Cooperating for better care.

News & Views

Humana starts bundled-payment model for maternity

Humana, the big insurer, is contracting with physician practices to create a bundled-payment model for maternity care.

The Louisville, Ky-based insurer  will work with five OB-GYN practices to cover beneficiaries with low-to-moderate-risk pregnancies to try to improve quality and lower costs.

The model, among other things, is meant to make available more data and analytics to improve  care, and reduce duplications and readmissions.

Interestingly, the announcement comes soon after news  that Walmart might want to buy the insurer.

The  maternity bundle  is Humana’s second  bundled-payment model. It started  its joint-replacement bundle in 2016, citing an effort to cut costly readmission rates.

To read the FierceHealthcare take on this, please hit this link.


Quality improvement in nonclinical teams


An  article in NEJM Catalyst reviews quality-improvement efforts by nonclinical teams in healthcare organizations. Hit this link to read the piece.  The authors conclude:

  • “Continuous quality improvement is applicable to corporate strategic and support services, as well as clinical services.
  • Applying quality improvement in corporate services can influence the clinical realm, including patient experience, outcomes, and value for money.
  • Quality improvement in corporate services can help bring corporate staff closer to the clinical staff by better understanding their needs and {the} mission.
  • Challenges to applying quality improvement have included access to data to understand process performance, and balancing time and energy for improvement with operational and business priorities.”


How hospitals can avoid doom

Last Judgment by Stefan Lochner (1435)


Sheila Talton warns that U.S. hospitals face doom unless they become more agile in providing clinical care. She is president and CEO of Gray Matter Analytics and on the boards of companies and nonprofits, including Deere & Co, Wintrust Financial Corp. and Chicago’s Northwestern Memorial Hospital Foundation.

She writes in Med Page Today:

“Until now, most hospitals have tried to consolidate to achieve economies of scale — think of HCA and Tenet’s advances, or Mayo Clinic and Partners Healthcare, which have been echoed in numerous regional markets. Or they have outsourced non-medical operations like food service, parking lots and maintenance. But this does little to make them more agile in their core business of clinical care. That is where hospitals should be obsessively and narrowly focused.

“Hospital executives should constantly be asking how their medical staff can best care for patients, and then make investments and forge partnerships that make that possible. That does not mean hiring an in-house team to design a new cafeteria or re-arranging other deck chairs. It means having an innovative and well-equipped medical staff with a clear mission, and a network of outside companies taking care of everything else and helping them achieve it, making everything else aligned with the care. That’s not just outside partners who can do the work for less, it’s outside partners who can help them do it better and faster and make the patient experience and patient outcomes better. We’re not there.”

To read her essay, please hit this link.

Latest hospital expansions


FierceHealthcare reviews the latest hospital expansions and upgrades across America. To read the article, please hit this link.

Home health CEO says mergers can cut costs

FierceHealthcare reports:

“Mergers within the healthcare industry have been scrutinized for limiting competition, but one home health CEO says consolidation can reduce costs, improve care and help grow popular services.

“Keith Myers, CEO of LHC Group, said his company’s recent merger with Almost Family, finalized on April 1, created the second largest in-home healthcare provider in the country, behind Kindred Healthcare. The deal expands LHC’s geographic presence to 36 states and 781 locations, including joint venture partnerships with 336 different hospitals.

“Hospitals are increasingly focused on tapping into home health services to reduce readmission rates and streamline post-acute care to avoid financial penalties under the federal government’s Readmissions Reduction Program, Myers said. A bigger footprint will help LHC advance those partnerships and lower costs.”

To read the entire article, please hit this link.

Physician warns of undertrained NPs and PAs


In a Medical Economics piece, Rebekah Bernard, M.D., asserts that  undertrained nurse practitioners and physician assistants, whom states have been  giving more physician-like authority, are jeopardizing U.S. healthcare.

Among her observations:

“Unfortunately, this lower quality of training and clinical experience is beginning to become apparent. New studies are demonstrating that removing standardized curriculum and physician supervision from nurse practitioner training and practice is impacting the quality of patient care, including poorer quality referrals to specialists compared to primary care physicians, more unnecessary skin biopsies, than physicians, increased diagnostic imagingincreased prescriptions, including increased antibiotic prescribing[v] and higher opioid prescribing shown in the states of Connecticut and New Hampshire. Payouts for malpractice claims against NPs are also on the rise, as are claims for the improper prescribing and management of controlled substances. With training programs churning out NPs at a rate of 23,000 per year, compared to about 19,000 physicians graduating from medical school per year, we may see these trends grow.


To read her whole piece, please hit this link.

Penn Medicine sets alliance with two Catholic hospitals


Hospital of the University of Pennsylvania.

The University of Pennsylvania Health System (Penn Medicine) has announced an alliance with with two Trinity Health (a Catholic hospital chain) hospitals to expand access to care and develop clinical programs in cancer care, cardiology and surgical services in Greater Philadelphia.

One major part of the agreement (whose financial details weren’t disclosed) is for  patients at Mercy and St. Mary hospitals to get improved access to tertiary and quaternary care.

The alliance will let Penn Medicine  extend more routine care closer to patients’ homes while they continue to be able  to use Penn Medicine for complex and specialty care.

FierceHealthcare noted the arrangement is part of  “a recent trend which has seen providers eschewing mergers in favor of collaborative efforts. For example, Ascension Health recently walked away from a proposed merger with Providence St. Joseph Health in favor of a strategic overhaul seeking lower-cost ways to manage the increased risk hospital systems are required to take on due to the industry’s shift toward value-based payment models.”

To read more, please hit this link.


Medicare panel backs cutting payment rates for some standalone emergency departments

FierceHealthcare reports that the Medicare Payment Advisory Commission (MedPAC) will recommend  that Congress cut by 30 percent the payment rates for standalone emergency departments within six miles of an on-campus hospital emergency room.  Modern Healthcare has reported that  the proposal could save Medicare up to $250 million a year if adopted.

The creation of standalone emergency departments have been exploding the last several years; that has  driven up health costs in some states.

Fierce reported that, “According to a MedPAC report,  most of the 566 standalone emergency departments in 2016 were  in metropolitan areas with existing capacity in more affluent areas with higher rates of privately insured patients. The growth of standalone emergency departments, they said, has been driven by “payment systems that reward treating lower severity cases in the higher paying ED setting” as well as competition for patient market share.

MedPAC last week also voted to  allow rural hospitals more than 35 miles from another emergency department to convert to a standalone ED that could bill under the outpatient prospective payment system. “It would also allow for annual payments to assist with their fixed costs.”

To read the Fierce article, please hit this link.



How Walmart-Humana deal could hurt hospitals


Paige Minemyer writes in FierceHealthcare about how  Walmart’s purchase of Humana, the big health insurer, could hurt hospitals.

Among her comments:

“{A} wrinkle in the potential Walmart-Humana deal that could worry providers is how Walmart currently operates its employee benefits, according to the WSJ. It has increasingly formed direct contacts with specific hospitals.

“This practice, combined with Humana’s infrastructure, could lead the combined entity to build employer health plans with narrow networks that leave many hospitals out in the cold. Geisinger Health System, for example, currently contracts with Walmart and is paid notably lower rates—but it attracts potential patients it might not otherwise, according to {a Wall Street Journal} article.”

To read her article, please hit this link.



How Aetna, CVS might prosper from merger

Harvard Business School Prof. Leemore Dafny writes in NEJM Catalyst about how the Aetna-CVS merger might pan out. Among her observations:

“With a focus on total costs of care in Aetna’s corporate DNA, {the merged entity}  will aspire to reduce total spending for care (while increasing its own revenues) by redirecting patients to lower-cost sites for certain services, such as infusions or imaging (in which NewCo may have ownership stakes); using its physical convenience and non-visit care technologies to maintain contact with patients requiring closer monitoring, thereby potentially averting ED visits and admissions; and considering combined medical and pharmacy spending.

“Aetna can directly support these objectives by encouraging members to use Minute Clinics, other {merged entity} affiliated providers, CVS pharmacies, and Caremark services — perhaps through favorable cost sharing or more seamless scheduling, billing, and care or product delivery. To the extent that CVS’s physical and digital efforts can lower total costs of care, {the merged entity} can benefit directly from anyone insured by Aetna, and indirectly by sharing in savings with members of self-insured plans. Notably, Aetna is building market share in Medicare Advantage plans, and arguably Medicare Advantage enrollees are the members most likely to appreciate and benefit from frequent, high-touch interactions with CVS pharmacists and nurse practitioners.”

To read her essay, please hit this link.


Page 1 of 352123...Last

Contact Info

(617) 230-4965

Wellesley, Mass