Subscribe if you want to be notified of new blog posts. You will receive an email confirming your subscription.

Please enter your name.
Please enter a valid email address.

Please check the captcha to verify you are not a robot.

Something went wrong. Please check your entries and try again.

integrated delivery system

15472823 - doctor talking to her male senior patient at office

WSJ Article on MD Referrals & Leakage: Beware of Premature Conclusions

The question we should be asking is “How can we best align the interests of patients, physicians and hospital systems in referral decisions?”

The answer sometimes might be to make a referral outside of the hospital system — but let’s not jump to premature conclusions.

Is Hospital-Physician Integration Sustainable?

Reprinted courtesy of MCOL.

Perspectives on a Selected Key Topic |     April 2011/May 2011     |   Volume Three Issue Two

Will a material number of hospitals and their core medical […]

Could Facebook Be Your Platform for Care Coordination?

My guess is you’ve probably never asked yourself this question. A quick preview:

Technical barriers aren’t the limiting factors to Facebook becoming a care coordination platform.
Facebook’s company DNA won’t play well in health care.
Could Facebook become the care coordination platform of the future? If not Facebook, then what?

1) Technical barriers aren’t the limiting factors to Facebook as a care coordination platform.

Can you imagine Facebook as a care coordination platform? I don’t think it’s much of a stretch. Facebook already has […]

The Achilles Heel of ACOs? Shared Savings Payment Model Unlikely to Motivate Hospitals

Sometimes you read something and the full impact doesn’t hit you until hours — perhaps days — later.  As I was out mountain biking today, the importance of something I ran across yesterday suddenly hit me.

Accountable Care Organizations (ACOs) are today’s cure-du-jour for reforming the health care delivery system. Bob Berensen, MD of the Urban Institute strongly questions whether the shared savings model under current legislation provides enough economic incentive for hospitals to disrupt their existing core business of acute, inpatient care.

The dialogue […]

Megatrend Spotting: Health Plan Role of Having “Best Data About YOUR Medical Conditions” is Up for Grabs

Who has the most comprehensive data about YOUR clinical conditions?

For most people, the answer today is “your health plan”, but it’s not at all clear that health plans will continue to have this role in the future.

As physicians and hospitals adopt EHRs, it’s foreseeable that clinical data about patients will be far more available and accessible.

Will patient data become:

A jockeying point for control and business advantage between health plans and care providers,
A collaborative opportunity to optimize clinical care and care […]

The Big Idea in Understanding “Accountable Care Organizations”

Here’s the big idea: accountable care organizations (ACOs) are about creating accountability.

ACOs of various types are being proposed in national health reform legislation. For all you ever wanted to know about ACOs, read How to Create Accountable Care Organizations from the Center for Healthcare Quality and Payment Reform.   I spent an hour and a half poring over the details of this excellent report written by Harold Miller.

My mistaken impression has been to focus on the organizational form of ACOs, rather than their objectives.  Organizational form is relevant […]

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 […]

Despite Limited Penetration, Integrated Delivery Systems Have Advanced Chronic Care

The 1990’s experiment around development of integrated delivery systems (IDSs) mostly did not take root. This experiment was primarily about financial integration — doctors joining with hospitals so that they could together contract with health insurers for capitated reimbursement, hospitals starting their own health plan, or hospitals buying physician practices as a way of guaranteeing a future base of patients and revenues.

The systems and processes needed jointly to manage financial and clinical risk were an afterthought; information technology was not […]

One More Dark Cloud in the Stormy Skies of Medicare DM

Mathematica Research has just released a report: The Evaluation of the Medicare Coordinated Care Demonstration: Findings for the First Two Years.  It’s not pretty.

Section F of the Executive Summary is entitled “Synthesizing the Findings: What Works, and What Doesn’t”.  That section begins:

Given that few of the programs have shown convincing evidence to date of reducing beneficiaries’ need for hospitalizations and saving money or of improving the quality of care received, there is relatively little assessment that can be done yet […]

Today’s BFO: How can P4P Work W/O a QB?

Translation  Todays blinding flash of the obvious (BFO): How can you expect pay-for-performance (P4P) programs in Medicare to work with out a designated physician quarterback (QB)?

Please allow me to elaborate.

P4P programs are based on two assumptions:

Patients are assigned to a physician or a practice that will have primary responsibility for their care, and
That a meaningful fraction of the care physicians deliver is for patients from whom they have primary responsibility

Wouldn’t you expect that this would be problematic for older (Medicare) […]