EP503: Smart Collaboration With Direct-to-Employer Specialty Care, With Ryan Wells; Leo Spector, MD, MBA; and Adam Stavisky
Relentless Health Value
Rails weren't built for direct contracting
Ryan explains administrative waste in fee-for-service rails and the need to 'jump off the rails' for new models.
Episode 503 of Relentless Health Value features Stacey Richter with Adam Stavisky, Dr. Leo Spector (OrthoCarolina), and Ryan Wells (Health Here) discussing how self-insured employers and specialists rarely connect directly due to intermediaries and fee-for-service "rails."
They outline three common pitfalls when bridging this gap: defining and measuring quality and appropriateness (limits of claims data and missing patient-reported outcomes), achieving scale across geographies and specialties, and ensuring benefit design and incentives so members actually use direct-contracting programs. The conversation frames the evolution of Centers of Excellence from 1.0 (travel to brand-name hospitals) to 2.0 (more local but administratively manual) to 3.0 (new infrastructure enabling direct, efficient contracting).
Health Here is described as a digital bridge to support payment and communication pathways and reduce administrative waste.
=== LINKS ===
🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP503
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00:00 Introduction.
00:32 Collaboration as the next breakthrough innovation.
02:24 A summary of the upcoming conversation.
05:45 A summary of where we are and what the future looks like.
06:24 A relevant post from Jonathan Baran.
08:12 The conversation with Ryan Wells, Dr. Leo Spector, and Adam Stavisky: collaboration from the standpoint of a specialist.
12:22 The pitfalls of data accuracy and defining what quality means from the POV of a self-insured employer.
15:36 Defining quality and data accuracy from the POV of a physician.
15:57 How do you measure outcomes when assessing quality and looking at the available data?
21:45 EP294 with Steve Schutzer, MD.
22:06 Scale and operationalization: How do we do it?
27:00 Shout-out to OrthoForum.
29:58 Take Two: EP398 with Jacob Asher, MD.
30:13 EP501 with Ivana Krajcinovic, PhD.
30:30 How things could be better.
33:29 One last complication and how to structure benefit design to align incentives.
35:33 What an "anti-cricket" program looks like.
37:24 EP308 with Mark Fendrick, MD.
37:34 How do we operationalize benefit design and aligned incentives?
39:39 What we're seeing today in Centers of Excellence 2.0.
41:47 What Adam wants to make clear in all of this.
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