Defining quality and appropriateness

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.