Tag Archives: Jefferson College of Population Health

The Triple Aim, Well Two Out of Three… Really is Bad

One of the Triple Aim‘s has gotten lost. Will anyone in the healthcare sector publicly declare that they are in fact working on the Double Aim?

The Triple Aim, that lofty set of goals that the healthcare system claims to have embraced:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and.
  • Reducing the per capita cost of health care.

I agree with them and believe they are appropriate and necessary.

Everyone it seems, says they are working towards the Triple Aim, and many have taken to adding Provider Satisfaction and saying we in fact need a Quadruple Aim. Well, before we go there, let’s see what we are actually doing on the initial three.

After attending a number of conferences and seeing what the system is in fact doing,  I’m fairly certain, that healthcare is not actually going after the Triple Aim. In fact, it appears that almost everyone has quietly agreed on the “Double Aim” in an effort to short-circuit any true progress and continue on the path we have been on.

What do I mean by the Double Aim? Here are some examples of things I saw, heard or didn’t hear at HIMSS 2018:

After listening to an excellent panel on innovation, by three leading health system executives who oversee their systems innovation area or department, I just had to ask a question:

“At what point does this innovation actually lower costs?” A murmur arose in the room.

Response one:

“Well we could spend a whole day on that one”

The next answer? Well, there wasn’t one.

At the conclusion of the session, Gregg Masters spoke with one of the panelists and asked if as part of their innovation center they were tasked with lowering costs.  Their response “no, that’s not part of our charge.”

Why wouldn’t an innovation center also be looking for innovation that reduces costs?

At a dinner panel one evening, a health plan association executive when asked if health plans were really lowering costs, pointed to the Medical Loss Ratio (MLR) Rule (which I have written about here) as a key contributor to holding costs down.  When I explained my belief that the MLR rule ensures costs go up because “who would want 15% of a lower number next year” there were audible chuckles of agreement in the room, a shocked look on the panelists face and the panel quickly switched to another topic. While the person who asked the original cost question, looked at me, raised his eyebrows and laughed.

I do not recall any booth or individual discussing programs that save money, in fact most were talking about revenue enhancement.

Only Kaveh Safavi of Accenture and one other presentation discussed the elephant in the room; that healthcare is the only industry where as it adds technology, the workforce gets less efficient.  I would call the behavior we exhibit in this regard, an addiction.  We continue to do it, even though the outcomes will be bad for us.

Do we not hear the clamor associated with the Amazon, Berkshire-Hathaway, JP Morgan?

“Healthcare is the Tapeworm of the American economy”

 

Or the announcement by Wal-Mart regarding their narrow network, in which they said that about 40% of people referred to their center of excellence for back surgery were told they don’t need it. How about the growing relevance of Dave Chase and the Health Rosetta and books like Dan Munro’s Casino Healthcare, or the Health Value Awards.

Even the esteemed Dr. David Nash of the Jefferson College of Population Health saying there are too many medical errors and too many tests being ordered and it was “time for doctors to look in the mirror”.  But not just doctors, all sectors of healthcare, especially hospital systems, health plans, device and pharmaceutical manufacturers and vendors. You may be thinking you can slip by with the Double Aim, but others are AIMing to knock the inappropriate costs out of the system, and if you don’t get involved it might be you.

And now when CMS announces their Pathways to Success, a new ACO requirement that pushes ACOs which have been living off of one-sided risk in the MSSP program, and showing no savings, to two-sided risk, the industry goes bonkers.

Avalere_Health_MSSP_Performance_Results_Versus_CBO_Projections

We know there are excesses in the system, everyone talks about that, everyone talks about the Triple Aim, but it seems in the case of doing things versus talking about the Triple Aim, we are truly only interested in the Double Aim.

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Interview with David Nash

I had a fascinating interview with David Nash, MD, Founding Dean of the College of Population Health at Jefferson. Our discussion included everything from Patient Centered David NashMedical Homes (PCMH), Accountable Care Organizations (ACOs), medical errors and unnecessary services, to value based care and of course population health.  As David said, perhaps its time for Doctors to “Look in the Mirror.”

There is so much going on in healthcare with the recent Amazon, Berkshire Hathaway and JP Morgan announcement to the CVS purchase of Aetna, all roiling the healthcare market. So what does it mean and where might we go for solutions?

Listen in.

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David Nash, MD on PopHealth Week 1/31/18

And if you want to hear from a plethora of experts in the Population Health Field attend this years Population Health Colloquium at Jefferson March 19 – 21 in Philadelphia.  You can learn more here.

PopHealth Week is produced by Health Innovation Media.

 

 

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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 Validation Institute and Certification – Stand out from the Crowd

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As many of you know, I am on the advisory board of the Care Innovations Validation Institute.  This is an important organization for the Population Health and Wellness industry. The advisory board is chaired by Dr. David Nash, Dean of the Jefferson College of Population Health.

Our industry is facing some questions; one need only look at the multitude of population health and wellness vendors and their reports of amazing outcomes to know that something is not right.  RAND has published some very good studies (here, here and here)  that showed limited to negative returns from various wellness and employe health improvement programs and Al Lewis has published many examples in his books (here and here)  and on his website.  While on the other side, Ron Goetzel at the Institute for Health and Productivity Studies within Johns Hopkins Bloomberg School of Public Health,  has a whole section devoted to programs that do work.

Last year the Population Health Alliance held a debate between Ron and Al. The event was standing room only and came to the conclusion that many of the programs do not work, while a few very well designed and implemented programs do.

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