Hospital Readmissions Avoidance “Programs” — Vendors and Hospitals Not All On the Same Wavelength

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Last week I attended and participated in an excellent conference — the National Reducing Hospital Readmissions Forum sponsored by World Research Group.

One of my main take aways is to observe a simple — yet huge — difference in mindset between hospital executives and vendors.

Over the past few months I’ve heard many vendors with diverse health care offerings talking about building readmission avoidance “programs” that they want to sell to hospitals.  Their idea here is to put together a soup-to-nuts offering of technologies and services — a “program” that hospitals would mostly outsource to a 3rd  party vendor.

This concept has never quite sat right with me. Having spent the first 15 years of my career in and around the hospital world, I’ve often observed a “not-invented-here” aversion to anything brought in by outsiders.

My suspicions were confirmed at the conference.

The hospital mindset is NOT “we’re looking for an outsourced program from a vendor that will solve our readmissions problem.

While hospitals are in various stages of planning, here’s my sense of how hospitals have thought about readmissions:

Book Review: Good Health is Good Business

My colleague Dr. Dave Rearick asked me to review his recent book, Good Health is Good Business.  I’m pleased to recommend it enthusiastically.

Ghigb_cover_zeph[1]While the book is targeted at small to medium size employers, the lessons go far beyond this audience.

By the end of the 3rd chapter, Dr. Rearick had convinced me of two conclusions that I’d describe as indisputable, but uncomfortable:

  • The only way employers are going to control their health care costs is to influence the health of their workforce.
  • You (the employer) need to take charge

What’s uncomfortable here? 

How Will the HMO Stock Meltdown Affect Chronic Disease Management?

About three weeks ago Cain Brothers Investment Bankers released a report that foreshadowed the collapse of HMO stock prices that has occurred over the past few days.  The report was entitled: FAREWELL TO A TIME OF PLENTY? Health Plan Strategies for Growth in a More Challenging Market

Here are a few highlights from the report:

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

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 strategy session.

fyi, the DM Megatrends are:

MAGNITUDE: We are just scratching the surface of chronic disease challenges.
INTEGRATION:  The 50 year tide is shifting toward integration, away from specialization.
MEDICARE: While Medicare has endorsed the need for chronic disease management, disappointing results from recent demo projects make future direction unclear.
PROVIDERS: Care providers have woken up to DM opportunities and threats; they are promoting the medical home and the Chronic Care Model.
MAKE, ASSEMBLE, BUY? Fewer are buying as health management becomes increasingly strategic.
TECHNOLOGY:  DM in your home and your pocket.
BEHAVIOR CHANGE: DM is moving from a medical to a social model; behavior change has become the Holy Grail.
CLINICAL AND ECONOMIC ROI:  Round one is over, DM wins; Round 2 has just begun.
WILDCARDS! (employers, P4P, retail clinics, CDHPs, elections)

Comments are always appreciated.

Last week was a podcast of DM Megatrends…next week — the movie.  Brad has signed, Angelina is waffling.

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

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 surface of chronic disease challenges.
INTEGRATION:  The 50 year tide is shifting toward integration,  away from specialization.
MEDICARE: While Medicare has endorsed the need for chronic disease management, disappointing results from recent demo projects make future direction unclear.
PROVIDERS: Care providers have woken up to DM opportunities and threats; they are promoting the medical home and the Chronic Care Model.
MAKE, ASSEMBLE, BUY? Fewer are buying as health management becomes increasingly strategic.
TECHNOLOGY:  DM in your home and your pocket.
BEHAVIOR CHANGE: DM is moving from a medical to a social model; behavior change has become the Holy Grail.
CLINICAL AND ECONOMIC ROI:  Round one is over, DM wins; Round 2 has just begun.
WILDCARDS! (employers, PHRs, P4P, CDHPs)

United’s Move to Fine Physicians: The Other POV

Joe Paduda at the Managed Care Matters blog makes some great counterpoints defending United Health’s moves threatening to fine doctors for making out-of-network lab referrals.  I recommend that you read his essay and his readers comments.

In my posting from a couple days ago — Doctors and Health Plans: Can Care Management Opportunities Reconcile the Hatfields and the McCoys? — I picked on United Health Care to make a point.   Just to recap, my reasoning is that physicians could (and should) be important partners to health plans in implementing their disease/care management programs.  So, how smart is it to beat up the guys that are the key to your success? 

I still question the overall wisdom United’s moves, but Joe does a great job articulating the opposing point of view.

 

Doctors and Health Plans: Can Care Management Opportunities Reconcile the Hatfields and the McCoys?

I’m going to try something different in this blog posting. I’d like to introduce a fairly open-ended issue that 1) is of great importance, and 2) is highly debatable.   I’ll be the first to admit that my thinking about this is half baked.

Here’s the issue. Over the coming years, will health plans and doctors:

  1. Continue to have adversarial relationship such as they’ve had over the past decades (ala Hatfields v. McCoys, cats v. dogs, oil and water), or
  2. Is there strategic potential for reconciliation and partnerships to emerge?

A headline in yesterday’s Wall Street Journal caught my attention and got me thinking (again) about the issue.