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161 posts categorized "Health Reform"

January 29, 2015

Better, Smarter, Healthier: Medicare and Value Based Purchasing

EvolutionThe big announcement this week from Medicare -- setting forth specific targets for a historic shift away from fee-for-service reimbursement in order to reduce costs and improve quality -- is less than it seems.

Medicare has been talking about value based purchasing for decades now, and thus far has taken baby steps towards implementation. Even the strides taken in recent years, and the targets laid out this week for the future, don't really leave FFS medicine in the dust. ACOs and other MSSP innovations don't entirely move away from FFS reimbursement; they just add cost and quality kickers as part of a retrospective reconciliation.

CMS identified four categories of payment and targets related to each of these categories.

  • category 1—fee-for-service with no link of payment to quality
  • category 2—fee-for-service with a link of payment to quality
  • category 3—alternative payment models built on fee-for-service architecture
  • category 4—population-based payment

Continue reading "Better, Smarter, Healthier: Medicare and Value Based Purchasing" »

January 06, 2015

2015 Health IT Predictions and Reflections

Janus-Vatican-2Kate Ackerman at iHealthBeat asked me to participate in her annual piece on Health IT past and future, 12 Experts Weigh In on Health IT Progress, Disappointment in 2014 & Hopes for 2015. Check out her roundup of 2014 highlights, and the collected opinions of a dozen prognosticators, including the HealthBlawger.

Read them all. Agree or disagree. Most important of all: Work to make your own predictions come true.

For those of you dying to know what I had to say, have at it:

What was the most significant health IT development over the past year?

The continued slow but steady development of asynchronous telehealth services, leveraging resources such as wireless monitoring devices, which was potentially supercharged by the development of consumer-centric health data platforms by big consumer electronics firms.

Continue reading "2015 Health IT Predictions and Reflections " »

December 15, 2014

Farzad Mostashari on the Proposed ACO Regulation: The future of the Medicare Shared Savings Program examined in an interview with David Harlow

Mostashari_Farzad_ORIGINALThe Accountable Care Organization regulations were first promulgated under authority of the ACA's Medicare Shared Savings Program in 2011. Three years later, the regs are in the shop for a tune-up. Farzad Mostashari MD was one of the authors of the Brookings Institution ACO issue brief released in the spring, suggesting some changes to the program that would keep current ACOs engaged past the end of their three-year contract term, and improving the program overall. Dr. Mostashari, former National Coordinator for Health IT, is now the founder and CEO of Aledade, a startup focused on helping physician organizations develop ACOs. With a level of excitement shared only by a small coterie of health wonks -- and usually reserved for video recordings of unboxing the latest hi-tech toy -- Farzad livetweeted his reading of the 429-page typewritten version of the proposed ACO rule when it was released late last Monday. (See the CMS Fact Sheet on Proposed Changes to the MSSP and the Aledade post on the proposed reg.

The rule was published officially on December 8, with a 60-day comment period. I had the opportunity to interview Dr. Mostashari about the new rule. As he noted in our conversation, CMS is calling for input on a variety of issues, so don't be shy, especially if you have some data to back up your suggestions on the choices that remain to be made in this rulemaking process.

(Read or listen to the full interview after the jump.)

Continue reading "Farzad Mostashari on the Proposed ACO Regulation: The future of the Medicare Shared Savings Program examined in an interview with David Harlow" »

December 03, 2014

Down, Down, Down: Avoidable Errors, Uninsurance, Cost Inflation

Upside down churchToday was a good news day. The headlines, at least, would have us believe that we are making great strides in achieving the Triple Aim, dealing with quality, access and cost issues.

Exhibit A: Deaths due to Healthcare-Acquired Conditions are Down. Per the WaPo, AHRQ says:

 

Hospitals reported 1.3 million fewer hospital-acquired infections in all between 2011-2013 compared to the rate of mistakes that hospitals made in 2010, according to the report from the Department of Health and Human Services. That represented a 17 percent drop in hospital errors from 2010, but about 12 percent of all hospitalizations as of 2013 still experienced an adverse event during the course of care.

The reduction of these avoidable incidents — such as falls, pressure ulcers, adverse drug events and more — meant $12 billion in savings to the health-care system between 2011 and 2013, according to HHS.

Continue reading "Down, Down, Down: Avoidable Errors, Uninsurance, Cost Inflation" »

November 20, 2014

Health Wonk Review: The Turkey Edition

Turkey-palace.png Welcome to Health Wonk Review, the bi-weekly blog carnival featuring the latest and greatest blogging by a staggeringly wonkish agglomeration of health care policy nerds. The last edition of Health Wonk Review was hosted at Wing of Zock. The story behind the name of that blog seems (to this health wonk, at least) oddly relevant to this edition's theme, given the recent news that the construction costs of the new presidential palace in Turkey seem to have doubled ... again.

Well, our frame this week is the other turkey, the turkey that will lull many of us into a stupor late next week, and the health care policy decisions (and decisionmakers) that sometimes make us wish we were in more of a stupor ... so as to lessen the pain. Top of mind in that department this week is #GruberGate:

Continue reading "Health Wonk Review: The Turkey Edition" »

October 01, 2014

HealthCamp Boston, November 3, 2014 - Register Now For The Health Innovation Unconference

HCBOS-logo-sqHealthCamp is heading back to Boston. Once again we will be at the Microsoft NERD in Cambridge, MA. This was the venue for the inaugural HealthCamp Boston in 2009 and for the second edition in 2012. We are excited to be returning to this fabulous facility.

Register now!

Our date is set. HealthCamp Boston will take place on Monday November 3, 2014.

This is the day before the Digital Healthcare Innovation Summit. So come a day early and really turbocharge your conference experience by joining other passionate healthcare innovation people at Health Care’s leading unconference – HealthCamp.

Continue reading "HealthCamp Boston, November 3, 2014 - Register Now For The Health Innovation Unconference" »

May 23, 2014

The Affordable Care Act: How Provider Organizations Can Succeed Under Health Reform

The Affordable Care Act has triggered many changes in the health care delivery system. Learn about the health reform-inspired approaches to redesigning care that work (or don't work) for management of chronic conditions, including diabetes -- from ACOs to bundled payments to patient centered medical homes.

I recently had the opportunity to present to the domestic affiliates of Joslin Diabetes Center on this topic.

Continue reading "The Affordable Care Act: How Provider Organizations Can Succeed Under Health Reform" »

April 24, 2014

Hospital Readmission Data for All Payors

HCUPEfforts to reduce hospital readmissions have been focused on a handful of diagnoses and on government payors (primarily Medicare). In order to get a handle on the roughly 15% of the U.S. health care spend that goes to readmissions, it is vital to have a better understanding of what these readmissions are for, who is experiencing them, and why. Not every readmission is a preventable readmission -- though health reform wonks are pretty highly focused on preventable readmissions for specific diagnoses (starting with acute myocardial infarction, heart failure and pneumonia).

Here's the data from 2011, thanks to HCUP (the Healthcare Utilization and Cost Project) at AHRQ:

Continue reading "Hospital Readmission Data for All Payors" »

March 12, 2014

How do you get Young Invincibles to buy health insurance?

C480x270_48President Barack Obama is pushing his signature domestic program, enrollment in a health insurance plan via healthcare.gov by March 31, by shilling for it on the "Funny or Die" Zach Galfianakis mini talk show satire, "Between Two Ferns." I think it's hilarious, though not everyone thinks the humor involved befits a sitting president. Whether or not you appreciate the humor, I think you have to doff your cap to the Commander in Chief, because he is living by the maxim that you've got to fish where the fish are -- and choosing this website over network television, over White House-hosted online media, using video, using authority-subverting humor, has gotten the message out (including a clickable link) to the Young Invincibles in a way that other media just could not have done. The video was posted yesterday; it has already been viewed over 13 million times, and was associated with tens of thousands of click-throughs to the exchange website by the close of business yesterday.

Continue reading "How do you get Young Invincibles to buy health insurance?" »

January 03, 2014

Health IT Wisdom at the End of 2013 and Start of 2014

Janus1I am quoted in a couple of year-end / new year pieces on health IT, appearing this week in iHealthBeat and FierceHealthIT.

With new developments over the past year in the realms of telehealth, mobile health and health data privacy and security, and opportunities for accountable care organizations, integration of connected health and implementation of HIPAA compliance plans, there is plenty of material for prognosticators.

Kate Ackerman, Editor-in-Chief at iHealthBeat asked 13 experts three questions.

Here are the questions and my answers; follow the link above to read 12 other perspectives.

Continue reading "Health IT Wisdom at the End of 2013 and Start of 2014" »