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Population health in a community hospital ACO

An article in Health Affairs asks:

“{W}hen it comes to actual operations, what does ‘population health’ look like in an ACO, particularly in ACOs led by community hospitals? Do ACOs see their role in population health management as caring for their patient populations as a whole? Patients in their catchment areas? In their communities? And how do those views ‘sync’ with the care delivery and partnership approaches that hospital-based ACOs are actually using?”

“But when ACO leaders were asked what sorts of community health programs and services they were either employing or planning to employ within six months, the top three answers were, instead, related to care coordination, chronic-disease management, and health education.

“Similar to the aforementioned reasoning, this suggests that many ACOs may be taking a ‘walk before they run’ approach, establishing basic ACO infrastructure first before tackling more targeted community needs. It also implies that an additional focus may be needed on helping ACOs to expand their view—and services—beyond their current patient population.

“Likewise, while 71 percent of ACO leaders are either offering, or plan to offer, integrated physical and behavioral health services … fewer than 25 percent believe their ACOs will have adequate numbers of behavioral health staff to meet their populations’ needs.”

To read the Health Affairs article, please hit this link.

Program coordinating diabetes, cardio and depression treatment is touted


A nationwide initiative called COMPASS (Care of Mental, Physical and Substance-use Syndromes) is being touted for successfully coordinating patients’ diabetes and cardiovascular treatment with mental-health care to both reduce depression and improve patients’ glucose and blood-pressure numbers.

Patients  in the initiative talked at least once a month with  care managers, who worked with the patients and primary-care physicians to address  patients’ depression and medication for diabetes, hypertension or both.

Forty percent of patients with uncontrolled disease at enrollment achieved depression remission or response; 23 percent achieved glucose control, and 58 percent achieved blood-pressure control during an 11th-month followup.

Care managers had either behavioral health or  regular medical training.

The Center for Medicare and Medication Innovation funded the $18-million, three-year initiative.

“This was a successful wide-scale implementation of a collaborative care model that demonstrated it can be used in a variety of health care settings with positive effects for providers and patients,” Karen J. Coleman, Ph.D.,  of Kaiser Permanente Southern California Department of Research & Evaluation, said.

She added said that the study indicates that patients with mild and moderate depression can be cared for in a primary-care setting.

“Depression is a chronic disease like diabetes,” she  said. “Healthy behavioral changes like sleep, exercise, and better eating can improve diabetes and depression.

To read an article on this program, please hit this link.

3 big areas for new, profitable healthcare investment


Kapila Ratnam,  a partner at NewSpring Capital and NewSpring Healthcare, identifies and discusses  in MedCity News three areas of healthcare with big investment potential:

Behavioral Health

“According to the National Institute of Mental Health, approximately 10 million people experience a serious mental illness in a given year that substantially interferes with or limits one or more major life activities – evidence that behavioral health services are becoming increasingly necessary. While financing options for these services continue to improve,…the lack of available behavioral health service options is creating a growing demand. In fact, many people today with mental health issues are not receiving the proper treatment they require.”

“The  space has continued to see a number of growing opportunities since the introduction of legislative moves…. Additionally, regardless of this year’s election outcome, many aspects of the behavioral health market won’t change, making it appealing for prime investments in the near future.”

Home Health

“To combat the high cost of healthcare, we are starting to see a much-needed shift from a fee-for-service to a, which focuses on the quality of care that patients receive, rather than the number of services billed. Therefore, many providers are now being rewarded for keeping patients out of the hospital, which is the most expensive point of medical intervention, whereas the home is the cheapest. As this shift takes effect, providers are now incurring more risk, so it’s critical to establish home health networks that are efficient, safe, and convenient for patients out of treatment.”

“As investors, we are interested in the most cost-effective and care-effective home health services. Specifically, connected health technologies such as mobile apps, sensors and wearables that help patients proactively manage their health, offer tremendous investment opportunities.”

Big Pharma Outsourcing

“The pharmaceutical industry is currently battling a mounting number of issues, including shrinking profit margins, heavy competition, a cost-heavy structure, increased regulatory pressure, growing expenses, and more. Faced with these challenges, Big Pharma has shifted their business models. More specifically, they have embraced outsourcing as a way to drive economies of scale without hindering their operations. ”

As private equity investors, {we find that} the explosion of outsourcing over the last 10 years has created promising opportunities. We find the most value in companies that focus on cost saving initiatives for big pharma companies, provide a niche service — such as software — that either allows sponsors to access real-time data on clinical trials, or better manages patients or data or both. ”

To read the full article, please hit this link.

Brown wants more money for value-based-payment initiatives


California Gov. Jerry Brown has backed spending  more money for value-based payment initiatives and behavioral-health programs in the state’s Medicaid program and also wants to spend more money on covering healthcare expenses of immigrant children up to age 19 who are in the United States illegally.

Still, despite  modest increases in funding for Medi-Cal, the state’s Medicaid program, patient advocates complained that the revisions do little to restore $15 billion in cuts made during the Great Recession and its aftermath.

Universal Health CEO talks about behavioral health, bundled payments


This Modern Healthcare article with Alan Miller, chairman and CEO of the big for-profit hospital chain Universal Health Services, is well worth reading. His comments on behavioral health we found particularly interesting.

“One thing that was very helpful is that three years ago, we managed to buy the second-largest {behavioral-health} company, Psychiatric Solutions, when some of its leaders tried to take the company private and the board said no. …We had about 100 hospitals and they had about 100 hospitals. By putting them together, we got about 200 hospitals, and our company became the dominant entity in the free-standing psych business. We consolidated a good number of the free-standing psychiatric hospitals in the country.”

He was asked if  the political talk about expanding and improving behavioral health and substance-abuse treatment is going to benefit  his company.

He answered:  “Definitely, definitely. We provide excellent care, and there seems to be more of a need now, a better focus. A study just came out on the increase in suicides in the U.S. You have people with bipolar disorders, schizophrenia and depression, which leads to these suicides. These people are not taking their lives lightly. They’re suffering greatly. So there should be more treatment open to them. There are great stresses in our society, and I think sometimes drugs and alcohol are a reaction to that. Families, at one time, used to be ashamed or would hide mental illness. Now we realize that mental ailments are a sickness like physical ailments that can be treated, and there’s nothing to be ashamed of.”

And he said his company is open to new markets. “Since we are pre-eminent in mental healthcare, a number of acute-care people are talking to us about joining them and providing that expertise to build or manage their capability in mental health, which they don’t feel secure in because it’s not their direct business. The future appears to be having a network that can take on financial risk and deal with the whole continuum of care, including mental health.”

Modern Healthcare asked him about the push for bundled payments to replace fee for service.

He answered:  “It’s slow. We’re involved in the demonstrations, but it’s not widespread. There’s a lot of conjecture that this ultimately might be where we’re going, that fee-for-service will go away, there’ll be bundled payments, and providers will take some risk.”


How to get primary care and behavioral health to march together


This article  by Benjamin Miller looks at creating a “culture of whole health” in which primary care and behavioral heath advance together.

A report looks at:

  • Organizing integration efforts.
  • Workforce training and other education.
  • Financing, with  the current fee-for-service payment system presenting huge barriers to team-based integrated care.
  • Technology.
  • Care delivery, with integrated-care delivery requiring curating and sharing evidence on integrating mental health and primary care and including prevention and health promotion. 
  • Population and Community Health: The effort must consider such social determinants of health as housing, education, employment and environmental conditions. 

A Chicago-area clinics chief is upbeat



Varsa Health’s platforms link BH patients, PC providers


Varsa Health has some intriguing  pilot programs dealing with population health. It’s particularly interested in new approaches to behavioral health, especially in finding ways to link behavioral-health specialists and care managers to primary-care providers.

One example from MedCity News of its approach is academic medical center using “Varsa Health’s platform to identify young adults at risk for behavioral health problems such as depression and anxiety. Patients are either directed to a kiosk within a provider’s office or are connected to a Web site through a mobile phone, tablet or computer. Users receive feedback based on their responses through short multimedia content tied to their health status. Care teams receive notifications for patients at an elevated risk for a behavioral health condition based their responses on the questionnaire.”

“Another pilot includes a rural health system with a patient population dominated by people with serious mental illness. The idea is to reduce the gaps in follow-up care for its patients. Through mobile devices from patients or provided by case managers doing home visits, patients will be prompted to give outcomes data in a digital format. The idea is to gather information about patients’ health status from their perspective.”


Shortage crisis in mental-health care


Herewith a look at the where and why of America’s shortage of mental-health clinicians. That shortage, of course, leads to a higher incidence of more obviously “physical illness”.

Consider that {m}ore than half of U.S. counties have no mental-health professionals and so ‘don’t have any access whatsoever,’ according to Thomas R. Insel, M.D., director of the National Institute of Mental Health, told The Washington Post. Most of the severely underserved areas are in the South and West.

“Nearly one in five adults — about 43 million people — had a diagnosable mental disorder within the past year. For nearly 10 million, the condition was serious enough to affect their ability to function day to day. Millions of adolescents also struggle with a debilitating mental disorder,” The Post said.

“Many people have become eligible for mental-health coverage under the  Affordable Care Act. Yet finding the professionals to deliver that care is increasingly tough.”

“Experts cite inadequate reimbursement from government and private insurance plans as one factor.

“‘A medical student leaves medical school and residency with the same amount of debt no matter their specialty, yet primary care and psychiatry are professions with some of the lowest annual salaries,”‘ Chuck Ingoglia, senior vice president for public policy at the National Council for Behavioral Health, told the newspaper.

‘”If you look at the valuation for an hour of therapy, you could say we pay plumbers, carpenters and handymen more than we pay for behavioral health,”‘ said  Paul Gionfriddo, president of Mental Health America.


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.

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