Abby Burns (00:14):
From Advisory Board, we are bringing you Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. I'm Abby Burns. Value-based care in the US is growing, and it's growing pretty quickly. 60% of healthcare payments are now tied to some form of value. 14% are capitated. Despite these numbers, if you look at the health system landscape, it's still surprisingly hard to find examples of health systems that have been doing value-based care at scale successfully over time.

(00:45):
So that's what Advisory Board has tried to do, find the systems that are exceptions to the rule. And across more than 65 conversations with 44 systems, our team found four organizations that fit the bill. That's not to say there are only four that are doing this well, but it speaks to just how hard it is for health systems to invest in value-based care long-term, build diversified risk portfolios, and be successful.

(01:10):
Today I'm talking to the population health leader at one of those systems. Advocate Health is the third-largest not-for-profit system in the country. It has 69 hospitals, serves about six million patients across six states. It's the product of the 2022 merger between Advocate Aurora Health based in Illinois and Wisconsin and Atrium Health based in North Carolina.

(01:31):
I'm talking with Don Calcagno, chief population health officer and president of Advocate's largest clinically integrated network, Advocate Physician Partners. I'm going to talk to Don about how Advocate has built and iterated on and grown a value-based care engine that has not only withstood a decade of change, both at the enterprise and industry levels, but that's generated billions of dollars of savings and improved patient outcomes in the process. Here's my conversation with Don. Hey, Don, thanks for coming on Radio Advisory.

Don Calcagno (02:02):
Thanks for having me.

Abby Burns (02:04):
Don, I am especially excited for our conversation because a lot of times when we're talking about value-based care, we're talking about ideas or principles. It's much less common that we're able to have the holistic conversation of what it actually looks like for a health system to do value-based care at an enterprise level. And maybe to start us off, can you orient us to your role and give us a lay of the land of what I'll call the value-based care engine at Advocate?

Don Calcagno (02:33):
I've been privileged to have a lot of disparate roles across Advocate over the last 30 years. I've been everything from a frontline lab tech to a researcher process improvement. I founded our analytics department. I was VP OPS of a hospital, SVP OPS of a system. I've done managed care contracting, PCO building, CIN management. So I've got a very nonlinear career path. So as you can tell, it was an unplanned trajectory, but it perfectly prepared me for this role of Advocate chief population health officer.

(03:03):
So what does that mean? Essentially it means I'm responsible for Advocate's network and value-based contract portfolio performance. You can break that down into it means, hey, I have to increase ambulatory quality, I have to lower total cost of care, and I have to manage profit and loss. And this will be a key thing we talk a lot about because that means I have to manage my infrastructure cost while maximizing my value-based contract revenue.

Abby Burns (03:28):
And I believe, correct me if I'm wrong, Don, Advocate has quite a robust list of contracts, of value-based care contracts.

Don Calcagno (03:36):
Exactly. So we think of what I lead as our pop health platform, but it serves to your point 13 different networks. So we have three CINs, seven ACOs, and several employed medical groups. Across those, we have about 18,000 physicians, about 72 hospitals, and somewhere between 120 and 130 value-based contracts.

(03:56):
It's hard to get that number right. It seems to keep growing. I don't know. But to your point, what I have the privilege of serving for is by building a platform, we get to take the advantage of the economies of scale, but we also have to be very sensitive to the local market and networks.

Abby Burns (04:11):
And I'm so glad you also mentioned the markets from the get-go because as we've said, Advocate has a huge footprint. So in a little bit, I want to come back to how do you do this across multiple geographies, but I also want to start with the end in mind. How do you know that this value-based care strategy is working?

Don Calcagno (04:30):
We are definitely maniacal about measurement and with a scientific rigor, quite frankly. And we really get to, hey, there's three things that matter in our world, ambulatory quality, what we call condition management and documentation, which is making sure people's acuity is accurately and correctly documented, and then total cost of care.

Abby Burns (04:51):
And these would be sort of like the north stars or the guiding light for all of your value-based care efforts.

Don Calcagno (04:57):
Exactly. Everything flows from there. As you might imagine. We have lots of process and sub-process KPIs underneath those. But those are the key things.

Abby Burns (05:06):
Don, when we're talking about value-based care, ultimately we're talking about trying to provide higher quality care at lower costs. So when you're evaluating "success of your programs," I imagine you're looking at both of those things. This has been a long-standing journey at Advocate. What are some of the outcomes that tell you that, yes, we're on the right track, we should keep going?

Don Calcagno (05:29):
We look at, as I mentioned, those three north stars. So the way that we can tell that these things are working is we are looking at trends. Let's take total cost of care. What's the best way to drive total cost of care? The best way is to make sure appropriate utilization is occurring. That you're not having duplicate testing, you're not having low-value care. And you're not going to flip a switch. You're not going to go from 10th percentile HEDIS to 90th percentile HEDIS in a year.

(05:55):
It's not going to happen. It's a journey and you have to be willing to have that incremental uphill run, if you will. And even then, one of the things I like to say is I think there's a huge risk for anyone in value-based care to overcomplicate, over-engineer, and get too obsessed about the numbers. The world we live in is a very, very wonky space. There's a lot of policy stuff you got to read.

(06:21):
There's a lot of complexities. The reality is that there is a risk that we forget about the patient. Let's take as an example hemoglobin A1C. You look at the 90th percentile for HEDIS, it's about 81.1%. So that means top 10% of the country are able to manage their patients. My viewpoint is we can't pat ourselves on the back and say, "That's great. We've achieved it," because there's 19% of patients that are not in control. And so you got to pull that thread. What's that translate to?

(06:54):
How many people are going to lose their vision? How many people are going to have an amputation? How many people have chronic kidney disease? And so it's very risky when you're staring at numbers all day to think they're numbers. And the reality is they're real people. And we firmly believe you do a good job on that, that's how you get the total cost of care reduction. We're better treating our patients. They have less sequelae down the way.

Abby Burns (07:15):
I will also say, I believe you've saved over $136 million through these contracts to add both of the financial as well as the care side of the equation. Am I right about that?

Don Calcagno (07:24):
Yes. I think we've saved CMS the most money, almost a billion dollars in MSSP over the last decade. And every year we have an incentive fund in Illinois as an example of usually north of $100-$110 million. We've been successful, but honestly, we think we're in the early innings. We continue to learn a lot from everybody.

Abby Burns (07:44):
Don, you have a broad and deep risk profile, right? Multiple types of value-based contracts with multiple different types of payers. You are seeing the outcomes both in terms of patient health and finances. We all know that this is far from guaranteed when a health system decides to take on risk and pursue value-based care. I happen to know that one of your mottos is that a value-based care strategy won't work if you treat it like a side hustle. My question is what does not being a side hustle actually look like in practice?

Don Calcagno (08:17):
If you think all the way back to how healthcare in the United States evolved, the way it evolved is the operating model and the business model departed essentially. So the operating model, think of it as how the work gets done. The business model thinks about how the financials flow.

(08:33):
If those aren't aligned, then you have a problem. So what happened is they clearly evolved separately. We became a predominantly operating model folks on fee-for-service. So what happened is as value-based care became a thing, it has started to get bolted on to the operating model and bolted on to the fee-for-service contracts.

Abby Burns (08:52):
Kind of like a nice to have, not a need to have.

Don Calcagno (08:55):
Right, exactly. As you imagine, anytime you bolt something on, it's not the main focus. So the way I term it a side hustle is if it isn't part of your strategic intent, if it is this thing that's happening in the corner, then it is probably not something your organization is committed to or focused on. And I do have a couple of litmus tests that I like to think about when you think about is it a side hustle. And so for instance, my first one is, are you budgeting profit loss?

(09:26):
And it's not just the surplus you're getting from MSSP or something else. Are you taking that gross surplus minus your infrastructure cost to get your net surplus? So if you're not budgeting it, I think there's a good chance that you're not really committed to value-based care, that it's a side hustle. The other thing is when you join an alternative payment model, do you have a strategic purpose or hey, somebody threw it at you and you just decided to do it, all the cool kids are doing, et cetera.

Abby Burns (09:52):
It's a passion project.

Don Calcagno (09:53):
Right. And there's no right answer to what your strategic purpose is, but you should have a strategic reason to do it. And then the third one I'd say is, are you making adequate infrastructure investment? Because again, since value-based care evolved separately from the operating model, it requires investment. And you look at the sophistication we've built at Advocate, it's not cheap, but we've gotten the results as a result. So if you're being starved for capital, there's a good chance that it's a side hustle.

Abby Burns (10:23):
What about governance over VBC?

Don Calcagno (10:27):
So the way we think about it is governance models, operating models, and business models. Governance is super important. I think the way I would probably boil down governance is more around how integrated are you with operations? For example, our governance model is we have clinicians and administrators side by side at our CIN boards, ACO boards, et cetera.

(10:48):
But what we do at Advocate is we created a value-based care council structure. And what that is is we bring all of the operators together. It could be the medical group operators, the health system operators, finance, enterprise pop health, post-acute network. We bring them all together, and we actually have the operational leaders, typically the hospital leaders, do the report outs.

Abby Burns (11:09):
For the value-based care contract performance?

Don Calcagno (11:12):
Exactly. Because if they're not engaged, again, it's going to be a side hustle. So we see ourselves as pop health as enabling them.

Abby Burns (11:21):
The word that came to mind immediately when you started talking about the structure was accountability. If you're the person standing up in the meeting and sharing out on performance, you feel a sense of accountability over the performance.

Don Calcagno (11:31):
Exactly. So our VBC council construct is essentially that. We want to say, here's some tools. That's where the enterprise pop health team comes to bear. Here's the expectation. And then by having them drive it, they're accountable to it.

Abby Burns (11:47):
Don, this is transitioning us really nicely into the tactical conversation that I was hoping we could have today to make it very clear what it looks like to go on a successful value-based care journey. When we talk about moving toward value-based care, we're really talking about two transformations that are happening side by side, the financial and the clinical. I want to talk about both and what these have both looked like at Advocate.

(12:12):
And I want to start with financial transformation. Frankly, this is one that I think really spooks a lot of people and keeps a lot of leaders from going after value-based care. It's this fear of financial failure. My read is that some of this comes down to the fact that a lot of leaders, like you said, don't have visibility into the impact of their value-based care activities on financial performance. How have you gotten around that? How do you make the case that value-based care is financially a worthwhile investment?

Don Calcagno (12:43):
Yeah, no, that's a great question. And I think one of the biggest barriers to this is status quo bias. Another way of saying it simplified, humans don't like change. So if I have a fee-for-service model that's working really well, why do I want to change? And honestly, I don't think this country can afford our fee-for-service model. We have to do it differently. And again, to me, it all goes back to when those operating business models diverge.

(13:08):
So if you keep pulling on that thread, think about all the financial reporting in most health systems was built on the operating model, because that operating model was supported by a fee-for-service business model. So again, now I'll go back to when I was VP of OPS of a hospital, I'd have these monthly operating reviews. I'd look at the income statement, and I could not see the value-based care coming through. And we're bearing at that point $1.3 billion in global capitated at risk. It was a pretty big number. It's 21% of our revenue at the time.

Abby Burns (13:42):
I mean, most organizations are around one to 2%, right?

Don Calcagno (13:45):
Yeah.

Abby Burns (13:46):
If they're doing value-based care.

Don Calcagno (13:47):
Yeah, exactly. So you'd think you'd be able to see it, but again, our systems weren't built for it. So I could not see my performance flowing through my income statements. You can't manage what you don't measure, or you manage what you do measure. And so it makes it very, very difficult to really get after that. So the way we've done it is because again, of that experience before coming into this role, I am obsessed about finance.

(14:12):
So I drive our CPAs crazy probably because I'm an armchair CPA. What we've done is we actually have a side sheet that our finance team puts together that actually flows it through. And so it's not ideal, because it's not part of the normal financial package. Fortunately, our CFOs are on board and our finance folks are on board and we flow this through.

(14:33):
But it has also had to be accompanied by a whole lot of education because most people that come up to run hospitals or even medical groups, they're not used to capitation. I would also be remiss if I didn't say, I think part of the problem on this finance stuff is health systems, hospitals, medical groups, they're afraid of risk. When we think about the risk, it's almost as if we're not aware that we're already under financial risk.

(14:58):
So perfect example, DRGs, you're paid a case rate. Every day that patient stays, every extra test you do costs you money and you don't get any more revenue. That is by definition risk, right? We're under all this risk already, but we think this value-based care shared savings, shared risk capitation, whatever, is a lot scarier. And I would argue in some cases it actually mitigates the risk that you're already bearing if you do it well.

Abby Burns (15:24):
Don, I want to say this again out loud because I don't hear most people talking about it like this. Health systems are already taking risk under what we think of as the fee-for-service DRG model.

Don Calcagno (15:37):
Yeah. I mean, if you're paid case rate, you're under risk. Now, it's mostly the hospitals, not the ambulatory practices and things, but the hospitals certainly are. So I think that's something we need to spend more as an industry thinking about.

Abby Burns (16:44):
So Don, you built out this visibility into your income statements that let you see the impact of your value-based care business essentially on the overall financial health of the organization. I imagine that let you evaluate ROI. How do you actually define ROI when you're talking about value-based care?

Don Calcagno (17:04):
I really simplify it to this is, is whatever you're doing increasing quality or lowering costs, either medical expense costs or infrastructure costs? So those are the outcomes I'm looking for. Think of those as the numerator. And the denominator is as simple as what did it cost me to make that happen? And so I tend to shoot for anything that's a two-to-one ROI. That's kind of my gold standard. But one of the challenges is how do you convert quality into a quantitative number on the top? It's really hard to do.

Abby Burns (17:35):
Exactly.

Don Calcagno (17:36):
And so in many ways when you're shooting for quality, you're saying, "Okay, where am I getting relative to benchmarks?" And again, you already heard my slim on benchmarks of, hey, even 90th percentile leaves a lot of people not getting the care they need, but am I materially moving the needle? And you may not be able to quantify that into an exact ROI, but you need to say that there's some return.

(17:57):
And a lot of people tend to think that ROI is purely a financial thing. That's why I want to be really clear, quality counts. We are a firm believer that if we better manage chronic disease, if we get patients to the right site of care, the right disposition, that is going to translate into lower total cost of care. So this is not the 1990s where it was rationing care to improve costs. It is by doing the right thing.

(18:26):
And in fact, so much so if you take an unmanaged population or patient, it's probably going to cost you more in your early years because you're for the first time getting preventative screenings, you're starting to manage your diabetes, et cetera. So really the other thing about it is you've got to look at this over a period of time. You can't be myopic and think January to December. It just does not work.

Abby Burns (18:47):
And I think that's where a lot of programs fall down is they look at a one or maybe even two year turnaround time to generate ROI. We know that it takes longer than that.

Don Calcagno (18:56):
Exactly. And that's a tough conversation to have because you're living budget to budget, right?

Abby Burns (19:01):
Yes. Yup.

Don Calcagno (19:02):
And your contract rates change year to year, et cetera. So if you think of that as the definition of what return on investment is, you do get into some challenges when it comes to how do you actually measure it. Most of the things we do are multifactorial in nature. So that means it's very difficult to isolate the interaction effect. The gold standard is really propensity testing, and that's the difference of differences. But it takes time. To do a propensity study, it can take upwards of nine months.

Abby Burns (19:33):
And it takes a sophisticated analytics team, which we know that not everybody has access to.

Don Calcagno (19:38):
Exactly. And so I think AI is going to help in the long run on that one, but it also has assumptions baked into it, so it's also not perfect. But I also think we tend to let perfect get in the way of good. I'm a firm believer if we're not at risk of harming a patient, why don't we just stop doing something or start doing something and see what happens. Colin Paul's statement that if you wait until you have more than 60% of the data to make a decision, you waited too long.

(20:04):
Sometimes we have to put our finger in the wind and say, "Does this make logical rational sense?" The thing I think about is if the intervention effect is big enough, you're going to be able to detect the effect even when the presence of confounders, the research nerdy way of thinking about it is the number needed to treat, the NNT. If you have a large enough effect, you'll see it. So yeah, maybe it's not about alpha being less than 0.05, but it's, hey, I did this and it seems to make sense. It logically tracks. Now I'm just going to deploy it.

Abby Burns (20:41):
Don, maybe this is a good transition point to talk about what some of these interventions actually are. And so it is important to look at the ROI of investing in value-based care at the highest level. It's equally important to look at the ROI of the changes you make to your care delivery models in order to succeed under value.

Don Calcagno (20:59):
Exactly.

Abby Burns (21:00):
What investments have you identified over time as driving, especially high ROI?

Don Calcagno (21:06):
Yeah, I think some things are just no-brainers. Like I said, the effect is big enough. You can see it. A lot of times it's some of the things we're doing like pharmacists' metformin dosing for diabetes, anticoagulation dosing, just no-brainers. And by the way, I think pharmacists are a superpower that are underappreciated.

Abby Burns (21:24):
Well, I think that's an especially good one to call out today in 2025, Don, because we know that the numbers vary, but a high percentage of adults in the US are polypharmacy patients. That's really complex for other clinicians to try and manage. We also know that drugs are becoming increasingly central to care pathways supplanting procedures as being almost the chassis of care delivery.

Don Calcagno (21:48):
Exactly. And you think about a pharmacist, those physiology pathophysiology, they know how to work with patients. So we say care management and most people think nurse care managers. I differentiate care management could be a pharmacist, a clinical social worker, et cetera. Care management is a much broader term than care manager. And I think sometimes people miss that point. And then we have other things called transition centers.

(22:13):
What we look for is when is the impactable moment for that patient, and oftentimes that is when you're transitioning from one point to another. So we have a call transition center. Every single patient that leaves our hospitals we call because we know med reconciliation. My dad, unfortunately, has cancer, and he gets discharged from hospital. You get a stack of paper like this.

(22:35):
And you're vulnerable. You're scared. It just doesn't make sense. So that transition call center is very important. We also put a SNFist in our SNFs. SNFist, incredibly valuable. So there's just a lot of things that the effect is big enough, even without perfect ROI calculations, it's obvious.

Abby Burns (22:54):
Yes. What investments might be less conclusive? Not everything is going to be a clear cut case. Where are some of the gray area?

Don Calcagno (23:03):
One thing I'll tell you is if you look at care managers, so again, not care management, but care managers, you look at the literature and the literature has a hard time using very sophisticated analyses to say, does care managers make a difference? Now, you turn around and say, well, that's interesting because everybody has care managers. Like there's no organization that doesn't have care managers.

Abby Burns (23:27):
If they've made any investment in population health, it is usually a care manager.

Don Calcagno (23:32):
Right. So clearly they're making a difference, or at least we all think they're making a difference. And so we've done our own propensity studies, but we're able to look a little more under the hood. And this is what I think is going on is care managers are a very heterogeneous population.

(23:49):
So there might be somebody that's at the clinic that is doing navigation. There may be somebody that's a disease specific care manager. There may be somebody that is simply navigating and scheduling appointments, et cetera. So the one thing I've come to conclude is you need to be a little more specific in evaluating the specific type of care manager you have.

Abby Burns (24:11):
And the way they're deployed.

Don Calcagno (24:12):
Right. So to your point, the second thing is who are you pointing them at? One of the things I talk a lot about with Oracle and others is what I call the next best patient, the next best action. So I'll give you an example. I have 2.4 million value-based lives at Advocate. A typical entity can touch somewhere between one and 2% of their population with a human. So just take 2%.

(24:37):
That means I have 2.4 million patients. I can touch 50,000 of them. So I have 2.35 million patients that I can't touch. How do I know the right patient to touch? I'm firm believer AI is going to do this. I need to take my 2.4 million patients and array them from most impactable to least impactable. So that's the next best patient so that I can feed that to my care managers. But then the next thing is the next best action.

(25:06):
And again, AI is going to be able to tell me, hey, based on this person, their geography, they live in their history, all the SDOHs, all their clinical stuff, their demographics, and tell me based on the evidence in the literature, this is what you should do. Or let's say there's nothing in the literature. If we do this well with super large LLMs, they should be able to look across the world and say, "Yeah, there's no evidence, but it looks like when you do this, this effect occurs."

Abby Burns (25:36):
I'm mindful of where Advocate's VBC journey started, which was with your clinically integrated network, Advocate Physician Partners, which worth noting, still one of the largest and the top performing ACOs and CINs in the country. Then you merged with Aurora Health in Wisconsin in 2017. Much different market from Illinois, especially when we look at physician employment, and the reality is a lot of value-based contracts hinge on the ability to engage the physicians.

(26:04):
They're the ones that are actually delivering the care. Then you merged again with Atrium in 2022, another market that looks very different from Illinois. So I'm wondering how you think about physician network development and how you've learned to think about it differently as Advocate has grown from operating in a single state to now operating across six states.

Don Calcagno (26:25):
As you've already mentioned, I cut my teeth in Illinois. And so in Illinois, Advocate Physician Partners, we refer to it as a pluralistic physician platform, meaning we have employed physicians alongside what we refer to as aligned physicians. So an aligned physician is an independent physician that joins our ACO or CIN, and so they're aligned to what we're trying to accomplish.

Abby Burns (26:47):
But not employed by the system.

Don Calcagno (26:48):
Correct. So our pluralistic platform is aligned and employed doctors. They may be in a CIN, an IPA, an ACO, et cetera. That was what I was used to in Illinois. When we merged with Aurora, very, very different. It's predominantly an employed physician market. In many ways, that actually set us up well for learning for when we merged with Atrium, because what it really taught us was a couple of things.

(27:11):
We had to listen and understand. We couldn't just pick up the Illinois model and blindly apply it to the Wisconsin model. It just wouldn't work. And quite frankly, it really got us thinking more about how can we adapt what we know to be true to different markets? How can we take advantage of the advantages that an employee group have? Employee group have lots of advantages. They have more structure. They have layers of administrators.

Abby Burns (27:38):
Easier to incentivize the physicians, right?

Don Calcagno (27:40):
Exactly. And they're on a common medical record, like APP is on I think currently 96 different EMRs versus employee groups on one. You have different advantages, but there are also disadvantages. You're further from the physician. Our team works very closely one-on-one with our line physicians, but in an employee group there's usually layers, so you don't quite get as pointy.

(28:04):
So how do you maximize the advantages and then try to mitigate some of the disadvantages, if you will? So we learned a lot. And frankly, we learned a lot of great things like the way we approach quality now in Illinois, we learned in Wisconsin and brought to Illinois.

Abby Burns (28:17):
Oh, cool.

Don Calcagno (28:17):
So you always have to be open to learning other things and adapting them to your model. So that was the Advocate Aurora. Then flash forward to when we merged with Atrium, similar, in Charlotte, we have most of our primary care are employed and a lot of specialists are employed, but a lot of specialists are also at our CIN. In Wake Forest, which is our academic core, we have a whole lot of employed physicians.

(28:41):
But you go down to Macon, Georgia, we have a model that looks a lot like Illinois, a lot of aligned physicians. But what we want to do is, again, we think pop health platform, so we want to capture the economy of scale. So be it the data and analytics, be it the expertise in CMD or quality, et cetera. We can scale that across the enterprise, lower the unit cost, and get a good standard of care quality.

(29:05):
But then we want to be very sensitive to the local market, because there are different things, different payers, different businesses, different physicians, different politics, different cultures. We need to be very specific to those networks.

Abby Burns (29:18):
So it's allowing a little bit of that local variability, and it's the here's the overarching goal or here's the north star, what is going to work in this market.

Don Calcagno (29:27):
My rule of thumb is, look, I want everything to be standard unless there's a reason it shouldn't be. So if you go to a network or a market or a practice and say, "This is how we do things," and they say, "Oh, I don't want to do it that way. I want to do it this way," that is okay as long as there's an objective reason, and it cannot be because that isn't how we do it. Healthcare is definitely local no matter how you slice it. And so you have to be able to capture the economy of scale, but be nimble enough to adapt to whatever's going on locally.

Abby Burns (29:57):
I think that is such relevant guidance, Don, because so many organizations are now the product of one or several, more likely several, mergers and acquisitions over the past let's call it decade. So this question is absolutely top of mind, and frankly, it's one that we get all the time at Advisory Board. As we wind down, I want to step back a little bit out of the tangible. You've been working in this industry, in population health specifically, for about three decades.

(30:23):
As you mentioned, you've earned your perspective as a thought leader. You've had all sorts of different roles within population health. When you look at the market today, and especially looking forward, maybe call it 2030, call it 2035, what parts of your VBC strategy at Advocate do you feel like you'll need to dial up or even consider dialing down based on what you're seeing in the market?

Don Calcagno (30:46):
I think primary care and population health are an AI problem. Because as an example, what happens between office visits, we don't have enough human capital, human bandwidth to touch patients. So it wouldn't be uncommon for standard care, a patient shows up in a doctor's office for something. And while they're there, they're noted to have hypertension.

(31:08):
Standard of care is they take it again, and if they confirm it, they send the patient home and say, "Hey, take your blood pressure every day and come back in five days or a week or whatever." Very few organizations have the bandwidth to be calling those patients and say, "Do this." And patients are notoriously not good at following up on things like that. But now imagine that you have an AI bot that the very next day reaches out via text or phone or whatever and says, "Hey, did you take your blood pressure?"

(31:35):
And not only can I ask if you took your blood pressure, I can ask how you're feeling. And if I'm having any symptoms of a stroke or whatever, I can say, call 911. I can hand you off to a doctor. So it's those moments between touches that I think is really the value of AI, and I think that's going to be immensely game changing.

Abby Burns (31:55):
Well, Don, thank you for coming on Radio Advisory.

Don Calcagno (31:58):
Thank you.

Abby Burns (32:03):
A theme that I noticed among the many things Don said that he's obsessed with, they're about bringing rigor to value-based care investments and operations, making sure that value-based care is more than a side hustle, and instead is a living, breathing part of what it means to operate a healthcare organization. And in the examples he shared, he showed that creating that type of rigor is possible.

(32:26):
Advocate success in VBC is one example, but there are more. Over the past year, Advisory Board's research has identified multiple systems deep in their value-based care journeys that you can learn from today. I'll include a link to our VBC roadmap series in the show notes. Because remember, as always, we're here to help.

(33:33):
If you like Radio Advisory, please share it with your networks, subscribe wherever you get your podcasts, and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by me, Abby Burns, as well as Rae Woods, Chloe Bakst, and Atticus Raasch. The episode was edited by Katy Anderson with technical support provided by Dan Tayag, Chris Phelps, and Joe Shrum.

(33:55):
Additional support was provided by Leanne Elston and Erin Collins. Special thanks to Clare Wirth, Daniel Kuzmanovich, and Rhea Jain. We'll see you next week.