Cooperating for better care.

Robert Whitcomb

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No more low-hanging fruit?

May 4, 2015by Robert Whitcomb in Uncategorized tagged , ,

low-hanginhg fruit

A JAMA study has found that a federal test program that stems from the Affordable Care Act involving physicians and hospitals slowed healthcare spending in Medicare coverage by hundreds of millions of dollars in 2012 and 2013 but savings were less in the second year.

Reuters reported that the study looked at beneficiaries in 32 Pioneer Accountable Care Organizations (ACOs), in which hospitals and physicians follow 33 quality and care standards for Medicare fee-for-service patients. In return they can receive part of any healthcare savings back from the government.

The savings were 4 percent in the first year but less than 1.5 percent in the second, compared with spending on beneficiaries in traditional Medicare fee-for-service.

The big question is, of course, whether it will much tougher to get hefty new savings over the next few years or whether new systems  and processes (including new technology) will make further efficiencies when those systems are fully integrated. Were the first-year savings simply low-hanging fruit?

New ACO incentive systems are in the pipeline.

One would suspect that some folks at JAMA might not like ACO’s at all because they would tend to reduce the revenues of physicians who have prospered greatly in the fee-for-service system now  under attack by private- and public-sector payers.

A patient-friendly and simplified-billing approach

May 4, 2015by Robert Whitcomb in Uncategorized tagged , , ,

patient

 

Iora Health is example of the new enterprises springing up to treat patients disenchanted by what they see as soulless and rushed physician groups and clinics. It’s not exactly “concierge care” for the rich, but it sounds remarkably pleasant.

The Cambridge,Mss.-based for-profit  runs  a total of 13 practices in six states. It provides a relatively new model emphasizing preventive care, technology, close personal attention and simplified payment, reports The Boston Globe. The last item is particularly important to many individuals and enterprises  utterly fed up with America’s byzantine, exorbitant and and  sometimes dishonest medical billing.

And patients usually get hour-long appointments.

Rushika Fernandopulle, M.D., from Massachusetts General Hospital,  co-founded Iora with entrepreneur Christopher McKown, the husband of Abigail Johnson, chief executive of Fidelity Investments — lots of  connections  for start-up capital there! Dr. Fernandopulle asserted that “We are building a brand-new version of healthcare.”

Actually, there have been similar enterprises popping up across America in the current healthcare churn, accelerated by new technology and the Affordable Care Act.

 

The Globe reported that “The company finds large companies or organizations such as unions that are interested in trying out a new approach. These sponsors …. have agreed to pay a flat monthly fee for each patient. Employees still carry standard insurance for medical needs beyond primary care.”

“If Iora can keep a patient healthy and provide care for less than the monthly fees, then Iora makes more money.”

 

 

 

 

 

 

 

 

E.R.’s pediatric deficits

May 3, 2015by Robert Whitcomb in Uncategorized

newborn

 

The Wall Street Journal reports that many U.S. emergency rooms are ill-equipped to treats children because they may be staffed with clinicians untrained in pediatric care.

Perhaps what’s needed, among other things, are many retail urgent-care centers specializing in pediatric care.

Opening up ACA mysteries

May 3, 2015by Robert Whitcomb in Uncategorized tagged

 

HealthAffairs looks at  important parts of the Affordable Care Act that have been little noticed although the  controversial law has been around for five years.

Among them are that many more people than you might think are eligible for special enrollment periods on health-insurance exchanges and that as many as 14 million children could become ineligible for insurance coverage by 2019.

 

 

Population-health coordinators in New Jersey

May 3, 2015by Robert Whitcomb in Uncategorized tagged ,

Passaic

The Great Falls of the Passaic River, in Paterson, N.J.

Steven Peskin , M.D., of  Horizon Blue Cross Blue Shield of New Jersey, talks about population-health management, which it uses as a vital part of its  goal to lower costs and improve care.

The core of the effort is “partnering with providers to offer valuable claims information to help them better manage patients with expensive chronic conditions,” reports FierceHealthPayer.

Dr. Peskin says: “A cornerstone to our work is what we call population care coordinators. We now have more than 250 nurses across the state of New Jersey who work in the physician practices. There may be a dozen working in a large system or there might be one coordinator for two or three small practices. Although they’re employed by the actual practices, these folks are trained by Horizon. We provide a two-day training at the beginning of their tenure, so to speak, but it doesn’t stop there. It continues with face-to-face mentoring, webinars and quarterly meetings. So that’s a real lynchpin to the work that we’ve been doing with the practices.”

“The care coordinators work metaphorically shoulder-to-shoulder, side-by-side with the physicians, the nurses and physicians’ assistants in the clinical practices.”

Seven deadly sins of management

May 3, 2015by Robert Whitcomb in Uncategorized tagged ,

mammon

“The Worship of Mammon” (painting) by Evelyn De Morgan, painted in 1909.

There’s  guidance that’s very applicable to C-suites in healthcare in management historian Morgen Witzel’s latest book, Managing for Success: Spotting Danger Signals — And Fixing Problems Before They Happen.

Mr. Witzel talks about the seven deadly sins of management — arrogance, ignorance, fear, greed, lust, linear thinking and lack of purpose. And he really does mean “deadly” since these sins can kill organizations.

He gives rich examples — most noteworthy the  rapid ascent and slow decline of Ford, after Henry Ford succumbed to hubris and greed, and the cataclysmic collapse of Lehman Bros. in 2008, which led immediately to the Great Recession.

His book’s makes it clear that  many disasters don’t result from  a single decision or a single bad leader but from  years  in which the seven sins poison corporate cultures.

 

 

 

Going after conflicts of interest

May 3, 2015by Robert Whitcomb in Uncategorized tagged

nast

Here’s a review of efforts to address the huge financial conflicts of interests that some physicians with investments in medical-device and pharmaceutical companies have when they prescribe their use for their patients.

Happily, a new federal database is starting to make these conflicts more visible to patients, regulators and even law-enforcement agencies. The federal Anti-Kickback Statute generally outlaws payments that reward someone to refer patients for treatments under government insurance programs.

The new Open Payments data from the Centers for Medicare and Medicaid Services (CMS) cover many types of financial relationships besides investments, such as consulting deals, free travel for conferences and straight gifts. The disclosure program was created as part of the Affordable Care Act to show hidden financial relationships in medicine  as healthcare costs surge.

The Minneapolis Star Tribune (which has some of the best healthcare coverage of any newspaper in America) reports that U.S. physicians had “investments worth more than $1 billion in device companies and drugmakers at the end of 2013, not including holdings in mutual funds and retirement accounts, which didn’t have to be reported because their impact is considered negligible.”

Gimlet eye on biomedical model for med school

May 3, 2015by Robert Whitcomb in Uncategorized tagged ,

 

John Henning Schumann, M.D., writes about how “the biomedical model of educating doctors, based largely on a century-old document called The Flexner Report, is coming under fire.”

“Instead, the new theory goes, students should be taught and evaluated on their ability to find, assess and synthesize knowledge. And they should be educated in teams to help prepare them for what goes on in the real world.”

“From another angle, critics of the {Abraham} Flexner model correctly point out that Flexner himself, an educational theorist with no medical training, was silent on issues such as poverty, housing, nutrition and other factors that we now call the social determinants of health.”

“Over the years since then, more research has shed light on the economic and health impact of social determinants. ”

Dr. Schumann said he has been pleasantly surprised by how many “medical schools are now getting serious about the importance of social determinants.”

 

 

Big insurer to include phone and video consults in network

May 3, 2015by Robert Whitcomb in Uncategorized tagged , , ,

mobilephone

As insurers strive  to keep operating profits high, some are making it easier for patients to consult physicians by smartphone. This would presumably keep more patients out of the hospital.Consider UnitedHealthCare,  the huge Minneapolis-based company, which plans to include phone or video consults in its coverage network. Boston-based American Well, a telemedicine service,  is one of three providers approved for UHC’s system, reports The Boston Globe.The Globe reports that “UHC will also support visits through Doctor on Demand, based in San Francisco, and NowClinic, a mobile service offered by Minnesota-based Optum. At launch, UHC will only accept claims from people who pay for their own insurance, but the insurer says it intends to include health plans funded by employers next year.”

Thus the push to keep outpatients from becoming inpatients continues.

 

 

Kaiser Permanente CEO suprisingly optimistic

May 1, 2015by Robert Whitcomb in Uncategorized tagged ,

 

Bernard J. Tyson, chairman and CEO of Oakland, Calif.-based Kaiser Permanente, told Fortune magazine he is more optimistic about the U.S. healthcare system now than ever, despite the possible dissolution of the Affordable Care Act and other challenges.

 Here are five key points from his conversation.

1. Medical institutions must shift focus to patient outcomes.

2. Changing how individuals approach their health will change the healthcare system.

3. Embrace email.

4. Interoperability must a priority.

5. The spiraling cost of drugs poses a major hurdle for healthcare reform.

 

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