A few months ago, I attended a community health annual event associated with one of the many initiatives started by a large organization to bring together groups and begin implementing programs to improve the health of the community.
At this particular event after a couple of years of meetings and work, there were a number of presentations by the organization, community groups, the local government and a review of work done to date. It was a Kumbaya moment. Near the end of the day when people were asking questions, a gentleman next to me stood up, he worked in one of the poorest neighborhoods in the city and oversaw a local effort in that community.
He said and I’m paraphrasing.
I look at our community and see it has the exact same issues today we had 50 years ago. Nothing has changed, nothing has been done and we look just the same. You tell us to exercise but we have no sidewalks, no parks, the nearest gym is 3 miles away, we have no transportation, no access to healthy foods…
and well you know the rest of the issues he raised. He was clearly frustrated and has every right to be.
The vast majority of employers are continuing to experience rising health insurance costs. We know there are areas of healthcare from quality differences to the variation in utilization that can negatively impact an employer health plan and its estimated that 30% of healthcare is unnecessary, waste and/or fraud. To solve this there have been many solutions proposed including wellness, imaging management, PBMs, High Deductible Health Plans, Direct Primary Care, Value Based Care, direct contracting and many, many others. In each of these solutions there is typically some sound belief that the concept will work, but there are also a lot of vendors or healthcare providers out there claiming they have the answer and this is often filtered through a broker who may or may not have your best interest at heart (Read about some the egregious behavior here “Insurers Hand Out Cash and Gifts To Sway Brokers Who Sell Employer Health Plans“).
So how can one identify providers of services who can achieve results? Well that’s where the Validation Institute comes in. To get a sense of the why and what the Validation Institute can do for you, watch this short video:
For full disclosure I was involved early with this group and since then have assisted in various capacities. I currently serve as a Senior Advisor, Standards and Compliance and also serve as a Judge for the Health Value Awards which are given annually at the World Health Care Congress to companies, employers and brokers who can show that they demonstrably improve the outcomes for their employees and lower costs. The validated Health Value Awards are also reviewed by the Validation Institute.
Every year at HIMSS, Gregg Masters and I get a chance to sit down with Kaveh Safavi, MD Senior Managing Director, Head of the Global Healthcare Practice at Accenture. It’s become one of the meetings we most look forward to. This year Kaveh discussed Accenture’s recently released Digital Health Consumer Survey and he also discussed a little bit about his thoughts on AI that he shared in a recent piece in Forbes.
Looking forward to presenting on Population Heath and conducting a workshop on Developing a Population Health Management Program for persons with Diabetes at this years Leading Healthcare Organizations Conference February 3 and 4th in Kuwait City, Kuwait.
I’m updating this post to let you know that the bill has been reintroduced as H.R. 660 in the 116th session of Congress. The new link to the bill is here. We are looking for sponsors and support.
This past week on PopHealth Week Gregg and I discussed the Annual Medicare Wellness Visit and how it came to be. I have always dabbled in policy and was fortunate enough to participate in the creation of that piece of legislation.
More recently, a small group including Reyn Archer, MD, the former Commissioner of Health for the State of Texas and current Chief of Staff to Congressman Jeff Fortenberry, Doug Goldstein and I have been exploring ideas on community health improvement. One of the key gaps we identified was that if a person or community works to improve their health, the financial benefit accrues to the payer or providers. At the same time, sustainable financing has been a fundamental problem with many of the community health improvement initiatives, such as Blue Zones, The Way to Wellville, the Clinton Health Matters Initiative,Humana’s Bold Goal initiative, which typically have the funds to get started, but after a few years have no source of revenue to continue. We sought to solve these two issues.
While I have been working on a concept I call Havens of Health, a Medicare /Medicaid Health Plan owned by its members; Reyn had come up with the concept of creating Community Shared Savings Accounts as the vehicle to distribute/share funds and provide incentives.
To give communities the tools to improve their own health outcomes through community-relevant health information and new health supporting incentives and programs funded without further appropriations.
The idea is simple:
it tasks HHS/CMS with putting together data sets of relevant Medicaid epidemiological and claims health information,
provides grants to states to carry out localized Community Health Improvement programs which includes the creation of dashboards for the community
The Community puts together a program to target one or more of these conditions and
if the program reduces the rates of illness in the community’s Medicaid beneficiaries and/or lowers costs, 70% of the savings would go back to the community.
These savings would be placed in the Community Savings Account to be overseen by a local board, and “used for promoting the health and wellness of residents of the community.”
This bill has bipartisan support, being co-sponsored by Congressman Jeff Fortenberry (R) and Congresswoman Eddie Bernice Johnson (D), and establishes an incentive for communities to work to improve the health of their residents while also creating a sustainable source of funding for communities to begin to work together on both the clinical and social determinants of health, as some have been doing for a while.
If you’d like more information on H.R. 7038 please contact me.