Stacey: If you are a plan sponsor thinking about, for example, primary care as a way to optimize healthcare spend, do know that any given plan sponsor will really only get maximum possible benefit from an investment in primary care, advanced primary care, when and only when said care is structurally architected to deliver real clinical value.
For a full transcript of this episode, click here.
If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.
I don't mean marketed as value but architected for it. Talk is cheap, as I discussed a couple of weeks ago with Kimberly Carleson (EP534) and we will discuss again coming up with a few other guests in a few upcoming shows.
But what does it mean, exactly, this architected for value? And I ask this question so that you can make sure that if you're a plan sponsor, that what you're buying actually has the architecture to actually deliver on a value promise.
And yeah, good news. By the end of this episode today, you will probably know what architected for value looks like, probably well enough to suss out at some level whether it exists.
And spoiler alert: Any given care design that is going to deliver actually for real on a promise of architected for value is going to include some form of team-based care—the real kind of team-based care now, not the unintentionally created, not really designed, talk is cheap sort of team-based care in name only.
If you're a clinician who's listening, please stay here for some hope and also some baseline foundational points that might help you get a little bit grounded as you consider your path forward and maybe a little bit more confidence that our healthcare system is not, in fact, intractably broken.
And I say this as a bit of a callback to what Lisa Rosenbaum, MD, warned us of in episode 519, which was about primary care.
What she was saying in that episode could be interpreted on the plan sponsor side, but also it's relevant on the clinical side. It is a warning. The more we treat our healthcare problems as intractable and unfixable, the more of our own agency we give away.
And that's why it is so important that you are here right now, because first of all, you would not be here. You would not even have made it to this point in the episode if you weren't rather deeply entrenched in the healthcare industry.
But because of that, you are one of the few in this country who knows enough to be a force to be reckoned with. You are a force to be reckoned with. The stuff that we talk about on the episode today won't exist unless plan sponsors demand it and vote with their feet if they don't get it.
But also, buyers have to have someone to buy from, and that means clinical teams who really work this way. And a side benefit may also mean just writ large slowing down or ameliorating at some level the PCP shortage that we have in this country today, which we also discuss coming up here.
Dr. Rebecca Andrews, my guest today, is a professor of medicine, director of primary care, and lead for patient-centered medical homes at the University of Connecticut.
Before we wrap up, a few thank yous. First, thank you to our founding sponsor, Aventria. This show would not exist without you.
Thank you to Payerset, who is our series sponsor in 2026. Thank you for helping bring these conversations all season long.
Also, thank you to Patient Rights Advocate for your financial support and for the work that you do every single day to make healthcare prices transparent—also for some of the lawsuits that you are bringing to make that a reality.
We also wanna thank the listeners who put something in our tip jar this past year, including Kimberly Carleson; Matt McQuide; Vivian Ho, PhD; Arielle Bose; and Casey Cormier, to name a few, along with everyone else who chipped in, including our anonymous supporters.
This is Relentless Health Value. Let's get to it, my conversation today with Dr. Rebecca Andrews.
Also mentioned in this episode are Kimberly Carleson; Lisa Rosenbaum, MD; Aventria Health Group; Payerset; Patient Rights Advocate; Matt McQuide; Vivian Ho, PhD; Arielle Bose; Casey Cormier; Robyn Leone; John Lee, MD; Gary Campbell; Shane Cerone; Stacy Mays; Cristin Dickerson, MD; Suhas Gondi, MD, MBA; Benjamin Schwartz, MD, MBA; and Jerry DiMaso.
For a list of healthcare industry acronyms and terms that may be unfamiliar to you, click here.
You can learn more at acponline.org/advocacy and by following Dr. Andrews on LinkedIn.
Rebecca A. Andrews, MD, studied biology at Boston College and medicine at the University of Connecticut, where she also completed her residency. She is a practicing internal medicine primary care physician and leader for the Patient Centered Medical Home at UConn Health, where her work sits at the intersection of clinical operations, medical education, and physician leadership. She is also a professor of medicine and medical educator at the University of Connecticut. She is the director of ambulatory education and associate program director for the Internal Medicine Residency Program.
Dr. Andrews has had a national impact on medicine through her leadership roles in the American College of Physicians and is currently the immediate past Chair for the Board of Regents. She is actively involved in advocacy for the medical profession and patient care with areas of expertise in performance measures, high-quality primary care, and effective communication skills. These passions interconnect at the point of creating a high-value, primary care that is sustainable with reduced unnecessary costs. She has a long-standing interest in medical education intertwining her experience in the federal qualified health center system and current practice in academic medicine to best train the next generation of primary care internal medicine physicians.
00:00 Introduction to this episode.
01:13 EP534 with Kimberly Carleson.
01:23 What it means to be architected for value.
02:38 EP519 with Lisa Rosenbaum, MD.
05:04 The conversation with Rebecca Andrews, MD.
05:11 What is not considered team-based care?
09:14 What true team-based care looks like.
14:27 How do we organize into team-based care with a physician shortage?
21:12 Two additional aspects of team-based care.
21:39 EP341 with Gary Campbell.
21:53 EP492 with Sam Flanders, MD, and Shane Cerone.
23:15 Why team-based care must also include the patient.
25:05 Maslow's Hierarchy of Needs.
28:08 LinkedIn post by Stacy Mays.
28:14 EP485 with Cristin Dickerson, MD.
30:29 Dr. Andrews' advice on what to keep in mind when building team-based care.
35:26 EP523 with Suhas Gondi, MD, MBA.
36:10 Why solving healthcare's problems isn't all about money.
Recent past interviews:
Click a guest's name for their latest RHV episode!
Robyn Leone, Kimberly Carleson, Frank Pennachio, Chris Klomp, Evan Anderson, Jake Velie and Keith Hartman, Dr Eric Bricker
NOTE This file was generated by Descript
00:00:00 --> 00:00:03 Looking at the people who have millions and billions of dollars that
00:00:03 --> 00:00:07 have thrown it into the healthcare system, and they still can't solve
00:00:07 --> 00:00:11 the problem, that tells you that it's not all about money, which everybody
00:00:11 --> 00:00:13 assumes it is, and it is part of it.
00:00:14 --> 00:00:19 It is about design, and we have to really be intentional.
00:00:28 --> 00:00:32 American Healthcare Entrepreneurs and Executives You Want to Know, talking
00:00:35 --> 00:00:36 Relentlessly Seeking Value
00:00:38 --> 00:00:44 If you are a plan sponsor thinking about, for example, primary care as a way to
00:00:44 --> 00:00:51 optimize healthcare spend, do know that any given plan sponsor will really only
00:00:51 --> 00:00:57 get maximum possible benefit from an investment in primary care, advanced
00:00:57 --> 00:01:04 primary care when, and only when, said care is structurally architected
00:01:04 --> 00:01:07 to deliver real clinical value.
00:01:08 --> 00:01:13 I don't mean marketed as value, but architected for it.
00:01:13 --> 00:01:17 Talk is cheap, as I discussed a couple of weeks ago with Kimberly Carleson, and
00:01:17 --> 00:01:22 we will discuss again coming up with a few other guests in a few upcoming shows.
00:01:23 --> 00:01:28 But what does it mean exactly, this architected for value?
00:01:28 --> 00:01:33 And I ask this question so that you can make sure that if you're a plan
00:01:33 --> 00:01:39 sponsor, that what you're buying actually has the architecture to
00:01:39 --> 00:01:42 actually deliver on a value promise.
00:01:43 --> 00:01:45 And yeah, good news.
00:01:45 --> 00:01:49 By the end of this episode today, you will probably know what architected for
00:01:49 --> 00:01:56 value looks like, probably well enough to suss out at some level whether it exists.
00:01:57 --> 00:02:03 And spoiler alert, any given care design that is going to deliver actually for real
00:02:03 --> 00:02:09 on a promise of architected for value is going to include some form of team-based
00:02:09 --> 00:02:14 care, the real kind of team-based care now, not the unintentionally created,
00:02:14 --> 00:02:18 not really designed, talk is cheap sort of team-based care in name only.
00:02:19 --> 00:02:25 If you're a clinician who's listening, please stay here for some hope and
00:02:25 --> 00:02:29 also some baseline foundational points that might help you get a little bit
00:02:29 --> 00:02:33 grounded as you consider your path forward, and maybe a little bit more
00:02:33 --> 00:02:38 confidence that our healthcare system is not, in fact, intractably broken.
00:02:38 --> 00:02:46 And I say this as a bit of a callback to what Dr. Lisa Rosenbaum warned us of in
00:02:46 --> 00:02:50 episode 519, which was about primary care.
00:02:51 --> 00:02:54 What she was saying in that episode could be interpreted on
00:02:54 --> 00:02:57 the plan sponsor side, but also it's relevant on the clinical side.
00:02:57 --> 00:02:58 It is a warning.
00:02:58 --> 00:03:03 The more we treat our healthcare problems as intractable and unfixable, the
00:03:03 --> 00:03:05 more of our own agency we give away.
00:03:06 --> 00:03:10 And that's why it is so important that you are here right now, because first
00:03:10 --> 00:03:15 of all, you would not be here, you would not even have made it to this point in
00:03:15 --> 00:03:19 the episode if you weren't rather deeply entrenched in the healthcare industry.
00:03:20 --> 00:03:24 But because of that, you are one of the few in this country who knows enough
00:03:24 --> 00:03:26 to be a force to be reckoned with.
00:03:26 --> 00:03:28 You are a force to be reckoned with.
00:03:28 --> 00:03:32 The stuff that we talk about on the episode today won't exist unless
00:03:32 --> 00:03:36 plan sponsors demand it and vote with their feet if they don't get it.
00:03:37 --> 00:03:42 But also, buyers have to have someone to buy from, and that means clinical
00:03:42 --> 00:03:44 teams who really work this way.
00:03:45 --> 00:03:51 And a side benefit may also mean just writ large slowing down or ameliorating
00:03:51 --> 00:03:56 at some level the PCP shortage that we have in this country today, which
00:03:56 --> 00:03:58 we also discuss coming up here.
00:03:58 --> 00:04:02 Dr. Rebecca Andrews, my guest today, is a professor of medicine,
00:04:02 --> 00:04:06 director of primary care, and lead for patient-centered medical homes
00:04:06 --> 00:04:08 at the University of Connecticut.
00:04:09 --> 00:04:11 Before we wrap up, a few thank yous.
00:04:11 --> 00:04:14 First, thank you to our founding sponsor, Aventria This show
00:04:14 --> 00:04:15 would not exist without you.
00:04:15 --> 00:04:19 Thank you to Payerset, who is our Series Sponsor in 2026.
00:04:20 --> 00:04:24 Thank you for helping bring these conversations all season long.
00:04:25 --> 00:04:30 Also, thank you to Patient Rights Advocate for your financial support, and for
00:04:30 --> 00:04:34 the work that you do every single day to make healthcare prices transparent,
00:04:34 --> 00:04:39 also for some of the lawsuits that you are bringing to make that a reality.
00:04:40 --> 00:04:44 We also wanna thank the listeners who put something in our tip jar this past
00:04:44 --> 00:04:50 year, including Kimberly Carleson, Matt McQuide, Vivian Ho, Arielle Bose, and
00:04:50 --> 00:04:54 Casey Cormier, to name a few, along with everyone else who chipped in,
00:04:54 --> 00:04:56 including our anonymous supporters.
00:04:57 --> 00:04:58 My name is Stacey Richter.
00:04:58 --> 00:05:00 This is Relentless Health Value.
00:05:00 --> 00:05:03 Let's get to it, my conversation today with Dr. Rebecca Andrews.
00:05:04 --> 00:05:07 Dr. Rebecca Andrews, welcome to Relentless Health Value.
00:05:07 --> 00:05:08 Thank you so much for having me.
00:05:09 --> 00:05:10 Let's just start here.
00:05:11 --> 00:05:13 What is not team-based care?
00:05:14 --> 00:05:18 What is not team-based care would be employing other team members, medical
00:05:18 --> 00:05:24 assistants, nurses, pharmacists, et cetera, and not clearly defining how
00:05:24 --> 00:05:29 everyone's going to work together, what falls into each role, and how
00:05:29 --> 00:05:37 you can find a synergy instead of unfocused extra busy work, right?
00:05:37 --> 00:05:39 How can we all help each other and work together?
00:05:40 --> 00:05:45 So it does involve knowing everybody's job description, and
00:05:45 --> 00:05:49 then the rules in your state, because sometimes they change by the law.
00:05:49 --> 00:05:53 So if you don't do that, it's not team-based care.
00:05:54 --> 00:06:01 It definitely doesn't sound like the, the team-based care, which is find a PCP
00:06:01 --> 00:06:08 who most likely is new, and find nine to 12 mid levels, and then tell the new
00:06:08 --> 00:06:12 doctor that they're now supervising the nine to 12 mid levels and have to…
00:06:12 --> 00:06:15 Well, and supervising kind of means just, like, sign off on what they've
00:06:15 --> 00:06:18 done without necessarily any discussion.
00:06:19 --> 00:06:21 And then that's team-based care, right?
00:06:21 --> 00:06:23 Like, you hear about things like this.
00:06:23 --> 00:06:27 That is not team-based care, and you, you see a lot of
00:06:27 --> 00:06:29 these models in private equity.
00:06:29 --> 00:06:33 But you see them all over, to be honest, and I would say this is one of the
00:06:33 --> 00:06:36 biggest pain points as a physician.
00:06:36 --> 00:06:40 You wanna provide good care, and that does not include just signing off on
00:06:40 --> 00:06:45 notes for someone you might not know their skill set, or you certainly didn't see
00:06:45 --> 00:06:48 the patient and discuss them together.
00:06:48 --> 00:06:53 And so that model really just stresses the physician who may be seeing
00:06:53 --> 00:06:54 patients at the exact same time.
00:06:55 --> 00:07:00 So there isn't this opportunity for what that model would look like
00:07:00 --> 00:07:01 if it was truly team-based care.
00:07:01 --> 00:07:08 So maybe the physician only has 30% of their normal patient load,
00:07:08 --> 00:07:12 and they're working with one or two particular mid-levels that they know
00:07:12 --> 00:07:17 really well, and they can reach out to them to say, "This one I think you
00:07:17 --> 00:07:21 need to see," or, "Before I send this patient, can I ask you a question?"
00:07:21 --> 00:07:28 So this sounds very different than put the mid-levels on the schedule, put the
00:07:28 --> 00:07:34 physicians on the schedule, and then whoever the patient manages to get an
00:07:34 --> 00:07:37 appointment with is who they see, the end.
00:07:38 --> 00:07:38 Exactly.
00:07:39 --> 00:07:42 A lot of this has happened, like, in this piecemeal way.
00:07:42 --> 00:07:43 This is what has happened.
00:07:44 --> 00:07:45 I'm a doc in practice.
00:07:46 --> 00:07:50 I don't have capacity for my community, and I really wish I did.
00:07:50 --> 00:07:51 I'm overwhelmed.
00:07:51 --> 00:07:52 I have no appointments.
00:07:53 --> 00:07:55 Let me hire some mid-levels who can help me.
00:07:56 --> 00:08:00 All very well-intentioned, and this is just one example of how it happens.
00:08:00 --> 00:08:05 All well-intentioned, but now all of us have schedules, so when do
00:08:05 --> 00:08:07 we get to work together as a team?
00:08:07 --> 00:08:11 If I am just cobbling together the definition of what good team-based
00:08:11 --> 00:08:16 care looks like based on what you just said, checks notes, working
00:08:16 --> 00:08:19 together as a cohesive unit.
00:08:20 --> 00:08:24 And what that means is everybody's got a job description where it's
00:08:24 --> 00:08:26 clear what everybody's doing.
00:08:26 --> 00:08:27 That has to happen first.
00:08:27 --> 00:08:33 There has to be processes then which are compliant with state laws, number one.
00:08:33 --> 00:08:38 But number two, enable everyone to work at the… And I'm gonna use this
00:08:38 --> 00:08:44 cliche, and I'm not gonna be happy with myself later on, but so that everyone
00:08:44 --> 00:08:46 can work at the top of their license.
00:08:46 --> 00:08:47 For real, not in the cliche way.
00:08:47 --> 00:08:53 Doing what they are educated to do, what they signed up to do so that
00:08:54 --> 00:08:59 patients can be cared for by the right person at the right time, which is
00:08:59 --> 00:09:05 determined by the team, not by whoever they manage to click on or whatever,
00:09:05 --> 00:09:10 however else the not team-based care manages to organize itself.
00:09:11 --> 00:09:16 That is absolutely a great summary, and I would go further to say true team-based
00:09:16 --> 00:09:21 care, I know top of the license has become this term that almost has lost
00:09:21 --> 00:09:25 meaning because so many people use it without really understanding what we're
00:09:25 --> 00:09:32 trying to say, but getting a person the right care in the right setting by the
00:09:32 --> 00:09:38 right person at the right time is really what the goal is for team-based care.
00:09:39 --> 00:09:46 I wanna mention right here the earlier episode from last week with Robyn Leone.
00:09:47 --> 00:09:50 We talked in that episode about patient experience.
00:09:50 --> 00:09:53 And one of the things that Robyn Leone said, she said, You know
00:09:53 --> 00:09:55 how to measure patient experience?
00:09:55 --> 00:10:01 No, not by how great the parking is or how closely the hospital resembles a hotel.
00:10:02 --> 00:10:05 Robyn Leone said, "You measure patient experience by how many
00:10:05 --> 00:10:08 patients got the right diagnosis and the right treatment for that
00:10:08 --> 00:10:10 diagnosis at an affordable price".
00:10:11 --> 00:10:19 And here we have kind of an analog to that when Dr. Andrews says, "Right
00:10:19 --> 00:10:22 care in the right setting by the right person is the goal of team-based care".
00:10:23 --> 00:10:26 So it is seeming a whole lot like team-based care is the
00:10:26 --> 00:10:31 operational model by which you achieve good patient experience.
00:10:31 --> 00:10:36 It's the way that you architect, that you design care to achieve good
00:10:36 --> 00:10:39 patient experience and also outcomes.
00:10:39 --> 00:10:41 And that is an actionable insight right there.
00:10:41 --> 00:10:44 It's an actionable for clinicians, obviously, but also for plan sponsors
00:10:45 --> 00:10:49 because it's what you wanna buy if you're buying primary care, probably
00:10:49 --> 00:10:51 if you're direct contracting, honestly, though, for almost anything
00:10:53 --> 00:10:55 And I'll, I'll give you an example.
00:10:55 --> 00:11:00 At the federally qualified health center I worked in was a joy to work in.
00:11:00 --> 00:11:05 It didn't matter that we had very complex patients, some who couldn't
00:11:05 --> 00:11:09 afford medications, who didn't have insurance, but when my patients came
00:11:09 --> 00:11:15 in, and we had exactly what you're talking about, processes, procedures, the
00:11:15 --> 00:11:18 medical assistants spent months training before they were released on their own.
00:11:19 --> 00:11:20 They brought the patient in.
00:11:20 --> 00:11:24 They went through a checklist of what they may or may not need.
00:11:25 --> 00:11:29 If they needed vaccines, they put it on the whiteboard for the nurse.
00:11:29 --> 00:11:33 We had standing orders, so the nurse could go in any time, before
00:11:33 --> 00:11:35 I go in the room, after, during.
00:11:35 --> 00:11:37 It was very timely.
00:11:37 --> 00:11:42 And they could also prep orders for all the health maintenance.
00:11:42 --> 00:11:47 This patient might not have had a mammogram, and they were due for it.
00:11:47 --> 00:11:52 Realizing that if they were coming here from their job that's an hourly wage,
00:11:52 --> 00:11:54 I might not get them back for a while.
00:11:54 --> 00:11:59 And we were able to do that all together, and then I'm making the
00:11:59 --> 00:12:04 decisions about the disease process when I'm in the room, or something that's
00:12:04 --> 00:12:07 really important that needs my brain.
00:12:07 --> 00:12:14 And the other benefit, which took me maybe six months to learn, is these
00:12:15 --> 00:12:18 patients in our community that lived with our medical assistants in the
00:12:18 --> 00:12:21 same communities, they trusted them.
00:12:21 --> 00:12:25 So every now and then, the medical assistant would pull me aside.
00:12:25 --> 00:12:28 We would be running the list in the morning for who was coming in,
00:12:28 --> 00:12:34 and she would say, "Oh, the last time Susie was here, she told me
00:12:34 --> 00:12:36 she was fighting with her husband.
00:12:36 --> 00:12:42 I think we should do safety scoring for her or just screen her for domestic
00:12:42 --> 00:12:48 violence." That's team-based care, and it is amazing when it happens that way.
00:12:48 --> 00:12:51 It sounds refreshing.
00:12:52 --> 00:12:52 It really does.
00:12:52 --> 00:12:58 And, and I'm really contrasting that by the definition of team-based care
00:12:58 --> 00:13:05 and working at the top of your license, which equals Doctor, you can have
00:13:05 --> 00:13:12 15-minute visits with everybody from somebody who sprained their finger to
00:13:12 --> 00:13:19 the most complex polypharmacy multimorbid patient you can possibly imagine.
00:13:20 --> 00:13:25 15 minutes, and by the way, please make sure you see 18 to 20 patients a day.
00:13:25 --> 00:13:28 That's, that's gonna be the top of the license for you.
00:13:28 --> 00:13:33 It's amazing what an actual team can manage to accomplish The team
00:13:33 --> 00:13:36 can be so much more confident in the serving of the patients.
00:13:37 --> 00:13:40 Yeah, I think that's actually a great word to use.
00:13:41 --> 00:13:43 Confident, I would also say enjoyment.
00:13:44 --> 00:13:51 We talk about burnout, and burnout hits pharmacists, nurses, medical
00:13:51 --> 00:13:55 assistants, just like it hits physicians, APRNs, and physician assistants.
00:13:56 --> 00:14:01 And when you provide this kind of care, everybody in the team knows
00:14:01 --> 00:14:06 that they're contributing to the care of the patient, not just pushing
00:14:06 --> 00:14:12 paperwork and forwarding tasks for the physician to do, and it's doable.
00:14:13 --> 00:14:17 There is hope and excitement, but we have to be very intentional from
00:14:17 --> 00:14:21 where we are right now to where we redesign how we provide care.
00:14:22 --> 00:14:27 Someone called me a hope-a-holic recently, which I took as a giant compliment.
00:14:27 --> 00:14:31 One of the things that comes up over and over again is that there are
00:14:31 --> 00:14:34 not enough primary care physicians.
00:14:34 --> 00:14:40 In fact, there's probably not enough of anybody to handle the
00:14:41 --> 00:14:43 patient populations that exist.
00:14:43 --> 00:14:47 So how would you, if I said to you, can team-based care with
00:14:47 --> 00:14:50 the, with the current number of doctors if we organized ourselves
00:14:50 --> 00:14:52 into teams, would we be okay here?
00:14:53 --> 00:14:55 Ooh, that's a great question.
00:14:56 --> 00:14:59 I think it's really hard to answer that 100%.
00:14:59 --> 00:15:04 So first, your comment, we don't have enough primary care physicians, we don't.
00:15:05 --> 00:15:09 We don't have enough of any physicians, really, and especially,
00:15:09 --> 00:15:11 like, just pick a disease.
00:15:11 --> 00:15:15 Chronic kidney disease has really … The numbers have just
00:15:15 --> 00:15:19 expanded over the last decade, so we don't have enough nephrologists.
00:15:20 --> 00:15:24 But if we have enough primary care physicians, only the people who need
00:15:24 --> 00:15:26 the nephrologist are then getting there.
00:15:27 --> 00:15:29 So how can team-based care solve that?
00:15:31 --> 00:15:36 One, there's a lot of information out there, and it has been studied about
00:15:36 --> 00:15:41 using pharmacists for inter-visit care, so almost like a leapfrog.
00:15:41 --> 00:15:46 My patient will see me, then my pharmacist, then me, then my pharmacist.
00:15:46 --> 00:15:53 And so that is one way to work with the limited people
00:15:53 --> 00:15:55 you have to increase access.
00:15:56 --> 00:16:00 There's really good outcomes in that for things like hypertension.
00:16:01 --> 00:16:06 So it's a little bit embarrassing that pharmacists have better control of high
00:16:06 --> 00:16:11 blood pressure than physicians alone, and my pharmacist is so sweet, but she
00:16:11 --> 00:16:15 manages to get the right meds or add a med that maybe the patient wasn't interested
00:16:15 --> 00:16:20 before, and that's a really good example of access and quality improving
00:16:21 --> 00:16:23 because you have another team member.
00:16:24 --> 00:16:29 So it would certainly be a giant leap in the right direction.
00:16:30 --> 00:16:34 Then people can fit in patients for those sick visits to keep them out
00:16:34 --> 00:16:38 of the emergency room or urgent care for something silly like a cold.
00:16:38 --> 00:16:42 But if you're already stretched to the gills, you can't do it.
00:16:43 --> 00:16:47 Or another way that it can work, if my nurse wants to do a blood pressure
00:16:47 --> 00:16:52 check and we bring the patient back and the blood pressure's beautiful, great.
00:16:52 --> 00:16:58 She can document that, send me the note, and there's nothing else that needs to
00:16:58 --> 00:16:59 happen until I see the patient again.
00:17:00 --> 00:17:04 So that pulls someone off my schedule just like seeing a pharmacist would.
00:17:05 --> 00:17:10 So the team really can reduce the burden, but we have to use it correctly.
00:17:11 --> 00:17:16 And I know I loved one of your recent episodes, listening to you discuss, you
00:17:16 --> 00:17:21 know, some people really only need the 15 minutes, and if we can do it correctly
00:17:21 --> 00:17:28 and not put people into little boxes of schedules, then you have the 45 minutes
00:17:28 --> 00:17:33 maybe for the family with a new dementia diagnosis where there's a lot that has to
00:17:33 --> 00:17:38 go together for that family to walk out feeling like they got the care they need.
00:17:39 --> 00:17:43 So the original question was, if we have team-based care, can we solve for
00:17:43 --> 00:17:47 the physician shortage in this country?
00:17:48 --> 00:17:54 In a way that AI maybe can't solve for, right?
00:17:54 --> 00:17:58 Because, like, there's so many times where, you know, enter a discussion about
00:17:58 --> 00:18:04 the physician shortage and the almost only presented answer is something that
00:18:04 --> 00:18:07 is, is tech-based, like we're gonna tech our way out of a physician shortage.
00:18:07 --> 00:18:10 And sure, that is a conversation for another day.
00:18:11 --> 00:18:16 But one of the things that doesn't come up with any regularity, honestly, is, Hey,
00:18:16 --> 00:18:20 maybe let's organize ourselves better.
00:18:20 --> 00:18:20 Yeah.
00:18:20 --> 00:18:27 So just to hit back to your original question, the studies that look at
00:18:27 --> 00:18:33 having a pharmacist co-manage patients do illustrate that you can increase
00:18:33 --> 00:18:35 the patient population that you see.
00:18:36 --> 00:18:40 And so, yes, I think we can solve some of the access issue.
00:18:41 --> 00:18:44 I think it's very complex to know if we could solve all of it.
00:18:45 --> 00:18:46 Understood.
00:18:46 --> 00:18:50 At the same time, just thinking about what is optimal if you're a plan sponsor, for
00:18:50 --> 00:18:54 example, just was having a conversation with Dr. John Lee, who is an emergency
00:18:54 --> 00:18:56 room physician the other day, who echoed the point that you're making.
00:18:56 --> 00:18:59 He's like, "Do you know how many patients I see in the emergency
00:18:59 --> 00:19:02 room for a cold?" A cold.
00:19:02 --> 00:19:03 And you, you understand why they're scared.
00:19:03 --> 00:19:05 Like, no, throw, throw no shade.
00:19:05 --> 00:19:08 Like, they're not sure if they've got pneumonia or something,
00:19:09 --> 00:19:12 but they have a cold and now they're in the emergency room.
00:19:13 --> 00:19:20 So it's just like this access issue has a number of different issues, both
00:19:20 --> 00:19:24 very short term, if we're just thinking about how much that cold visit cost.
00:19:25 --> 00:19:29 And also long-term, if we're thinking about if that patient, I don't
00:19:29 --> 00:19:34 know, maybe they had a cold because they've got underlying issues that
00:19:34 --> 00:19:38 are just, it's not the remit of the emergency room to solve for.
00:19:38 --> 00:19:39 Well, I'll do you one better.
00:19:40 --> 00:19:43 That patient might not have needed the emergency room and might not have
00:19:43 --> 00:19:46 even needed an appointment with me.
00:19:47 --> 00:19:52 So that patient calling my office, if I have true team-based
00:19:52 --> 00:19:56 care, the nurse can call them.
00:19:56 --> 00:20:00 You can have protocols like we do for questions to ask.
00:20:00 --> 00:20:04 Don't forget to ask about things like asthma and diabetes that, or pregnancy
00:20:04 --> 00:20:06 that could complicate the cold.
00:20:06 --> 00:20:09 And they do all this education over the phone.
00:20:10 --> 00:20:12 "Well, you've been sick for 72 hours.
00:20:12 --> 00:20:16 We have seen a lot of this same cold with your same symptoms.
00:20:16 --> 00:20:21 Symptomatic treatment is really what we're going to do." And then if the
00:20:21 --> 00:20:25 patient asks for something that maybe they think is indicated but isn't, so
00:20:25 --> 00:20:31 an antibiotic, my nurse can talk about why that's not the proper treatment
00:20:31 --> 00:20:35 right now, but what to watch for to let them know when they should call back.
00:20:35 --> 00:20:40 That saves an urgent care visit to try and get an antibiotic that
00:20:40 --> 00:20:43 the patient maybe really thinks they need because their friend or
00:20:43 --> 00:20:44 family member told them they did.
00:20:45 --> 00:20:49 Saves them a visit from me because they really didn't need it, and saves
00:20:49 --> 00:20:51 them the emergency room visit as well.
00:20:52 --> 00:20:57 Talk about cost containment, and quality of care, and maybe the patient
00:20:57 --> 00:20:59 didn't even need to leave work.
00:20:59 --> 00:21:03 So those are the ways that team-based care can really help.
00:21:03 --> 00:21:07 As I'm listening to you talk, and I listed a bunch of stuff a couple of
00:21:07 --> 00:21:11 minutes ago relative to our definition of team-based care, but I'm extending it now.
00:21:12 --> 00:21:14 I'm gonna add two additional things.
00:21:14 --> 00:21:16 One of them is having leadership.
00:21:16 --> 00:21:21 And you start to see why physician-led leadership becomes absolutely essential
00:21:21 --> 00:21:26 here because I could try to maximize the incentives there so that it doesn't,
00:21:26 --> 00:21:28 it doesn't really turn out so well.
00:21:28 --> 00:21:29 So that's number one.
00:21:29 --> 00:21:34 But then also really conceiving of, again, the leadership model so
00:21:34 --> 00:21:39 that all of the parts happen here in the way that you are describing.
00:21:39 --> 00:21:41 Gary Campbell was on the pod.
00:21:41 --> 00:21:46 He also was a CEO of a FQHC saying many of the same things, like how the organization
00:21:46 --> 00:21:50 needs to be organized to do many of the things that you're talking about.
00:21:50 --> 00:21:53 You can't have an administrator three states away,
00:21:53 --> 00:21:57 Shane Cerone said this, making spaghetti diagrams on a whiteboard and then
00:21:57 --> 00:22:03 just like being like, "Okay, we did the diagram. Good luck." Like, having
00:22:03 --> 00:22:06 no idea what the fallout is gonna be.
00:22:07 --> 00:22:12 So if you don't have leadership that is seeing patients and working in
00:22:12 --> 00:22:17 the same environment, they won't understand the stressors on the team.
00:22:17 --> 00:22:19 And so you're absolutely right.
00:22:19 --> 00:22:23 You have to have leadership, and the leadership needs to
00:22:23 --> 00:22:26 be able to mentor the team.
00:22:27 --> 00:22:34 So if your medical assistant is getting as much information as they can before they
00:22:34 --> 00:22:39 pass a message to you, so you can decide, does this patient need to be seen or not?
00:22:41 --> 00:22:41 That's great.
00:22:42 --> 00:22:46 If they aren't, then leaders have to be willing to say, "I think we need to do
00:22:46 --> 00:22:52 some retraining. Let's take a couple of phone calls and talk about what the best
00:22:52 --> 00:22:54 approach to this phone call would be."
00:22:55 --> 00:22:59 So, you know, the structure of your team is really important.
00:23:00 --> 00:23:04 You have to have meetings together to say, "Is this working?" That's team-based care.
00:23:04 --> 00:23:08 You're really in the trenches together, all pulling in the same direction.
00:23:09 --> 00:23:12 We talked about the not team-based care, which is there's doctors
00:23:12 --> 00:23:15 over here, there's others over there, they don't really talk.
00:23:15 --> 00:23:19 You could really see that the physicians in this mix, really everybody, needs
00:23:19 --> 00:23:25 to trust each other because if I have a medical assistant or even if a nurse
00:23:25 --> 00:23:28 who I don't really know, right, I might sign off on their notes, but, like,
00:23:28 --> 00:23:32 we're not really working together, and that individual told me something
00:23:32 --> 00:23:37 about a patient, I might be like, I really, like, this is my patient.
00:23:37 --> 00:23:40 I feel like I gotta talk to them myself because I don't, I don't know what's being
00:23:40 --> 00:23:42 communicated is necessarily accurate.
00:23:42 --> 00:23:45 You hit on something so important, trust.
00:23:46 --> 00:23:47 You are 100% right.
00:23:48 --> 00:23:51 And really, team-based care also includes the patient.
00:23:51 --> 00:23:57 And the reason that adding 10 primary care physicians to 100 people,
00:23:57 --> 00:24:02 you know, reduces mortality and other things that we don't want, like late
00:24:02 --> 00:24:08 onset diagnoses for cancer, the reason is because of the trust that develops
00:24:08 --> 00:24:10 between the physician and the patient.
00:24:10 --> 00:24:13 But you are 100% correct.
00:24:13 --> 00:24:18 You have to be able to hands down trust your team, and that happens
00:24:18 --> 00:24:21 from multiple everyday interactions.
00:24:21 --> 00:24:25 So the APRN that I was telling you about earlier, she saw my patient,
00:24:26 --> 00:24:30 knew she had pneumonia, diagnosed her correctly, but was worried
00:24:30 --> 00:24:32 about her and her smoking history.
00:24:32 --> 00:24:33 Something felt off.
00:24:33 --> 00:24:36 She sent her to the emergency room to be evaluated.
00:24:36 --> 00:24:40 I read her note, I read the emergency room note, and I replied back to
00:24:40 --> 00:24:44 her, just a nice message, and I said, "Thank you for seeing her. That was
00:24:44 --> 00:24:46 really sharp clinical reasoning."
00:24:47 --> 00:24:51 That's the kind of day-to-day interaction where you learn to trust
00:24:51 --> 00:24:55 each other because I don't worry if she sees my patients because I've
00:24:55 --> 00:25:01 seen it over time, and she knows if I give her feedback, it's only to make
00:25:01 --> 00:25:05 all of us better and the patient care safer, not because I'm overworked.
00:25:05 --> 00:25:08 Think about Maslow's Hierarchy of Needs.
00:25:08 --> 00:25:12 If you are struggling to survive in those situations where you're
00:25:12 --> 00:25:18 seeing high volume every 15 minutes and supervising other people, you do
00:25:18 --> 00:25:24 not have the emotional, physical, or time bandwidth to build that trust.
00:25:24 --> 00:25:30 That just logically makes a lot of sense, right?
00:25:30 --> 00:25:33 Like, this is all, you're not saying anything where I'm like,
00:25:33 --> 00:25:35 "Whoa, that is not intuitive."
00:25:35 --> 00:25:39 Like, everything that you're saying is ridiculously intuitive, which just
00:25:39 --> 00:25:44 makes my antenna even go up higher.
00:25:44 --> 00:25:46 If it's so intuitive, why aren't we doing it?
00:25:46 --> 00:25:47 You said piecemeal.
00:25:47 --> 00:25:48 We've kind of piecemealed our way.
00:25:50 --> 00:25:52 Okay, that is certainly one explanation.
00:25:53 --> 00:25:57 Additionally, let's really look at these incentives because if you get
00:25:57 --> 00:26:02 so far off of, like, what makes just the most sense in the world, there's
00:26:02 --> 00:26:06 something that just really feels off.
00:26:07 --> 00:26:12 It also sounds like in a true team-based approach, you don't have, you know,
00:26:12 --> 00:26:19 you talked about nephrology, you don't necessarily have so many patients who
00:26:19 --> 00:26:23 are a little bit too early and a little bit too often getting booted out of
00:26:23 --> 00:26:28 the primary care setting and shoved into some specialty service line.
00:26:28 --> 00:26:33 I think referral machines happen when you're trying to see a
00:26:33 --> 00:26:35 patient and you have no access.
00:26:35 --> 00:26:40 So you have 15 minutes, you think they're coming in for a stubbed toe,
00:26:40 --> 00:26:43 but they've been trying to get in to see you for six months, so they have
00:26:43 --> 00:26:45 20 things that they wanna talk about.
00:26:45 --> 00:26:50 And there's no way, with good conscience, you could evaluate those
00:26:50 --> 00:26:55 20 things, come up with a reasonable, well-thought-out plan with clinical
00:26:55 --> 00:26:58 reasoning, and provide it to the patient.
00:26:58 --> 00:27:05 So your options are to choose and negotiate on what are most important and
00:27:05 --> 00:27:14 then bring them back to refer or just to try and do all of them but not do
00:27:14 --> 00:27:16 them appropriately, which nobody wants.
00:27:17 --> 00:27:21 If you have true team-based care, and we're improving access,
00:27:21 --> 00:27:25 and I train internal medicine residents, this is something I
00:27:25 --> 00:27:26 talk to them about all the time.
00:27:27 --> 00:27:30 When they see something that maybe they haven't seen before and they wanna
00:27:30 --> 00:27:34 refer to the specialist, I pause and I say, "We have not worked this up."
00:27:36 --> 00:27:40 Our job as primary care is to treat this condition or symptom
00:27:41 --> 00:27:44 to the very best of our ability.
00:27:44 --> 00:27:49 And when we then don't know or are stumped, that's when we
00:27:49 --> 00:27:52 refer to the sub-specialist.
00:27:52 --> 00:27:57 And if we can allow primary care to do that, it will alleviate
00:27:57 --> 00:28:01 a lot of the pressure that the other specialties are feeling.
00:28:01 --> 00:28:04 It's interesting what you're saying because you're connecting
00:28:04 --> 00:28:08 the dots not only to incentives, and incentives definitely exist.
00:28:08 --> 00:28:13 In fact, I read a post the other day from Stacy Mays that reminded me
00:28:13 --> 00:28:17 actually of the show with Dr. Cristin Dickerson, where we talked about some,
00:28:17 --> 00:28:21 the weird incentives that actually can happen with even capitation.
00:28:22 --> 00:28:27 This idea that if you make a primary care physician's panel too big, and then
00:28:27 --> 00:28:32 you pay capitation, and then you pay all of the specialists fee-for-service,
00:28:33 --> 00:28:38 you actually, for all the reasons that you just said, wind up with maybe more
00:28:38 --> 00:28:42 referrals, which is the exact opposite of what you're trying to incent.
00:28:42 --> 00:28:45 So I'm kind of, I'm hearing what you're saying and saying, yeah,
00:28:45 --> 00:28:46 that, that can happen, right?
00:28:46 --> 00:28:50 Like, if you have lack of access, like, all these things compound, right?
00:28:50 --> 00:28:52 It's probably not one thing, it's probably three things.
00:28:52 --> 00:28:57 You've got incentives, you've got, we don't necessarily have team-based care
00:28:57 --> 00:28:59 right now, patients can't get a visit.
00:28:59 --> 00:29:02 Let's just stop looking for villains here and start really thinking about
00:29:02 --> 00:29:05 how the whole system functions.
00:29:05 --> 00:29:08 We have to just move forward, and we have to start innovating.
00:29:08 --> 00:29:14 We can't just throw up our hands and say, "I'm overwhelmed, this isn't working."
00:29:14 --> 00:29:20 We need a little bit of your hope to say, what would I do if I could rewrite
00:29:20 --> 00:29:22 the script for how we practice medicine?
00:29:23 --> 00:29:25 And I think we're seeing it everywhere.
00:29:26 --> 00:29:32 Nobody has solved it, but this is why people you least expect, like
00:29:32 --> 00:29:34 Amazon, are getting in to healthcare.
00:29:35 --> 00:29:41 I think we have organically moved into the advice portion of this conversation,
00:29:41 --> 00:29:47 and you have definitely listed a few, certainly points to ponder.
00:29:47 --> 00:29:50 And the one that I'm hearing loud and clear is,
00:29:52 --> 00:29:56 instead of piecemeal, maybe w- this is the moment to take a step back and
00:29:56 --> 00:29:59 really consider what we're trying to do here, look at the evidence, look
00:29:59 --> 00:30:07 at the data, look at other industries, honestly, and construct the endeavor
00:30:07 --> 00:30:12 to actually meet the moment, meet the needs, make use of technology in
00:30:12 --> 00:30:16 the best possible way, even construct a leadership team in the right way.
00:30:16 --> 00:30:21 Like, make sure there's a doctor, a nurse on those teams.
00:30:21 --> 00:30:26 There's really that dyad-type leadership contemplating this, this redesign.
00:30:26 --> 00:30:29 What else would you be keeping in mind here?
00:30:29 --> 00:30:34 There are many solutions that are out there that don't require more people.
00:30:34 --> 00:30:38 We just have to design everything better.
00:30:38 --> 00:30:44 So take a step back wherever you are, and look at what your resources
00:30:44 --> 00:30:50 are, find the pain points, innovate, try something, but study it.
00:30:50 --> 00:30:52 Did it make a difference?
00:30:52 --> 00:30:54 If not, then change direction.
00:30:54 --> 00:30:58 Sometimes in medicine, we just keep plowing forward, but what we really need
00:30:58 --> 00:31:01 to do is look at things that we institute.
00:31:02 --> 00:31:03 Has this been better for the patient?
00:31:04 --> 00:31:07 Okay, if that's a yes, does it cost more?
00:31:08 --> 00:31:10 If that's a no, great.
00:31:10 --> 00:31:16 If it's a yes, does it cost more just in the short term or the long term?
00:31:16 --> 00:31:21 And if both of those are a yes, or certainly the long term, are there other
00:31:21 --> 00:31:25 ways that we can reimburse for this?
00:31:25 --> 00:31:28 Can we partner with a payer?
00:31:28 --> 00:31:34 There are some really creative situations out there where you will find healthcare
00:31:34 --> 00:31:40 organizations have partnered with a payer and said, "You want reduced costs.
00:31:40 --> 00:31:41 We want better care.
00:31:42 --> 00:31:49 Maybe you can help fund a research project." So for Medicare, transitional
00:31:49 --> 00:31:53 care management visits are after someone's admitted in the hospital,
00:31:53 --> 00:31:55 for example, and then discharged home.
00:31:56 --> 00:32:01 And they found that patients were happier, they stayed at home, it reduced
00:32:01 --> 00:32:03 readmissions, and it reduced costs.
00:32:04 --> 00:32:09 That's a win to everyone, the patient, the payer, and then the providers.
00:32:09 --> 00:32:15 So getting that kind of collaboration is also important, so as we take a step back.
00:32:16 --> 00:32:19 I think the second thing I would say is build your teams.
00:32:20 --> 00:32:23 Build your teams and foster your teams.
00:32:24 --> 00:32:30 I love having a pharmacist on my team, and I know, disclaimer as a COI
00:32:31 --> 00:32:32 because I am married to a pharmacist.
00:32:33 --> 00:32:39 But when I've gone back and forth about a prescription four times with the pharmacy,
00:32:39 --> 00:32:41 they can always solve my problem.
00:32:42 --> 00:32:43 You don't want me doing it.
00:32:43 --> 00:32:44 You want me seeing patients.
00:32:44 --> 00:32:46 So who's on your team?
00:32:46 --> 00:32:54 Think about embedded mental health, social work, pharmacy, nursing, medical
00:32:54 --> 00:33:00 assistants, your front staff, maybe people to help you do coding and billing.
00:33:00 --> 00:33:04 if the physician's brain is not on that, it can be on treating the patient.
00:33:04 --> 00:33:10 And the third thing, which you've talked about, is Reimbursements.
00:33:10 --> 00:33:12 How do you fund this?
00:33:12 --> 00:33:13 Knowing what is out there.
00:33:14 --> 00:33:18 If you are the physician leader of your team, you cannot have your head down.
00:33:18 --> 00:33:22 You need to pay attention to when Medicare comes out with their proposed
00:33:22 --> 00:33:27 changes every year, comment on them, think about how that will affect you.
00:33:27 --> 00:33:32 But there are also changes that Medicare has made to benefit primary care.
00:33:32 --> 00:33:34 So how can you utilize that?
00:33:35 --> 00:33:40 And if there are new reimbursements, quality reimbursements, reinvest those
00:33:40 --> 00:33:45 so you can build your team and foster your team, everyone's gonna wanna
00:33:45 --> 00:33:51 continue to work together, which is joy of practice, good patient care.
00:33:52 --> 00:33:54 I don't know, hopeful for the future of primary care.
00:33:56 --> 00:33:57 I love what you just said.
00:33:57 --> 00:33:59 Gary Campbell, this is five years ago, right?
00:33:59 --> 00:34:04 So, like, this is not some kind of, like, news flash.
00:34:04 --> 00:34:09 He said, "It's every health system's first inclination, every organization's
00:34:09 --> 00:34:12 first inclination to," in, in his words, "Throw a body at it".
00:34:13 --> 00:34:13 Right?
00:34:13 --> 00:34:17 And maybe if we actually start thinking about what's the process here.
00:34:17 --> 00:34:22 My big takeaway here is let's rethink what our assumptions are, and maybe we
00:34:22 --> 00:34:27 are getting to a certain place due to a suboptimal process or suboptimal something
00:34:27 --> 00:34:32 or other, not these things that we're saying are givens are actually a given.
00:34:33 --> 00:34:36 Is there anything I neglected to ask you, Dr. Rebecca Andrews, that
00:34:36 --> 00:34:37 you would like to bring up here?
00:34:38 --> 00:34:41 I love your comment about assumptions.
00:34:41 --> 00:34:47 So I think really stopping and just throwing out all the assumptions we
00:34:47 --> 00:34:54 have and trying to do redesign, but redesign in the physician's office where
00:34:54 --> 00:34:56 we know what the challenges are best.
00:34:57 --> 00:34:59 And how would we do that?
00:34:59 --> 00:35:02 I think maybe the only thing we didn't talk about is there has to be some
00:35:02 --> 00:35:09 collaboration between active clinicians, so a physician seeing patients and
00:35:09 --> 00:35:14 their team, with the people who are trying to change the healthcare system.
00:35:15 --> 00:35:21 And if that link is missing, then, for example, congressional bills
00:35:21 --> 00:35:26 will never really address what the problems are to fix the system.
00:35:26 --> 00:35:31 The episode recently with Dr. Suhas Gondi on the sleeping giant, that is
00:35:31 --> 00:35:37 physicians working together, would be a good place to hear an underline of
00:35:37 --> 00:35:39 this point that Dr. Andrews just made.
00:35:40 --> 00:35:44 And then you could stay tuned for an upcoming show, I think it's next week,
00:35:44 --> 00:35:50 with Dr. Ben Schwartz, where we dissect why it seems to be so difficult for
00:35:50 --> 00:35:54 physicians to collaborate well enough to fix the problems with the healthcare
00:35:54 --> 00:35:59 industry that most of them very clearly see, really, really clearly.
00:35:59 --> 00:36:05 Dr. Andrews is saying in so many words for docs and others to take back their agency.
00:36:05 --> 00:36:09 I also absolutely love what she says next.
00:36:10 --> 00:36:14 But looking at the people who have millions and billions of dollars that
00:36:14 --> 00:36:18 have thrown it into the healthcare system, and they still can't solve
00:36:18 --> 00:36:22 the problem, that tells you that it's not all about money, which everybody
00:36:22 --> 00:36:24 assumes it is, and it is part of it.
00:36:25 --> 00:36:30 It is about design, and we have to really be intentional.
00:36:30 --> 00:36:35 Dr. Rebecca Andrews, if someone is interested in learning more about your
00:36:35 --> 00:36:37 work, where would you direct them?
00:36:37 --> 00:36:39 You can find me on LinkedIn.
00:36:40 --> 00:36:44 A lot of the topics that I've discussed today, you can also find
00:36:44 --> 00:36:48 under the advocacy site for the American College of Physicians.
00:36:48 --> 00:36:52 I would be happy to toss ideas back and forth with anyone else in
00:36:52 --> 00:36:54 the trenches trying to solve this.
00:36:54 --> 00:37:00 Your points about no evil characters, just working through the business
00:37:00 --> 00:37:06 of medicine, but putting the patient at the center of it, I think is a
00:37:06 --> 00:37:09 good topic for us all to focus on.
00:37:09 --> 00:37:10 Hard agree.
00:37:12 --> 00:37:16 Dr. Rebecca Andrews, thank you so much for being on Relentless Health Value today.
00:37:16 --> 00:37:17 Thank you.
00:37:18 --> 00:37:21 Hi, I'm Jerry DiMaso, CEO, and co-founder of Payerset.
00:37:21 --> 00:37:24 Relentless Health Value is one of the best resources out there for understanding
00:37:24 --> 00:37:28 how healthcare really works, and it's actually required listening for anybody
00:37:28 --> 00:37:29 that comes on board at Payerset.
00:37:29 --> 00:37:32 Stacey gets into the real mechanics of healthcare pricing and what
00:37:32 --> 00:37:33 it takes to fix this system.
00:37:34 --> 00:37:36 If you care about making healthcare more affordable and transparent,
00:37:37 --> 00:37:38 this is the show to tune into.
00:37:38 --> 00:37:41 I highly recommend signing up for the weekly newsletter.
00:37:41 --> 00:37:44 It's a great resource because it includes all the links mentioned in
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00:37:48 --> 00:37:49 to someone who should be listening.