Consumers & PatientsFuture of Health CareWomen and Health Care
January 16, 2019

The Real Trend to Watch in 2019: #MeToo for Health Care

Health care pundits need to sharpen their game. Year-end trend predictions are mostly old news. Growth of Artificial Intelligence and other technologies, entry of non-traditional business in health care, and pressure on the bottom line from Value-Based Health Care—all have been well underway for several years. Further, these developments only reinforce health care providers’ inward focus on managing internal machinery and health care financing, instead of real health care. But consider this underreported trend that promises to reshape demand and shake up the supply of health care services: We are in the midst of a dramatic transformation of health care…
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Consumers & PatientsMedical Decision-MakingValue-Based Health Care
December 12, 2018

Conflict of Interest in Medical Practice Is Hardwired: Unless We Acknowledge It, Nothing Will Change

In philosophy class, we were asked to choose which of two children falling out of a boat, unable to swim, should we save. Kant believed all people share the same moral equivalency, and a choice cannot be made to save one or the other based on morality. They must be treated the same. This question was paired with a second question forcing a choice between sacrificing one to save others, or many to save one. Tough moral questions. However, both questions were moot if the one being saved or sacrificed was your child. No matter what moral principle studied, whether…
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Consumers & PatientsFuture of Health CarePopulation HealthValue-Based Health Care
December 5, 2018

Should Value-Based Health Care Help Improve Life Expectancy?

As Americans in a highly developed and prosperous economy, we have ascribed a value to our highly sophisticated, expensive health care system—that it should enable us to achieve better health. If we didn’t believe in the value of our health care system, we would not support health coverage, most people would not visit health care providers, and the public health system would not get be funded. This may sound all too obvious, but it isn’t. Whether our health care system actually achieves that ascribed value of improving health status is now in question. Given last week’s release of Center for…
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ACOsConsumers & PatientsPopulation HealthValue-Based Health Care
October 31, 2018

ACO Population Health Best Practices: More Respect for Physicians and Patients

How important is it to agree on principles and best practices for population health? More important than most providers believe, and here’s why: Population health can be a powerful engine for improving patient outcomes and cost performance in Value-Based Health Care. Failure to create a standard of population health practices means that every ACO or health system scrambles independently to create initiatives, without the benefit of broader experience and results. The outcome? ACOs make similar decisions or duplicate others’ programs with meager results. They may also inadvertently consign population health to safer territory as administrative instead of strategic and innovative…
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Consumers & PatientsFuture of Health CareValue-Based Health Care
October 24, 2018

Consumers Want More Value from Value-Based Health Care: Why Providers Need to Listen

The dramatic rise in personal costs for health care services and coverage, sharpened by political battles over affordable care, is driving consumer health care activism to a new level. Voter projections indicate that health care will be the largest single voting issue in the 2018 mid-terms, with 30 percent of voters saying their decisions will depend on where Congressional candidates stand on health care coverage. While there may be a strong partisan split regarding the solution, broad dissatisfaction with the current system crosses party lines. Health care today takes a huge bite out of most Americans’ personal finances. It is now…
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Consumers & PatientsFuture of Health CareMedical Decision-MakingResearchValue-Based Health Care
October 17, 2018

Wise Patients Really Can Make Medical Decisions

“The numbers in this blog are hard to believe. Why is the medical profession recommending shingles vaccine? It is one thing to say that patients should be their own advocates. But why would medical professionals recommend a vaccine to their patient that has such a paltry risk/benefit outcome? After all, we go to doctors because we presume that they know more about medical conditions, prevention and treatment than we do. If they don’t, what’s the point?” A wise patient reading my blog on the shingles vaccine made the above comments. The adjective “wise” has been defined as “able to make good judgments.”…
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ACOsConsumers & PatientsFuture of Health CareValue-Based Health Care
October 10, 2018

Cost Savings Aren’t the Only Objective for ACOs: Growth Matters, Too

Keeping within expenditure limits is a top priority for most ACOs for Medicare. That makes sense. Savings are the main distinguishing feature of an ACO arrangement, as opposed to straight Fee-for-Service reimbursement. ACOs that accept downside risk can’t afford to exceed the expenditure target. It’s in their best interest to create initiatives to cut costs and control expenses—especially for services outside the ACO, such as post-acute care. But a cost strategy only focused on trimming expenses will likely fail the ACO in the long run. Why? Medicare ACOs face an annually decreasing expenditure limit that mandates them to lower costs…
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ACOsConsumers & PatientsFuture of Health CareMedical Decision-Making
August 22, 2018

How ACOs Can Leverage Price Transparency To Create Value for Consumers

Health care consumers are being forced to assume a greater share of costs for treatment. But how can patients determine the value of health care services if they can’t compare costs? Lack of price transparency is a major obstacle to value-based medical decisions. In evaluating treatment options or services by different providers, consumers have no reliable means to monetize their choices. They are powerless to do anything about it—as yet. But that may well change as ACOs adapt to downside risk. Price transparency is a tool that exclusively benefits consumers, because health plans already, obviously, know the prices they negotiated…
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Consumers & PatientsMedical Decision-MakingResearch
August 8, 2018

Why Randomized Clinical Trials Are Essential to Informed Medical Decisions

I am not a card-carrying philosopher, although I did study philosophy as my undergraduate major. What I enjoyed most was epistemology, the theory of knowledge. We debated, hotly, from the standpoints of social interaction and humanism, “What is knowledge? What constitutes knowing?” But such philosophical debates are not relevant in medical care. Medicine is not a philosophical province. By that I mean that when we are ill, we are philosophically the same; debating differences is a waste of time. We have equal value; have the same rights to the same efforts and same actions to get us better. The essential…
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ACOsConsumers & PatientsFuture of Health CareMedical Decision-Making
July 11, 2018

Create Value for Consumers by Leveraging ACO Provider Choice

Medicare and commercial insurers are adamant about moving providers from Fee-for-Service to financial risk for services, and CMS is losing patience over providers’ reluctance to embrace downside-risk ACOs. Why are providers so worried about accepting risk? Because, they say, provider choice will ruin their potential for savings. With an estimated 25 percent of patients seeking services outside the ACO—for 60 percent of attributed total costs—providers argue that they can’t control total expenses, yet are on the hook for savings. They blame lack of coordinated care, duplicate tests and differences in the standard of care. Coordinated Patient Care Inside the Organization:…
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