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Ian Morrison

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Why Rochester does so well with healthcare


High Falls in downtown Rochester

— Photo by Evilarry

The healthcare-industry speaker, consultant and futurist Ian Morrison, Ph.D., looks at the many decades of success of the Rochester, N.Y., area in community collaboration among providers to better manage costs and improve care.

Among his observations in a Hospitals & Health Networks piece:

“Rochester still leads the country as a beacon of high performance on cost and quality. For Medicaid, the city was hailed by New York Gov. Andrew Cuomo as the most cost-effective in the country. In Dartmouth Atlas and commercial spending analyses, Rochester is a high-value performer. And for commercial self-insured employers like Paychex, the results are remarkable: low deductibles and co-payments not seen by most Americans since the 1990s. If value and affordability are important, we should continue to learn from Rochester.”

Mr. Morrison writes  that “the Rochester experience provides great insights on a number of factors and forces relevant today that we don’t often discuss:

  • “Managing bed and technology capacity is a fundamental tool for reducing cost.
  • “An engaged business community — activated to do more than simply play with benefit design, and engaged in the measurement and management of healthcare delivery — ensures high quality and low cost, and eliminates unnecessary resource use and capacity.
  • “As more burden is placed on state and local communities for risk and financial responsibility, local communities must figure out the best way to come together to serve the people.
  • “Going upstream to the determinants of health — diet, nutrition and exercise — is critical in primary prevention such as blood pressure measurement.”

To read his entire essay, please hit this link.


Income inequality is a killer


Ian Morrison writes about the strong role that income inequality and socio-economic status play in the health of individuals and populations.

And, he writes in Hospitals & Health Networks: “{T}hat role persists even after accounting for risky personal behaviors such as overeating, indolence, smoking and imbibing.”

“Being poor will kill you.”

To read his essay, hit this link.

Video: Hospital volunteers and moving to value-based care


In this video, consultant and author Ian Morrison discusses the role of hospital volunteers in American healthcare’s transition to a value-based system.


States’ surging role in healthcare-payment reform


Readers would do well to read this Hospitals and Health Networks article by Ian Morrison about the states’ expanding role  in healthcare reform. He focuses on the fact that more  and more states, with huge purchasing power, are consolidating their purchasing  activities and coordinating with private players.

“Increasingly, states including Washington and Arkansas are using this combined purchasing power to transform the healthcare marketplace and coordinate their payment reform efforts with private purchasers. Public purchasers (acting in concert with willing private purchasers) can have a powerful influence on healthcare transformation.”

He writes that the states will:

  • “Drive value-based purchasing across the community, starting with the state as ‘first mover.”’
  • “Improve health overall by building healthy communities and people through prevention and early mitigation of disease throughout the life course.
  • “Improve chronic illness care through better integration of care and social supports, particularly for individuals with physical and behavioral ‘co-morbidities.”’

Mr. Morrison cites Washington State’s Health Care Innovation Plan, which we at Cambridge Management Group are very familiar with because of our ongoing work in Oregon and Washington State.

In that plan, “foundational building blocks” include, he notes, “robust quality and price transparency, activated and engaged individuals and families, regionalized transformation efforts, accountable communities of health, leveraged state data capabilities, practice transformation support, and increased workforce capacity and flexibility.”



Other examples in his piece include:


  • “Arkansas has initiated multi-payer-based episodic payment initiatives and patient-centered medical home programs.
  • “Minnesota’s multi-payer payment and delivery system reform strategy primarily is tied to spreading an ACO concept (the Minnesota Accountable Health Model framework) among Medicare, Medicaid, commercial payers and self-funded populations in the state.
  • “Oregon’s recent multi-payer efforts center on spreading the coordinated care organization model {like ACOs} introduced into the state Medicaid program in 2012.
  • “Vermont is at the forefront of state efforts to reform its health insurance payment and delivery system, and continues to actively test value-based payment approaches with multiple public and private payers.”

Bundled payments or population health?


Ian Morrison, Ph.D., a consultant and futurist based in Menlo Park, Calif. , writes about whether hospitals should focus on population health or bundled payments.

He notes that there’s  “growing skepticism among many respected industry experts who question whether population health, providers at risk and Accountable Care Organizations are really the right answer. They fear these models may all turn out to be a bridge too far. Instead, they argue, we should get the basics of healthcare delivery right first. Then we should use bundled payment–type models as our lead foray into financial incentives that promote improved care coordination and clinical performance delivered by focused, high-performing teams.”.”So, there is a plausible … conclusion that meaningfully incenting providers to deliver care by taking financial risk for a defined population they serve (across the continuum of care) is an impossible dream that will end in failure. Therefore, we should settle back on bundles and other less grandiose improvement initiatives instead.”On the contrary, I still believe that our best hope for sustainable health care may well come from large integrated systems of care competing on the basis of cost and quality for a defined population.”

“Overall, my forecast can be summed up as follows:

“Integrated systems with their own health plans, regional scale, direct contracting and Medicare Advantage contracts is the end game for some large players who are preparing for population health risk.”

“Many hospitals will be caught between two paradigms for the next five years (at-risk vs. fee-for-service), but the direction is toward more risk-bearing on the basis of value through a variety of constantly evolving partnerships and risk-sharing arrangements.

“Bundled payment for procedure-oriented care presents a major step toward promoting value and care coordination that does not require population health (frequency risk).

“And finally: Value-based payment trends are not enthusiastically embraced by providers. So expect public payers to make more payment innovations mandatory, not just voluntary.”



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