Tag Archives: ACOs

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.

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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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PopHealth Week – Annual Medicare Wellness Visit,Value Based Care and Employers

Gregg and I had an interesting discussion on this week’s episode of PopHealth Week. We covered the Annual Medicare Wellness Visit and how it came to be, as well as value based care and some interesting moves by employers (Walmart and the Utah State Employee Health Plan) and providers (Oschner and their ACO).  Listen in:

PopHealthWeek-logo-TWTTR-sq PopHealth Week – The Medicare Annual Wellness Visit, Oschner and Walmart, Utah Employees and high Cost Pharmaceuticals, a new approach.

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John D. Bower School of Population Health

JDB LogoI’m honored to have been appointed as Graduate Faculty at the John D. Bower School of Population Health at the University of Mississippi Medical Center.

The School is one of the few schools of Population Health in the nation and “their mission is to educate leaders who will transform health care delivery and the health of Mississippians.

This really resonated with me as I had previously done work in Mississippi when Specialty Disease Management Services Inc. (SDM) was involved in the Medicaid disease management initiative as a subcontractor to McKesson Health Solutions.  SDM provided on the ground RNs and community care coordinators located throughout the state seeking to improve the health and care for Medicaid beneficiaries with asthma, diabetes heart failure and COPD. I also have in-laws in Leland, Mississippi in the heart of the Delta.

beech,-bettina1The school is led by Dr. Bettina Beech, their Dean, who is a dynamo building the school and truly working to embed the schools expertise into the state by getting involved in programs to leverage population health in an effort to improve the health of all Mississippians.  Her areas of scientific inquiry focus on the role of nutritional factors in the primary and secondary prevention of obesity and type 2 diabetes, with a particular focus on child health disparities.

The School has three departments, Continue reading

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The Jefferson Population Health Colloquium – A Full Serving of Population Health

 

Population Health continues to be a major buzzword around the healthcare industry. At the recent HiMSS 17 conference in Orlando the talk of population health was everywhere from the vendor booths to the presentations, but where does one turn to get more than just the IT focus of population health? Where can one get a sense of the breadth and depth of population health from operations to policy, current status to future state,  provider implementations, data and analytics, patient engagement, in the weeds medication adherence and wearables to large community based initiatives? In other words where can one find a full serving of all that population health is?

That place is the Jefferson Population Health Colloquium, also in its 17th year.

This year’s event features keynotes ranging from the Future of Managed Care to Good Health is Good Business: The Results of an Innovative Alignment with Physicians and Communities.

Here are just a few of the many leaders providing keynotes this year include:

The balance of keynotes can be found on the program Agenda. The range and diversity topics covered is impressive.

Digging deeper into the Colloquium’s agenda we find ‘mini-summits‘ and ‘concurrent sessions’ on day two covering the following topics:

And concurrent sessions:

The most difficult part of this conference is deciding which sessions to attend. The complete agenda is available here, and a direct registration link for full details, here.

Also on Day two will be the awarding of the Hearst Health Prize For Excellence in Population Health now in its second year, this $100,000 prize goes to……..? Check out last year’s debrief of the winner ‘Community Care of North Carolina‘.

Tuesday evening closes with an optional dinner session, but one definitely worth attending to hear from Michael Dowling and Dr. Stephen Klasko on a panel moderated by David Nash MD, MBA.  This interesting and informative panel will discuss The Future of Clinically Integrated Networks a critically important component of creating a better health system and integrating population health.

I hope to see you there.

 

 

 

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The Underlying Issue is Often the Same in Health Care – Ethics

So I opened my AIS Health Daily email and read two seemingly different stories that are actually related on an underlying level. The first discussed the 340B pharmacy pricing program that allows hospitals and other provider to buy drugs at a lower rate to when they  services to indigents and the uninsured.

 

340B Program Shirks Charitable Care, Undermines Formularies, Argue PBMs
Reprinted from Drug Benefit News

A new report from a coalition of stakeholders suggests that a considerable portion of the hospitals enrolled in the 340B Drug Pricing Program furnish a negligible amount of free or reduced-price care to indigent, uninsured patients …. Read Full Story

and the second pointed out the large amount of duplication of case management services found by ACOs , and that quote is here:

“The opportunity (for accountable care organizations) is so amazingly large when you get the systems to start talking to each other. One of the most amazing things to us is the duplication across systems — five [case] workers being assigned to one person was not unusual, and nobody knew anyone else was working with the individual.”

— Jennifer DeCubellis, Hennepin County (Minnesota) assistant county administrator for health, told AIS’s ACO Business News.

Click here to read the ACO BUSINESS NEWS article in which this quote appeared. (Free for ABN subscribers; $17 for non-subscribers).

Neither of these are a surprise to me nor probably to most professionals in health care and they relate to two fundamental problems with the system as structured today. Fee for Service as the payment mechanism of choice makes it too easy to set up shop and bill for services and, secondly, if there’s a way to make a buck or “stretch” the system someone will do it.

Obviously moving away from our current fee for service system will create the impetus to look at these issues, and maybe fix them (see the closing paragraph), but more importantly it get back to ethics.  In many if not most of the cases associated with the two instances above, these are non-profit organizations providing 340B drugs or case management services.

Lets look at the Case Management issue.

Case managers are supposed to be coordinating cases, yet don’t know that others are involved?

Come on, that’s their role.  More likely they know or have an inkling, but their organization recognize’s that in order to keep the funds flowing, they just don’t find out. When I worked with Medicaid programs around the country I saw this all the time; supposed case managers not truly coordinating services, closing the office too early, not knowing what was going on with their clients, tracking lots of contacts and other process measures, but having little to no tracking of outcomes. Other  providers servicing Medicaid had similar issues, home health aides providing little to no service, meals on wheels delivering inappropriate foods because they never knew the patient was a diabetic (in this case the patient had both a case manager and a 12 hour a day home health aide who accepted the meals), and the list goes on and on.

The health care system is a giant feeding mechanism for tens of thousands of companies and organizations. Its just too easy to ensure your own survival at a cost to the system because we have allowed it. As we change the payment method,  what do you think some of these organizations will do if they go full risk in a capitated model?  Might their current lack of ethics lead to under-serving their population to make sure they survive?

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