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HCI3 Blog

Offering Up Relief in the Dog Days of Summer

Offering Up Relief in the Dog Days of Summer

In the dog days of summer we opened up the cooler to give everyone some lasting relief – Implementing innovative payment models is hard work, and it’s made all the harder when there’s endless discussions and debates about the boundaries of an episode of medical care for which a physician or hospital will take financial risk. Invariably these discussions center on how broadly or tightly the episode is defined. If it’s too tight, then payers aren’t interested because the volume of patients having those episodes will be too low, and the variability in costs and outcomes that we know exists will artificially disappear. If it’s too broad, then quasi-random variation is introduced which can put the provider at financial risk even when the management of the patient is excellent. To a certain extent, these decisions can be arbitrary and since neither party truly trusts the other, an entire effort can get bogged down or even defeated because no one can agree on the boundaries of a medical episode. These decisions have far more impact when there is a multi-payer initiative or when there’s little opportunity for back-end reconciliations. To-date, there haven’t been standard definitions around which we can establish some form of consensus. And that’s the relief we’re offering up.

What this means to you – During the past seven years, with the help and support of charitable foundations including the Commonwealth Fund, the Robert Wood Johnson Foundation, New York State Health Foundation and Colorado Health Foundation, we’ve been developing and field testing the definitions of our episodes, which we call Evidence-informed Case Rates (ECRs). While we certainly don’t claim they’re perfect, they have proven to be resilient enough to be useful and valuable in many implementations. We’ve now released them as open-source definitions that everyone can use for whatever purpose they may see as useful and valuable. Employers should consider using them to help define the prices for certain medical events such as elective procedures, whether it’s to provide those prices in transparency tools or to contract with providers in “carve-out” arrangements. That’s because methodology really matters when defining a medical episode for price comparisons, and we’re co-hosting a webinar in a few weeks with CPR to discuss some of these related issues. Health plans should consider using these definitions as the basis for their bundled payment arrangements to increase the level of acceptance by providers. To facilitate that acceptance, we’re openly explaining the rationale for how we’re building ECRs, and engaging in open discussions with clinicians and others via free monthly webinars focused on specific clinical domains. We’re going to continue to work very hard to refine the ECR definitions in a collaborative and open way so that, at the end, they can become a standard on which everyone can build innovative payment and benefit design solutions. And, hopefully, the relief we’re providing now to all who are toiling hard in the field can be enduring.

Sincerely,


 

Older Blog Posts

Saturday, August 30, 2014 - 03:28

In the dog days of summer we opened up the cooler to give everyone some lasting relief – Implementing innovative payment models is hard work, and it’s made all the harder when there’s endless discussions and debates about the boundaries of an episode of medical care for which a physician or hospital will take financial risk. Invariably these discussions center on how broadly or tightly the episode is defined. If it’s too tight, then payers aren’t interested because the volume of patients having those episodes will be too low, and the...

Saturday, August 23, 2014 - 05:36

As P.T. Barnum was fond of saying, without promotion something terrible happens....nothing - That's certainly not the only reason behind the recent announcement by the Cleveland Clinic and North Shore Long Island Jewish hospital to partner in a growing cardiac care network of "excellence", but it's a big reason. These self-promoted and described networks of excellence are forming in response to two important industry...

Wednesday, August 20, 2014 - 03:51

The push for improving the quality and affordability of health care is gaining momentum. It's an exciting, but challenging time as there is great need for additional support to implement successful payment reform programs.

To provide that much needed support, HCI3 has released episode of care, or Evidence-informed Case Rate (ECR), definitions for public use. An ECR is an entire episode of care that includes all covered services across all providers that would typically treat a patient for a single illness or...

Tuesday, August 19, 2014 - 02:26

More than 80 procedures and conditions now available; goal is 80% coverage of all costs of care by 2015

NEWTOWN, CT — August 19, 2014 — A new milestone toward health care payment and delivery reform has been reached with the release of more than 80 Evidence-informed Case Rate (ECR®) definitions from the non-profit Health Care Incentives Improvement Institute™, Inc. (HCI3). An ECR is an entire...

Saturday, August 16, 2014 - 08:21

When I was growing up, my doctor was Dr. Pomerantz. He knew me and I knew him. I can't say the same for my current PCP - And yes, times have changed, but it seems today that the importance of the personal relationship between the physician and the patient is in for a long overdue comeback. The transaction of individual care services desensitized the entire care system and the switch to payment for groups of services, whether in simple or more complex bundles, is forcing the delivery system to adapt to more comprehensive patient management than a single office...

Saturday, August 9, 2014 - 03:30

Here they go again twisting the truth for the sake of cheap headlines. Don't get taken in - In yet another piece of disingenuous writing that passes for "science", RAND has published an "evaluation" of the IHA's three-year bundled payment pilot. The more thorough explanations from Tom Williams and Jill Yegian are a must for those trying to get to the truth. One of the more astonishing omissions in the official evaluation, and that Tom...

Tuesday, August 5, 2014 - 05:18

HCI3’s Bridges to Excellence recognition program rewards clinicians who provide quality care to help patients manage chronic conditions

AUSTIN, TEXAS – AUGUST 5, 2014 – To improve care for Texans with diabetes, Superior HealthPlan is partnering with the non-profit Health Care Incentives Improvement Institute’s (HCI3) Bridges to Excellence (BTE) program. BTE is the nation...

Saturday, August 2, 2014 - 05:44

The Empire Strikes Back - Last week, UnitedHealthcare announced that it would make its price transparency tool available to everyone in the country, irrespective of whether they are a UHC member. Health4Me, which is the name of the app, provides consumers with price comparisons, by provider, by episode, and is very useful. While the release seems innocuous and even benign, it is anything but that. Since Castlight's inception, United has been...

Saturday, July 26, 2014 - 13:28

As the scrutiny on narrow networks increases, the argument by proponents focus on the inherent cost savings they bring - Consumers are being told that less choice means lower costs. That's got to be intuitive, right? The lack of consistency of that statement with every other consumer purchase is what health plans are going to have to explain. Why is it that in any other consumer purchasing experience, the increase in selection equates to increase in...

Saturday, July 19, 2014 - 06:48

We watch with horror as children are bombed in Gaza and blown out of the Ukraine sky, and the world's indignation mounts - Closer to home, Ashish Jha and other Patient Safety experts testify that U.S. hospitals aren't any safer today than they were 15 years ago when the IOM issued its sentinel report on the quality of health care. While some progress has been...

Saturday, July 12, 2014 - 04:20

So far, this year, there have been an estimated 111,498 health care-related preventable deaths - That's more than due to any other cause and yet few seem to care and many of those that do have become desensitized to the number. But not all. At a recent event in Aspen, Jonathan Bush of Athenahealth let loose during a panel discussion that included Toby Cosgrove of Cleveland Clinic. He called those who donate money to...

Saturday, June 28, 2014 - 04:04

Once in a while, even the DC cronies should let facts get in the way of the "truth" - The "truth" in Medicare payment policy has been that the DRG system (also known somewhat incorrectly as the prospective payment system - incorrectly because DRGs are assigned AFTER the patient is discharged, not at the intake) reflects the activity of hospitals and determines correctly the payment required for the services provided to patients during an inpatient stay. When patients are admitted to the hospital, it can be for elective surgeries, in which case...

Saturday, June 21, 2014 - 03:51

Inertia is the resistance of any object to any change in its state of motion, including changes to its speed and direction. It is the tendency of objects to keep moving in a straight line at constant velocity - It describes the state of mind of those that we've often referred to as the agents of the status quo, and it also explains why the larger institutions that rule over the industry will miserably fail in the next few years unless they beat their inertia. Take for example the presentation from Karim Habibi of NYU Langone at this week's...

Saturday, June 14, 2014 - 05:34

Could it be that incentives reform is having an effect? The latest figures from the U.S. Census Bureau (albeit sans Rx costs) shows that medical cost inflation continues to be moderate. Year-over-year hospital revenue is anemic at 2.9% after having risen considerably in the past. Before we rejoice, however, we should note that at 4% it's still rising faster than the GDP. That means health care costs, in aggregate, continue to rise as...

Saturday, June 7, 2014 - 11:21

Is this the best that we can do?
Those who purport to be in charge of provider and payer organizations, in both the private and public sectors, clearly don't ask this seminal question often enough. Let's take the recent surge in Medicaid enrollment facilitated by the ACA as the first example. While it's certainly a good thing that folks who until now were denied access to insurance finally have it, is that truly the best we can do? It's not that Medicaid is a bad health plan, quite the contrary, but it was designed as a safety net for those...

Tuesday, June 3, 2014 - 01:14

Payers report cost savings and some impact on quality

WASHINGTON — June 3, 2014 — Bundled payment is no longer assigned only to pilot status as a number of public and private payers are committing to this model as a core payment and delivery reform strategy according to the latest research commissioned by the non-profit Health Care Incentives Improvement Institute™, Inc. (HCI3) and conducted by...

Saturday, May 31, 2014 - 03:43

Most new product introductions have a life cycle that is dictated by the pace of the industry in which it is placed - For electronic and communications products, the life cycle goes from introduction to mainstream adoption in a matter of months, sometimes weeks. Clothing often takes a little longer. Healthcare takes forever, or at least it seems that way. The time span from early pilot stage to high adoption takes about seven years. Think about past innovations in benefit design or insurance products, or even add-ons like disease management and pharmacy formularies...

Saturday, May 24, 2014 - 05:11

Price matters and depending on a consumer's sensitivity to price the results can be good, bad or ugly - When consumers are insensitive to price, as is still the case for many health plan members, prices rise whether overtly or under the cover of "greater integration for the greater good". A Commonwealth Fund supported report highlights several ways to combat price increases caused by market consolidation, and the bottom line is...

Thursday, May 22, 2014 - 23:19

Policy makers, national hospital and physicians leaders share best practices; focus on how to best engage consumers in bundled payment programs

WASHINGTON – MAY 21, 2014 – As efforts continue across the U.S. to improve the quality of health care and lower costs, bundled payments are increasingly being looked to as one of the solutions by policy makers, payers and providers. Sharing successful strategies for implementing bundled payment contracts for high cost procedures and conditions will be the focus of the...

Saturday, May 17, 2014 - 04:06

"We have to break people away from the choice habit that everyone has"....yes, that's an actual quote from an insurance executive only a few days ago - Only in this warped upside down lunacy of a non-market can such a statement make sense. While every single other industry that caters to its customers is focused on offering choice and value, insurance and health system execs are busily finding ways to restrict choice for health care consumers....

Saturday, May 10, 2014 - 06:07

An apple a day keeps the doctor away....and if you don't want to eat apples, we'll force feed you - That's been the driving philosophy behind the "demand" side management by employers for decades. The focus on the demand side comes from the belief that third party administrators are managing the supply side and that "if only patients could comply with their doctor's recommendations, everything would be ok." Of course we all know that's a bunch of hooey, but it's easier to believe that than to face into the consequences of...

Saturday, May 3, 2014 - 03:38

Price Transparency and Bundled Payment are two keys to healthcare system reform - Both have recently received much attention and for good reason: they each present a tremendous opportunity to decrease our soaring healthcare costs. I believe that with adequate access to healthcare information on price and quality, consumers will make informed decisions that will not only benefit their health, but the system as a whole. In addition, the implementation of Bundled Payment encourages providers to hold down variable costs while satisfying a minimum set of quality metrics...

Saturday, April 26, 2014 - 04:12

Newtown, CT - April 25, 2014

In our recent Scorecard on Price Transparency, Massachusetts got a B - one of the best grades. So imagine our surprise when the Data Review Committee balked at our efforts to further the State Law's goal - The legislation that enables the all-payer claims database in Massachusetts clearly specifies that the goal is to disclose pricing information on health care services and procedures for facilities, physicians and medical practices. However, to-date, the website in MA only focuses on facilities and medical groups,...

Monday, April 21, 2014 - 01:12

Newtown, CT - April 18, 2014

We are our brothers' and sisters' keeper - Too often, in the hustle and bustle of everyday life and in the pursuit of corporate and other goals, we forget or reduce this moral dictum. This week as some celebrate Passover and others Easter, we remember that the preparation of the exodus from Egypt called an entire nation to watch its own, to care for each, to share with all, and that 1500 years later the sacrifice of one was for the sake of the entire world. The message of 2000 years ago was the same as the one 3500 years...

Saturday, April 12, 2014 - 03:32

Newtown, CT - April 11, 2014

It's funny to see how fast the cockroaches scurry when you turn on the light - This week Medicare released a set of data on physician payments that's making a lot of folks nervous, and I'm not talking about the physicians because they're simply optimizing around bad incentives. As I've repeatedly said, it's difficult to be good when you're encouraged to be bad. So who's heading for cover? Well let's start with those who are knowingly...

Saturday, April 5, 2014 - 07:56

We call it the DNA of medical episodes because it tells you a lot about patients and the way they were managed (or mismanaged) - There are lots of different ways to look at how health care resources are being used. In a recent podcast, Bruce Landon, Scott Halpern and Carrie Colla discuss the importance of clamping down on the "grey zone" of medicine, where provider discretion can make a big difference. For many years we've been looking at the sequelae of sub-...

Saturday, March 29, 2014 - 04:40

What's the big deal about price transparency? After all, is it that important in helping consumers choose providers? This seems like a dumb question, but given how few states in the US provide information on the price of health care services to their residents, one wonders. And it's not just inaction that causes this opacity, it's direct action. For example, Florida's Governor, the ex-HCA CEO, recently failed to include a budget for the State Agency responsible...

Saturday, March 22, 2014 - 11:09

Newtown, CT - March 21, 2014

There's another tail that tells a very different tale than last week's. It's the PAC tail. PACs are Potentially Avoidable Complications, something about which we've published a lot and that causes significant variations in costs of care. By definition, these are avoidable events that include patient safety failures, hospitalizations and ED...

Saturday, March 15, 2014 - 11:19

Newtown, CT - March 14, 2014

What's the difference between unpredictable variation and unwarranted variation: Solvency - Think of it as the tale of two tails. The distribution of total costs per year for an average commercially insured population includes some plan members with no claims experience, some with moderate to high, and some with a lot. Since the left side of the distribution is locked at the intercept of $0, all the unpredictable variation in costs is on the right side. This includes the occurrence of rare and complicated diseases and...

Saturday, March 8, 2014 - 05:21

Newtown, CT - March 7, 2014

The tide of change is rising, and it's got the hand-wringing ivory tower dwellers gasping for air - There are thousands of healthcare services researchers busily employed by hundreds of organizations across the country. It's actually astonishing how many of these people are around. Some focus on the effects of care patterns and protocols, or of new medical innovations, and that work should continue at a rapid pace, even accelerate. There are others, however, who study the effects of micro-environmental changes in what some...

Saturday, March 1, 2014 - 05:34

Newtown, CT - February 28, 2014

You only know if processes and systems are doing their jobs by monitoring outcomes. It's a lesson the NCQA refused to listen to and now the results are in - In 2002, shortly after the release of the IOM's "To Err is Human" report, we launched an effort to encourage physicians to redesign their systems of care and deliver better patient outcomes, especially for those with chronic conditions. As part of that effort, we hired the NCQA to work with us to develop a survey that could assess "systemness" in...

Saturday, February 22, 2014 - 04:49

Newtown, CT - February 21, 2014

It's often more politically convenient to lock away some problems than to deal with them, and that certainly is the case today with the mentally ill - As reported in September by the WSJ and more recently in the NYT, many jails and correctional facilities around the US have turned into the 21st century's version of Arkham Asylum...or, more to the point, Fairfield Hills. Built in the early part of the 20th century, Fairfield Hills in Newtown CT...

Saturday, February 15, 2014 - 05:27

Newtown, CT - February 14, 2014

Imputed values aren't the same as inherent ones, but it seems as if too many are forgetting that distinction - Let's start with the values imputed by some policymakers on those who may now "choose to not work" because they have access to coverage through means other than their employers. We should stop and ponder this for a minute, and realize that the statement is equivalent to saying that the loss of indentured servitude leads to idleness instead of freedom. Wow....I thought that thinking went away at the...

Saturday, February 8, 2014 - 07:23

Newtown, CT - February 7, 2014

Boy have I got a deal for you...Behind door #1 is a non-negotiable complex formula defined by the government that will yield a single "value" score of your performance, and behind door #2 is a negotiable deal of your own making. Which one will you pick? Methinks that most folks with M.D, D.O., and other such initials behind their names will figure out this brain teaser. And I'm pretty sure that's what the sponsors of the...

Friday, February 7, 2014 - 01:20

By Michael Painter, MD

“‘Let’s go.’ ‘We can’t.’ ‘Why not?’ ‘We’re waiting for Godot.’” ― Samuel Beckett

For the economists in our midst, demand is a critical but pretty dry idea: the quantity of a good or service a buyer is willing to purchase at a given price. It’s presumed to be part of working health care markets.

It’s one of the first things an undergraduate might learn in Econ 100.
There’s no urgency in this demand; it just is.

Of course, nothing...

Saturday, February 1, 2014 - 07:31

Newtown, CT - January 31, 2014

A fascinating interactive graphic sums up the drag on the economy created by U.S. health care expenses - The NEJM published a chart devised from work by Meredith Rosenthal and Laura Smith that helps understand where the US ranks relative to all other OECD countries for different components of the total health care spend. It shows the evolution of that spend over time and gives a sense of the acceleration of the spending gap during the past decade. There are two...

Saturday, January 25, 2014 - 05:32

Newtown, CT - January 24, 2014

It's time to reimagine health plan benefit designs - The by-product of health benefit plans that have high deductibles and co-insurance is the current transparency revolution that is sweeping the country. The outcome of that revolution has yet to fully play out, but we can see the outline of a true market for health care services emerge. Take the legislation enacted in NC in mid 2013. It creates complete public transparency on the price of a large basket of episodes of care - "products" that consumers understand...

Saturday, January 18, 2014 - 04:18

Newtown, CT - January 17, 2014

"A glooming peace this morning with it brings. The sun, for sorrow, will not show his head. Go hence, to have more talk of these sad things. Some shall be pardoned, and some punishèd. For never was a story of more woe than this of"...

...an academic and his ACO - This doomed love affair has lasted far longer than that of the famed Juliet and her Romeo, and yet they seem to share a common fate. The passion between some academics and ACOs has burned bright and hot. To...

Tuesday, January 14, 2014 - 23:24

Change to an established and large institution is a long and difficult process. Think about the American Revolution. A small, but able group of passionate visionaries started a small movement in their towns and cities that grew to a unified fight against a powerful establishment. It wasn't an easy or short fight, but in the end, a new nation was born and those who it was affecting most changed the status quo: the American people.

Fighting for healthcare reform, while very different from the tragedies of a physical war, has similar beginnings. It is the American people who need...

Saturday, January 11, 2014 - 05:39

Is a 3.7% growth in U.S. health care spending a cause for celebration? The government seemed to think so. We beg to differ - The U.S. health care bill stands now at $2.8 TRILLION...a mind-blowing number. And while the GDP's share of health care hasn't grown (which is good news), it's still twice that of any other country. The paper announcing the "good news" was published last week and seemed to offer much needed relief to the government given the debacle of the health...

Tuesday, January 7, 2014 - 01:11

It's amazing how a number, however arrived at, if proposed by an "authority", has lasting power even when it's flawed - A few years ago, researchers at Dartmouth came up with what they felt was a reasonable minimum number of Medicare plan members to be included in an "Accountable Care Organization". That number was 5,000. Since then CMS has used it for its Shared Savings Program and commercial payers have used it (to the extent they even have 5,000 plan members with a provider...

Saturday, December 28, 2013 - 04:46

Newtown, CT - December 27, 2013

In a few days the calendar resets and provides us an opportunity to measure what has improved and what still needs to - certainly we can and should celebrate that fewer are uninsured. We should also take stock of the marked decrease in overall health care expenses. Hospitals and physicians are participating in new payment models at a rate that has rarely been seen before. Health plans are moving away from basic fee for service contracts, and states are initiating value-based insurance design and payments in bold new ways. The...

Thursday, December 26, 2013 - 04:34

Happy Holidays from all of us at HCI3!

 

With warmth and gratitude, the HCI3 team wishes you a joyous holiday season and a prosperous and healthy New Year!

Saturday, December 21, 2013 - 05:49

Newtown, CT - December 20, 2013

With only a few days left before Christmas, the shopping frenzy is in full swing. Consumers are pouring through web sites, stores and catalogues, comparing prices, quality, and making decisions - Comparison-shopping isn't a new behavior. In fact it's been around for as long as there's been more than one merchant, store or other provider of goods and services. Thousands of years ago prudent shoppers would stop by the stalls in a market, examine the vegetables and fruits, compare prices and make a purchase. And I...

Thursday, December 19, 2013 - 00:10

By Elizabeth Bailey, MPH
Program Implementation Leader, Midwest Region

At some point in our lives, we all become consumers of health care services. If we are lucky, our interactions with the health care system are few and far between - an occasional, minor inconvenience coupled with a limited amount of money out of pocket. For others, particularly those with chronic conditions, these interactions are much more frequent, serious, and costly. It is paramount that we as consumers, regardless of the extent of our health care needs, are armed with...

Tuesday, December 17, 2013 - 04:11

What do we even mean by “value-based payments”? Technically, it means we’re paying for value, but what is value? Some have tried a quasi-mathematical approach by dividing quality into cost. However, the numerator is defined in either stars or percentage of quality goals met, while the denominator is defined in dollars. So what does the division of one into the other produce?

Ultimately, what value really means is that the services received are reliable and produce good clinical outcomes, and the cost is reasonable. Hence value is not the division of two numbers,...

Saturday, December 14, 2013 - 05:16

Newtown, CT - December 13, 2013

At this time of year, bells are the harbingers of joy, telling us to pay attention to the upcoming Good News - Tomorrow, in Newtown, they will ring for a very different reason. At 9:20 am, the Bells of Consolation, part of the Bells of Remembrance project, will ring for the slain school children, their teachers, and their principal. They will also ring for the killer's mother, and even for the killer. Mostly, they ring for the...

Sunday, December 8, 2013 - 09:42

Newtown, CT - December 6, 2013

Is it reasonable to ask physicians to know the price of health care services? That was one of the topics debated this week during the Price Transparency Summit in DC, and, as for many issues in health care, the answer depends. If a patient is locked in a capitated system, then the answer is no. Why would it matter to the patient or the physician since neither is actually "shopping" for health care services? But let's now focus on the 90% of consumer-patients who...

Sunday, December 1, 2013 - 09:36

Newtown, CT - November 30, 2013

There are several hundred thousand people who are thankful that, come January, they will get something that is taken for granted in all other highly developed countries - good health insurance. Despite its false start at the federal level, the ACA is playing out in States across the country and producing, at its core, what it intended to: affordable health insurance for the many to whom it had been denied to-date. The expansion of Medicaid in states like Arkansas and Kentucky will help lift thousands out of...

Saturday, November 23, 2013 - 05:18

Newtown, CT - November 22, 2013

It seems that, this week, in the battle between the price fixers and the price warriors, the latter had the upper hand - Last week the infamous (for good reason) RUC announced boldly that it had started to embrace "transparency". Now before you fall off your chair and think that the rotation of the earth has shifted, understand that the RUC's concept of transparency is to...

Thursday, November 21, 2013 - 03:35

By Stacey Eccleston
Program Implementation and Research Leader

The data is in!—an astounding 400,000+ patients die each year related to preventable harm occurring at hospitals across the U.S. This puts medical errors at the third leading cause of death in the U.S. The new 2013 study from the Journal of Patient Safety updates the nearly 3 decade-old figures estimated by the Institute of Medicine and should certainly...

Saturday, November 16, 2013 - 04:49

Most of the time bad numbers are bad news, but sometimes they're not, at least not for all - According to a newly published report, the health care industry has the highest rate of worksite injuries for its workers. Leading the way are nursing homes followed by other types of inpatient facilities. That's worrisome at many levels. At the most basic level, as...

Saturday, November 9, 2013 - 04:20

It should be self-evident that delivering healthy babies is good for everyone. Good for the child principally, but also good for the mothers, and good for society. And yet...two reports this week remind us of the chasm between what should and what is, between a few smart policies and the numbing stupidity of most others. With support from the Milbank Memorial Fund, CPR has published a report that outlines an innovative and good program in South...

Thursday, November 7, 2013 - 07:31

By Amita Rastogi, MD, MHA, MS
Medical Director, Cost of Care Programs

I initially trained as a cardiothoracic surgeon in India, in one of the apex institutions of Southeast Asia. When I moved to this country in 1988, I retrained by doing a fellowship in cardiothoracic surgery at the Mayo Clinic in Rochester, Minnesota, and then a transplant fellowship to get certified in heart and lung transplants. My experience at both institutions was superb. Patient care was the central focus., processes of care were well established and there were quality control checks...

Saturday, November 2, 2013 - 04:02

Trick or treat....only time will tell, but we do have some early signs, and it's a mixed bag. There's no denying that October has been a catastrophic month for the ACA. The rollout of the federal exchange is a disaster and there are more gremlins and goblins in that system than there were last night in all the towns and cities of the US. It will take more than the wave of a magic wand to get rid of them. This comes on the heels of other reversals that have the same root cause...expediency mixed with the delusion of being all-knowing and invincible. That's...

Wednesday, October 30, 2013 - 22:59

By Douglas Emery, MS
HCI3 Program Implementation Leader, Western Region

Recently I had a wonderful opportunity to attend a site visit hosted by ThedaCare in Appleton, Wisconsin. For almost 11 years now, under the visionary leadership of Dr. John Toussaint, ThedaCare has been implementing an aggressive Toyota-style Lean Management approach to reorganizing their hospital and ambulatory care processes. And I must say, the results are impressive. I wish I could say payer response has been just as impressive....

Saturday, October 26, 2013 - 05:01

What will it really take to make health care affordable? Zero increase in per capita costs for the next decade. Most might say it's simply impossible, that the very best we can hope for is that the rate of increase stays tied to the growth in GDP. As such, the 18% of the economy that is sucked into health care would stay there and the unaffordability of health care would also stay at its current level. That's not an acceptable solution for the 50% of Americans ...

Tuesday, October 22, 2013 - 05:08

Numbers often mask life’s reality. Politicians and policy experts speak about the unaffordability of health insurance and the high prices of health care, but what does that really mean? For many average American families, life’s reality is that insurance is traded off for something else. It could be taking on a second mortgage payment to send a kid to college. It could be buying a car to get to and from a second job. It could also be buying groceries. How did we get here? America is the richest country in the world when dividing the value of all goods and services produced by...

Saturday, October 19, 2013 - 04:13

Newtown, CT - October 11, 2013

How much of a price premium can excellent quality demand? This is a question that we will be answering over the next several months and for which we already have insights to share. Health care is becoming a retail market, despite the hue and cry to the contrary. This transformation is occurring because of the continued shift of health care insurance benefits to something akin to classic indemnity, very similar to what most consumers experience with property and casualty insurance. In this retail market, there will be (...

Saturday, October 12, 2013 - 02:15

Newtown, CT - October 11, 2013

Much like for provider incentives, consumer incentives must be directed at reducing the penchant for bad behaviors - that's basically the conclusion from the current experiments that are under way in value-based insurance design and were presented earlier this week at the University of Michigan's VBID Center. From Oregon to Connecticut, Rhode Island to California, public and private sector employers are successfully changing behaviors by, yes,...

Friday, October 4, 2013 - 15:00

Newtown, CT - October 4, 2013

There's a lot of talk about "big data" and its potentially transformative power in health care, and the Health 2.0 conference this week showed how transformative it could be - Feedback loops are the quintessential way in which all professionals get insights on the effects of their activities. By creating sequential designs of experiment, professionals can also use those same feedback loops to refine processes and interventions and move continuously towards more optimized results. Harnessing the power of...

Saturday, September 28, 2013 - 00:49

Newtown, CT - September 20, 2013

As the central component of the ACA launches in a few days, it’s important to review the macro changes to US health care – Over the next three months several million uninsured and underinsured will finally have access to more affordable coverage. Yes the picture is mixed, and yes some will underestimate the potential out-of-pocket expenses they’ll have to incur, but for the first time ordinary residents who have been denied what is a basic right in any other industrial nation, will finally have it....

Saturday, September 21, 2013 - 03:39

Newtown, CT - September 20, 2013

In the on-going battle between the federalists and the constructionists, we see the balance shifting again to the States - While the ACA and its implementation might have set the tone, the breadth and depth of the transformation of payment and the delivery system driven by the federal government has been underwhelming. In the meantime, States, under increased budget pressure and realizing that affordable health care is necessary to keep a thriving business community and growing companies, have taken the reins of...

Saturday, September 14, 2013 - 05:59

Newtown, CT - September 13, 2013

The fight between the medical industrial complex and the innovators is now in full swing - Several studies this week highlighted the manner in which the medical industrial complex feeds itself and the growing reactions of payers to counter the naturally bad fee-for-service incentives. First, the spotlight was on ED visit use and the associated fees charged. Unsurprisingly, much like with DRGs, there has been a consistent...

Saturday, September 7, 2013 - 03:32

Newtown, CT - September 6, 2013

In a few weeks the new health insurance exchanges will open for business and we shouldn't underestimate the importance of that event. Apart from finally providing all who reside in the US with an option to buy a standard policy, the exchanges also offer some hope of greater market discipline in the years to come. The process of buying health insurance today is often opaque and the multitude of policies, brokers and options make comparisons difficult and the choices suspect at best. Many have benefited from this...

Saturday, August 31, 2013 - 03:59

Newtown, CT - August 30, 2013

Trends are down and we should rejoice, but let's not keep the eyes off the prize - According to a new CBO report, Medicare trends have decreased more than expected and the causes are not simply the aftermath of the Great Recession. Many others are asking the same question: Are we in a new "normal"? It's highly likely that we are, and a combination of factors continues to reshape the...

Saturday, August 24, 2013 - 07:45

Newtown, CT - August 23, 2013

"For too long, North Carolina patients have been in the dark on what they can expect to pay for common medical procedures when they are admitted to a hospital. This new law gives patients and their doctors pricing information so they can make an...

Saturday, August 17, 2013 - 03:25

Newtown, CT - August 16, 2013

When pressure builds, the steam has to eventually come out or the pot will blow up, and boy is the steam coming out - A few weeks ago Penn State announced that it was going to institute an employee benefits change that would create a penalty for those that didn't comply with certain wellness steps. Unsurprisingly, the coddled and entitled employees of that institution...

Saturday, August 10, 2013 - 05:38

Newtown, CT - August 9, 2013

Getting high on life. It's a funny expression, but sums up the discussion between internal motivation and external charges - Those who get high on life don't really need external charges to keep moving. But those who "get a charge" from an activity will invariably need another one, and another, and another, and another. And at some point the charge needs to get greater to keep the person going. The bottom line is that these charges have been pretty much proven to be ineffective in motivating...

Friday, August 2, 2013 - 04:08

Newtown, CT - August 2, 2013

A free ride is never free to the person who bears its cost, but it is to the person who hitches the ride- and therein lies the dilemma for most employers who are trying to manage the demand side of healthcare. For many employees, health care insurance gets close to a free ride. While some employees exercise, control their body weight, eat healthy foods, others do the opposite, and the former pay the same premium as the latter. Why is that? After all, it doesn't work that way for auto insurance. The driver with...

Friday, July 26, 2013 - 23:58

Newtown, CT - July 26, 2013

A culture bred by opacity inevitably leads to denial of responsibility, and this week’s physician survey in JAMA should be the last nail in that coffin - if you haven’t yet read it, then read Zeke Emanuel's editorial on the survey. While it’s depressing,...

Saturday, July 20, 2013 - 02:55

Newtown, CT - July 19, 2013

This week’s announcement by ACO Pioneers reminds us that culture does eat strategy for breakfast – Take for example the reaction of Atrius Health to the news that they were going to pay a penalty for not meeting their first year’s cost targets.  They didn’t complain that no good deed goes unpunished, that the hard work they had done in years past to lower their overall cost of care was now hurting them in their ability to reduce costs further. No, they acknowledged that the investments needed...

Saturday, July 13, 2013 - 03:13

Newtown, CT - July 12, 2013

"Nothing astonishes people so much as common sense and plain dealing", sayeth Ralph Waldo Emerson - And this week two friends remind us in their writings that common sense is just that. First, Judy Hibbard and her colleagues report that activated patients are more likely to rate their physicians higher in patient experience of care surveys. The...

Saturday, July 6, 2013 - 04:13

Newtown, CT - July 5, 2013

Dogs can teach us a lot about the conflicts of motivation - Like many in suburbia, my dog wears a zapping collar that will discharge a small shock if she gets too close to the invisible fence. The fence runs alongside the main road, which has high traffic. My neighbors also have a dog with the same type of collar. My dog is very often motivated to get past the invisible fence, for example when she sees me go for a run, or when she sniffs out a deer who runs to the other side of the road. However strong that motivation, it...

Saturday, June 29, 2013 - 04:17

Newtown, CT - June 28, 2013

Those who can, do. Those who can't, teach. Those who can't teach, administer - We're reminded this week of these simple truths. Across the country, those who can are doing wonderful work. Communities are engaging stakeholders in accepting the imperative for change and leading that change with concrete projects. For example, the Pittsburgh Regional Health Initiative, an Aligning Forces community, is working on local chronic care management with community hospitals (outside of Pittsburgh) and reducing hospital...

Saturday, June 22, 2013 - 04:24

Newtown, CT - June 21, 2013

Myths die hard, but that doesn't stop them from being myths - Earlier this week the Wall Street Journal published a point/counterpoint on pay-for-performance. I argued for (I really argued against FFS), while Dr. Woolhandler argued against (she really argued against any change!!!). The response, which has been substantial, can broadly be split into two groups of unequal size....

Saturday, June 15, 2013 - 03:29

Newtown, CT - June 14, 2013

It's only when the first large health system will have declared bankruptcy that we'll know there's hope for the US health care system - There have been other industries in which the players have been coddled, protected by laws and regulators, and market forces. Inevitably, when the market revolution hits them, the big players failed, declared bankruptcy, and the industry massively shifted to provide value to consumers. Right now we need to stop and look around at what's really going on. First, the...

Saturday, June 8, 2013 - 03:35

Newtown, CT - June 7, 2013

"You're either habitually excellent, or not."
                                    Paul O'Neill, former CEO of ALCOA and Treasury Secretary

Disproving the it-can't-be-done crowd has been a hallmark of Paul O'Neill's career. And he reminded us this week that excellence - zero defects - can...

Saturday, June 1, 2013 - 03:48

Newtown, CT - May 31, 2013

Health care costs vary significantly; we spend twice as much as any other country; and have the same, or lower outcomes in quality. That's the plain old truth because it's based on clear and unambiguous facts....dollar for dollar, index for index. And while Rome is burning, the ivory tower dwellers are fiddling away. The latest dust-up on regional variation is a good example. A few researchers publish a paper...

Saturday, May 25, 2013 - 04:56

Newtown, CT - May 24, 2013

"Continuation of a 1.7% gap [health care cost increase - GDP increase] until 2040 would result in health care's absorbing 26% of the GDP, a level that would still pose problems for the economy and especially the federal budget."

Victor R. Fuchs, Ph.D. NEJM Perspective, May 22 2013

That's one way to put it. Another way is to say that premiums that would...

Saturday, May 18, 2013 - 02:54

Newtown, CT - May 17, 2013

Alamosa is a small community nestled in the San Luis Valley, surrounded by the Rockies, in Colorado. It's also the site of an operational implementation of chronic care bundles and offers lessons for the rest of the country. The total population of the San Luis Valley is less than 50,000, and the San Luis Valley HMO has a portion of that population under management. In other words, it's a small plan. However, a few years ago, under the auspices of a...

Saturday, May 11, 2013 - 04:11

Newtown, CT - May 10, 2013

It appears as if we should get ready for a period of medical cost deflation, and to continue to fuel it - Several papers, summed up in a recent blog, show that the slowdown in health care spending is caused by factors other than just the modest economic growth of the past decade. This is a point that we've argued for a while, against the then conventional wisdom, and...

Saturday, May 4, 2013 - 03:29

Newtown, CT - May 3, 2013

Lourdes is a little town nestled in the Pyrenees mountains, on the banks of the river Gave, to which, every year, about 6 million pilgrims travel - of those, perhaps a third are afflicted with one or more illness; some are young, very young; some are old, very old. This weekend, a little over 1000 of those pilgrims will be from the US, and among them are 200 who need serious care. That care is provided 24 hours a day by skilled physicians and nurses who come as part of the pilgrimage. And on site are dozens of other skilled...

Saturday, April 27, 2013 - 04:32

Newtown, CT - April 26, 2013

There's something afoot, which many seem to deny. It's the type of popular revolution that always catches us by surprise - Economists are arguing that the current slowdown in medical costs is simply an artifice of the Great Recession, and that costs are bound to get back up to historical levels. All the deficit reduction plans have spending caps in place, triggering cuts and adjustments if trend rates are too high; and yet CBO projects that none would be applied for at least another decade. I find today's...

Saturday, April 20, 2013 - 05:05

Newtown, CT - April 19, 2013

As the legend goes, the Gordian Knot was cut in half by Alexander, revealing the ends, curled inside - Our own problems often seem just as intractable. Where are the ends from which the solutions can take hold? However much we try, however much we examine the problems from all angles, we simply can't grab hold of a reasonable solution. And that's because, over time, the conflicts of interest have become so intertwined that very few of the incumbents, if any, want to unravel the thread that has become their...

Saturday, April 13, 2013 - 03:15

Newtown, CT - April 12, 2013

Super-utilizers. It seems like a marketer's dream target audience, and, for some, it is. For most of us, it should be a target audience of a different sort - When Jeff Brenner first realized who these folks were, the solution seemed simple: deploy good care management close to where they live, and save Medicaid millions. As the story continued to unfold, as well counted in Gawande's Hot Spotters, the savings for...

Saturday, April 6, 2013 - 05:31

Newtown, CT - April 5, 2013

The power of report cards is truly amazing, especially when it's on something for which everyone should get darn close to an A - Last month, with our friends from CPR, we published a report card, with little fanfare, on how well states are helping their residents understand the price they're paying for health care services. Two states got an A (NH and MA), and a bunch got an F (including my home state of CT). The report card,...

Saturday, March 30, 2013 - 05:07

Newtown, CT - March 29, 2013

For anyone who has seen The Passion Of The Christ, the more chilling scenes involve the Devil offering the easy way out to Jesus - He doesn't take it, but we're not Him. Earlier this week, RWJF's Michael Painter recounted a personal journey in discovering the effects of payment incentives on provider behaviors and, more importantly, on patients. Mike reminded us that our goal should not be to "social-engineer" behaviors, but rather to let the natural good flourish by removing the temptation to be...

Saturday, March 23, 2013 - 04:49

Newtown, CT - March 22, 2013

There's an old (therefore politically incorrect) saying that in the land of the blind the one-eyed man is King....or in the land of mediocre health care, the Kaiser - So sayeth and admits George Halvorson in an insightful article in the New York Times. And this brings us to a larger and more fundamental...

Saturday, March 16, 2013 - 04:18

Newtown, CT - March 15, 2013

In most States, consumers are granted protection against unfair trade practices, such as bait and switch, or masked prices. This protection, however, doesn't extend to health care purchases - We all know that health care is consuming about 18% of the GDP, and yet, as frequently reported in CostsOfCare.org, it's virtually impossible to get a straight answer from any provider on the costs of the services/"products" they sell. This comes as a...

Saturday, March 9, 2013 - 05:28

Newtown, CT - March 8, 2013

They call themselves the "Pioneers", but naming oneself such and being one is very different - When CMS was in process of issuing its final rule on what the "Pioneers" would be held accountable for, many of us expressed concern over giving these organizations too much of a pass. In fact, one of our...

Saturday, March 2, 2013 - 07:16

Newtown, CT - March 1, 2013

"We've created a secure, prosperous island in an economy that is suffering under the weight of the riches those on the island extract. And we've allowed those on the island and their lobbyists and allies to control the debate, diverting us from what Gerard Anderson, a health care economist at the Johns Hopkins Bloomberg School of Public Health, says is the obvious and only issue: "All the prices are too damn high."

--- Steven Brill,...

Saturday, February 23, 2013 - 05:27

Newtown, CT - February 22, 2013

Ninety tests and treatments out of thousands doesn't seem like a lot, but it is - And that's because, building on their important (albeit modest) initial work, the ABIM Foundation has gathered support from additional medical specialty societies to call out overused treatments that harm patients and contribute to the billions in excess spending in the US. The new list, released...

Saturday, February 16, 2013 - 05:48

Newtown, CT - February 15, 2013

A confidence interval is a simple measure of significance. It tells us, with a degree of certainty, whether or not a measure, a benchmark, or a goal has been achieved or exceeded - For example, in a 2008 paper published in the AJMC, we showed with a degree of certainty that BTE-recognized physicians have lower costs of care and deliver higher quality than non-recognized peers. That certainty was further...

Friday, February 8, 2013 - 04:35

Newtown, CT - February 8, 2013

The Good, the Bad and the Ugly....now playing at a health care spectacle near you - We've known for a while that activating consumer-patients and engaging them in intelligent and thorough discussions with their clinicians can only lead to good results, and this month's Health Affairs is replete with evidence of such goodness. In particular, work from our friend Judy...

Saturday, February 2, 2013 - 04:25

Newtown, CT - February 1, 2013

In her poignant book on her husband's fight with cancer, The Cost of Hope, Amanda Bennett reflects on the complete lack of price transparency in health care - It's a theme that we also often reflect upon and puzzles everyone outside of the industry. We're told that it's too complicated, that so many different...

Friday, January 25, 2013 - 06:33

Newtown, CT - January 25, 2013

20% - 54% - 91,000 - 10% - 7 - 790 - 10,400 - Respectively, the percent of household income used to pay for health care costs; the percent of American families for whom health care is unaffordable; the number of excedent preventable deaths from health care; the percent of dollars flowing from the private and public sectors in value-based payments; the number of States with adequate transparency laws; the number of A-rated hospitals for patient safety; and the number of clinicians recognized...

Saturday, January 19, 2013 - 04:59

Newtown, CT - January 18, 2013

"Americans used to do big things together. We squared our shoulders and met our challenges. Now it's time to mobilize for a new national project: Fixing our health care system once and for all." The Incentive Cure, by François de Brantes and Bob Conte, illustrated by Kriss Wittmann and edited/researched by Jenna Sirkin.

For most of 2012, with the help of the talented people mentioned above, I've worked on a book to explain what ails the US health care system and what might cure...

Saturday, January 12, 2013 - 05:19

Newtown, CT - January 11, 2013

With all the talk of medical homes, better care coordination, higher quality and lower cost, why are C-section rates in the US twice as high as recommended by the WHO, causing excess harm to moms and babies, and $5 billion in excess spending? What in the world are these medical homes doing if they're not even taking care of the basics? Some will argue that it's not about the medical homes, it's about the OB/GYNs and the moms. Others will argue that this is a too highly charged issue for plans or employers...

Saturday, January 5, 2013 - 05:39

Newtown, CT - January 4, 2013

We too often think of an insurance contract as being between an insurer and an insured - and while that is true, there are two parallel and often uncoordinated parts to the health insurance contract. The first part is, in fact, between the insurer (whether an employer or a health plan - including Medicaid or Medicare) and the insured. And that contract creates terms under which health care services "consumed" by the plan member will be paid, the portion of the services paid for by the insurer and the insured,...

Friday, December 28, 2012 - 16:00

Newtown, CT - December 28, 2012

C...that's the overall grade for the CMMI's 2012 efforts to reform payment in Medicare - While the CMMI has been busy in 2012 launching a number of initiatives, the net impact on Medicare spend is negligible. Adding up all of the Medicare beneficiaries in the launched initiatives, we get to less than 10% whose care will mostly be paid with something else than straight fee-for-service (FFS). As such, 90% of all funds flowing, especially for professional and...

Saturday, December 22, 2012 - 07:15

Newtown, CT - December 21, 2012

"I'm as mad as hell, and I'm not going to take this anymore", Howard Beale (Peter Finch), Network, 1976.

In his iconic role, Peter Finch expresses the deep frustration of the American public faced by a series of problems, and at a seeming loss for answers. And while he doesn't pretend to have the answers, Peter's character exhorts ordinary citizens to rise up in anger and to refuse to accept the status quo....

Saturday, December 15, 2012 - 04:30

Newtown, CT - December 14, 2012

Percentages often mask reality even when they reflect it, especially when they're about the impoverishment of Middle America - A new report this week from the Commonwealth Fund includes a powerful infographic that reflects a percentage reality. We quickly see how in seven years the vast majority of Americans has come to devote more than 20% of family income to healthcare costs (...

Saturday, December 8, 2012 - 04:18

Newtown, CT - December 7, 2012

A few decades ago, Signal Detection Theory came to life - Its purpose was simple (to detect a signal when there's a lot of noise) and has shown great relevance to the practice of medicine. A good summary of the theory and its application to healthcare can be found here, courtesy of Prof David Heeger, son of Nobel laureate Alan Heeger. The premise is straightforward: people make inferences and decisions based on information. Sometimes...

Saturday, December 1, 2012 - 04:13

Newtown, CT - November 30, 2012

We should remember that knights could afford their knightly behavior. Even then, extrinsic incentives were in play -- A recent post by Bob Wachter reignites the debate about knights and knaves, and highlights the evidence to-date, for and against, the use of incentives to drive certain behaviors. Before slicing the shrubberies, it might be time to recast the debate in its...

Saturday, November 24, 2012 - 05:37

Newtown, CT - November 23, 2012

From Maine to New Mexico, and Arkansas to Washington, the pace of change is accelerating - Now that the dust has settled on the elections, the realization has finally set in that we will be gradually moving away from the status quo. And for that, we should all give thanks. While some of the states whose leaders were in denial have been given more time to implement their health care exchanges, these functional markets for health insurance are being set up, ready to open for business in a little over a year. Millions of...

Saturday, November 17, 2012 - 05:05

Newtown, CT - November 16, 2012

"Like many businessmen of genius he learned that free competition was wasteful, monopoly efficient. And so he simply set about achieving that efficient monopoly." Mario Puzo, The Godfather.

And so the story goes for most companies, including hospitals, whether for profit or not. Acquisitions and mergers have ballooned in 2012 and are forecast to grow again in 2013. The consequence of these consolidations has, in the past, almost always resulted in price increases for the private sector, and a...

Saturday, November 10, 2012 - 06:11

Newtown, CT - November 9, 2012

One thing is certain now, the ACA is here to stay - and that means the move by Medicare and Medicaid towards value-based payments will continue to accelerate, and with it, the needed transformation of the incentives that power today's behavior of the delivery system - to always produce more services. However, we must also guard against the second foe of health care affordability, the inexorably higher pricing of health care services by the increasingly consolidating provider market - which is something that...

Friday, November 2, 2012 - 04:33

Newtown, CT - November 2, 2012

On the wake of Irene, the importance of transparency took center stage and was applied to Sandy - The Governors of Connecticut, New Jersey and New York learned the lessons from last year's debacle and set out to ensure that the utility companies that operate in their States be open and honest about what to expect and when. As such, while utility customers might not be happy about the power outages, they can log on to their utility's website, monitor the level of outages, report their own and get periodic...

Friday, October 26, 2012 - 10:11

Newtown, CT - October 26, 2012

How do we avoid continuously committing the seven deadly policy sins that undermine our ability to deliver the noble mission of health care? In an article this week Julie Appleby lists the seven factors driving up healthcare costs. They are: (1) paying for volume rather than value (greed); (2) an increasingly unhealthy population (gluttony); (3) desire for new technologies and drugs (envy); (4) tax breaks on insurance premiums...

Saturday, October 20, 2012 - 03:15

Newtown, CT - October 19, 2012

I see fewer patients a day, spend more time with each, practice costs are down, and revenue is up - That's not a pipe dream, nor is it the statement of a physician in a "concierge" practice. It's from a self-described country doc in Appleton, Wisconsin, and he and his colleagues are practicing in a reengineered environment. The walls are the same, the patients are the same, but the processes used to support the care management teams have been completely rethought and redesigned. Not in a rip and...

Saturday, October 13, 2012 - 03:08

Newtown, CT - October 12, 2012

In the 1960s and early 1970s, deaths from car accidents rose to a peak of about 54,000 per year. They've never been that high since - and there are far more drivers and cars today than there were then. So what happened? In short, two books. One by Ralph Nader, "Unsafe at Any Speed", and one by the National Academy of Sciences, "Accidental Death and Disability-The Neglected Disease of Modern Society". These prompted a national outcry which resulted in Congress passing legislation on seat belts...

Saturday, October 6, 2012 - 03:56

Newtown, CT - October 5, 2012

It's time for a Consumer-patient's Right To Pricing Information Act - A 2011 Government Accounting Office report on Health Care Price Transparency concluded that: "meaningful price information is difficult for consumers to obtain prior to receiving care". And when you consider that, according to the 2012 Kaiser Family Foundation survey of employer health care coverage,...

Friday, October 5, 2012 - 16:58

Newtown, CT - October 5, 2012

It's time for a Consumer-patient's Right To Pricing Information Act - A 2011 Government Accounting Office report on Health Care Price Transparency concluded that: "meaningful price information is difficult for consumers to obtain prior to receiving care". And when you consider that, according to the 2012 Kaiser Family Foundation survey of...

Friday, September 28, 2012 - 06:49

Newtown, CT - September 28, 2012

The Empire strikes back - Financial suicide isn't at the top of a health system's CFO's list of priorities, and yet that's what we seem to expect them to do by entering into voluntary agreements that will decrease revenue, reduce occupancy, and force all kinds of nasty restructuring that no one wants to do unless they have to. As a CFO from a large renowned "ACO" told me: "I have a five year financial plan that includes very high occupancy rates at a brand new facility, and I intend to...

Saturday, September 22, 2012 - 02:54

Newtown, CT - September 21, 2012

Blockbuster, Circuit City, and Kodak share a root cause to their decline and failure: they forgot that incentives drive function, and that function drives form - Why do we need a roll of film when we have digital cameras or smartphones that can automatically upload pictures to social media? Why do we need to go to a "big box" store when we can move through Amazon's web pages? Why do we need to spend time and fuel getting and returning DVDs when the mail carrier can bring it to our doors? The form didn...

Friday, September 14, 2012 - 04:30

Newtown, CT - September 14, 2012

Healthcare, we are often told, is different, and shouldn't be compared to other industries. The Institute of Medicine begs to differ - In a recent report, the IOM went to great lengths to compare healthcare to other industries and, indeed, healthcare is different. A third of what we spend doesn't improve anything, clinicians don't work in teams centered around...

Saturday, September 8, 2012 - 03:28

Newtown, CT - September 7, 2012

Why is there always a tendency to go for the "or" instead of the "and"? Policy experts, physicians, health plan leaders and many in the industry shape their positions and strategies as alternatives. And yet decades of experimentation in healthcare should have taught everyone by now that there isn't a single alternative that will work. We need a combination of efforts that will dovetail with each other, some working for some areas of care and some providers and some working for others. After all...

Saturday, September 1, 2012 - 03:28

Newtown, CT - Aug 31, 2012

Ready? Set?....Whoa, hold on, and think before you sign on the dotted line - Two months ago, at the end of June, hospitals, health systems and other organizations submitted applications to the CMMI for the Bundled Payment for Care Improvement (BPCI) pilot. The program was launched a year ago, and, since then, hundreds of potential applicants have received two years' worth of Medicare claims for their market area, and performed various analyses to determine if they want to file a formal application. Many walked away...

Saturday, August 25, 2012 - 03:12

Newtown, CT - Aug 24, 2012

It's usually dangerous when we confuse the talkers for the doers - A recent paper published in the British Medical Journal had an innocuous enough title: "When Financial Incentives Do More Good Than Harm: A Checklist", and yet it set off a firestorm of reports across the US that concluded (because of an accompanying editorial by physicians advocating a single-payer system) that incentive programs such as P4P are ineffective, at best, and...

Saturday, August 18, 2012 - 03:35

Newtown, CT - Aug 17, 2012

It takes a bridge to cross a chasm, and that's why we named it Bridges To Excellence - In 2002, a group of employers that included GE, Verizon, UPS, Ford, P&G, and Raytheon decided to take the IOM's report on the Quality of Health Care in America to heart. In Crossing the Quality Chasm, the authors of the report pointed to the toxicity of the payment system as one of...

Saturday, August 11, 2012 - 03:09

Newtown, CT - Aug 10, 2012

It's tough to be good when you're encouraged to be very very bad - and two recent investigative reports highlight the very very bad behaviors of physicians from coast to coast. In California, the supposed mecca of ACOs, a creative entrepreneur, self-proclaimed a "Robin Hood of physicians", decided that the best way to negotiate with "greedy plans" was to...

Friday, August 3, 2012 - 04:20

Newtown, CT - Aug 3, 2012

18% -- that's the portion of the GDP that's collected in taxes, and it's also the portion of the GDP that's consumed by national health expenditures. No wonder we have a problem. Now, of course, the government pays only about half of healthcare expenses, but that's still a chunk of change and has been growing. The result: budget deficits. If half the government's spending is on entitlement programs, that doesn't leave...

Friday, July 27, 2012 - 04:49

Newtown, CT - July 27, 2012

Why aren't patients protected as well as diners or workers? Across the US, municipalities send out their public health inspectors to ensure that diners are protected from serious harm or injury that can be caused by poor hygiene and other practices. These inspections result in restaurants receiving a grade, alerting the diners of potential health safety hazards. All businesses with more than a handful of employees are equally subject to...

Friday, July 20, 2012 - 15:00

Newtown, CT - July 20, 2012

What will it take to have the rug pulled out from under the RUC? With CMMI moving evermore aggressively to institute value-based purchasing contracts with willing health systems, practices and hospitals, the arcane, opaque, and self-serving process in which fee schedules are proposed and adopted by CMS via the RUC needs to go. For those who aren't familiar with the process, the RUC committee, staffed by members of specialty societies, sits around in closed meetings and decides which fees for what services should increase and by...

Saturday, July 14, 2012 - 03:21

Newtown, CT - July 13, 2012

Two recent books summarize the massive potential for improvement in the delivery system and lead to this observation: It's the incentives, stupid! The Pittsburgh Regional Health Initiative and the ThedaCare Center for Healthcare Value have each published a set of best practices from delivery system reengineering. In Potent Medicine, John Toussaint illustrates the real measurable improvements in cancer care, primary care,...

Saturday, July 7, 2012 - 03:15

Newtown, CT - July 6, 2012

Joey Chestnut's win offers us a lesson on the power of intrinsic and extrinsic incentives - it took 68 hot dogs and buns to win, and the crowd went wild. The other contestants faded away and the championship belt and $10K check went to Joey. It might be interesting to look at the fate of the champions and runner ups of prior years, although we can offer a guess....they're probably stented to the hilt and stomach stapled, and that...

Saturday, June 30, 2012 - 03:52

Newtown, CT - June 29, 2012

Uncertainty carries a significant cost - it makes estimates more difficult, increases the potential business risks of any venture, and since most of us have a tendency to overestimate losses rather than gains, uncertainty is a big brake on forward motion. And yet, despite the uncertainty of the Supreme Court's decision on the ACA, hundreds of provider organizations and dozens of health plans had taken their cue from the long...

Saturday, June 23, 2012 - 03:46

Newtown, CT - June 22, 2012

Sometimes it's useful to consider the theories of Nobel Laureates - in his seminal work on Game Theory, John Nash exposes a situation in which an equilibrium can be reached where neither party can gain more than the other. The Nash Equilibrium should be what we strive for when considering the design of new payment programs, a situation in which neither the...

Saturday, June 16, 2012 - 03:09

Newtown, CT - June 15, 2012

There are only ten Commandments. Everything else is pretty much a guideline - During the next two weeks, hospitals, physicians, and others will decide whether or not to apply to the CMMI's Bundled Payment pilot. Many, including some that participated earlier this week in the Bundled Payment Summit, have concerns about the design of the pilot proposed by CMMI. They fear the risks can be high and the reward dependent on the pure luck of the draw. We've shared those concerns and expressed them publicly. Yet on Wednesday,...

Saturday, June 9, 2012 - 07:16

Newtown, CT - June 8, 2012

In the mid 1960s, Frederick Herzberg laid out an important theory: the factors that lead to job satisfaction are different than the factors leading to job dissatisfaction - his paper on motivating a workforce would become the most widely read paper in the Harvard Business Review...ever. Herzberg's insights are often forgotten today, at a time when they are most relevant, especially as we design...

Saturday, June 2, 2012 - 03:43

Newtown, CT - June 1, 2012

As the proverb goes, the person who says something cannot be done should not interrupt the person doing it. Nine months ago we were almost interrupted by an out-of-date and misleading report that said that bundled payment had not been and could not be implemented. That was wrong then and even more so today. In a report released this week, co-authors Michael Bailit and Megan Burns detail the results of a comprehensive review of private sector...

Saturday, May 26, 2012 - 03:21

Newtown, CT - May 25, 2012

On May 11th 1944, a few weeks before the allies land in Normandy, my grandfather (and namesake) dies in a concentration camp in Austria, of aggravated pneumonia, in an environment in which there was little to no value given to a human life. One of the enduring and endearing features of the US healthcare system is that it has, so far, refused to put a value on a human life. As we all fire up barbecues this weekend, and celebrate the beginning of summer as much as the memory of all those who died defending freedom, we should remember...

Saturday, May 19, 2012 - 03:21

Newtown, CT - May 18, 2012

Organizations that currently dominate an industry have, as the theory goes, survived a process of brutal evolution. How is it, therefore, that they can sometimes be so incompetent? Let's examine the evidence. A benefits consulting and health care analytics company sends corrupted files, twice, and acknowledges they knew the files were corrupted. A large health insurance company spends months trying to load a claims file on a FTP server, to no avail. Another laments it doesn't have the resources to manage two bundled payment...

Saturday, May 12, 2012 - 03:26

Newtown, CT - May 11, 2012

Clay Christensen's seminal work on innovation offers important lessons for healthcare - The most important is that disruptive innovations will force the centralization of skills to become decentralized. In other words, many aspects of care and care decision-making will be pushed down from the current center of skills - hospitals - to the outer edges of skills, the consumer. That seems hard to believe for the many...

Saturday, May 5, 2012 - 04:01

Newtown, CT - May 4, 2012

It's good to know that sometimes things work out like you hoped they would - in a new report we released today we show that practices recognized under the NCQA Patient-Centered Medical Home recognition program, and those recognized under BTE's Diabetes recognition program have lower overall costs of care per patient than their non-recognized peers. We've shown...

Saturday, April 28, 2012 - 04:24

Newtown, CT - April 27, 2012

What happens when you use a product for a purpose other than the one it was designed for? If you're lucky, it might work. But most often you get bad results. There are two current examples that offer important lessons in that respect. First are DRGs. They were designed and introduced for a very specific purpose - to cap the facility costs for hospital stays. And the designers had an option either to create a cap for every possible stay, or to group like stays together and create a single payment for all those like stays. They...

Saturday, April 21, 2012 - 08:21

Newtown, CT - April 20, 2012

Sometimes, what's more important is who's not on a list than who's on it - Last week CMS released the list of the 27 initial organizations that have made the cut for the ACO Shared Savings program. This follows a list of...

Saturday, April 14, 2012 - 05:06

Newtown, CT - April 13, 2012

Health care utilization continues to be flat, yet total healthcare expenditures continue to rise by close to 4%, keeping healthcare at 18% of GDP. Time to unleash the price slayers - The most recent report from the Altarum Institute shows that while use is flat, healthcare prices are either equal to or greater than prices...

Saturday, April 7, 2012 - 04:29

Newtown, CT - April 6, 2012

What does it take to activate a consumer? Impact on the wallet and information on cost and quality - it's a super simple formula, and one that every employer in the US has understood for decades. In the 1990s, the formula was very effectively applied to HMOs (lower co-pays and heavy premium subsidies + NCQA accreditation), but as the market moved away from that simple product approach, the formula was put on a shelf. Pricing information on specific procedures or even units of service was close to impossible to pry out of health...

Tuesday, April 3, 2012 - 06:25

Newtown, CT - March 30, 2012

There's one simple lesson that keeps eluding many in our field: It's the design, stupid! Poorly designed incentive programs usually garner poor outcomes. For example, when CMS launched the Premier demo a decade ago, they tied marginal benefits to a tournament-style incentive program. The result, as reported in this week's NEJM, is underwhelming. The researchers' conclusion? It's the design, and they caution CMS on its...

Saturday, March 24, 2012 - 07:59

Newtown, CT - March 23, 2012

Close to $200 million. That's the added "tax" imposed on Pittsburgh residents by the city's too numerous hospitals (a.k.a. UPMC) - Pittsburgh, Cleveland, Cincinnati and St. Louis have about the same number of people living in and around each city, but the combination of lots of hospitals with lots of hospital beds and long lengths of stays puts Pittsburgh in a category of its own compared to the three others. In our...

Saturday, March 17, 2012 - 03:45

Newtown, CT - March 16, 2012

Dr. Hammond, like many independent physicians, is trying to do his best to make ends meet and continue to serve his patients - And unlike many physicians, Dr. Hammond has received several Bridges To Excellence recognitions, attaining level 2 recognition for Diabetes and Cardiac care, Level 3 for office systems and, as a result, a BTE Medical Home recognition. There are very few doctors in the country that have achieved this level of excellence. Yet,...

Saturday, March 10, 2012 - 06:49

Newtown, CT - March 9, 2012

"Assuming technical risk and offering a warranty is an effective way for providers to reduce information asymmetries" - this powerful insight by Michael Hicks of Pinnacle Partners summarizes the way in which health care can be transformed in a manner similar to other industries. We all know that defects are bad. They're bad because they cause harm and they're expensive. By extension, bad quality increases costs. It's a simple concept and one that consumers have come to understand in all aspects of...

Saturday, March 3, 2012 - 05:00

Newtown, CT - March 2, 2012

On Wednesday, potential CMMI Bundled Payment applicants received their 70 plus files of Medicare claims. In addition, CMS awarded its contract to build a public domain episode grouper - Another page has turned. For the first time in our history, providers now have access to two years' worth of Medicare claims data, which should help them analyze their past performance, and, if they're forward-thinking and courageous enough, to apply for the CMMI Bundled Payment pilot. With our colleagues from Brandeis University,...

Saturday, February 25, 2012 - 05:49

Newtown, CT - February 24, 2012

Dutch auctions, inventory funding, public domain source code, conversational blogs ....healthcare - these aren't words that are usually associated together, and yet they are. A recent GAO report illustrated how even in the controlled pricing domain of Medicare, implantable medical device (IMD) prices were all over the place. Hospitals engaged in bundled payments, like Baptist in San Antonio, have...

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 - 06:19

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 - 04:26

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 these...

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 describes in detail...

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 healthcare premiums...

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 a simple...

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 Physician...

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...