Category Archives: Healthcare Costs

Making a Bigger Leap after Coronavirus the New Age of Primary Care and Telehealth

I have been watching our country and the world as we struggle with this pandemic, a truly eye-opening experience for all of us.  May we rapidly slow the spread and heal the sick.

As we consider the longer-term implications, there are a lot of areas (I’ll steer clear of the Government, its response and the politics that we all saw, as well as its major impact) that need work including:

  1. Our public health infrastructure
  2. Our lack of resources
  3. Our disjointed system
  4. Our use of just in time supplies
  5. Our lack of manufacturing and production capabilities here in the United States for basic supplies and medicines
  6. Our focus on revenue generation by elective procedures
  7. Our overall health literacy and many, many more.

While all these issues has been influencing our response, our doctors, nurses and other healthcare professionals and staff, who are truly on the front lines, have been doing amazing work with what they have and risking their lives for us.

What I’d like to discuss is the issue of Telehealth/Telemedicine and its potential to radically transform our care delivery system.

When hospitals and clinics were told to stop doing any elective or non-emergency work, many procedures and visits were cancelled.  Primary care doctors and other specialists are now rapidly running out of cash to keep their offices open because no one is coming in and they are generating less revenue.

A few weeks ago, an email was sent by my provider group notifying me that a follow-up visit with a specialist scheduled for early May, may be done virtually.  I was happy to hear this as my wife, an RN, had recommended that I contact the clinic and cancel it, because there were other more urgent matters that the doctor might need to see.

If we consider that this visit, a post-surgical follow-up could be done virtually and then also in particular looked at the primary care system, how many of these could be done without the need to be seen face to face?  And think of the potential universe of visits with the addition of remote monitoring devices and tools.

While everyone recognizes the need for Telehealth and is rapidly embracing it, the majority of implementations have been similar to our experience with Electronic Medical Records, which was:

Take the paper chart and digitize it. 

So now we take the office as it is and add Telehealth.

But lets think more broadly, imagine the amount of resources that a redesigned practice around Telehealth could free up, from built offices, to exam rooms, to front desk staff, the MA to walk you back to the room, waiting room space, to supplies (wash your hands between seeing each patient), throw that paper towel away, replace the paper on the exam table, to cleaning the room, heating/cooling the space etc.

The net savings and efficiencies of moving to a modified virtual/face to face delivery system are potentially enormous; let alone the reduction in risk to the physicians, other clinicians and staff and those in the waiting rooms that they may bring in or catch an infection from someone else.

These changes would also prepare us for the next pandemic or disaster when we are once again home bound.

This new Telehealth/face to face approach should be the front end and major component of a healthcare system built for the 21st century.  A new primary care approach and a new specialty care approach.

Doctors and patients will have to learn new ways to do things, but it can work, freeing up money and allowing for the built infrastructure to be designed and capable of handling those requiring more critical services; without using that built infrastructure for non-critical needs. It also ensures that services continue, and providers can practice during crises like this.

This is but one of the many changes we should make that include addressing the other issues listed above so this type of situation never happens again.

Rahm Emanuel said, “Never let a good crisis go to waste”. By moving to a hybrid Telehealth/face to face approach we can improve healthcare from a quality, operations, cost and satisfaction perspective, let’s start with Primary Care.





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What the Walmart Decision to Send all Spine Surgeries to Centers of Excellence Really Says

Walmart announced this past year that they were modifying their Centers of Excellence (COE) program and requiring employees to travel to one of their eight approved COEs for Spine Surgery. That raised a lot of eyebrows and interest among other self-insured employers, benefits consultants and of course the healthcare system itself. Walmart did this after finding that perhaps 40 percent of those referred to a COE after having a recommendation for surgery by their local physicians, were not recommended for surgery by the COE.

There are 650,000 to 700,000 spine surgeries performed per year, with around 280,000 to 300,000 being done in an outpatient setting and ( spine surgery is the most highly reimbursed subspecialty within orthopedics. (

Amazingly, 90% of Americans live within 10 miles of a Walmart and they employ about 1.5 million people in the United States ( Think about that! I would assume that somewhere close to 90% of the spine surgeons also live within 10 miles of those Walmart’s’, many of whom Walmart has deemed were potentially doing unnecessary surgeries on 40% of the employees they referred to the COEs with spine issues. BTW the hospitals I’m sure were doing well by these referrals too.Becker’s said they did this to save money (, not mentioning that 40% of the cases were reviewed by the COE and determined to not need the surgery that had been recommended by the local doctor, sure that saved money, but what about quality of life for the patients, and quality in general . Should they just go ahead and let those surgeries be done?

Here are some other outcomes as reported by Beckers Spine Review

1. About 2,300 employees — around half of the Walmart employees who underwent spine surgery or evaluation without surgery from 2015 to 2018 — utilized a center of excellence. During that time, 46 percent of patients underwent surgery and 54 percent received other forms of treatment.

2. The employees who underwent care at center of excellence sites reported shorter hospital stays; the COE employees stayed in the hospital for 2.5 days, compared to 2.9 days for the non-COE employees. Then, 0.6 percent of the COE patients were discharged to skilled nursing facilities, far lower than 4.9 percent of the non-COE patients.

3. Over the past three years, the readmission rate per 1,000 patients in the program was three for COE patients, compared to 65 for non-COE patients.

4. On average, patients who received care at a center of excellence returned to work after 10.6 weeks, which was 2.6 weeks sooner than the non-COE patients.

5. Cost for care was 8 percent higher at the center of excellence — $32,177 on average — compared to $29,770 at the non-COE, but the lower readmission rates, earlier discharge and lower skilled nursing facility use was a “payoff” of the COE model.

So now getting back to something I have seen little attention paid to, what does that say about the state of spine surgery around the United States? Its not as if Walmart has a little footprint around the country.

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My Interview on the “Unlocking Accountable Care” Podcast

I recently had the pleasure of joining Emily R. George on her Podcast Unlocking Accountable Care where I shared my thoughts about giving communities a mechanism to create interventions to improve their own health. In the value-based world, health care providers are trying to keep people healthy and are incentivized to do so, but what if we shift some of that responsibility and those incentive dollars to the communities themselves?


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Filed under #SDOH, Healthcare Costs, Population Health

Looking to the Validation Institute and Validated Programs as an Employer

Disclosure – I serve as an Advisor to the Validation Institute.

Costs for their employees’ health care have continued to rise even as employers have implemented numerous programs and benefit changes, from raising employees’ deductibles and co-pays, to implementing wellness programs.  While employers pay most of the premiums, which now exceed $20,000 for family coverage, employees now shoulder $6,000 per year on average, a heavy burden.

Here is a look at premiums growth over the years from the Kaiser Family Foundation Employer Health Benefits Survey..

Image result for employer healthcare costs continue to rise

So, what’s an employer to do?

That’s where the Validation Institute comes in.  The Validation Institute or VI does three things:

  • Validate
  • Educate, and
  • Connect

This post will discuss Validation and its importance.

No doubt employers have been looking at their health benefits and listening to their brokers or consultants explain how this program or that health plan is the best way to go and will result in better employee health and lower costs or a lower growth in costs. But how do they know? While most have heard these statements year after year, their costs have continued to rise.

The good news is there are solutions that deliver better clinical outcomes and/or reduced costs. Finding and validating the claims being made has been the hard part. The marketing of health care services has been fraught with all sorts of performance claims and many of the studies and white papers used to support them are just plain wrong.

The VI, through its Validation process, handles that process for you. It rigorously looks at claims being made by companies throughout heath care. 

For a company to be validated, it must submit its data.  The source, measures, analysis and results are reviewed to determine whether the claim being made stands up to a rigorous evaluation. Only after a thorough review can a company place the Validation Institute seal on its website and use the VI certification in its marketing materials.

There are four different “levels” of Validation. They are, in ascending order of rigor:


Many companies develop calculators to show prospects their expected savings or outcomes.  If the calculator has been validated, that means  it uses reliable and linked data sources, reasonable parameters and estimates, but allows the users to change certain assumptions. It also means that the calculator produces credible estimates of an intervention’s impact and the intervention has been shown in published literature to be correlated with the impact.

The company may  not have produced a study showing these results, but based upon their calculator and other research, the calculator is likely a credible estimate.

Program Impact – Metrics

In this case the vendor has a credible measure (either from a published source or modeled closely to a standard measure) of the program impact, but the measure has yet to be applied to data from a population receiving the program. The intervention has been shown in published literature to be correlated with the impact.

So, the program has been shown in other cases to be correlated with creating the outcome, they are measuring and doing something similar, but have not yet measured their own results to the satisfaction of the VI.

Program Impact – Outcomes

The vendor has used credible data about a population receiving the program and reliable measures (either from a published source or modeled closely to standard measures) to estimate impact.  The intervention has been shown in published literature to be strongly correlated with the impact.

The program being reviewed by the VI has been shown to strongly correlate with creating the outcomes, and the company has obtained these outcomes on a population with credible data and reliable measures.

Program Impact – Savings

This is the big one. The program has been shown to the Validation Institute’s satisfaction to produce savings.

As a health care purchaser, you want the best for your employees and your company. Look to the Validation Institute and their certified companies to know that what you are implementing for your employees is based on sound studies, measures and/or outcomes and is more likely to do the same for you.

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Meet Dr. Rita Numeroff on PopHealth Week

On this episode of PopHealth Week our guest was Rita Numeroff, PhD of Numeroff and Associates.  We discussed some of the findings from their survey, The State of Population Health: Fourth Annual Numeroff Survey Report; which was released at this  years Population Health Colloquium. Dr. Numeroff had some fascinating insights regarding the slowing down of the move to value-based care and some of the reasons for this.


Dr. Rita Numeroff on PopHealth Week

Here’s some more information on Dr. Numeroff.

Her dedication, leadership, and passion have guided Numerof into its third decade of continuous growth and success.

From the firm’s inception, Rita has focused on developing new business models for rita numeroffcompanies in industries undergoing major market changes. Her work has spanned industries that are critical to global economic growth – financial services, healthcare delivery, pharmaceuticals, medical devices, telecommunications, and major industrial manufacturing. Bringing experience, style, and boundless energy, Rita has applied her expertise to help organizations create and execute successful new strategies in the face of fundamental market shifts.



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Filed under Healthcare Costs, PopHealth Week, Population Health