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 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 11, 2019
When Women Call Out Medical Gaslighting, Providers Lose the Whole Family
A smart business would not deliberately blame customers for needing their services or accuse them of spinning fictions. A business dependent on customer loyalty and engagement for their success—and what business doesn’t?—would normally pay close attention to customer concerns in social and mainstream media. All the more so in health care, where the needs are generally much more significant, and the consequences of failing the patient are literally a matter of life or death. That’s why providers In Value-Based Health Care should pay close attention to the increasing din of “medical gaslighting” charges by women. These are not idle accusations.…Read More
March 28, 2019
Women with Autoimmune Diseases Fight Uphill Battle on Every Health Care Front
Our articles on women’s health care issues have focused on areas that must change in order to provide better quality and outcomes, to lower costs, to advance treatment, and to treat women respectfully and equitably as patients and providers. We have demonstrated how women have been sidelined from getting the right health care because of two key systemic obstacles that must be addressed: Cultural bias that prevents accurate clinical assessment of symptoms and diagnosis, adoption or use of protocols relative to women’s biology, and effective health care therapies, and Inadequate basic science and clinical research that will illuminate sex-differentiated biology…Read More
March 13, 2019
Women’s Health Research Needs an Infusion: How Health Systems and ACOs Should Help Correct Gender Disparities
Women receive health care that is below par, and the consequences are unnecessary morbidity and death. It is fact, not fiction—borne out by significant data that reveal disparities across many major conditions—that inattention to women’s unique symptoms, risk factors, disease biology and treatment effects are causing harm to women. Despite the reality, a poor body of research exists to point women’s health in the right direction. Value-Based Health Care (VBHC) assumes that we can measure providers’ delivery of health care against clinical standards. What if we don’t even know how half the population exhibits disease or responds to therapies? At…Read More