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What makes for a successful ACO?

FierceHealthcare reports in a new article headlined “Considering becoming an ACO? These are the common traits of those most likely to succeed”:

“As the feds look to push accountable care organizations to more quickly take on greater risk, a new report highlights common traits of ACOs that have already successfully taken that leap. 

“Leavitt Partners analyzed ACOs across Medicare, including the Medicare Shared Savings Program, Pioneer ACOs and Next Generation ACOs, to find common threads among programs finding success and identify ways to better support those that are being left behind. 

”The report found that larger, more experienced ACOs were more likely to switch to tracks with higher risk than younger programs. ACOs taking on greater downside risk were more likely to be in urban or metropolitan areas, according to the study. ”

To read the whole article, please hit this link.

Providers’ role in curbing health-care costs

In an NEJM Catalyst video, Harvard Health Care Policy Prof. Michael Chernew discusses strategies to control health-care costs. He notes that those costs have historically grown at 2 percentage points higher than personal income.

“That cannot happen indefinitely. We will have no clothes. We will have no food. We’ll have no shelter, but we’ll just be very healthy.”

“I do not believe that the payment system will drive us to success, necessarily, but I certainly think the payment system, if we’re not careful, can be an impediment to success. We need to design a payment system that will allow organizations that can find efficiencies, to have those incentives to create those efficiencies. And the notion is we share the savings. Why? Because if you won’t share the savings there will not be savings to share.”

NEJM says he suggests, in NEJM words, “building payment models like population-based payment, where the delivery system assumes accountability for the full amount of spending and individual clinical outcomes, and bundled payments, assuming accountability, for an episode of care, and allow the provider system to rearrange the resources they need to provide that service or care for that patient more efficiently and share some of the fiscal savings it generates.”

To see the video and read the text version, please hit this link.


Shift training to meet market needs

Ole J. Thienhaus, M.D., in a Med Page Today piece headlined “Docs Shouldn’t Have to Do Everything: Let labor demands influence training,” writes that “if we are serious about meeting market needs, we will have to let ultimate labor demands influence the design of professional training programs. {For example} Using fully trained obstetricians and fetal-maternal health experts to deliver babies in low-risk situations is indefensible if midwives can provide the same service. Expanding this concept to all medical specialties would dramatically change the physician shortage calculus.

“But to fully take advantage of the inherent efficiencies, our clinical training paradigms have to shift quite radically. Such a shift, in turn, presupposes a flexibility about the definition of healthcare worker roles that is currently in short supply among the physicians in this country.”

To read his essay, please hit this link.

“The Doctor”, by Sir Samuel Luke Fildes (1843-1927).

The status and promise of ACO expansion

A piece in Medical Economics looks at current state of Accountable Care Organizations. It notes that “Transitioning the U.S. healthcare system from one driven by volume to one driven by value could take another 15 to 20 years, experts say. For the independent physician, there is ample opportunity to consider a leadership role in the evolution by joining an accountable care organization (ACO). 

”Federally regulated, fee-for-service Medicare ACOs are setting the standards for value-based payment structures nationwide, and participation remains voluntary. In Medicaid programs, 12 states are actively pursuing ACOs, with another 10 states pursuing the option. In the commercial market, all the large payers have their own versions of accountable care with a variety of benchmarks and reimbursement details. About half of all ACO contracts cover commercial populations, according to consulting firm Leavitt Partners.”

To read the article, please hit this link.


Restarting physician enthusiasm

To reignite physician enthusiasm to practice, NEJM Catalyst reports, “Cleveland Clinic’s Office of Professional Staff Affairs empowered a team of dedicated physicians to lead an effort to reinvigorate our culture. This group embarked on a town hall listening tour in 2016 to more clearly identify roadblocks to physician and scientist engagement and factors that contribute to burnout. After assembling the data from this listening tour into themes, we learned that communication topped the list of factors (20%), followed by technology (17%), workplace culture (16%), stress (16%), and staffing (16%).”

The article then describes in detail Cleveland Clinic’s programmatic response to these numbers.

To read the article please hit this link.

Measuring the benefits of physician coaching

An article in NEJM Catalyst reports:

“Effective clinician-patient communication is essential for high-quality care and is linked to better patient adherence and greater satisfaction for both patients and clinicians. Direct one-on-one coaching has the potential to improve clinician-patient communication as well as clinician and patient satisfaction compared with other techniques commonly used. We tested its effectiveness in a randomized controlled trial of 62 clinicians at Duke University School of Medicine.

“High-quality care depends on effective communication between clinicians and patients. Effective communication comprises several components of patient-centered communication, including exchanging information, enabling patient self-management, and managing emotions.

“Robust evidence links effective communication to important patient outcomes, such as better adherence to instructions, greater satisfaction, and fewer malpractice suits.

“Further, evidence shows links between communication and clinician satisfaction. Satisfied clinicians are less likely to depart from an already understaffed workforce and make fewer medical errors….

“We found that the coaching improved patient satisfaction ratings and clinician communication skills. Coaching represents a method of teaching that requires little clinician time and seems to have a positive impact. This is consistent with a recently published study that showed that four coaching sessions had a greater impact on oncologist communication than just one.”

To read the article, please hit this link.

Rembrandt’s “The Anatomy Lecture of Dr. Nicolaes Tulp.”

How to avoid making physicians obsolete

Milton Packer asks in a Med Page Today piece if biomarkers will eventually replace physicians. He concludes:

“{I}F you are a non-procedural physician — someone who is paid to interact with patients, make a diagnosis, order tests, and prescribe non-procedural treatments — your days may be numbered. Artificial intelligence can easily do all of these things, with no need for an expensive intermediary.

“Artificial intelligence can even be programmed to say hello, ask about symptoms, and provide comforting words. The computer would be very thorough and can be programmed to be very empathetic. Arguably, some patients might not even notice the absence of a human presence, or miss it.

“Fortunately, that day has not yet arrived.

“However, if you are a physician who robotically moves through their daily routine with minimal patient interaction and with a heavy reliance on ordering and treating biomarkers, you are only one step away from making yourself obsolete. In ten years from now, who will need you?

“So here is my advice to all healthcare providers: The mission of delivering healthcare is being a healer — a uniquely human experience. If you do not want to be replaced by a computer, then you should stop acting as if you are following a programmed algorithm.

“Think about that the next time you order your next routine biomarker.”

To read his whole piece, please hit this link.

After a heart attack some cardiac biomarkers can be measured to determine exactly when an attack occurred and its severity.

How to nurture a hospital

Madeline Bell, the CEO of Children’s Hospital of Philadelphia, discusses how to cultivate a better culture in hospitals. Among the observations of the former nurse in Becker’s Hospital Review:

The infrastructure has to be in place so you have collaborative space with ways to mine new ideas, cultivate them and take them to the next level. On the people side, it’s about hiring people with new ideas from outside of your organization and, at the same time, promoting the right people from within. Half my team is promoted from within and half come from the outside, so there are new ideas and ways of looking at things. The cultural piece is always a journey. Hospitals used to be relentlessly standardized and deliver things the same way, because you want to be highly reliable and not harm patients. That’s really important, but it has to coexist with the spirit of innovation and entrepreneurship. Hospital leaders and staff have to coexist with the idea that they can make mistakes and learn from them to think about new ways of solving problems.”

To read the whole article, please hit this link.

Orszag touts healthcare vertical integration, experimention

Peter Orszag, vice chairman and global co-head of healthcare at Lazard, discusses the need for vertical integration and experimentation in a piece in NEJM Catalyst, which summarizes four of his points thus:

  1. “There is significant opportunity to improve value in health care; recent research indicates both the availability of that value improvement and where it may reside.
  2. “To create and capture that improved value, it’s important to influence what doctors recommend.
  3. “To influence doctors’ recommendations, change the financial incentives and information that providers face. The best approach to doing that is vertical integration.
  4. “It is a mistake to elevate the status quo in asking whether the alternative is better than today. Instead, ask, “Is the alternative statistically worse than today?” If it’s a draw, try something else — experiment aggressively.’’

To read and hear his remarks, please hit this link.

5 steps to transform U.S. healthcare into a true ‘system


In a MedPage Today piece, Stephen Parodi, M.D.,  chairman of the Council of Accountable Physician Practices (CAPP), a coalition of multi-specialty medical groups and health systems,  presents five things needed to improve America’s mediocre medical-delivery world.

He notes that ”to improve the healthcare industry’s quality and costs, we need a true ‘system,’ with coordinated care delivered by teams linked by technology that closes the gaps in our current fragmented structure. ”

His five steps are, in an edited version:

More Value-Based Care

“First, we must continue the march toward value-based care and away from fee-for-service payments. Payment by service discourages the cooperation and collaboration each and every patient deserves. Fee-for-service payment increases the likelihood of poor communication. In contrast, when healthcare providers are paid based on their ability to improve the patient’s condition, the care team and the patient can come together to achieve common goals. Consequently, outcomes are better, and resources are used wisely.”


“Second, we need to accelerate the journey toward interoperability. Everyone on the care team needs the latest information on the patient’s condition, at their fingertips at all times. When everyone is connected to the medical record, the best, most timely decisions are made and errors avoided.”

Balance Digital and In-Person Care

“Third, we must rapidly move forward to leverage digital communication in patient care and in physician-to-physician consults.”

Address Drug Prices

“Fourth, high drug prices must be addressed and remedied. When patients can’t afford their medications, they can’t get the treatment needed. … Fortunately, there may be bipartisan support for solving this problem. We need better, independent data to assess new therapies so we truly understand which patients need a particular treatment. We need to subject high drug prices to public scrutiny and oversight and give Medicare, purchasers, and patients more tools to rein in escalating drug prices.”

Let’s Set Standards

“Finally, we must establish common consensus standards to measure quality care. Patients, health plans, providers, government entities – everyone needs clarity on the high-impact, minimum set of quality measures that capture outcomes and patient experience. We must leverage the electronic medical record to lower the administrative burden of collecting measures.”

To read his whole article, please hit this link.


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