e-CareManagement blog

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Health Wonk Review at Managed Care Matters

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.

 

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3 Critical Elements of Clinical Collaboration

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”

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Editorial: A Duty to Share Patient Information

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”

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Universal American: A “Healthy Collaboration”

JP Morgan Healthcare Conference | Universal American

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””

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ACOs: We’re NOT There Yet

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”

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ACOs: Are We “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?”

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“It’s the Data, Stupid”

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

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

exhibit

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

 

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Are Hospital Business Models on a Burning Platform? Not Yet, But It’s Inevitable.

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.”

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Physicians Shouldn’t Wait for Big Data: “Small Data” Can Jumpstart Your Care Management Program

by David C. Kibbe MD, MBA and Vince Kuraitis JD, MBA

Everywhere we turn these days it seems “Big Data” is being touted as a solution for physicians and physician groups who want to participate in Accountable Care Organizations, (ACOs) and/or accountable care-like contracts with payers. We disagree, and think the accumulated experience about what works and what doesn’t work for care management suggests that a “Small Data” approach might be good enough for many medical groups, while being more immediately implementable and a lot less costly. We’re not convinced, in other words, that the problem for ACOs is a scarcity of data or second rate analytics. Rather, the problem is that we are not taking advantage of, and using more intelligently, the data and analytics already in place, or nearly in place.

For those of you who are interested in the concept of Big Data, Steve Lohr recently wrote a good overview in his column in the New York Times, in which he said:

“Big Data is a shorthand label that typically means applying the tools of artificial intelligence, like machine learning, to vast new troves of data beyond that captured in standard databases. The new data sources include Web-browsing data trails, social network communications, sensor data and surveillance data.”

Applied to health care and ACOs, the proponents of Big Data suggest that some version of IBM’s now-famous Watson, teamed up with arrays of sensors and a very large clinical data repository containing virtually every known fact about all of the patients seen by the medical group, is a needed investment. Of course, many of these data are not currently available in structured, that is computable, format. So one of the costly requirements that Big Data may impose on us results from the need to convert large amounts of unstructured or poorly structured data to structured data. But when that is accomplished, so advocates tell us, Big Data is not only good for quality care, but is “absolutely essential” for attaining the cost efficiency needed by doctors and nurses to have a positive and money-making experience with accountable care shared-savings, gain-share, or risk contracts. The promotional literature for Big Data is peppered with jargon and catch phrases — “close to the point of care,” “synthesizing large amounts of information,” “transformational analytics,” and so on — that promise to “de-fragment” the current health care environment and offer predictive insights that the doctors, nurses, and patients do not now possess.

This all may be true. But why wait for Big Data to be put in place, when what we’ll call “Small Data” is already available and can offer information and analytical insights sufficient to get a good start on care management programs capable of improving quality and reducing some unnecessary costs?

Continue reading “Physicians Shouldn’t Wait for Big Data: “Small Data” Can Jumpstart Your Care Management Program”

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