):
And you know it's like many things, right?
The principles remain the sameand it's just how you apply them
.
And, ironically enough, youknow, there comes an analogy
that I draw out to a lot of ourhealthcare pursuits from time to
time, and that's you knownothing.
Nothing good happens fast,right?
You know if the tendency toreact and do things quickly or
on a whim or on a spur usuallybackfires more often than it
succeeds, Right?
(07:11):
And so you know an aquariumhobby, as you firsthand know, is
it takes time, it takes love.
You can't fix things fast, youcan't make them happen fast, and
you just have to be planned andmethodical and patient and
stick to your stick to your gunsand good things happen over
time.
And so that's been a prettypractical lesson to apply to the
health care environment, whichwill eventually come around, I'm
sure yeah, yeah, we will andwe're getting close and you know
(07:31):
what?
Speaker 1 (07:32):
I think, the last guest we had, we had this
conversation and and now withyou here, I I now know more than
ever that ellen we get, we pickguests because they do iron
mans and stuff like that.
So so here we are again withyet another guest that has these
shared interests with Ellenrelated to little things like
(07:52):
Ironmen and Ironmans.
Speaker 3 (07:55):
Is it an Ironman or?
Speaker 1 (07:56):
Ironmans, how do you say?
Speaker 3 (07:58):
I'm a sporty girl.
That's the bottom line.
I'm a sporty girl.
Speaker 4 (08:01):
No arguments from this.
Try to be well-rounded, right.
Yes, pets and musicians, andoutdoor activities.
Speaker 3 (08:06):
I play one on TV, but let me assure you I am rocking
the top knot most of the time ofmy life in sporty clothes.
Speaker 1 (08:13):
I like that.
Yes, tell us about it.
Speaker 3 (08:15):
What is it?
First of all, we had to definewho Nikki Sixx is.
Speaker 4 (08:18):
That's right.
What is an actual Ironman Inthe spirit?
Speaker 3 (08:21):
of Nikki Sixx, I think I know what an.
Speaker 4 (08:22):
Ironman is Complete an Ironman there's got to be
some questions I'm not allowedto weigh in on right.
I think I know what an.
Speaker 1 (08:31):
Ironman is Can I try to guess?
Yes, okay, it's running,swimming and biking.
Speaker 3 (08:36):
Yes.
Speaker 4 (08:37):
Okay, I don't know the distances though Excellent,
that's so much better becauseoftentimes if you hear Robert
Downey Jr's name come in, it'sthe wrong Ironman.
We're not talking about that.
So, yeah, the distances theIronman refers to a specific set
of distances.
Of course, triathlon is thesport itself.
And then when you say tosomeone I ran an Ironman or I'm
training for an Ironman, it's aspecific brand and it's
indicative of certain distances.
(08:58):
Oh, okay, and those distancesin an Ironman are 2.4-mile swim,
112-mile bike and then a fullmarathon which is 26.2 miles of
running or walking or crawling,as it may be more often than not
the case.
So, yeah, to say you do Ironmanis indicative of that's your
level of commitment and again,like the aquarium hobby, like
the healthcare pursuit, it'sfast if you're really doing it.
(09:19):
Well, it's very slow in my case, but it's methodical and it's a
great day out.
No, that's not true.
Speaker 3 (09:24):
I just want to be clear that.
Okay, so I had, as Dave andJustin know, cause we have all
worked together for 20 years offand on.
Yeah, and they truly are mybrothers and um.
So I had my Ironman phase.
Right, we all have our phases,but I was half Ironman phase.
Speaker 4 (09:41):
I just want to be clear.
Speaker 3 (09:42):
But I will tell you, the half is always my distance.
I love a half marathon, whichis 13.1 miles.
I like half distance.
So the half Ironman was likeperfect for me Super competitive
, ended up going to worldchampionships, got my podium
there.
It was amazing.
And Kona.
So I am jealous, though,because Kona is on my list.
(10:03):
But what I've decided is Idon't make good life choices
when I'm training for races.
So now what I do is I trainwith friends who are doing races
so that I can say no, right,they're still on the ball.
But then I say no, but I amsaving for the Ironman until I'm
in my 60s, because then not asmany fast girls show up and I
have a better chance atqualifying for world.
So so when you said, in my caseyou're not telling the truth,
(10:26):
because you also shared with usthat you qualified to go to the
world championships fire and man, and I know race times and I
know your age group and you'renot walking it.
Let me be, clear, so tell us,tell us about your most recent
experiences.
Speaker 4 (10:40):
Yeah, ironically, I think it was this weekend.
It may have very well been, itwas September 10th of last year?
Speaker 3 (10:48):
Did you do Utah?
Speaker 4 (10:49):
No, I did Nice, france, okay, and it was this
weekend last year.
It was a great privilege to goand you know.
Speaker 3 (10:57):
Oh Worlds, I'm sorry, I thought you were talking
about your qualifying.
Speaker 4 (11:00):
Oh my apologies.
No, the last full distance Ironman that I actually did was
Worlds, literally almost a yearago today.
Oh so apologies, no, the lastfull distance Ironman that I
actually did was Worlds,literally almost a year ago
today.
Speaker 3 (11:07):
Oh, so you've just right, exactly.
Speaker 4 (11:08):
And then have been doing a number of things over
the course of the summer and thespring.
Speaker 1 (11:13):
I don't want to say I took the year off.
Speaker 4 (11:14):
That's not even accurate.
But as full distance Ironmangoes, that was a pretty fun day
for me and so we're in a littlespell.
We'll do a half here in Floridain December.
Speaker 2 (11:25):
So, that's the next one on the books, and yeah.
Speaker 4 (11:28):
and then to your point about Kona, I have the
privilege of saying I'm alreadylocked for October of 2026.
Speaker 3 (11:34):
Nice.
So you're re-qualified and youget to go to.
Speaker 4 (11:36):
Kona.
You will be in Kona, yes, andrealizing that dream.
So one of these days, very soon.
Speaker 3 (11:41):
Yes, anyways, all right, I'm geeking out on this.
I learned?
Speaker 1 (11:44):
what I learned here is that a triathlon can be as
long as it's the three eventsswimming, running and bicycling.
It can be different distances.
Exactly so now what I'mwondering is that Justin and I
could do a triathlon we could doa sprint.
Speaker 3 (12:00):
Do a sprint triathlon , or when I get back.
Speaker 1 (12:01):
Absolutely when I get back to my friends.
Maybe that's an event.
Speaker 2 (12:05):
Have you ever seen what these people look like
swimming, like crashing intoeach other?
Speaker 1 (12:09):
I'm talking about swimming 50 yards, biking about
half a mile.
Speaker 3 (12:12):
Well, a sprint is.
I think sprints is a verymanageable distance.
Speaker 2 (12:16):
Absolutely Well.
It's something to.
We'll have a future podcastepisode about our Dave and I
training for it.
Okay, love it about our Daveand I training for it Okay, love
it.
Let's do it All right.
No more triathlon talk for now.
Okay, for now, partying thefronts over.
Speaker 1 (12:29):
Yeah, it is Wah-wah, wah-wah-wah.
Speaker 2 (12:38):
So let's talk about what you think could affect real
change, and that real is incaps, because that's what we ask
all our guests in thisimportant issue, and so I'm
really interested to hear whatyour thoughts are.
Speaker 4 (12:48):
Yeah, you know, and it was kind of queued up in the
introduction and I really likethat.
That was the case, right, Ithink.
Most simplistically put, Ithink real change can happen
independent of your space withinhealthcare, right, Because we
speak of healthcare writ large,but what people fail to capture
is there's so many parts tohealth care, there's so many
segments of health care, focuses, niches, et cetera.
To effect change, though, Ithink, is a universal answer,
(13:11):
and I think when the systemagain the royal we sees patients
as a story, doesn't see them astheir chart, as some of their
medical diagnosis, as a billingcode or part of a sequence of
events, as a billing code orpart of a sequence of events.
When you look at someone and yousee a 56-year-old engineer
who's just trying to get totheir daughter's graduation, if
you see someone as a mother ofthree who wants to make certain
(13:32):
her kids have the most time withthem possible, your approach to
delivering care changes, yourempathy changes, your look at
what is the best care for themchanges, and that follows all
the way down the pathway.
Your views on reimbursementchange, your views on follow-up
and accountability change, andit sounds so simple to do, but
(13:52):
it's the old butterfly effectright, or dropping a stone into
the water and watching theripples take.
That initial approach has suchlong-lasting ramifications to
the entire system that that'sjust kind of the soapbox that I
like to get on, because you saywhat one simple thing can really
hold impact and change.
That's where I always start.
Speaker 3 (14:12):
I will say this I wanted to be a physician when I
was growing up and I couldn'tcut it in college chemistry and
so then I got into the businessside of health care eventually
and I always said I feel like Ican impact people's lives if I
can help bring outcomes-basedpayment transformation,
(14:33):
healthcare delivery intomainstream medicine.
Because if physicians areincented to help people with
their outcomes right which isthis idea of the person as a
person with their story, how tohandle that, as opposed to how
many times they can come see meso I can get more money right?
So I'm totally with you that itis.
I've always believed that thatparadigm shift is absolutely
(14:56):
paramount to shifting and reallyaffecting change.
Speaker 2 (15:00):
So yeah, I think it's needed.
In our system today, the waywe're so fragmented and it's
very easy just to look atsomebody and treat like just
where you are within thespectrum, as opposed to like
looking the person holisticallyand really understanding what it
?
Is Like they're a person, youknow person first.
Speaker 1 (15:18):
That's why you're a perfect guest for this podcast,
because we've literally spentdecades I mean decades on
payment transformation right,shifting from fee-for-service to
value-based care and outcome.
So tell us the good, bad andthe ugly in terms of shifting
from fee-for-service tovalue-based.
Speaker 4 (15:38):
Well, I'm glad I bring more than knowledge of 80s
hair metal.
Speaker 3 (15:41):
Yes, you do, and that's why we always have the
party in the front.
Speaker 4 (15:44):
The layers of the onion right.
Speaker 2 (15:45):
Don't discount the effectiveness of that.
That was very effective.
Speaker 4 (15:50):
You find your in where you can right Justin's
like, let's just wrap it now.
Speaker 1 (15:54):
We're done.
Speaker 4 (15:54):
It's a fantastic podcast.
Yeah, the goods, bads and ugliesof transformational healthcare
delivery.
Right, I'll actually probablyavoid the the ugly I don't know
that ugly is is necessarily acomponent of this to me, but I
think goods and bads are a fairstarting point.
And I think there's an oldadage and I'm not going to give
credit properly, but you knowthere's a saying, and apologies
(16:17):
to whoever coined it.
You know every system isperfectly designed to get what
it gets right.
And and you know it soundssimple when it's said out loud,
but when you really stop tothink about it, you know it's
not the system's fault, it's howa system is applied.
And if you don't like theresults you're getting, you work
on how that system is builtright.
And to that end, we at theorganizations that I had the
(16:38):
privilege of representing, withboth chapters and Care New, had
said okay, our problem is notthe people, our problem is not
the patients, it's not the payermechanisms, the problem is the
system.
And if we don't like that, thenwe should take the bull by the
horns and try to address thesystemic issues.
And in doing so, we focusedfirst on the good.
What is the best part of whatyou do?
It's your mission, it's yourorientation, it's your calling,
(17:00):
and in our specific line of work, which really focuses on care
for the chronic ill, the elderly, the frail, right, as opposed
to you know more the maintainingthe wellness of the youthful
populations, things of thatnature, you know we have a very
specific population that we lookto work with and in that
process we realized we needed avery specific type of employee
base, right, and so you canstart to see where this goes.
Now you have a different groupbeing served than has
(17:23):
historically been served.
You have a different workforcebeing cultivated and nurtured
than has traditionally beencultivated and nurtured and you
start to build a system in itsown right and eventually and
listeners are going to be askingthat sounds great how do you
get paid, right, if you bring avalue proposition to the table
(17:50):
that says, statistically we'redifferent, culturally we are,
know, as care outcomes go, we'redifferent, we're targeting a
population that's different.
You have created a system, oryou have at least embraced a
system, differently than existstoday and that creates audiences
, that creates buy-in and itcreates sort of that cultural
competency and currency of anorganization to say, now we have
enough traction to do thisdifferently than others, right,
the bad is if you don't have thegood fortune of an organization
(18:13):
to be nimble, to be quick tochange, to have stakeholders who
are lined up behind you on thisjourney.
You've got some headwinds right.
It's not a secret.
I'm going to again screw up thenumbers, but the concept is
accurate.
The United States economy isone of the largest in journey.
You've got some headwinds right.
It's not a secret.
I'm going to again screw up thenumbers, but the concept is
accurate.
The United States economy isone of the largest in the world.
Our healthcare spend as aportion of our own economy is
(18:33):
one of the largest parts.
Speaker 3 (18:34):
Four trillion, four trillion.
I thought it was four, six Overfour trillion.
It's like four and a half.
Speaker 1 (18:38):
I didn't want to take a chance on record of getting
it wrong, but I feel that muchbetter, but the per capita
expenditure is twice as much asthe next.
Speaker 3 (18:44):
Yeah, and our outcomes are the worst.
Speaker 1 (18:46):
Bingo.
You finished my statement.
Speaker 2 (18:47):
Sorry, no, no, absolutely.
We're finishing sentences now.
Speaker 4 (18:50):
This is going Very prescient crew, you know, into
that end.
That means there's a lot ofsystem already in place.
There are a lot of stakeholdersor a lot of investors or a lot
of protocols.
If you, as an organization, aregoing to build from the ground
up, you have the good fortune ofsaying yes, we don't have a lot
of traction today, but we getto start this the way we want it
(19:12):
to be.
If you're a very largeinstitution with years of muscle
memory, so to speak, you'regoing to have a different path
to that.
But to your point about goodand bad.
Speaker 3 (19:29):
You know, it's still a system and, like any system,
it starts with moving one brickat a time, one Lego at a time,
one block at a time, howeverthat looks, and you just have to
determine your path.
You said it really well and Iwant to go back to this point.
It is and you didn't say itexactly like this, but it was
the idea that, economically, youhave to align with the outcome.
So, hey, look at the savingsthat I'm generating, look at the
(19:51):
economic value that I bring inthe model of care that I have
created, in the system of caredelivery that I have created,
that I have created in thesystem of care delivery that I
have created.
And you're willing to stand upand say and I'm confident in
that and I'll stand behind thatcommitment and guess what, if I
save that money, it's mine tokeep, but if I lose it, it's
(20:11):
also mine to lose.
Unfortunately, that's where we,again, we have created a system
that doesn't require that, wherewe, again, we have created a
system that doesn't require that.
And so to your point if you'rereporting to a board that's used
to seeing margins on a bed, ona stay, on an admission, on a
(20:36):
DRG basis right, it's verydifficult to think about the
financial risk associated with a$12,000 a year premium versus
an $1,800 daily bed rate.
Do you know what I'm saying?
Absolutely, I think that's areally important aspect of
value-based care that peoplecan't seem to get over.
And then we all point fingersat each other, right, but there
is an absolute that when youcreate the value, they will come
(20:56):
.
That's right.
Speaker 4 (20:57):
Well, you know, and I tend to draw oftentimes bad
metaphors or bad analogies, andI speak in them and my team has
just gotten used to it so theycan decipher what I'm trying to
say.
So I'll be very kind to theaudience and not go down that
path, but I will attempt oneshabby one.
You know, last night, as I waskind of just thinking through
tomorrow, as we often do, I waslike all right, what are what
are going to be my speakingpoints?
How is this going to come outarticulately?
(21:18):
And I kid you not, in the timethat I was just sitting there
with TV running in thebackground, two or three law
firms came on and the same adagewas there you don't pay
anything unless we win right.
And then there was a pizza at alocal pizzeria.
It's like, you know, if you'renot completely satisfied, get
your money back.
(21:41):
And I thought to myselfaccountability and value-based
exists in almost every otherline of work.
Why is healthcare the last andit so often is the last to adopt
what the rest of the worldknows about?
If you have a product andyou're confident in your
delivery, and if you areaccountable to the results and
you're an expert in your space.
The notion shouldn't scare you.
The problem exists as peoplehave gotten comfortable and
people have these well-oiledmachines and expectations.
People have gotten comfortableand people have these well-oiled
(22:03):
machines and expectations.
So oftentimes I would tellpeople you probably have more
competence than you realize.
What you have lacked is apurposeful strategic plan on how
you change other stakeholders'views on this.
I doubt very sincerely you'vehad any guest on this podcast
who doesn't believe they'reproviding top quality care to
their patient or their member orwhomever their population is.
But you probably had more thana couple who said but I wouldn't
(22:24):
be able to convince otherpeople to go a different
direction.
So that's what I usually focusmy conversation.
Speaker 3 (22:29):
Well, I think part of it is.
It's also just a fundamental.
I just want to be clear too istaking insurance risk is very
different than offeringhealthcare delivery, and so it
is a it's a bonus if you'rewilling to do that and and,
quite frankly, there's noincentive to do it and it's much
(22:49):
scarier to do it.
So I, so I get it.
So, justin, you have a lot ofexperience.
I mean you're like the king ofexperience.
We, we have worked with you toimplement a lot of the value
based care care, but I mean youspeak from this experience.
Speaker 2 (23:03):
Yeah, no, absolutely, and a lot of that comes from
you mentioned product right, andthen we're talking insurance
risk.
We have so many differentsystems, right, and when I say
systems, we're talking Medicare,commercial Medicaid that have
different insurance amounts tiedto the individuals right, that
you would be taking risk for Inmy background it was a fully
(23:26):
integrated plan for Medicare andMedicaid right, so you're able
to take both sets of dollarstogether, right, and provide a
more unified bring thosestakeholders together that
you've talked about in a waythat you know when you're siloed
you just can't.
So I guess where I go to is Ifound the value, particularly
(23:47):
for community, home andcommunity-based services.
Can you tell us your thoughtsabout home and community-based
services and what you've worked?
Speaker 4 (23:56):
Yeah, more than pleased to.
It's always one of thesemoments where that's a wide open
door that I kind of run fullspeed through.
And so I tend to also realize,as I've listened to these you
know encounters in my past, Ilike it when people give me an
example, something that's liveto work with they, our PACE
(24:18):
centers not too long ago, andfor those of you to the
uninitiated, pace is the Programfor All-Inclusive Care of the
Elderly.
But to your point, it is aMedicare-driven program with a
Medicaid component, so you havethe federal and state elements
and, to your point, it is afully integrated delivery
focused on that home andcommunity-based approach.
So it's kind of the perfectexample to play with as we speak
(24:40):
.
And you know I had.
If any part of my next statementcomes out as my taking credit
for my team's good work, let meapologize in advance, because
these people are phenomenal, thestaff are phenomenal, the
members are phenomenal, theparticipants are phenomenal and
in this they're engaged in theirown care.
By the very virtue of how PACEis set up, it looks to reward
(25:00):
living right.
It looks to reward experience,it looks to see people as that
story that I spoke of initially.
And yes, there are absolutelymedical components, right, you
know, multi-specialty care,primary care, any unexpected or
unplanned episodes that mightcome through.
But the real magic happens intheir social engagement, it's in
their travel, it's in theirfamily engagement, it's in their
(25:21):
travel, it's in their familystory, it's in coming to the
Pace Center.
And it really is illustrativeof, to me, that perfect Venn
diagram of where great attentionto social determinants, great
attention to the medicalcomponents and great attention
to that psychosocial, spiritual,emotional component intersect.
And that, to me, is value-basedcare.
Value-based care, I know,carries a connotation of
(25:42):
upside-downside risk,sub-delegation, capitation, all
those terms, and that's fine.
That's a part of it, that's thefinancial, that, to me, is the
economics of it, that's not thedelivery of it, it's not the
heart of it.
Right, you pay your check at arestaurant, but the restaurant
is not about the check.
The restaurant is about theexperience, right?
And so, to that end that's whatwe always say we define
value-based care.
The setting is home andcommunity-based.
(26:02):
It's where patients andfamilies want to be, it's where
outcomes can be delivered andit's where the highest level of
engagement in someone's socialand emotional well-being takes
place.
The model is a proven chronicillness model that you know, as
you might expect, is rooted instatistical outcomes and
clinical outcomes, and thesocial side is based in the
health equity components of this.
And we, as an organization Iwon't turn this into a
commercial, but haveaggressively pursued health
(26:24):
equity certifications because webelieve in that three-legged
stool, if you will, of how toapproach true value-based care.
Speaker 2 (26:30):
So these models have been around for decades.
This is what I like to bring upin a lot of the discussion,
because we tend to think likeooh, the latest new idea is the
greatest.
I am super passionate aboutPACE, the fully integrated
programs, but they've beenaround for a really long time.
Why do you think they'regetting more traction,
particularly PACE, at this pointin time?
Speaker 4 (26:49):
You know I don't ever point to one moment, right, you
know, it's almost like askingsomebody how did society get the
way it is?
There's no one moment.
There's certainly aprecipitating set of factors,
but let's lay out a couple ofthose.
One, you know the agingpopulation supply demand curve
is clearly something thateverybody is aware of.
A diminishing workforce, arapidly multiplying population
(27:10):
in need of care and that dynamichas shifted.
You have the you know, adult,the sandwich generation, where
adults caring for children andtheir own parents, right, and so
where often does that happen?
In the home, as opposed to youknow the other piece.
And then it's even very simplebut kind of mind-blowing numbers
.
We built a health careecosystem around the few days a
(27:32):
year that you're in a hospital,a physician's office, a nursing
home, never really fully givingcredit to the fact that you're
probably in your own privateresidence 300, 300, 320, 350, if
it's a great year, 360 days,right, sheer percentages.
Why is more of the healthcareecosystem not driven where
you're at 90, 95% of the time,right.
(27:53):
And if you really think aboutwellness or sickness, or
proactivity over reactivity,that's where that's going to
happen Lowest cost, idealsetting, most engaged patient
population and ultimately givesthe clinical practitioners
themselves that sense offulfillment that many of us
daydreamed about and tried toreally make a difference.
Speaker 2 (28:12):
So how do we get?
Speaker 4 (28:13):
a pace on every corner.
Speaker 1 (28:17):
Well.
Speaker 3 (28:17):
Walgreens has real estate available because Bill
and Jim D is opened up.
I think there's a new businessmodel coming out.
So, do you want to answer that?
Because I have another questionhow do we get a pace on every
quarter?
Do I get any free?
Speaker 4 (28:32):
passes that I can take.
I know I think honestly it's.
You know I hate the wordgrassroots because it has such
an overplayed usage, but thereality is it's to your point.
It's been around a long time.
You don't find anybody who hasexperienced it and not liked it,
which you find more often thannot, as those who have said.
I don't know what that is.
It's like anything in itsorganic state.
You really just need to lookfor every opportunity to promote
(28:54):
and discuss and press, and sothank you for that being here
today.
Secondly, it's as the membersthemselves are engaged.
It's having them tell the story, and then, of course, there are
legislative and politicalcomponents to that too.
Anything that's codependent onbudgets at a state and federal
level has more headwinds than alot of programs do as well.
But whether it's PACE orwhether it's Accountable Care or
(29:14):
whether it's any of the otherprograms that approach this,
you're starting to spread theword.
Speaker 3 (29:18):
So that was going to be my next point programs that
approach this.
You're starting to spread theword, so that was going to be my
next point.
So a lot of people bash CMS and, believe me, there's a lot of
stuff that they do that is, Ithink, a little bit too
aggressive and it aggregatessort of ambiguously and it
shouldn't.
But CMMI, in my opinion, is oneof the really good things that
(29:40):
came from ACA and there havebeen a lot of really good
programs that have come out ofthat, and so the one that I want
to talk about a little bittoday is Guide.
So it's one of the new.
So, just to put this intocontext for the people that are
listening that may not know,this is, cmmi is the innovation
center under the Centers forMedicare and Medicaid right, and
(30:01):
they have, in the first decadeof their existence, they put 50
programs in place and they areall value-based programs and
their goal is that everyMedicare and most Medicaid
people will be under a form ofvalue-based care by 2030.
And that's only six years fromnow.
So that's a very aspirational.
That's their second decade plan.
(30:22):
So this new program, guide, Ithink, is a perfect example of
what we're talking about so, andwe've talked to a number of
clients that have implemented itor are going to implement it as
part of their value-based careportfolio.
But it's those that arelistening.
It stands for it's a newprogram.
This year it's Guiding, anImproved Dementia Experience.
I have to look at that becauseit's a new acronym for me.
(30:42):
Unlike the other ones, I canspit out still at the top.
Speaker 1 (30:46):
CMS never puts out new acronyms.
No, no, no.
Speaker 3 (30:50):
But this one, actually, when you talk about
the sandwich generation, thisone's actually near and dear to
my heart, because my mom wasrecently diagnosed with moderate
to severe vascular dementia,which again, for those that are
listening, that was that isactually a will be her cause of
death from being an uncontrolleddiabetic for 10 years.
(31:11):
That that's it.
And so, like, when we talkabout, you know, cardiometabolic
disease and we talk about allthese things that are happening
in your thirties, your forties,you're setting yourself up for
that dementia right, she setherself on that path, but we are
now finding ourselves as afamily trying to navigate
dementia right, and so I waslike I've got to ask Andrew
after this if he has anythingover on the East Coast, so tell
(31:34):
us.
You guys are one of theinaugural participants in the
guide program beginning thisyear.
Speaker 4 (31:39):
Yes, absolutely correct.
There's about a dozen things inthere I wanted to get to.
Yeah, I figured, I figured, Ijust asked you like a ton, but
this is a really I love talkingabout these value-based programs
.
So on.
I think we got here by theroute of you explaining where
CMS and CMMI sort of motivationslie in that 2030 deadline.
And it's funny you say that.
You know, in our office I havea little countdown clock right
(32:01):
and it's actually set to 2030.
And I don't remember the lastcount.
I think it's a little over 2200days, probably give or take.
But that notion is that that tous, is a bit of the North Star
right.
That is that moment where andthey've not shown any wavering
from that commitment withemerging models and with
recommitment to those models andmaking them move from, you know
, demonstration projects intostatutory projects or programs,
(32:24):
you know.
So we believe fully in the 2030, you know ambition right and
chapters and Care.
New, by its portfolio ofbusiness investments, are all in
on that.
And so the guide model was onethat we pursued with vigor for
several reasons.
One it fits our core audience,our core disease management
platform.
It's certainly something thatmany of us have a personal
connection with.
I do have no problem giving ashameless plug.
(32:46):
I had the privilege of servingon the Gulf Coast chapter of the
Alzheimer's Association boardand those folks do just do
tremendous work.
And for those who have everpersonally experienced it with a
family member, professionallyexperienced it in a clinical
caregiving setting, you know thestress it takes not just on the
patient but on the family aswell.
So when you start to look atCMMI, investing in models that
are equally focused on caringfor a patient but also the
(33:09):
patient's social environment,that to me is a giant leap
forward.
Right, there's lots and lots ofprograms out there, all of which
are exceptional, but they'revery clinically driven.
Right, it's all about a certaintest, it's all about a certain
threshold.
There's not as many models thatare focused on that social
component, the familialcomponent, the societal
component, and you start to seethings like ACO, reach and the
(33:29):
guide program, and I want togive credit to the federal team
for realizing and bringing.
You know it's a big ship, theyalways say.
You know, turning a giant shiptakes time.
So this to me is no small feat.
Right, they're starting to moveinto things that are disease
specific.
But take into account thosethree circles that I say create
the ideal Venn diagram forsuccessful, value-based care.
(33:52):
And this is just yet anotherillustration of it.
Right, and so you know I havenothing, but we haven't seen a
kickoff yet.
Certainly there are bumps orrough edges to any program, no
matter who administers it, sowe'll get through that.
But yeah, we're certainlyexcited about that.
Speaker 3 (34:06):
Yeah, it's good stuff .
Speaker 1 (34:07):
Yeah, got to give them credit 50-plus programs in
the first 10 years.
Speaker 4 (34:12):
Yeah, yeah, I mean I try it.
When we come Friday night We'vegot to figure out where we're
going to have dinner as a family.
Speaker 3 (34:17):
We there's four of- us and we can't settle on one
answer.
I cannot imagine finding aperfect solution for all of
America.
We can't even have family movienight anymore in my house, like
literally, I think we can haveone a year.
That's when everyone has theirphone out staring at something
different, on the couch together, or like you get into a huge
it's either you pick somethingand within five minutes someone
leaves or you get, or you or youget in such an epic fight that
(34:37):
you can't even pick a movie, andthen someone storms off and
then you end up with like two orthree people at best, and then
I end up just going to bed.
You know it's like well, we try.
Speaker 4 (34:46):
I'm going to work on health care, some things I've
given up on.
Speaker 3 (34:50):
Getting a little more serious.
Speaker 2 (34:54):
Like I say serious, no, sorry, go ahead.
Serious about your legacy.
Can you tell us what yourlegacy like your legacy to be in
healthcare?
Speaker 4 (35:06):
That's a great question and there's, you know
there's so many.
I'm going to address it fromkind of an organizational
perspective because certainlywhat I ambition to do is very
different.
Speaker 2 (35:14):
And maybe I'll answer both just to give the listeners
a wider view.
Speaker 4 (35:19):
So, organizationally, if this all happened tomorrow,
if I retired tomorrow andChapters said that's it, we are
just going to freeze everythingwe've ever done and we want to
be remembered for this day.
I hope that people rememberChapters as an organization that
was focused on three thingsFirst and foremost, a superior
experience by not just thepatients but their families, the
volunteers, the patients buttheir families, the volunteers,
(35:41):
the donors, the philanthropists,everything that we support.
We wanted to have changed howour communities viewed the
resource that we were, becausethat does you know ebb and flow,
where some days we're doinglots of things for lots of
people, other days we're morefocused, but we want to always
be able to say we've made a bigdifference.
We weren't a transactional partof someone's life, I would say.
The second piece that would bea great legacy organization to
(36:04):
leave is that little eye rollwhen someone's like man.
They were always on the edge,they were always pushing the
envelope, they weren't afraid totry Bend, don't break.
Be innovators, right.
I would be really sad if wewere ever thought of in the same
sentence as the word status quo.
Speaker 3 (36:21):
That would be a fail to me.
It would be the opposite oflegacy.
Speaker 4 (36:24):
Exactly right, I mean that's certainly a legacy, but
it's not one that we want toleave and I'm not suggesting
there's not a place for that.
There's great parts ofhealthcare that don't need to
evolve as much.
That's just not where we'refocusing our time, and I'll
offer you this one, because ithe made the team his focus and
(36:48):
in doing so, any success he mayhave incurred was done the right
way.
Speaker 1 (36:52):
We have.
Speaker 4 (36:53):
I think we're trademarked.
If not, we're working on beingtrademarked On a phrase that I
believe very passionately about,and there's only two jobs.
No matter what our HR teamwould say, the manual is bigger
than this, but there's only realtwo jobs at our organization,
and that's be caring forpatients or caring for those who
do.
And if you can't look at thestack of work on your desk and
(37:15):
correlate it to either improvingone of our team members
experiences or one of ourpatients experiences, rethink
your priority set, because I dostrongly believe that that is
the.
You know, those are the leadmeasures that ultimately create
the change that you're lookingto implement.
So, as legacies go, personallyI want to have been that kind of
leader in organization.
We want to have left that kindof mark.
Speaker 1 (37:34):
That sounds like a piece of cake, though.
Speaker 4 (37:37):
Done and done.
I mean, all you got to do issay it and will it into
existence, right?
Speaker 1 (37:41):
All right.
No, I mean you talked aboutin-home patient care and all
that, and it's like what did yousay?
Say that one more time Eitherbe caring for a patient or there
are two jobs at ourorganization be caring for
patients or caring for those whodo I love that that's fantastic
.
Speaker 3 (38:00):
So what are some of the key areas that have to be
addressed to move towardsvalue-based care?
For those that are listening,they're like, if I have to do it
by 2030, maybe I do have tostart thinking about this.
I was on a call this morningtalking about this with the
health system that's fullyintegrated with the change
management that they're dealingwith, to try to move more
(38:21):
towards value and away fromfee-for-service transactional.
Speaker 4 (38:25):
That's right, and so you know we've we've had this
laugh.
You know, uh, executive of myteam and she's shy individual,
doesn't like to be called out byname, so I'll avoid that, but
she's listening right now.
She knows I'm talking about her.
You know, she asked me once.
She said so what are we goingto do when we're successful?
Speaker 1 (38:41):
I said that's a great question, right?
Speaker 4 (38:42):
Because if you sell this to your board or to your
investors, or to yourstakeholders, or whomever it is
you need to help convince, comeon this journey there's going to
be a moment where they look atyou and say, that's a good idea,
let's do that, and then it'sgoing to land back in your court
.
You know it's intellectualtennis.
Now the ball is back to me, andwhat am I going to do with it?
So here's what I would suggestYou're going to call BP too.
That's right, there you go,sorry.
Speaker 2 (39:04):
It starts with this.
Now work from our sponsor.
Speaker 4 (39:07):
But wait, there's more.
Yeah, we can have some laughsabout that, but that is not an
inaccurate statement.
There are answers out there.
This is not something that'snever been done.
It's not something that can'tbe done.
It just requires, like wetalked about with an aquarium or
with a 10-hour, 12-hour,15-hour race.
Right, it's one step at a timeand you don't think about a
(39:28):
finish line or finished product.
You think about the next waterstation, you think about the
next waypoint right and, forthose of you who've ever done a
marathon, half floor.
Speaker 3 (39:35):
I'm envisioning the.
I'm literally envisioningputting ice in my cap as I'm
trying to finish the last threemiles of the run.
Speaker 4 (39:42):
Yeah, yeah, a race medal is a long way off.
I need a cup of Gatorade.
It's got to get there next.
And to that end, I would saythat design, or the migration to
value-based care, follows apathway.
Take a look at yourorganization and everything that
you have built.
Check that right.
Is this ready?
And if it's not, then you haveto make sure in your following
kind of a rate limiting or alowest common denominator
(40:02):
approach.
So, is your workforce ready forvalue-based care?
Are their compensationstructures aligned to quality
over quantity?
Are there recruitment, training, development, retention tools?
Are there promotionary pathwaysfor those who perform well,
because it's not aboutnecessarily tenure?
There are some skill sets.
That translates better.
You can follow the workforcepath.
(40:22):
That becomes very real.
What are your capital needs?
If you're going to have to havereserves to take a dual
integrated plan to be in an ACO,right?
Do you need to drive marginsfor a few years in order to put
reserves on the shelf and makethat migration?
Do you have an outside investor?
Do you have to change your realestate portfolio to be less
intensive on acute carestructure and more on home
(40:42):
community based?
So there's that component right, and then you have to look at
your business acumen.
Who is handling your contracts?
How locked into certain thingsare you?
What is your ability to handlea massive switch from revenue
streams based on you know all?
So all these components arethings.
There's not one solution.
You don't wake up one day andhire a value-based care expert
and say now go, do your thing.
(41:03):
In a vacuum.
Value-based care is not a niche.
It's not a single provider orsingle service line.
It has to be kind of anorganizational ethos, and that's
what I would suggest to peopleis.
Value-based care often carriesthis sort of business acumen
connotation.
What I would suggest is is yourcompany or is your organization
ready to move to a quality overquantity approach?
(41:24):
Because that's a little bitdifferent.
You can embrace quality overquantity and still keep a lot of
your traditional businessmodels, but it will change the
whole ethos, which is a nicetransition to when you have to
put your money at risk.
Right, if you're just reallyfocused on quality, you can
still be in a fee-for-serviceenvironment, delivering
exceptional, innovative care andstarting to squirrel away a few
(41:44):
dollars for when you have toput some things at risk in the
more traditional definition ofthe word.
So I'm all over the place.
Speaker 3 (41:49):
But Well, no, I think and I and I appreciated what
you said too about you can'tjust hire a value-based care
expert, because it's true, it's,it is, it is change management
and you have to operationalizesome things.
You have to it's and and like,we have a lot of times where we
(42:09):
literally get the call becauseMcKinsey's come in, or some big
firm has come in and dropped it,and everyone's gone, yes, we're
going to do value-based care,and then they leave and
everyone's like what do we donow?
Speaker 4 (42:22):
You know like.
Speaker 3 (42:23):
I mean, now we have to do all the things that you
just said and we don't.
We don't even know what allthose things are.
And then that's when we get thecalls like, well, can you
actually make us, help us do it,because you know it's like it's
, it's a, it is, it is redesign,it is structural redesign, it
is system, it is really systemredesign, it's engineering,
(42:44):
almost right, it's like how do Ire-engineer my wife and I?
Speaker 4 (42:51):
we like to pick at each other because she's, you
know, also in the healthcarespace, and so our, our, our
dinner talk is quite interesting, but she got chickens not too
long ago and I kind of chuckled.
I said so are we a farmer now?
Speaker 1 (43:02):
Yeah, Actual chickens egg laying chickens.
Speaker 4 (43:04):
They're in, they're in a coop and the whole thing
yeah.
Speaker 1 (43:06):
Yeah.
Speaker 4 (43:06):
And if you ever came to know me as an individual, you
know this is about as far frommy natural tendency as possible
and I said are we farmers?
And she said, oh yeah, causewhen you have a chicken you're
automatically a farmer.
But I kind of laughed because I, you know, the analogy here is
apropos.
You know, so are.
Does a value-based design makeright?
It's a commitment.
You know, if you want to be afarmer, and a good one, you need
(43:33):
the space, you need the acumen,you need someone to teach you,
you need all the equipment, youneed to understand the weather
patterns.
To be in value-based care isnot just a trend or a current
payment model or a singlecontract.
Speaker 3 (43:52):
It's a.
Thing.
So Justin you're trying to jumpin, sorry.
Speaker 2 (43:55):
Well, now I know how he's getting in such good shape,
as he's chasing the chickensaround.
You know they like their eggs.
Speaker 1 (44:03):
So when do you become a farmer?
Do you have to have pigs too,or what's the where's?
Speaker 3 (44:07):
the line.
Oh, you're getting ready forthe last question.
Speaker 2 (44:09):
Yeah, so yeah.
Speaker 3 (44:11):
Wait, yes.
Do you have a definition ofwhen you become a farmer?
Speaker 4 (44:14):
Uh, I think we were done when, when my legacy is
left because I don't havefarming in my future.
Speaker 3 (44:18):
But we have a last question for you.
Speaker 2 (44:24):
We do so.
We ask all our guests whattheir buy a world of Coke or
pigs when pigs fly?
Speaker 1 (44:31):
When pigs fly.
That's where I was going.
Yes, right Segway.
Speaker 2 (44:36):
For fixing the health care system.
So what is yours?
Speaker 4 (44:40):
I kind of gave away my secret a little earlier you
know and I don't know if this isthe technical definition of how
the phrase Occam's razor isused.
But but what I'd like to impartis I do actually believe that
the solutions oftentimes are assimple as they're presented
right.
Healthcare at its core yes,there are, you know, components.
Yes, there are, you know, testsand diagnoses, codes.
(45:01):
Those are all very vital partsof it, but what it really is is
humans caring for humans for themost part.
Now AI takes over and we're allworking for the machines.
We'll revise this podcast then,but until that, day the
machines will revise it for us.
Speaker 3 (45:15):
They'll do it for us.
Speaker 4 (45:17):
I wouldn't even need it for that.
But until then I think we havesome time.
It is humans caring for humans.
It is not humans administeringtests to humans.
Caring is, I think, thecritical word.
So when we at the organizationbelieve you have two jobs, tie
the work on your desk to one oftwo jobs taking care of our
patients and if you're not inthat capacity, then you're
(45:38):
taking care of those who do.
That to me, I believe, wouldfundamentally shift healthcare.
There's a lot of headwinds togetting there.
There's investors who needtheir money back.
There's regulatory statutesthat keep things from getting
done.
There's a lot of red tapeinvolved.
It's what we've built.
We can unwind it, just the waywe wound it.
But I do think it starts withfundamentally recognizing that
(45:58):
health care, when done right,whether it's acute, post-acute,
non-acute, whatever it might be,it is fundamentally humans
caring for humans.
It is fundamentally humanscaring for humans.
And if we can strip all thenoise and all the layers of
nonsense away from thatprinciple and direct our
resources, our time and ourattention to that, I think
things change Well mic drop,that's it and that would be my
(46:23):
Coke, because my wife woulddisown me if that was my Pepsi.
We're a Coca-Cola householdunwaveringly Well sometimes.
Speaker 1 (46:30):
I mean, is that the cue for the song?
Speaker 3 (46:32):
No, oh, come on, we aren't going to sing it today.
Speaker 1 (46:36):
We're going to get a season to sing it.
Do it real quick, do it realquick.
I'd like to teach the worldthat was it.
Never mind Forget it.
Speaker 3 (46:43):
All right.
Speaker 2 (46:44):
It's only a matter of time before Coke suites us
Right, so we've kickstarted myheart If you want to do that, no
.
Speaker 4 (46:52):
They would that I was not.
I'll be a farmer before I'll bea big deal replacement.
You're like thank God youdidn't keep singing because I
wasn't ready for that.
Well, andrew, thank you so muchfor your time today.
We appreciate you coming mypleasure.
Thanks for highlightingsomething so important to us.
Speaker 3 (47:06):
Well, thanks again.
I'm Ellen Brown.
Speaker 1 (47:09):
I'm Dave Pavlik, I'm Justin Politi.
We are the partners at BP2Health your best chance for real
change.
As you can tell, we talk aboutthis stuff all day.
It's on our website at2healthcom.
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