e-CareManagement blog

Pop quiz:

What do address books, video cameras, pagers, wristwatches, maps, books, travel games, flashlights, home telephones, cash registers, Walkmen, day timers, alarm clocks, answering machines, The Yellow Pages, wallets, keys, transistor radios, personal digital assistants, dashboard navigation systems, newspapers and magazines, directory assistance, travel and insurance agents, restaurant guides and pocket calculators all have in common?

This question was posed by Paul Nunes and Larry Downes in their recent Forbes article “How Innovations Become Better and Cheaper“.

For today’s quiz, we’ll have 3 levels of scoring– 2 points for a good answer, 5 points for a better answer, and 10 points for the best answer.

The 2 point answer: each of these products or services is in the process of being disrupted by a new technological innovation.

The 5 point answer: each of these products or services  is being supplanted  by what Nunes and Downes refer to as a “Big Bang Disruption”.  Read their Harvard Business Review article for more details on Big Bang Disruption.

The 10 point answer?

Continue reading “Quiz: Is Healthcare Next on the List?”

The latest and best on the healthcare blogosphere is featured on Joe Paduda’s blog — Managed Care Matters. Click here to check it out! Thanks, Joe.

A colleague recently wrote to me and asked me my definition of “collaboration”.

It doesn’t mean that care providers need to hug each other and sing Kumbaya. Ideally, care providers will like each other, but that’s not foundational.

I see 3 critical elements to clinical collaboration:

Continue reading “3 Critical Elements of Clinical Collaboration”

by Vince Kuraitis and Leslie Kelly Hall, Senior Vice President, Policy, Healthwise.

The sharing of patient information in the US is out of whack — we lean far too much toward hoarding information vs. sharing it. While care providers have an explicit duty to protect patient confidentiality and privacy, two things are missing:

• the explicit recognition of a corollary duty to share patient information with other providers when doing so is the patient’s interests, and
• a recognition that there is potential tension between the duty to protect patient confidentiality/privacy and the duty to share — with minimal guidance on how to resolve the tension.

In this essay we’ll discuss

1. A recent recognition in the UK

2. The need for an explicit duty to share patient information in the US

3. Implications of an explicit duty to share patient information in the US

1) A recent recognition in the UK

Last week a long-awaited study commissioned by the Department of Health was released. Here are a few key findings from The Information Governance Review Report (Caldicott Review):

…safe and appropriate sharing in the interests of the individual’s direct care should be the rule, not the exception. Continue reading “Editorial: A Duty to Share Patient Information”

By Gregg A. Masters, MPH; originally posted at ACO Watch

I intended to post updates from Aetna and Cigna next in this series, yet today I received a tweet by Vince Kuraitis, aka @VinceKuraitis, calling attention to Universal American a managed care player I’ve not spent much time on. Yet they present a rather interesting profile and operating footprint some of which I will highlight below. According to their website Universal American (UAM):

...provides health benefits to people with Medicare. We are dedicated to a Healthy Collaboration, working together with healthcare professionals in order to improve the health and well-being of our members.

The JPMorgan Healthcare conference deck is here, and webcast here (you may need to register). Of note is with the recent release of CMS certified ACOs, UAM now operates ’31 ACOs approved for participation in the Shared Savings Program which include more than 2,000 participating physicians covering an estimated 300,000 Original Medicare beneficiaries in 13 states.’ So not only are they a player in Medicare Advantage (the end game for risk bearing ACOs), they have a presence in the gateway market as well. For complete details, click here. Two pieces from their narrative tell the story, 1) the ‘healthcare landscape’: 

Continue reading “Universal American: A “Healthy Collaboration””

by Brian Klepper

On The Health Care Blog, veteran analyst Vince Kuraitis reviews a report from the consulting firm Oliver Wyman (OW), arguing that the trend toward reconfiguring health systems to deliver more accountable care is more widespread than any of us suspect.

“The healthcare world has only gotten serious about accountable care organizations in the past two years, but it is already clear that they are well positioned to provide a serious competitive threat to traditional fee-for-service medicine. In “The ACO Surprise,” our analysis finds that 25 to 31 million Americans already receive their care through ACOs-and roughly 45 percent of the population live in regions served by at least one ACO.”

OW provides a well-reasoned analysis and conclusions, but I’m skeptical. In discussions with health system executives around the country, I hear some movement toward change, but relatively few organizations are materially turning their operations in a different direction. The specter of policy change is looming, but it is still abstract. As I’ve described before, market forces are intensifying, but they’re mostly still scattered and immature. Continue reading “ACOs: We’re NOT There Yet”

A  recent analysis of the ACO market by Oliver Wyman market suggests we’re well on our way toward being “there”.

My personal take on this report:

Provocative, fresh, thoughtful, well reasoned, expansive — albeit a bit of a stretch

However, I suspect many others will describe it as: 

Speculative, harebrained, unsupported, overly extrapolative, out-to-lunch, wishful to the point of being woo woo

So now that I hopefully have your attention, what’s this report all about? In a nutshell: 

The healthcare world has only gotten serious about accountable care organizations in the past two years, but it is already clear that they are well positioned to provide a serious competitive threat to traditional fee-for-service medicine. In “The ACO Surprise”, our analysis finds that 25 to 31 million Americans already receive their care through ACOs—and roughly 45 percent of the population live in regions served by at least one ACO.

Let’s dig in to the report. In this blog post, I’ll summarize their math, surface their critical assumptions and observations, and comment on their reasoning. I’ve indented direct quotations from the report and have italicized wording that spells out the major assumptions.

While I don’t agree with all of Oliver Wyman’s math and assumptions, I applaud them for the process they have gone through. Please take my commentary as “quibbling at the edges” and that overall I’m on board with their methodology and conclusions. Continue reading “ACOs: Are We “There” Yet?”

Where will the next layer of value in health care come from?

This is a case where a picture is worth a thousand words.

Source: Boston Consulting Group, Health Reform Should Focus on Outcomes, Not Costs, October 2012

From reading recent headlines, one might easily get the impression that hospitals are resistant — or at least ambivalent — in their pursuit and adoption of accountable care initiatives.

Are Hospitals Dragging their Feet on Accountable Care?

Commonwealth Fund: “only 13 percent of hospital respondents reported participating in an ACO or planning to participate within a year”

KPMG Survey: “(only) 27 percent of [health system] respondents said current business models were either not very or not at all sustainable over the next five years”

Health Affairs: “Medicare’s New Hospital Value-Based Purchasing Program Is Likely To Have Only A Small Impact On Hospital Payments”

The Bigger Picture

Do hospitals today perceive their current business model on the metaphorical “burning platform” — when the status quo is no longer an alternative? Continue reading “Are Hospital Business Models on a Burning Platform? Not Yet, But It’s Inevitable.”