Consumers & PatientsFuture of Health CareMedical Decision-Making
February 28, 2018

Shared Decision-Making May Be the Next Consumer Health Movement

Consumers are rapidly mobilizing around all aspects of health care—affordability, access to the system and choices about their care. As changes in health insurance shift more and more cost onto consumers, patients want to be involved in decisions that will affect their finances as well as their health. Yet they face a dilemma: The only way to really affect their costs is to be involved in decisions about how much and what kind of health care they use. That means being involved in medical decisions. But when prices are hidden and consumers don’t know the facts about alternative—and uncertain—outcomes, they…
Read More
Academic Medical CentersConsumers & PatientsFuture of Health Care
February 21, 2018

How Safe is Medicare? What To Know About White House Budget Proposals

Health care providers may be lulled into believing that Medicare budget cuts proposed by the White House last week won’t happen. Media reports have repeatedly emphasized that the budget is simply a policy proposal. Congress alone has the authority to determine spending limits and allocate funds. But labeling this budget—and the Medicare proposals in it—as “dead on arrival” is a mistake. For one, the proposal includes efforts aimed at reducing drug prices and fighting the opioid epidemic. But these are minor political enticements, compared to the proposed Medicare cuts labeled as “Reducing Wasteful Federal Spending.” Those are the most significant ideas…
Read More
Consumers & PatientsFuture of Health CareMedical Decision-Making
February 14, 2018

Don’t Just Check the Box: Capture the Patient’s Story to Define Meaningful Goals of Care

What does Shared Decision-Making between doctor and patient really look like? I spent four decades as a primary care physician, as well as 27 years teaching medical students and residents. Looking back on my treatment of patients, I now question whether my management was driven by what the patient wanted—or by what I wanted for the patient. Certainly, I wanted to do what was in the best interest of the patient, and I sincerely hope that our interests were often well aligned. In certain specific cases, I acted against the stated desires of the patient, a necessary call (discussed below).…
Read More
Consumers & PatientsFuture of Health CareValue-Based Health Care
February 7, 2018

Five Lessons from Big Business on Value-Based Health Care

Last year we predicted that CMS would step back from the complex requirements of its Value-Based Health Care initiative, in favor of reducing provider burdens for quality reporting and reducing regulation, in general. While MACRA MIPS and the move toward financial risk still remain, we correctly anticipated that Medicare would focus its efforts on its own beneficiaries—and less on leading the charge for cost control in health care. We hoped that providers would seize the opportunity to take ownership of making health care work better, rather than respond to external requirements. Instead, despite several organizations that have pushed the agenda…
Read More
Consumers & PatientsFuture of Health CareMeaningful MeasuresValue-Based Health Care
January 31, 2018

What Does #MeToo Have to Do With Value-Based Health Care?

Are we measuring the right things in Value-Based Health Care? That’s the question I am asking myself while reviewing recent efforts by CMS to create better measures of health care value, called Meaningful Measures. Given current, widespread reports of sexual abuse and my recent reading about the dismal state of elder health care, I can’t respond affirmatively. A Value-Based Health Care System should curtail rising health care costs and promote better health for individuals. But we can’t miss the forest for the trees. If we focus on the minutia of medical processes or even outcomes of moderate value, yet miss…
Read More
Alternative Payment Models (APM)Bundled PaymentsFuture of Health CarePerformance ImprovementValue-Based Health Care
January 24, 2018

BPCI Advanced Means Financial Risk Is Coming for Specialists

In case you missed Medicare’s messages about its reimbursement direction in recent years, CMS just reminded us that financial risk is well on its way. If you’re developing strategies that assume the status quo, it’s time to reassess your organization’s financial footing. CMS has already stated its intention to shift 50 percent of Medicare provider reimbursement into Alternative Payment Models (APMs) by the end of this calendar year. And those APMs are quickly transitioning toward putting providers at financial risk, because CMS is rewarding them to do so. CMS’s goal to impose financial risk was front and center again this…
Read More
Future of Health CareMedical Decision-MakingPerformance ImprovementQualified Clinical Data Registry ReportingValue-Based Health Care
January 17, 2018

Time Out! How Strategic Pauses Can Enhance Medical Decision-Making to Improve Outcomes 

Health care providers are under increasing pressure to improve outcomes for patients with chronic conditions. There is pressure to meet quality measures, to establish programs that improve outcomes, to decrease costs for these conditions (utilization as an outcome)—or a combination of goals. At issue: what works, what is affordable, what is acceptable to patients and clinicians. The answers are elusive because there are many factors involved in the care of patients who have numerous chronic conditions, co-morbidities and medications, as well as multiple healthcare professionals providing their care. Adding to this complexity, any outcomes improvement for patients with chronic conditions…
Read More
Future of Health CareMedical Decision-MakingValue-Based Health Care
January 10, 2018

Reining In Medical Costs Might Work If We Could All Agree What “Cost” Means

A few days ago, a couple of providers commented on my recent posts about cost performance improvement in health care. The first of these posts reviewed obstacles to provider strategies for managing costs and how to overcome them, and the second addressed technology that providers would need to both measure and improve performance. One commenter took issue with my statement that providers have not embraced cost reduction because the reimbursement system rewarded growth and more services. Another stated that providers have undertaken cost control for years, and they have invested heavily in accounting and financial systems, as well as aggregation of…
Read More
Future of Health CareMedical Decision-MakingPatient EmpowermentValue-Based Health Care
January 3, 2018

Can the New Year Bring A Real Solution to Affordable Health Care–From Providers?

Every New Year, we commence another round of solutions to fix our expensive health care system.  2018 will be no different.  A predicted 5.5 percent increase in medical costs over last year will no doubt spawn new efforts to contain direct payments to providers or transfer costs to consumers—or both. No solution has appeased health system stakeholders, including employers, health plans, consumers and providers. No matter where the system is pinched, another part reacts, and costs continue to outpace inflation. Most solutions, however, have been implemented by payers—government and commercial health plans, as well as employers—against providers and consumers. Why…
Read More