Saturday, February 18, 2012 - 04:47
Newtown, CT - February 17, 2012
Following the First World War, the French built the Maginot line to protect themselves from another invasion. The Germans simply went around it - Faced with a potentially disruptive force, incumbents react in one of two ways: they innovate or they protect. We see both happening today at a breathtaking pace. Let's start with the basics, the campaign by the American Board of Internal Medicine to encourage Medical Specialty Societies to voluntarily identify five procedures that are commonly overused....
Saturday, February 11, 2012 - 06:18
Newtown, CT - February 10, 2012
Over ten years ago, the Nobel Prize in Economics was awarded for work done on information asymmetries, a topic that was first brought to the attention of health care industry leaders in the 1960s by Kenneth Arrow - and fifty years later we continue to suffer from information asymmetries in healthcare, mostly due to the continued opacity in price and quality. In a recent blog post, Uwe Reinhardt...
Saturday, February 4, 2012 - 04:23
Newtown, CT - February 3, 2012
If, as recently reported by the CBO, high touch care management and payment reform work, why aren't they being widely deployed? This is our collective $500 billion question, because that's roughly what would be saved if you add up the impact from these interventions. With that much at stake, public and private sector payers should be rushing in. Some are, but many aren't. Our work suggests that incentives matter and impact behaviors, so let's examine who would significantly benefit (or not) from...
Saturday, January 28, 2012 - 06:01
Newtown, CT - January 27, 2012
For those who want the truth about effective care management and payment reform, here it is: it's hard work and there aren't any shortcuts - Last week's reports by the Congressional Budget Office on these two topics are a must read for anyone who actually wants to know what to do (and not to do) to affect change. Importantly, when done right, payment and care management reforms work. They save money and improve quality. But it's hard work....
Saturday, January 21, 2012 - 04:59
Newtown, CT - January 20, 2012
Something's going on, and passing it off to the Great Recession is no longer holding water - The CMS's report on the growth of health care spend in 2010, and the Altarum Institute's estimates of 2011 both continue to provide good news for all: price growth has significantly slowed. For the first time in decades, healthcare price inflation is not much greater than...
Saturday, January 14, 2012 - 06:14
Newtown, CT - January 13, 2012
Each quarter we highlight field activities and opinions from experts in our Newsletter, Improving Incentives - in this latest issue, you'll read about the launch of a new bundled payment initiative in Wisconsin, led by the Robert Wood Johnson Foundation's Aligning Forces for Quality...
Friday, January 6, 2012 - 10:09
Newtown, CT - January 6, 2012
As we start 2012, it's appropriate to reflect on the distance travelled in 2011 and the distance to be travelled these next twelve months - First, the leadership at the Innovation Center has yielded tremendous dividends in shifting the industry's mindset from volume to value-based payment. The responses to the various initiatives - ACO Pioneer, Bundled...
Friday, December 23, 2011 - 02:36
Newtown, CT - December 22, 2011
Consumers understanding that avoidable complications are costly, ever-improving information on the quality and cost of care, and smart apps that help consumers find the care they need - If these are on your Christmas wish list, then Christmas has come early (and you can ask for more routine things that won't have your family shaking their heads). Last week, our friends at the Consumer-Purchaser Disclosure Project held an audio conference during which Shoshanna Sofaer presented some...
Saturday, December 17, 2011 - 04:24
Newtown, CT - December 16, 2011
PepsiCo recently announced that it would waive employee costs for having certain surgeries done at Johns Hopkins. Perhaps it should consider Stockholm as well - Employers are increasingly designating Centers of Excellence for more routine elective procedures such as total knee replacements (TKR) and minimally invasive cardiac procedures. And some are establishing reference prices for preventive procedures such as...
Friday, December 9, 2011 - 07:21
Newtown, CT - December 9, 2011
There's an important principle of organizational change that, to date, has been mostly ignored: Form follows function, and function follows incentives - so the key is really to focus on the function (e.g. delivering highly coordinated care to reduce avoidable complications) and then determine what set of incentives will cause that function to occur. The form of the organization best suited to deliver that function (or set of functions) will then follow organically. The "social engineers" have...
Saturday, December 3, 2011 - 06:45
Newtown, CT - December 2, 2011
A Perspective by Bohmer in this week's NEJM identifies four habits of successful high value health systems, that can be summarized into two management principles -- organizations (large and small) need relevant and timely feedback loops on their performance, and effective managers are provided with clear boundaries for their management, accounting and accountability. These principles have been in place in successful companies in all other industries for...
Friday, November 25, 2011 - 11:13
Newtown, CT - November 25, 2011
For every pro, there always seems to be a con (and vice versa), which can lead to inaction - The recently released final regulations for Accountable Care Organizations have, more than others, elicited strong comments from both pros and cons. In a BNA-sponsored paper, Lara Cartwright-Smith, Jane Hyatt Thorpe, and Sara Rosenbaum articulate many arguments as to why the final ACO regulations strike a good balance, and provide an...
Saturday, November 19, 2011 - 03:27
Newtown, CT - November 18, 2011
Rockford, IL, is one of three original PROMETHEUS pilot sites and today we report on findings from that implementation - Last week Health Affairs released a qualitative review of three implementation sites, relating the impressions of the evaluators, gleaned from a few phone interviews and a couple of site visits. This week we release a comprehensive qualitative and quantitative report on one site, with more to follow in the coming months. It...
Saturday, November 12, 2011 - 03:31
Newtown, CT - November 11, 2011
It's really pathetic when a reputable research organization sacrifices the integrity of their work for the sake of a few cheap headlines - And yet that's what RAND did this week. They issued a press release with this title: Bundling Payments To Curb Health Care Costs Proves Difficult To Realize. Now, I don't know about you, but to the casual and not so casual reader, that headline implies that bundling payment to contain health care costs doesn't work. And, in fact, that's the erroneous conclusion drawn...
Friday, November 4, 2011 - 18:00
Newtown, CT - November 4, 2011
Today is the day - By close of business, the window to file a letter of intent for the CMMI Bundled Payment pilot will be shut. The preliminary numbers are very strong and if the final rush holds, the Innovation Center will have quite an announcement to make early next week. Of course, an LOI does not an Application make, nor does it guarantee participation. But the overwhelmingly positive response to the request shows how much closer we've gotten to the proverbial tipping point....
Saturday, October 29, 2011 - 04:41
Newtown, CT - October 28, 2011
Why do smart professionals who individually get an A, collectively get a D - the grade given the US in the Commonwealth Fund's latest scorecard. It's mostly because they've turned into piece workers, focusing on their individual tasks and not on the patient's total care. They (and their patients) have become the victims of Taylorism, decades after the rest of the sectors of the economy...
Friday, October 21, 2011 - 05:48
Newtown, CT - October 21, 2011
It's taken more than 30 years, but Jerry Solon must be smiling from heaven - In 1967, Dr. Solon published a paper in which he describes a novel way to measure the use of services, one that would be more consistent with the way physicians treat and manage a patient's condition or illness. He called it the analysis of an episode of medical care. Two years later he published another...
Saturday, October 15, 2011 - 03:14
Newtown, CT - October 14, 2011
There's nothing more infuriating than hearing hospitals complain that lower costs for those who pay for health care means lower revenues to them and potentially fewer jobs - it's infuriating because while their bank accounts have gotten fatter, and their buildings have gotten shinier and bigger, the average income of an American family has decreased by 7% in the last decade. And as we reported recently, much of that decrease was caused by higher...
Saturday, October 8, 2011 - 00:16
Newtown, CT - October 7, 2011
As episode of care payment (a.k.a. Bundled Payment) becomes more prevalent, private and public sector payers will have to work through member benefit issues - in particular when bundled payments are prospective budgets against which FFS claims accumulate. This and other internal plan operations issues reveal the antiquated nature of the claims and benefit platforms that have inflated US healthcare spend. For every problem, however, there are solutions, and ...
Saturday, October 1, 2011 - 00:12
Newtown, CT - September 30, 2011
Our third-quarter newsletter comes out at an important time in the transformation of the U.S. health care system - A few weeks ago, CMS' Innovation Center launched the boldest and broadest pilot program in the agency's history. Hospitals, physicians, health plans, and coalitions around the country have a unique opportunity to prove that they are willing to walk the walk. Delivering high-value...
Friday, September 23, 2011 - 09:44
Newtown, CT - September 23, 2011
Earlier this week, Andy Webber and his team at NBCH hosted a webinar on the CMMI Bundled Payment Pilot - Valinda Rutledge, who is heading up this important effort at the Innovation Center, reviewed the different models available to potential applicants, and I was struck again by the significant flexibility of the program. There is a downside to having too many options; it can sometimes lead to analysis paralysis. Last week we unveiled...
Friday, September 16, 2011 - 09:14
HCI3 Update from the Field - Newtown, CT
Fall is a few days away and it's time to plant the bulbs that will come out in Spring - Many of those bulbs should be the Letters of Intent by Applicant-providers and other conveners for the Bundled Payment Pilot, and they will come out in the early Spring of 2012 when CMS awards the pilot status to those who have successfully filed applications and received high enough...
Friday, September 9, 2011 - 18:00
Newtown, CT - September 9, 2011
As we approach the sad tenth anniversary of the September 11th 2001 events, we must take pause to consider the path traveled since and the path we must travel from now on - On September 11th 2001, I was in Kentucky, with one of my sons, waiting to present to hospitals in Anthem's network that participated in its quality improvement and incentives program. The talk was focused on the Leapfrog Group's efforts and the imperative for hospitals across the country to report on these few important measures in a very public...
Friday, September 2, 2011 - 16:00
HCI3 Update from the Field - Newtown, CT
The day the CMMI announced its Bundled Payment pilots, there were two tectonic shifts - the first shook the East Coast of the US, and the second will continue to shake the health care industry for years to come. In launching what could be the largest shift in mode of payment in the history of Medicare, CMS has sent a definitive signal to hospitals, physicians, and other health care providers that the day of value-based payment has come. The four models currently included in Phase 1 cover inpatient stays...
Tuesday, August 23, 2011 - 11:39
HCI3 Update from the Field - Newtown, CT
Hallelujah! - Today, Rick Gilfillan and Valinda Rutledge announced the CMMI's rollout of a national pilot to pay a bundle of services for a comprehensive episode of care. The plan is simple and elegant, broad and appealing, and builds on the successes of current CMS and private sector efforts. It's a huge step in the right direction and the CMMI should be commended and...
Saturday, August 20, 2011 - 03:58
HCI3 Update from the Field - Newtown, CT
Positive deviants can be defined as organizations whose results are significantly and positively better than others - and a study published in the Annals of Internal Medicine a few months ago by Leslie Curry and colleagues at Yale, identifies some key characteristics of these positive deviants. The study focused on hospitals that had shown to be in the top 5% of performance in AMI survival rates for at least two consecutive years, and...
Saturday, August 13, 2011 - 03:49
HCI3 Update from the Field - Newtown, CT
The time gap between knowledge acquisition and formal dissemination of that knowledge in peer-reviewed journals is maddeningly long - especially in an environment in which solutions are desperately needed today. This week we found out that some of our research will be published in early October in the American Journal of Managed Care. The study reveals what we've known and seen in our work for some time, namely that much of the variation in episode costs within a plan's network comes from the...
Friday, August 5, 2011 - 16:00
HCI3 Update from the Field - Newtown, CT
In a week in which gloomy news has been followed by gloomier news, we were privileged to witness how payment reform efforts are having a really positive effect - some of our implementation partners got together earlier this week to share some lessons learned from rolling out episode of care payment, and they were truly encouraging. First, the focus on managing a patient through a complete episode is prompting physicians and hospitals to communicate. They're sharing best practices; they're finding...
Friday, July 29, 2011 - 09:00
HCI3 Update from the Field - Newtown, CT
Trajectories can be changed, and will be changed if everyone truly steps up to take a swing - two studies released this week provide a bleak picture of our current and future well-being if the status quo remains. First, an issue brief from the Commonwealth Fund on a recent OECD report shows that the US continues to outpace every other nation in spending on health care....
Friday, July 22, 2011 - 09:00
HCI3 Update from the Field - Newtown, CT
18 months and counting - that's the amount of time CMS has to launch the national episode of care pilot. In a new report released earlier this week by the Center for American Progress, Harriet Komisar, Judy Feder and Paul Ginsburg outline some important recommendations for CMS to make this pilot a true success. At a meeting on Monday to...
Friday, July 15, 2011 - 11:28
HCI3 Update from the Field - Newtown, CT
A number of papers in this week's NEJM remind us of our challenges and opportunities - and do so in an adult and constructive dialogue that is quite refreshing given the imbecility currently reigning over the debt ceiling discussions. Mike Chernew and Katherine Baicker remind us that even in the best of circumstances, the growth in Medicare spending will have to require some increase in allocation of general revenues (and therefore...
Friday, July 8, 2011 - 18:00
HCI3 Update from the Field - Newtown, CT
Every quarter we release more in-depth news from the field - and this quarter is no different. In this newsletter we introduce several columns from our Board members. The Lawyer's Brief reviews some of the issues that providers face when initiating clinical collaboration. The...
Friday, July 1, 2011 - 09:17
HCI3 Update from the Field - Newtown, CT
When the CFOs of many of the country's hospital systems got together this week at the HFMA's annual conference, the talk was all about the conversion from volume to value-based payment - that's more than just a small shift and shows how significantly the 2009 debate on health care and the 2010 passage of the ACA has changed mindsets. There are two reports that the HFMA has released this week that are important to read. The...
Friday, June 24, 2011 - 09:09
HCI3 Update from the Field - Newtown, CT
Turning data into actionable information is hard but essential in the effort to transform practices - and many times, it doesn't take a huge organization to do it. A case in point is the work Dr. Brenner did in NJ to identify "hot spots" - areas in the community that were responsible for the majority of ED and other hospital admissions. Similarly, our continued work with practices across the country to achieve...
Friday, June 17, 2011 - 05:04
HCI3 Update from the Field - Newtown, CT
How can we move away from the status quo if we bake it into the design of new programs? We can't and shouldn't. Which is why I encourage everyone to carefully read the recent letter from the Consumer-Purchaser Disclosure Project to CMS on the proposed regulations for ACOs, a letter to which we've signed on. The point made is simple: it doesn't matter...
Friday, June 10, 2011 - 05:45
HCI3 Update from the Field - Newtown, CT
When does "no we can't" become "no we won't" - when the technical and operational barriers to implementing an innovative or disruptive program have been removed. At that point, what's left is the unwillingness to innovate or disrupt, not the ability. Many employers over the years have been met with "no we can't" from their plan administrators, and then spent the following years creating the prototypes, figuring out the operational bugs, and then presenting the solutions...
Friday, June 3, 2011 - 18:00
HCI3 Update from the Field - Newtown, CT
There's an interesting contrast between what most of us think is right and what consumers want - Atul Gawande's recent commencement address to the graduating class of the Harvard Medical School perfectly encapsulates what most of us know to be true: that practicing medicine the right way is a team sport. The number of known treatments corresponding to the...
