June 19, 2019
From women’s health care to the future of the Affordable Care Act, Roji Health Intelligence CEO Terry Hush has shared her insights with numerous industry publications in recent months. Here’s a sampling of current articles: Value-based arrangements in ASCs — 3 quotes from an industry CEO Becker’s ASC Review | June 11, 2019 Terry’s predictions, based on 25 years of industry experience, for what to expect for the future of risk-based agreements. Hint: Episodes of care and bundled payments will become increasingly important. The Future of Healthcare: “Make tools available for women so that they can have a real voice…Read More
June 12, 2019
Get the eBook “Not Second Best: Inject Value in Women’s Health Care”
Six months ago, I started writing about women’s health, in response to this simple question: What trends are emerging in health care for 2019? The New Year is filled with predictions about what is coming, and I thought this year’s list from health care leaders was too “last-year.” Artificial intelligence, medical science advancements in biologicals and genetic therapies, and business consolidation are not coming; they are already here and will simply go further. Witnessing the debate about health care rights in the country, and the increasing distrust of health care by consumers, I observed that most of those speaking are…Read More
June 5, 2019
Can Small PCPs Succeed in Medicare’s Primary Care First?
Medicare’s announced primary care models will provide an interesting test of whether financially-motivated primary care practices (PCPs) can improve hospital utilization, the key outcome measure that will determine provider revenues under the pilot. While provider risk for costs of patient care is inevitable for most physicians in the future, providers don’t have the same potential for financial success. That is especially true for PCPs, whose volume and roles in health care have been eclipsed by specialists and industry consolidation. Whether Value-Based Health Care can restore primary care to a central role of coordination—with the potential for cost reduction—is at the…Read More
May 29, 2019
Here’s One Way to Do Better Science
Clinical research with randomized trials (RTs), as opposed to basic or bench research, is the science of comparison. RTs ask a fundamental question: Is “x” better than “y”? They do more than observe how treatments work; they also require methods that control the research environment. Finding an independent contribution of one action over another demands random, stratified populations in order to find truthful differences, as medical care advances on these differences. But the way that patients are typically recruited for RTs can undercut the validity of the study’s findings. I propose we take a different approach, one I call “Gallup…Read More
May 22, 2019
Can Provider Risk Cure High Medical Costs?
Fee-for-Service (FFS) has been on a slow march toward risk-based reimbursement for two decades. But FFS has proven to be remarkably resilient—until now. In the last six months, Medicare has doubled down on creating new provider risk models for ACOs, specialists and primary care physicians. All of them have methods to ensure that providers are held accountable for medical expenditure targets. Wait. Haven’t we been here before? What‘s different between now and the 1980s, when HMOs and provider risk first prevailed in the market—and then were purged as both ineffective and unpopular? Is provider risk a cure for high medical…Read More
May 15, 2019
How Providers Must Improve Value in Women’s Health
Writing the Roji Health Intelligence® series on gender disparities and other women’s health issues has been a revelation. As a woman who has worked in so many parts of the health care industry, I was already aware of basic gender disparities, risk levels, incidence of disease, and economic issues that are predominant among women. Most women in health care have had their knowledge and judgment doubted as both patients and professionals. Women everywhere encounter the economic barriers associated with affordable health care, some much worse than others, and every woman who is a mother struggles with balancing the interests of…Read More
May 8, 2019
How Will New Primary Care Models Affect Providers in VBHC?
Embraced by some provider groups and disparaged by others, CMS’s five new payment models for practices focused on primary care include much to consider. All reflect a key departure of Medicare’s Value-Based Health Care (VBHC) efforts to date: they are direct efforts by Medicare to transition physician practice revenues to risk without the necessity of ACO participation. The primary care models will affect both providers and patients. In this article, we’ll address the provider issues. How patient choice of care and outcomes for patients and patient populations will be affected deserves dedicated scrutiny in a future post. No Surprise that…Read More
May 1, 2019
Do “Women’s Health Centers” and Services Deliver on Value-Based Health Care?
Women make an astounding 80 percent of health care decisions for themselves and their families. But there’s a disconnect between what women need and how providers have organized health care for them. While Value-Based Health Care (VBHC) is struggling to achieve more value for every health care dollar spent, providers are simultaneously sabotaging women in their customer base. How? This might surprise you: through promotion of “women’s health” services. While providers may have good intentions for offering a dedicated place for women’s health needs, those services have actually fragmented care for women, especially those with more complex conditions. Let’s evaluate…Read More
April 24, 2019
If Not Now, It’s Too Late: More Clinical Science Pitfalls and a Path to Improvement
Let’s review three major vulnerabilities with how randomized trials (RTs) are conducted, as discussed so far in this series. Critically appraising a research study involves determining the “internal and external” validity. Internal validity deals with the conduct of the study, per se. External validity deals with whether the study’s findings can be generalized to others in the population. Here’s what can go wrong: Populations being studied in RTs are too often convenience samples of patients/subjects rather than random or systematic samples of subjects. This diminishes our ability to externalize findings from the RT to the population at large. This is…Read More
April 17, 2019
Bootstrapped ACOs Facing Risk? Adopt Cost Strategies With Long Term RoI
The experimental phase of Medicare ACOs has been officially declared dead, per CMS. Going forward, ACOs must agree to take on financial risk for expenditures beyond their targets. That’s sobering news for the majority of ACOs still struggling to succeed. The reality is that most ACOs are bootstrapped—light on extra funding and dependent on existing tools to do more. In fact, about two-thirds of ACOs report that funding is their most significant challenge. And that is probably understated, since patient engagement problems (also reported by two-thirds of ACOs) and lack of data (reported by 40 percent) are remedied by solutions…Read More