Cooperating for better care.

Robert Whitcomb

Author Archives

Vt. single-payer plan at a glance

mont2 Montpelier,  Vt., with the gold-topped state capitol.

Here’s what Vermont’s dead (f0r now anyway) single-payer health-insurance plan looked like at a glance. In the end, officials of the liberal state decided  that citizens and businesses in the Green Mountain State just couldn’t afford the plan — the centerpiece of Gov. Peter Shumlin’s vision for the state.


In value-based care, new kinds of disputes

fight
”Some believe ‘we’re going to see more of these price disputes than less,’ said Texas A&M health economist Michael Morrisey, because true price transparency has not yet permeated the consumer market and negotiations remain veiled in secrecy.”
Still, Richard Hirth, a health-policy professor at the University of Michigan, told Modern Healthcare,  ”value-based reimbursement might decrease price conflicts  because it should, hypothetically, result in more collaborative, less wasteful care.

“If their incentives are a little more aligned, they obviously have less to fight about,” Hirth said.

The news service said: ”Experts predict that determining lump-sum payments, quality metrics to be used for bonuses or penalties, and arrangements for how shared savings should be split will be the new payment bargaining chips.”

 

 


How about it, Dr. McAneny? What’s your SGR cure?

 

Rep. Larry Bucshon, M.D. (R.-Ind.), a cardiac surgeon and member of the House Energy and Commerce Health Subcommittee, asked Barbara McAneny, M.D., chair of the American Medical Association’s board of trustees, if the AMA could offer “substantial possible pay-fors” to cover the cost  of repealing the sustainable growth rate (SGR), which the Congressional Budget Office estimates as costing about $140 billion over 10 years.

MedPage Today reported that she said: “The AMA stands ready to assist and help by weighing in on any specific suggestions; we don’t really have the ability to give you specific pay-fors, because the devil is in the details.”

Dr. Bucshon, responded with frustration:  “I would implore you for the AMA to reconsider and maybe help us. If someone is going to offer an opinion at the end, you should be part of offering solutions on the front side …. If you are just going to wait and be a critic and not offer solutions yourself, to me it’s not very helpful.”

 

 


‘Staff-heavy’ approach won’t work

 

sys2

 “Sisyphus,” by Titian, painted in 1549.

Alexandra B. Kimball, M.D., Kristen C. Corey M.D.,  Joseph C. Kvedar, M.D., write in Medical Economics say that in  ”healthcare, we continue to insist on human resource-intense solutions. However, the proportion of a provider organization’s cost borne by human resources is 56%, and healthcare workers are generally less productive than those in other sectors. A staff-heavy plan of action is doomed to fail.”

They say that a mix of more patient engagement and technology can address the mounting pressures on physicians’ time and energy that stem from payers’  mandates to somehow decrease costs and improve outcomes.

Among the partial solutions they recommend:

* Online appointments.

* Previsit check-ins.

* Online visits

* Remote monitoring programs.

 

 

 


Southern hospitals doing best with MSSP

 

Some early evidence reported in HealthAffairs indicated that geography, not size, is the key factor in success among Accountable Care Organizations of  participating in the Medicare Shared Savings Program.

In any event, of course, there will have to be more changes in the program for it to fulfill its creators’ hopes for hospitals across America

Fierce Healthcare summarized: ”The size of the ACO didn’t necessarily determine its likelihood of producing savings, as large ACOs ‘generally did not have an advantage in financial performance compared to smaller ACOs,’ according to the article.”

ACOs in the South outperformed  other regions’, and those in expensive areas were particularly successful in producing savings. The HealthAffairs study reported that “the way medicine is practiced (or at least has been practiced) in a region is important to the ACO’s ability to generate shared savings under current benchmarking methodology.”

”Financial performance, though, is only one part of ACOs’ overall mission, and the first HealthAffairs analysis notes that the savings produced by MSSP ACOs is not necessarily related to how they were able to improve the quality of care. ”

 

 


No rush to pricey specialists under the ACA

 

Some observers have feared that many who signed up for insurance under the Affordable Care Act would be  sicker than those with employer-based health programs and would be especially likely to seek out expensive specialists.

But a Reuters study suggested that these new entrants, while enthusiastic about getting preventive care, were no more likely than others to see the aforementioned pricey specialists. If anything, the study reminds us at Cambridge Management Group that the newly insured  is boosting demand not only for primary-care physicians but also for nurse practitioners and physician’s assistants.

Reuters said that  the profile of people covered by the Affordable Care Act exchanges came from  ZocDoc, a free online appointment-booking tool used by millions of people in all 50 U.S. states.

”The data, covering thousands of users aged 18 to 64, suggests that ‘the vast majority who signed up in the first wave of Obamacare didn’t have acute medical needs, contrary to expectations,” Dr. Oliver Kharraz, ZocDoc’s co-founder and chief operating officer, told Reuters. ‘The biggest news here is the absence of dramatic utilization differences.”‘

 

Still, a caveat: ”The question is whether, over time, preventive care visits lead to more use of specialists,” Elizabeth Carpenter, director of the healthcare-reform practice at Avalere Health, told Reuters. “Obviously, the more individuals seek preventive care and screenings the more likely they are to be referred to a specialist.”

 

 

 

 

 


‘There’s gotta be an app’ to reduce patient chaos

Fred N. Pelzman, M.D., laments the number of patients who show up unannounced and those who constantly forget their appointments,   even as providers are told to provide ever more “access”.

He suggests:

”The insurance industry should be able to develop a more modern system of monitoring the use of resources by their patients, … maybe by monitoring these things electronically through claims data, actively informing patients each time they use up one of the benefits they have remaining.

”There’s gotta be an app for that …

”Taking the doctors out of this process could improve our quality of life and the satisfaction of our patients. And no doubt the system’s efficiency will also dramatically improve, and savings will undoubtedly follow.”

 


Oregon bill seeks to modernize public-health system

Mount_Hood_reflected_in_Mirror_Lake,_Oregon

Mt. Hood, Oregon’s highest peak — a volcano that hopefully will not erupt before Oregon upgrades its public health system.

The Lund Report says that Oregon state Rep. Mitch Greenlick plans to introduce a bill  to begin a ”decade-long process to modernize the state’s public health system.”

”The bill…will ask for $500,000 for the Oregon Health Authority to devise a 10-year plan for each county to improve its services ‘so that every Oregonian has access to modern public health,’ Greenlick said.”

This recalls the sort of community/population health projects that Cambridge Management Group has been working on in Oregon for the past several months.

”The legislation is based on findings by a 15-member task force…  to study the regionalization and consolidation of public health services. The task force concluded last September that the state needs new laws to establish ‘foundational capabilities’ as the minimum requirements for public health…,” Lund reported.

”The report defined those ‘foundational capabilities’ as assessment and epidemiology, emergency preparedness and response, communications, policy and planning, leadership and organizational competencies, health equity and cultural responsiveness, and community partnership development.”

In other words, it recognizes that there’s a lot more to community health than just medicine.


Primary-care clinics grow and grow

 

The Sacramento Bee reports on the sort of primary-care clinic transformation we’ll be seeing a lot more of, many focused on treating low-income people. Here’s another new Federally Qualified Health Center.

 

 

 


Arkansas to keep Medicaid-expansion private option for now

albie

In sign of how entrenched Medicaid expansion has become  even in some Tea Partyish states, Arkansas’s new Republican governor, Asa Hutchinson, has asked the legislature to keep the state’s ”private-option” approach to Medicaid expansion, backed by his Democratic predecessor, through 2016. Mr. Hutchinson doesn’t want to deal with the firestorm that would ensue if about 200,000 low-income residents lost access to insurance coverage that they had won through the Affordable Care Act.

But Hutchinson has proposed a legislative task force to study other options for insurance for low-income people. We wouldn’t be surprised if those options end up where many “blue-ribbon commissions” end up — the Bermuda Triangle.


Page 359 of 368First...358359360...Last

Contact Info

info@cmg625.com

(617) 230-4965

Wellesley, Mass