EP414: An IRL How-To for Delivering Better Care and Getting Paid for It—A Value-Based Case Study, With Justina Lehman

Delivering Better Care and Getting Paid: A Value-Based Healthcare Guide with Justina Lehman

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In Episode 414 of 'Relentless Health Value,' host Stacey Richter interviews Justina Lehman to explore practical strategies for healthcare practices to provide coordinated, high-value care while achieving financial growth. The discussion covers the detailed steps for developing and implementing value-based care models, including assembling a committed team, defining ideal care pathways, navigating payer relationships, and engaging with self-insured employers. Lehman emphasizes the importance of close collaboration between physicians, clinicians, and payers to enhance patient outcomes and reduce costs. The episode provides actionable insights for healthcare professionals aiming to transition from fee-for-service to value-based care.

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07:35 What has Justina been up to, and why is it relevant to this conversation?

08:23 What is high-value care, and how do we figure out what it is in reality?

08:59 EP412 with Robert Pearl, MD, on the art and science of medicine.

10:08 “What is the clinical design of … high-value care?”

10:21 Care as usual vs ideal care.

11:11 Summer Shorts 8 with Larry Bauer.

12:23 How does Justina figure out what the benchmark is for high-value care?

12:36 Meeting patients where they are at, not where we want them to be.

17:42 EP402 with Amy Scanlan, MD.

18:28 “What is the story as a group to the payer? What is the story as a group to the self-funded employer?”

19:19 How do you align business operations and the financials?

20:16 What are the four avenues for getting paid for high-value care?

21:58 What are highly engaged payers most intrigued by in high-value care?

24:11 What are the different ways a practice can get compensated?

28:52 Are there programs that have advanced without payers leading the way?

29:37 What’s the “hook” for payers?

31:12 What’s a winning message to payers and employers?

33:04 Summer Shorts 4 with Eric Gallagher.

34:13 “Not everyone needs to participate.”

38:24 Can a program be successful even if a physician is a passive participant in the program?