Tag Archives: Primary Care

Saving on Employee Health Benefits: Would you Hire this Consultant?

Over the years as an HMO executive and later founding a disease management and Healthcare IT company, I have analyzed a lot of medical claims and quality data. One of the largest was an analysis of a State Medicaid program with about 675,000 beneficiary lives with two years of inpatient, outpatient and pharmacy claims. The pharmacy file alone contained about 15 million prescription fills.

More recently I became certified as a Professional by the Care Innovations Validation Institute and sit on their Advisory Board. This certification tested my ability to look at data and decide whether the outcomes reported were likely to be valid or not.  As you look for vendors or consultants I would suggest you start with the Validation Institute. The following example is a good reason why.

Cruising around the web looking at various healthcare consulting firms and company websites I came across  a company that is targeting employers and claims they  have vetted and can bring in vendors to lower the costs for a company’s self funded health plan. Their website says they can identify, evaluate, oversee, manage and report on the vendors they propose.

On their home page is a chart used to show the savings an employer can expect to see by implementing their various cost saving approaches.  Can you spot the flaw(s)?

 

high-performing-network-chart1

 

Let’s start with the first and most glaring error and its on the first line. Continue reading

Leave a comment

Filed under Healthcare Costs

Marketing Presentations: You Never Know What you May Learn.

I was on a call the other day with a company that provides a targeted consumer engagement platform based on psychographic data that is used to “bucket” people into one of a few groups and then send targeted messaging to them via different communication systems. When they got to their results slide my antenna went up.

Here were two of their claims directly off of the PowerPoint slide:

  • 72% of at risk employees joined a diabetes education program versus 10% nationally
  • A personalized patient messaging program created an additional $70,000 in revenue per month for a 300 physician group.

So I asked a few questions:

Me ” What data source did you use to claim that 10% of employees typically enroll in a diabetes education program?”

Him “We looked at the Rand Report (The DOL) Study which showed that 21% of employees typically engaged and then…(wait for it, wait for it)… only 50% of companies have programs, so that’s how we came up with the 10%”

To say I was incredulous would be a huge understatement.

So I asked to clarify

“So, you are counting the 50% of people who have no access to a program to begin with?”

Him “Yes”

Me “that’s just not right”

Him “Well it is true on a national basis”.  (On a side note this also may or may not be true on a national basis; just because 50% of companies don’t have a program does not mean that 50% of the employees don’t, depends on the companies in each group and their employee size.)

I was finally able to get him to admit, that the statistics he used might be a problem, when he then said “The original program was done with on-site staff enrolling employees and they were getting over 50% engagement.”

So the truer statement is they went from somewhere north of 50% to 72%, not bad, but much different than from 10% to 72%.

Now I dug into the second issue, the $70,000 per month. So I asked about this,

Him “yes, they told us that the program had increased their revenue by $70,000 per month.”

Me “lets do some calculations. It’s a 300 physician group, correct?”

Him “yes”.

Me “So lets assume that each physician generates $500,000 in annual revenue, that’s $41,666 per month. Multiply that by 300 and they are generating about $12,500,000 per month. $70,000 is just over one half of one percent of $12,500,000. That’s peanut’s, now take that and divide it by 300 physicians that equals $233 per month per doctor. Or maybe 4 office visits.”

Him “but wait, that’s profit, does the slide say revenue?”

Me “Yes it does”

Him “oh I need to correct that”

Me “yep, and still, so if its ‘profit’ they generated an additional $233 per doctor? Still seems rather small.

Him “Well that’s the number they gave us.”

Word to those who are looking for vendors and being presented with marketing materials: Ask a few Questions; you never know what you may learn.  Perhaps I should refer them to the Intel Care Innovations Validation Institute.  Full disclosure, I am on the Validation Institute’s  advisory board.

3 Comments

Filed under Uncategorized

Paul Grundy, MD the “Godfather” of the Patient Centered Medical Home on PopHealth Week

Dr._Paul_Grundy,_Lecture_2011This week on PopHealth Week, Wednesday at 3 pm eastern, 12 pm pacific, in our continuing focus on primary care and population health we are pleased to welcome Paul Grundy, MD, Global Director of Healthcare Transformation IBM, President PCPCC and Ambassador Healthcare Denmark. Paul is known as the “Godfather” of the Patient Centered Medical Home (PCMH).

 

Learn how the Patient Centered Medical Home concept developed and why its “where the data resides” and not the type of clinical practice that’s important.

Paul’s work at IBM is directed towards shifting healthcare delivery around the world towards data driven, accountable, consumer-focused, primary-care based systems through the adoption of new philosophies, primary-care pilot programs, new incentives systems, and the information technology required to implement such change.

The Patient Centered Primary Care Collaborative (PCPCC) is a not-for-profit membership organization dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home.

Click here to see a recent video of Paul presenting to the NHS in the UK.

Join Paul Grundy, MD as our guest on PopHealth Week and learn more about this incredible thought leader.

PopHealthWeek-logo-TWTTR-sq

 

 

Leave a comment

Filed under PopHealth Week

The Changing Role of Primary Care Providers – PopHealth Week’s Focus in July

Listen to the episode here:

PopHealthWeek-logo-TWTTR-sq

The role of Primary Care Providers is changing and much of this is for the better. With the Triple Aim of improving the patient experience, improving the health of populations and reducing per capita costs; along with new payment methodologies, quality measures, organizational structures, and the like, primary care providers are being asked to to play an expanded role in the healthcare system; but what is that role and how can they ensure success?

During the month of July PopHealth Week will focus on Primary Care and Population Health, interviewing primary care providers and thought leaders who have developed innovative new ways to practice. We’ll explore patient centered medical homes, capitated contracts, team based care, meeting patients needs, are the incentives in ACOs large enough to change behavior, and where these trend setters believe primary care is headed.

Join PopHealth Week for the following shows:

Roy Hinman, MD, Island Doctors

July 1, 12 PM ET

Roy H. Hinman, II, M.D. is the founder of Island Doctors which employs more than 50 people within 14 offices in Florida stretching from Jacksonville to Interlachen and New Smyrna Beach. They also manage a network of 32 affiliate providers throughout these six counties and around the Orlando area. Their mission is to promote health improvement to each and every patient that walks through their doors.

The practice focuses on improving their patients’ health and participates in numerous community events and health fairs including holding Diabetes Awareness Seminars several times per year. Island Doctors want each patient to achieve optimal health status through education, meal planning, exercise, smoking cessation and cholesterol management.

Dr. Hinman opened his first family practice office in 1991 on Anastasia Island in St. Augustine, Florida.

Rushika Fernandopulle, MD, iorahealth

July 8,12 pm ET

Dr. Fernandopulle is the founder and CEO of iora health, an innovative primary care practice that offers Team-based care that puts the patient first, a payment system based on care, not billing codes and technology built around people, not process.

July 15, 3 pm ET – TBD

Paul Grundy, MD Global Director of Healthcare Transformation IBM, President PCPCC and Ambassador Healthcare Denmark

July 22, 3 pm ET

Dr. Grundy, known as the “Godfather” of the Patient Centered Medical Home is one of the leading thinkers in the transformation of Primary Care and is the Founding President of the Patient-Centered Primary Care Collaborative (PCPCC).

PopHealthWeek-logo-200

1 Comment

Filed under Uncategorized

PopHealth Week Explores Full Risk Medicare Advantage with Roy Hinman, MD, Founder of Island Doctors, a Pioneering Primary Care Physician

Island Doctors Capture_03B_CleanPopHealth Week’s guest on July 1 at 12 pm ET is Roy Hinman, MD the founder and CEO of Island Doctors which employs more than 50 people within 14 offices in Florida stretching from Jacksonville to Interlachen and New Smyrna Beach. He opened his first family practice office in 1991 on Anastasia Island in St. Augustine, Florida.

Dr. Hinman is a pioneer and began to take full risk Medicare Advantage in 1998. Since then, Dr. Hinman’s practice has grown to approximately 16,000 capitated Medicare Advantage patients in Florida. He anticipates having 20 offices by the end of 2015 to meet the demand. In addition to his owned offices, he also manages a network of 32 affiliated providers.

With innovative programs targeting diabetes, COPD, cholesterol, smoking and weight loss, he understands keeping patients healthy and how to manage capitated contracts. His comments may surprise you.

Here’s some of Dr. Hinman’s bio:

Dr. Hinman was raised in Tulsa, Oklahoma. He is a graduate of Oklahoma Military Academy, received his Bachelor’s Degree in Psychology from Tulsa University, and his Master’s Degree in Human Resource Management from Pepperdine University in Malibu, California. He completed medical school at Universidad Technologica de Santiago in Santo Domingo, The Dominican Republic. He served his family practice residency with the University of Florida Medical Program at the University Medical Center in Jacksonville, Florida and worked as an emergency room physician at Bradford County Hospital in Starke, Florida and at Ed Fraser Memorial Hospital in Macclenny, Florida.

Commissioned as a Second Lieutenant in the U.S. Armored Cavalry in 1975 at Oklahoma State University, Colonel Hinman ultimately retired from the U.S. Army Reserve in 2014 as a Medical Corps officer, after 37 years of military duty in the United States, Germany, Korea, Kuwait, Nicaragua, Panama, Saudi Arabia, Ecuador, the Dominican Republic, and Iraq where he served three combat tours. He recently served as the Territorial Surgeon of the U.S. Virgin Islands.

Dr. Hinman is Board-Certified in Family Practice and is a member of the Florida Medical Association, the American Association of Family Practitioners, the Florida Association of Family Practitioners, the St. Johns County Medical Society and the American Academy of Anti-Aging, and has full Family Practice admitting privileges at Flagler Hospital in St. Augustine, Florida where he has been an active staff member since 1991.

So join PopHealth Week’s guest, Dr. Roy Hinman and gain valuable insights into how he has been doing what many have, and or will be trying in the not to distant future, full risk capitation.

Leave a comment

Filed under Uncategorized