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Using pain-care reform to improve primary care for under-served populations


The Port of Newark, with the much  feared New Jersey Turnpike in front.

The Nicholson Foundation, which seeks to improve New Jersey’s healthcare- delivery systems and reduce the costs of care for its underserved populations, has a program to reform pain care and reduce opiate addiction and in so doing strengthen overall primary care in the state’s safety-net system. Its key  is integrating  behavioral healthcare —  mostly  substance-abuse and mental-health treatment — with primary-care settings.

The authors of a Health Affairs article on this note: “With the explosion of the prescription opioid crisis in the past several years, and the concomitant awareness of the role of primary-care providers in inadvertently contributing to it, this integration work has become urgent and essential.”

To read the article, please hit this link.

Behavioral-health leader Robert A. DeNoble joins CMG



Providers, patients, insurers, regulators and the general public are increasingly aware of behavioral health’s centrality in improving medical outcomes and controlling costs across the healthcare sector.

That’s one of several big reasons why Cambridge Management Group ( is very happy to welcome Robert A. DeNoble as a senior adviser. His experience as a healthcare executive, management consultant and national thought leader, especially in behavioral health, make Mr. DeNoble a very valuable resource for everyone coping with the sector’s ongoing disruptive changes.

Key aspects of his work have included:

  • Strategic planning and assessment. He has initiated and led strategic-planning programs for hospitals and medical groups.
  • Organizational assessment. DeNoble has reorganized institutions to improve coordination and operational efficiency, leading to greater patient satisfaction and reduced costs. These efforts included revising position descriptions and work flows and incorporating new technologies, such as electronic medical records, automated reminder calls, etc.
  • Financial assessment and planning. He has developed financial plans and projection models to assess organizations’ financial viability. These have been used to evaluate the costs of implementing strategic plans and determining the revenue required for successful implementation.

Mr. DeNoble has been president and chief executive of the Marino Center for Integrative Health, in Cambridge, Mass.; president and chief executive of Applied Management Systems, in Burlington, Mass.; senior manager/director in the healthcare-consulting practice at KPMG, and senior executive at Rhode Island Hospital, in Providence, Mount Auburn Hospital, in Cambridge, Mass., and McLean Hospital, in Belmont, Mass.

Especially note that as McLean’s associate general director of operations and planning, he helped change the hospital’s focus from inpatient service to a continuum-of-care delivery model — change that’s now happening at hospitals across America.

Mr. DeNoble is on the board of the Austen Riggs Center, the internationally famed psychiatric hospital in Stockbridge, Mass. As Finance Committee chairman for many years, he helped guide the institution to financial health. He also served on the Strategic Planning Committee, and chaired the Medical Director/CEO Search Committee.

As a sub-contractor for a national consulting firm, he led a team redesigning the behavioral-health programs at Jackson Memorial Hospital, in Miami. That institution has an extensive behavioral-health program serving a predominantly Medicaid population. He has also been a behavioral-health expert for a leading consulting firm for a Delivery System Reform Incentive Payment program and Vital Access Provider projects in New York State.

Robert DeNoble was one of the founding directors of the Harvard Business School Healthcare Alumni Association, its president from 2005 to 2008, and chair or co-chair of its annual conference from 2000 to 2004. He has also taught healthcare financial management at the Boston University School of Public Health.

He holds a bachelor of science degree in finance and accounting from St. Peter’s College, in New Jersey, and a master of business administration from the Harvard Business School.

Conn. hospitals denounce Medicaid cuts



Governor Malloy.

Connecticut Gov. Dannel Malloy will make more than $63 million in new cuts to hospital Medicaid payments, says  a WSHU report.

His budget office said the cuts are necessary for the state to maintain a balanced budget.

Not surprisingly, Connecticut Hospital Association CEO Jennifer Jackson said reducing hospitals’ Medicaid payments will hurt patients and providers.

“With nearly one in five Connecticut residents on Medicaid, withdrawing even more funding from the state’s obligation is outrageous. It puts a tremendous additional strain on healthcare providers who already provide services with reimbursement that is nowhere near the actual cost of delivering that care.”

The cuts will certainly hurt, but we at Cambridge Management Group note that there’s vast opportunity to save money in Medicaid by reducing the number of avoidable hospital re-admissions and far better integrating behavioral healthcare and other healthcare.

This is particularly important in Connecticut’s struggling cities, with their large low-income populations.

The long failure to adequately address the impact of behavioral, emotional and mental illness on the cost of treating “physical illness” accounts for much of Medicaid’s spiraling expenses. And connected with this is American healthcare long giving short shrift to the social determinants of health.

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Wellesley, Mass