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CEOs had expected more progress on value-based care

FierceHealthcare reports:

“Healthcare CEOs admit they thought they’d be farther along in the transition to value-based care than they are today, a new survey shows. 

“Consulting firm Deloitte polled 25 hospital CEOs and 6 payer CEOs, all running companies with at least $1 billion in annual revenue, on their perspectives on a slew of industry issues and found that they’re shifting investment focus to consumer tech and improving care coordination, including through virtual health. 

“Many CEOs in our prior studies predicted that they would be much further along in adopting value-based payment models than they are today,” the analysts wrote. “They admit now that progress was much slower because efforts were much harder than they anticipated.” 

To read the full article, please hit this link.


Leadership development needs ‘mentors-of-the- moment’

In a Harvard Business Review article, W. Brad Johnson and David G. Smith argue that an organization’s culture, not specific mentoring programs, is most important in developing leaders.

Among their observations:

“Here is the problem: Mentoring programs typically rely on single mentor-mentee matches, pairings that by nature are quite formal and hierarchical, when all the evidence shows that many employees — especially women — prefer mentorships with a more reciprocal and mutual character. Single mentors are also less career-enhancing than robust developmental networks or mentoring constellations. What’s more, even the best mentoring programs are unlikely to achieve intended outcomes when the surrounding workplace is competitive and individualistic, and when senior members of the organization only engage in developing junior talent when pursued by a prospective mentee or “voluntold” to participate in formal program.”

“Mentoring programs alone won’t sufficiently engage or develop your junior talent, especially if your culture doesn’t encourage mentoring on a regular basis. What your company needs instead are mentors-of-the-moment.”

Among their conclusions:

“Genuine mentoring values and daily mentoring behaviors must be embedded in the workplace DNA. Not only can mentor-of-the-moment exchanges offer a less-threatening alternative to an assigned ‘relationship,’ they also fuel inclusion. Actively engaging colleagues with diverse experiences in frequent, transparent, affirming conversations may be less daunting than a formal assignment, especially when it is a clearly articulated performance expectation.”

To read the whole article, please hit this link.


Providence St. Joseph Health’s’ ‘tight, loose, tight’ management style

In an NEJM Catalyst article, Amy Compton-Phillips, M.D., executive vice president and chief clinical officer for Providence St. Joseph Health, based in Renton, Wash., and serving large parts of the western U.S., describes how her organization’s simple model has led to substantive change there in managing complex, seemingly intractable health-care problems.

Among her remarks:

“Since 2015, Providence St. Joseph Health has employed a simple model for leading complex change at scale. The simple concepts that we used to achieve meaningful change can be summarized into five essential foci: Vision (the ‘Why’), Trust (the ‘Who’), Data (the ‘What’), Capacity (the ‘How’), and Alignment (the ‘What’s In It For Me?’). PSJH has applied this change model along with a ‘tight, loose, tight’ management style, which serves to standardize a few critical elements across the system while allowing each local group to customize implementation based on their context, environment, and innovation.”

To read her article, please hit this link.


Many organizations lag in physician-leadership training programs

An article in NEJM Catalyst by Gary S. Kaplan, M.D., and Stephen Swensen, M.D., about training physician leaders, says that “Leadership is teachable, and leadership development and training are important, according to NEJM Catalyst’s recent Insights Council survey on the topic. Yet the same survey reveals that more than half of respondents think their organizations’ efforts to develop and train leaders are lacking in quality and time commitment.”

Dr. Gary Kaplan, chairman and CEO at Virginia Mason Health System in Seattle, finds these results concerning, especially as the complexity of delivering health care continues to increase. ‘Leadership doesn’t just happen,’ he says. ‘We need strong leaders for greater focus and to execute improvement work in organizations and the health care industry overall.”’

“Internal leadership training programs are the top approach used at Insights Council members’ organizations, by a wide margin, ” the article says.

To read the article, please hit this link.


More ACO’s, fewer small practices

From FierceHealthcare:

“Researchers examined changes in physician practice sizes associated with ACO market penetration three years after the launch of the Medicare Shared Savings Program, which began in 2012 and is one of the country’s largest ACO programs. In counties with more ACOs, they found more large practices and fewer small practices, according to a study published in Health Affairs.

“And they found evidence suggesting that ACO-driven physician consolidation is accelerating. ‘These patterns suggest that the consolidation concerns initially raised regarding ACOs were warranted and that gains from care coordination facilitated by ACOs will have to be balanced against higher prices and possibly lower-quality care that could result from consolidation,’ the study authors said.

“The catch is that while ACOs are associated with higher quality and lower costs, consolidation of physician practices is associated with lower quality and higher prices in some settings.”

To read the whole article, please hit this link.


How will AI affect health-care delivery?

Authors of an article in NEJM Catalyt look at how artificial intelligence will affect health-care delivery. Among the conclusions:

“{H}umans still will be required to sustain the core doctor-patient relationship, and several universal obstacles could hinder the pace of AI adoption in health care delivery for the foreseeable future. For example, development of AI technology requires access to data sources that accurately and equitably reflect the general patient population. However, medical AI is likely to emerge in high-resource settings, such as academic medical centers, leading to contextual bias when it is deployed in lower-resource settings such as community health centers or rural areas. Additionally, developers must attain physician and staff buy-in regarding using AI in clinical practice. Despite great promise, some digital health tools have faltered at the stage of clinical adoption and diffusion.

“Finally, questions remain about reimbursement, liability, and regulation. In the U.S., the FDA has been establishing regulatory policies and guidelines around software and digital health. The agency has, for example, built a pre-certification program aimed at making sure consumers have access to high-quality digital health products.”

To read the article, please hit this link.


Should systems buy or build?

An NEJM Catalyst article looks at whether health systems should buy or build to expand. Among the comments:

“As in many industries, health care has experienced waves of consolidation in the name of growth. Hospitals have bought physician practices, doctors are opening ambulatory surgical centers, and there is a buy free-for-all across all parts of the continuum of care (and new forms of payment) as never before. Such vertical integration purportedly drives financial efficiencies with scale, improves clinical quality by reducing problems of care transitions, encourages teamwork, and calibrates scope of practice to services provided. Yet the jury is still out. Costs continue to rise as the market power of health systems grow (with lots of finger pointing), readmissions and problems in patient handoffs persist, anticompetitive practices emerge, and quality remains highly variable.

“Perhaps this lack of progress toward the Triple Aim suggests that we should reconsider our assumptions that vertically integrated systems will achieve productivity, patient-centeredness, and will deliver on a scalable version of Kaiser Permanente. Perhaps we should revisit the so-called rules of health care.”

To read the article, please hit this link.


Peer advice on managing a practice

Physicians Practice surveyed 943 practice owners, managers and physicians to ask them about their staffing challenges and solutions. To read the report, please hit this link.


How to respond as new tech invades health care

Picture: Visualization of some Internet routes

— The Opte Project

Namita Seth Mohta, M.D., David Blumenthal, M.D., MPP, president of The Commonwealth Fund, and Robert Galvin, M.D., MBA, chief executive officer for Equity Healthcare discuss why and how big private-sector health-care organizations are responding to the onrush of technology into the sector.

One of Dr. Galvin’s observations:

“Sometimes the unintended consequences exceed the benefits, to be honest. When you get into a system as big as health care, as resistant to change in health care, and inherently much more complicated, this is not buying goods and services over Amazon; this is not getting an Uber or using Lyft. These are in many cases very sick people with complicated diseases in a system that’s already very complicated.

“One unintended consequence is you make it more complicated for people, so the number of choices they have — and the array of opportunities they have to access these apps — can be overwhelming. The misinformation is another unintended consequence; I’m not sure how good Alexa is going to be, or whether there’s going to be any clinical judgment in Alexa. If you go onto the Web and look for health care information, it’s as likely to be inaccurate as it is to be accurate.”

To read and hear the full discussion, please hit this link.


Warning about ‘medical directors’

An article in Physicians Practice warns practices and hospitals:

“There are often situations where a physician holds the title of medical director. The physician, however, does not necessarily perform any substantive roles or functions, but the title is sometimes given to induce patient referrals to the facility. These types of situations can — and do — give rise to liability under the False Claims Act….”

“Sham medical director agreements to induce patient referrals violate the Anti-Kickback Statute and Stark Law. Doctor’s Choice also allegedly paid some employees in a manner that accounted for the volume of referrals by their physician spouses, in violation of the Stark Law….”

“Physicians, medical professionals and facilities should appreciate the legal liability for not performing the requisite functions. They should also ensure they are meeting an Anti-Kickback safe harbor and a Stark Law exception.” 

To read the whole article, please hit this link.


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