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Integration
BCBSIL Refuses to Negotiate Jointly With “Affiliated” Providers. Now What?
Tensions between health plans and care providers have taken an fascinating turn in Chicago. Blue Cross Blue Shield of Illinois (BCBSIL) is refusing to allow care providers “affiliated” through a clinical integration agreement to negotiate contracts jointly.
The ramifications for future network contracts are significant and could play out very differently in other health care markets.
Background
In February 2014 Advocate Health Care and Silver Cross Hospital announced a clinical integration affiliation agreement. Advocate is the state’s largest hospital network and Silver Cross […]
A One in a Hundred Whitepaper: “Better to Best” Transcends PCMH, Care Coordination, Access, HIT, and ACO Payment Reform
Let me try to get you in the right frame of mind to read one of the most remarkable white papers in a long time: Better to BEST: Value Driving Elements of the Patient Centered Medical Home and Accountable Care Organizations — released yesterday by the Commonwealth Fund, Dartmouth Institute, and PCPCC.
Having been a debater in high school and then trained as a lawyer, my default mode of thinking is to be critical:
“Hey, Vince, how ya doin’? Great day isn’t […]
Walled Gardens vs. the Open Web: A Central Debate in Tech Finally Coming to Healthcare
The September issue of Wired magazine and an article in last Sunday’s New York Times illustrate a central debate in technology circles. The debate is not new — it’s being going on for two decades — but it has newfound vibrancy. The essence of the debate is about competing tech/business models: walled gardens vs. the open world wide web (web).
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The debate is highly controversial and nuanced. There are “experts” on both sides.
My point today is not to take sides […]
“Meaningful Use” Criteria as a Unifying Force
by Vince Kuraitis, Steve Adams, and David C. Kibbe MD, MBA
Over the past several years, many diverse initiatives have arisen offering partial solutions to systemic problems in the U.S. health care non-system.Â
We see Meaningful Use Criteria recommended by the HIT Policy Committee as a unifying force for these previously disparate initiatives. These initiatives have included:
Patient Centered Medical Homes (PCMHs)
Regional Health Information Organizations (RHIOs)/Health Information Exchanges (HIEs)
Payer Disease/Care Management Programs
Personal Health Record Platforms — Google Health, Microsoft HealthVault, Dossia, health banks, more to come
State/Regional […]
Spider Webs of Care Coordination Networks
We have learned that coordinating care of patients — particular care of Medicare patients — is complex and time consuming for physicians.
A breakthrough study quantifies just how complex and challenging care coordination really is.  The study is reported in the February 17 issue of Annals of Internal Medicine and is entitled Primary Care Physicians’ Links to Other Physicians Through Medicare Patients: The Scope of Care Coordination :
We found that in a single year for just fee-for-service Medicare patients, the typical primary care physician needs […]
HealthSpring “Gets” Physician Engagement.
I’ve written a lot recently about Medicare Health Support (MHS). We are learning a lot from MHS about what DOESN’T work with the frail, elderly Medicare population.
But, what DOES work?
One key lesson emerging from MHS is the need to integrate and engage physicians and other local care providers…easier said than done.
The PowerPoint — DM Megatrends 2008
Last week I did the major annual tune-up of my presentation on Disease Management Megatrends for the MCOL Future Care Web Summit.Â
I’m pleased to share a copy of the PowerPoint presentation with you, and I hope you find it useful and provocative. You can view and/or download a copy here (6MB). This version contains 77 slides, which would be about the length I’d use for a 3 hour workshop; you’d see a more compact version for a conference keynote, Board summary, or management […]
Hospital Economics Don’t Reward Chronic Disease Management
My colleague and friend Dr. Jaan Sidorov has recently started a blog — Disease Management Care Blog. Check it out and add it to your RSS feed. Jaan is eminently qualified to write on the topic — he spent 25 years at Geisinger Health System in Pennsylvania as a practicing physician and as an executive, and he just ended a term on the board of DMAA—the Care Continuum Alliance (formerly Disease Management Association of America).
Jaan’s sense of humor and articulateness shine […]
Podcast: The 20 Minute Version of “DM Megatrends”
Over the past week I’ve been doing a major tune-up of my presentation on Disease Management Megatrends for the annual MCOL Future Care Web Summit.Â
More typically, DM Megatrends is 45–90 minute presentation with accompanying PowerPoint slides.
As part of the Web Summit, the good folks at MCOL asked me to do a short podcast on highlights of this presentation. They’re allowing me to share it with you… click here to save or listen to the podcast.
fyi, the DM Megatrends are:
MAGNITUDE: We are just scratching the […]
A Founding Father of DM Astonishingly Declares: “My Kid is Ugly”
Al Lewis, one of the founding fathers of DM, has shaped the face of the DM industry probably more than other any single individual. (This is all fine unless you happen to be the person whose face is being shaped by Al.)
Al has been unabashedly pro-DM. Until now. Al writes in a recent article in Managed Healthcare Executive:
Disease management as we now define it may be on its last legs, though no one knows it yet. The Disease Management Purchasing Consortium has noticed that the savings in all […]