Roji Intel Blog

Theresa Hush 0
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Consumers & PatientsFuture of Health CareMedical Decision-Making
July 4, 2018

Life, Liberty and Happiness Require Good Health: What Consumers Need to Get There

Independence Day reconnects us with our Founders’ values that “Life, Liberty, and the Pursuit of Happiness” are our fundamental rights. There is a basic concept underlying this dream: While the country will provide the opportunity, its citizens will act to achieve it. But there’s a catch—citizens’ potential to realize the dream depends on good health. Health has never been as threatened as now. The epidemic of chronic disease, exacerbated by poor nutrition and life choices, is overwhelming a system running out of money. We keep paying more for health care and coverage, and getting less in health outcomes. Even worse,…
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Theresa Hush 0
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Consumers & PatientsFuture of Health CareMedical Decision-MakingValue-Based Health Care
June 27, 2018

Tech Tools Empower Consumers to Reform Health Care: Will Providers Cooperate?

Health care is ripe for change, but providers have yet to take the lead. Who will push for much needed reform? Investors and technology experts are betting on consumers. Money is chasing health care technology (IT) startups to create consumer tools for everything from evaluating and comparing treatments and related costs, to managing medical conditions. The underlying assumption is that consumers will shop for good, affordable care. It’s the right time for health care IT to focus on consumers, who are feeling the pain of huge medical costs that were once paid by employers or government health plans. Either through…
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Robert McNutt, M.D. 0
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Consumers & PatientsMedical Decision-MakingResearch
June 20, 2018

Deciphering Outcomes: Thirty Percent More of Nothing Is Still Nothing

Trying to pass a Bill through a legislature demands a hardy disposition. I have been involved in three attempts on different issues—one bill passed, one is still in limbo, and a third, the most salient for me, failed. In the latter case, I was the sole proposer of the Bill. My idea captured the imagination of a state representative who said she would sponsor it, but, first, she wanted to get some other views. Eleven lobbyist conversations later, my Bill was dead. Something about the legislator being worried that my Bill would be taking on the First Amendment, which allows…
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Dave Halpert 0
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ACOsAdvanced Alternative Payment ModelsAlternative Payment Models (APM)MedicareMerit-Based Incentive Payment System (MIPS)Value-Based Health Care
June 13, 2018

Medicare Paths to Value-Based Health Care: Which Way is Up?

If you’re scratching your head about the direction of Value-Based Health Care (VBHC) in Medicare, you’re not alone. The current mix includes a swirl of separate initiatives, some new and others recently re-labled. As CMS pushes toward VBHC, providers may feel confused and frustrated as concepts emerge that will affect multiple programs. Within the last several months, the Patients Over Paperwork and Meaningful Measures initiatives have shaken up CMS value-based care programs, particularly: Merit-Based Incentive Payment System (MIPS) Medicare Shared Savings Program ACOs (MSSP ACOs) Direct Provider Contracting (DPC) Even more confounding, CMS is taking a non-linear development path for…
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Theresa Hush 0
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ACOsAlternative Payment Models (APM)Consumers & PatientsMedical Decision-MakingValue-Based Health Care
June 6, 2018

Where’s the Value for Physicians in VBHC? Four Strategies for ACOs and Other APMs

When we talk about “value” in Value-Based Health Care (VBHC), we’re referring to the high-quality/lower-cost services that buyers want from health care providers. Who are the buyers? Health plans, Medicare and other governmental purchasers, plus employers (for the most part, the term is notably not interpreted to include patients). What do buyers want? “Truth in purchasing” for the best health care they can get. Indeed, the very term “Value-Based Health Care” implies that buyers are on a righteous quest for good care from irresponsible providers. Provider organizations, in turn, have sometimes adopted a similar attitude toward physicians. The generation of…
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Theresa Hush 0
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Consumers & PatientsFuture of Health CareMedical Decision-MakingValue-Based Health Care
May 30, 2018

Why Patients Should Ask Questions—and Physicians Should Listen

For health care providers and payers, Value-Based Health Care (VBHC) is a hot topic, with most all payers pressing a shift toward financial risk contracts and ACOs based on quality and cost performance. But if you ask consumers about the trend, chances are you’ll get a blank stare. Why? They’re not really part of the conversation. That’s a major problem, because consumer involvement is essential for VBHC success. When outcomes fall short, providers may complain about poor “patient compliance” with physician orders, and ACOs may bemoan lack of “patient engagement.” But they are minimizing patients’ preferences and concerns, or perhaps…
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Theresa Hush 0
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ACOsFuture of Health CareValue-Based Health Care
May 23, 2018

Tipping Point Test for ACOs: Consent to Financial Risk

Last week the conversation about financial risk for providers in ACOs took on a decidedly different and more contentious tone. After months of CMS reports of ACO growth and success, while retreating on MIPS quality reporting requirements as concessions to “provider burden,” CMS signaled that they were finished waiting for providers to accept financial risk under Value-Based Health Care. With a third of Medicare patients served by an ACO and an even higher number of patients receiving health care via private sector ACOs, the industry seems on track to adopt ACOs as the preferred model of health care contracting and…
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Robert McNutt, M.D. 0
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Future of Health CareMedical Decision-MakingResearch
May 16, 2018

“Just the Facts, Ma’am”

Communication, according to Webster’s: “exchange of information” You and I talk all the time. We are constantly “communicating.” Communication is a huge idea that encompasses and displays our views of the world. But communication is more than just the sum of the words used to communicate; the words are contextual. Raymond Carver wrote with simple, universally understood words, but I could not communicate like him even if I used the same words and labored intensively. Communication, in a sense, is a five-syllable word that is nearly elevated to a sixth sense, like taste, sight, touch, smell and sound. But here’s the rub. I don’t…
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Theresa Hush 0
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ACOsFuture of Health CareSpecialty PhysiciansValue-Based Health Care
May 9, 2018

ACOs and Specialty Physicians: How Episodes of Care Create a Win-Win Cost and Quality Strategy

Specialty care is a thorny cost and political issue for ACOs and physicians alike. No ACO can provide good or comprehensive patient care without specialists. But if ACOs are to produce savings, they will almost certainly need to address how, when and at what cost those specialists will be used. The degree of concern about specialist-generated costs for most ACOs currently depends on the ACO’s structure. ACOs that are hospital-led or formed by multi-specialty health systems or networks may be less apt to look to specialty care for savings, except when the specialists are outside the ACO. Physician-led groups with…
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Robert McNutt, M.D. 0
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Consumers & PatientsMedical Decision-MakingResearch
May 2, 2018

Patients Deserve Truth-based Medicine—But Most Aren’t Getting It

“I have breast cancer; I read that I should not drink wine because it may cause my cancer to return. I always wanted to be a sommelier, but that dream is dashed!” People, sensibly, read about their medical conditions, searching for things that might help or hurt them. However, patients are vulnerable. Their vulnerability may cause them to overestimate concerns, or, alternatively, hopes after learning of a medical advance. Physicians and medical reporters have a daunting, yet crucial obligation to give people information that is credible; strategically, we also need to thwart information that is useless. Giving poor, non-science information…
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