MGMA Podcasts

Daniel Williams: Well, hi, everyone.

Daniel Williams here, senior editor at
MGMA and host of the MGMA Podcast Network.

We are back with another MGMA Weekend
Review podcast, and we are back along

with co host Colleen Luckett, who's
an editor and writer at MGMA and We're

going to take a look at the news today.

So Colleen, anything you want to
share with me before we get going?

Colleen Luckett: Um, no, I
think we could just dive in.

I have a little, little something to
share about, um, an event I've never

attended before, but I'll, I'll talk
about that in a little, in a little bit.

Yeah.

But yeah, let's just start out
with, um, just the regular old news.

Um, so you know, what's worse
than waiting in line at the DMV.

Prior authorizations, but good news, at
least some of them are getting the axe.

According to Healthcare Dive, senior
reporter Rebecca Pfeiffer reported on

March 19th, that OptumRx is eliminating
prior authorization Reauthorizations

for about 80 drugs used to treat chronic
conditions like migraines, multiple

sclerosis, and high cholesterol.

So starting May 1st, this move
will cut up to 25 percent of all

reauthorizations, about 10 percent
of prior authorizations overall.

Prior authorizations have long been a
pain point for physicians, pharmacists,

and patients, adding layers of paperwork
and often delaying necessary care.

OptumRx's move follows industry
pressure to streamline the process

and reduce administrative burden.

While PBMs argue these requirements
control costs, critics say they hinder

patient care and lead to harmful delays.

This change comes amid growing scrutiny
of PBMs like OptumRx, which along

with CVS Caremark and Express Scripts
have faced antitrust concerns and

legislative efforts aimed at curbing
their power, with regulators circling and

competitors touting Transparent models.

OptumRx's latest reform could be as much
about public relations as patient care.

For now, at least, some patients and
providers will breathe a sigh of relief,

not to be confused with the sigh of
frustration that usually accompanies

dealing with prior authorizations.

Okay, Daniel, over to you.

Daniel Williams: All right, for
our next story, let's talk about,

drumroll please, workplace happiness.

And why it should matter to
every practice leader out there.

Now we've all heard the saying,
find a job you love and you'll

never work a day in your life.

But let's be real, that's
not how most people feel.

Pew Research shows that job
satisfaction has been on the decline.

since the pandemic.

And that's a big deal because
when employees are happy, they're

more engaged, more productive,
and more likely to stick around.

Plus, happy employees lead to
better patient experience and

stronger financial performance.

So really, everyone wins.

And that brings us to an
interesting case study.

Out of the Harvard Business
School, Lanco Medical Group.

This is a fast growing pharmaceutical
intermediary in Central and Latin America

that's doing something a little different.

They're making workplace happiness a
key part of their strategy for growth.

The co founder, Lissette Hermida,
realized that in order to expand

successfully, they had to keep their
employees motivated and engaged,

especially because they're working across
multiple countries and dealing with both

government in private sector clients.

So what's really cool is how they
decided to measure happiness.

They brought in a third party company to
survey employees not just about work, but

about their overall life satisfaction.

And the results?

Well, they were eye opening.

Some of the perks Lanco thought
were big wins, like free healthcare

and company trips, weren't actually
appreciated as much as they expected.

In fact, employees saw them as just
part of the job, not as incentives.

They had to be, that had to be tough to
hear as a leadership team, but instead

of getting defensive, Lanco leaned in.

They listened, and they
adjusted their approach.

One of their biggest insights?

Employees wanted better
financial education.

At first, the leadership team
questioned whether that was even their

responsibility, but then they realized
if financial stress is affecting job

performance, it makes sense to address it.

So they started offering financial
literacy programs to help

employees plan for their futures.

And that's really the takeaway here.

Workplace happiness isn't just
about throwing perks at employees.

It's about understanding
what truly matters to them.

And that's going to change over time.

What motivates someone fresh out
of school is different from what

a seasoned professional wants.

Leaders who take time to ask,
listen, and adapt are the ones

who build strong, engaged teams.

For medical practice leaders, this
is something worth thinking about.

And if you are offering benefits
and incentives that truly resonate

with your team, well, That's
the question you have to ask.

And if you're not, maybe
it's time to start asking.

So Colleen, what's next?

Colleen Luckett: Yeah, I was
gonna say first, um, free medical

care would be great for me, but
what are these people thinking?

But that's just me.

Daniel Williams: Yes.

Colleen Luckett: All right, well,
let's get to our MGMA stat polling.

So this week's poll results told us
that of 455 medical group practice

leaders, 23 percent of you plan to
switch or significantly update your

EHR system in the next 12 months,
while 70 percent do not and 7 percent

of you are Kind of unsure right now.

Well, here are some key takeaways.

So most groups making a change are
switching vendors entirely, with Epic

being a common destination, often
as part of a merger or acquisition.

Some practices are taking a phased
approach, having switched in

2024 and planning further enhance
Enhancements this year among those

sticking with their current system.

Many recently transitioned and are
satisfied with their platform, while

others are staying put due to cost
considerations or physician preference.

Few respondents cited contractual
obligations as a reason for not switching,

suggesting more flexibility in the EHR.

EHR marketplace.

And then I AI powered documentation
tools and new integrations are emerging

as popular add ons for groups looking to
enhance not replace their current systems.

And why does all this matter?

Well, selecting the right EHR system,
as many of our listeners know, is a high

decision, and one that can make or break
operational efficiency, revenue cycle

management, and clinician satisfaction.

To support leaders considering a
transition, MGMA has updated its guidance

on crafting a strong RFP, or Request for
Proposal, that reflects the following.

The latest regulatory requirements,
including interoperability mandates

under the 21st Century Cures Act,
evolving technology offerings such

as cloud based systems, AI powered
documentation, and data analytic tools,

and the specific needs of different types
of practices, from smaller outpatient

clinics Needing simple turnkey solutions
to large multi site systems, requiring

robust data exchange, compliance,
and advanced reporting capabilities.

A well structured RFP ensures
EHR vendors don't just promise

the moon, but demonstrate how
their system meets the real.

clinical, financial, and operational
needs of your organization.

And on that note, Daniel, I mentioned
at the beginning of the podcast, I got

to attend an event for the first time.

Well, that was the HIMSS Colorado chapter
advocacy day breakfast this past Monday.

You know, super interesting, lots of
panelists who were just really dynamic.

Well, our stat poll reminded me of a
panel session there that highlighted

some of the unique technology hurdles
that providers in alternative care

settings, like behavioral health.

senior living and community
health centers face.

And lo and behold, one of the big things
that came up was the ongoing challenges

with EHR systems and these alternative
care environments and how many of the

established EHR platforms just aren't well
suited for the needs of their settings.

So Jason Greer, one of the
panelists, he's the CEO of

Community Health Provider Alliance.

and Colorado Community
Managed Care Network.

He noted how the EHR technology in
primary care is often behind the curve

compared to the rest of the industry.

And Stephanie Haley Andrews from
Atria Senior Living mentioned how

they've had to really work to move
their senior living data away from

subjective free text notes toward
more structured objective assessments.

The panelists emphasized the
importance of EHR systems that can

support whole person coordinated care
across the community, so integrating

physical, mental, and social needs.

But they said the data, the data
sharing and interoperability to

enable that level of coordination
is still a major challenge, even

with newer cloud based EHR options.

So, it's clear that EHR selection
and optimization remains a top

priority for many practices, whether
they're looking to make a full

vendor switch or just significantly
update, upgrade their current system.

The need for technology that can truly
meet the unique needs of different

care settings is an ongoing pain point
that providers are working to address.

And hey, MGMA members, if your
organization is thinking about

an EHR change, Make sure your
RFP doesn't just check the boxes.

It should align with your practice's
long term strategy and avoid

turning into an expensive regret.

So as always, we'll drop the link
to our MGMA stat poll results

article in the show notes.

Check that out for more information
and how to develop a really, uh,

really tailored RFP for your new EHR.

system.

And hey, do you want to have your
voice heard in future MGMA polls?

Well, just join MGMA stat by texting
STAT STAT to 33550 or visit mgma.

com slash MGMA.

hyphen stat to participate in
weekly healthcare leadership

insights sent via text.

It's real easy.

Okay, Daniel, back to you.

Daniel Williams: All right.

Next, we have a topic that
might seem a little fishy.

Literally.

Turns out doctors can learn
a thing or two from salmon.

Yep.

You heard that right.

Not from fancy business consultants
or Ted Talks, but from the

determined, relentless, and sometimes
downright impressive journey.

Pacific Coast Salmon.

Think about it.

These fish are born in cold, rocky
river beds, swim downstream to the

ocean, spend a few years living
their best lives, and then, well, you

probably know the rest of the story.

They fight their way back upstream,
dodging bears, leaping over waterfalls,

and pushing through some serious currents.

Just a return to where they started and
they do all this without GPS, a wellness

app, or an overpriced cup of coffee.

Now if that's not dedication,
I don't know what is.

So what can doctors take away
from the life cycle of a salmon?

A few big lessons, actually, and I
might add, this article originally

appeared in Physician's Practice.

It's an opinion piece there,
and so, let's get into it.

First, remember your roots.

Just like salmon instinctively return
to their birthplace, physicians

should remember the mentors, the
training, and the early experiences

that shaped their careers.

Medicine is a tough road, but those
who came before you paved the way.

Keeping those connections
strong can keep you grounded.

Next, perseverance.

If you think med school was tough,
try swimming against a raging

current for hundreds of miles while
predators wait to snatch you up.

Salmon don't quit, and neither do doctors.

You push through long hours,
administrative headaches, and

ever changing policies because
you believe in the work you do.

That persistence is what makes great
doctors, just like it makes great salmon.

If salmon had medical degrees, then
there's leaving your comfort zone.

Salmon don't just stick to
their safe little rivers.

They explore vast open waters.

Adapting to new environments.

Doctors, the same deal.

Whether it's adapting, adopting new
technologies, learning a new specialty.

or adjusting to the latest
health care regulations, success

comes from adapting and growing.

And then, let's not forget
deferring gratification.

Salmon give up eating during
their long journey upstream, all

in service of the bigger goal.

Sound familiar?

Whether it's residency, long
shifts, or putting patient care

before personal comfort, physicians
understand what it means to delay

rewards for a greater purpose.

And then finally, adaptability.

Male salmon actually change physically
as they prepare for the final stretch of

their journey, growing hooked jaws and
sharper teeth to protect their future.

Doctors may not grow.

New teeth, thankfully, but they do
have to evolve constantly, whether it's

shifting their approach to patient care
or adjusting to new health care models.

The bottom line, nature has some
pretty solid wisdom to offer.

Physicians like Salmon, navigate
complex and demanding journeys.

And while there's no one size fits
all roadmap, staying connected to your

purpose, pushing through challenges,
and adapting along the way are the

keys to a meaningful career, and,
hopefully, a successful swim upstream.

Colleen, keep on swimming.

What is

Colleen Luckett: next?

I like that metaphor.

All right.

Well, we will shift to some
mental health care news.

So mental health care in the U.

S.

right now feels a lot like
waiting for a delayed flight.

It's stressful, frustrating,
and you're not even sure if

help is ever going to arrive.

But according to one expert,
the solution isn't just to add

more planes to a broken system.

It's to rethink the entire Runway.

A recent MedCity News article by Jenna
Glover published on March 18th covers

the state of mental health care and why
simply scaling teletherapy and existing

models isn't enough to fix the system.

Here's some key takeaways
from the article.

The current mental health system is
struggling with health high costs.

Long wait times and staffing shortages
making care inaccessible for many.

Expanding a broken system
isn't the solution.

Instead of just increasing teletherapy
or traditional care options, healthcare

leaders need to rethink how mental health
services are structured and delivered.

AI and digital tools are playing a growing
role offering real time support for

individuals who may not have access to
traditional therapy, but they need to be

integrated responsibility, responsibly
ensuring evidence based ethical care.

Health equity remains a major challenge.

Many marginalized communities
are still being left behind and

solutions need to be Culturally
responsive, scalable, and accessible.

For healthcare leaders,
this is a wake up call.

Simply adding more therapists or
expanding telehealth options won't

solve the deeper issues in the system.

Instead, the industry needs to focus
on innovative, holistic approaches that

blend human expertise, AI driven tools,
and new care models to meet patients

where they are, especially those who
have been historically underserved.

At the end of the day, mental
health care doesn't need a bigger

truck, it needs a better road.

And for those leading the charge
in health IT operations and patient

care, the challenge is to build that
road with smarter, more effective,

and more equitable solutions.

And again, we will drop that link
in the show notes, so you can

check it out for more information.

And that does it for me today, Daniel.

Daniel Williams: All right, and that
is going to do it for this episode

of MGMA's Week in Review podcast.

Just want to thank all of you for being
MGMA podcast listeners, and please drop

us a note, and we will respond to that.

We'll see what you're talking
about, what stories you have,

and if you want to appear on the
podcast, let us know that as well.

So until then, thank you
for being podcast listeners.

Colleen Luckett: Thanks, everyone.

See you next time.