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Collaborative Care Management Networks

The New ACO Rule is Here…The New ACO Rule is Here…and more!

429 p. Proposed ACO Rule

ACO Fact sheet from HHS

Medicare Fact Sheet: What Providers Need to Know

HHS press release

Don Berwick’s article on ACOs in the NEJM

ACO Quality Performance Standards Summary

FTC/DOJ Joint Antitrust Statement on ACOs

TheHill article ā€œLeaked memo reveals Dem strategy for defending healthcare regā€

The leaked memo

Will ACO IT Models Be Walled Gardens or Open Platforms?

Will ACO (accountable care organization) IT models be walled gardens or open platforms?Ā  i.e., will ACO IT platforms focusĀ onĀ exchanging information within theĀ provider network of the ACO, or will they also be able to exchange information with providers outside the ACO network?Ā (If the question still isn’t clear, click here for a further explanation.).

ā€œDoes This ACO Thing Really Mean We Need to be ā€˜Accountableā€™ā€

The American College of Physicians (ACP)Ā just released a well-reasoned and thoroughĀ position paper,Ā The Patient-Centered Medical Home Neighbor: The Interface of the Patient-Centered Medical Home with Specialty/Subspecialty Practices.

As I’ve written before, the Big Idea behind ACOs (Accountable Care Organizations) is the notion of accountability, not the specifics of organizational structure.

The purpose of the ACP position paperĀ is to address the gaps that exist in care coordination whenĀ a physician refers a patient to a specialist. The obvious and logical answer proposed is to develop […]

Megatrend Spotting: Health Plan Role of Having ā€œBest Data About YOUR Medical Conditionsā€ is Up for Grabs

Who has the most comprehensive data about YOUR clinical conditions?

For most people, the answer today is ā€œyour health planā€, 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 […]

16 Capabilities Physicians Will Need to Implement New Payment Models

(click on the graphic to download the document)

Depending on the nature of the payment changes which are made, physicians may need to enhance their capabilities in some or all of the following sixteen areas:

Achieving sufficient patient volume to support a new or improved service.
Having sufficient upfront capital to design and implement a new or improved service.
Having the skills/experience to efficiently/effectively implement a new/improved service.
Having the ability to obtain and analyze data on the quality of services.
Having the skills/experience to […]

Is Gawande Right? Are Pilot Programs the Key to Delivery System Cost Reductions?

Atul Gawande’s most recent New Yorker article ā€œTesting, Testingā€ addresses the critics who lament that there is no master plan to curb delivery system costs in pending health reform legislation.

Gawande retorts: ā€œIs that a bad thing?ā€

…and he answers his own question by describing the value of pilot programs contained in both the Senate and House versions of health reform legislation.

Is Gawande correct?Ā  Yes and no….

The Real Secret Sauce of Medicare’s Participation in Regional Collaboratives — Network Effects

Last week I asked whether Medicare’s Biggest Change in 40 YearsĀ is on the horizon.Ā That post described and discussed implications of Medicare’s new direction for the medical home — the shelving ofĀ Medicare Medical Home Demonstration (MMHD) and the refocusing on the recently announced Multi-Payer Advanced Primary Care Initiative (MAPCI).

In that post I touched briefly on the potential for MAPCI to create effective networks at multiple levels — contracting networks, health IT networks, social and collaborative care networks.Ā  I’d like to expand […]

Complimentary Webinar: Introduction to Clinical Groupware and the Clinical Groupware Collaborative

BrightTALK is sponsoring a complimentaryĀ Electronic Health Record Summit this Tuesday, October 20, 2009.

David C. Kibbe MD, MBA and I will be presenting ā€œIntroduction to Clinical Groupware and the Clinical Groupware Collaborativeā€

Clinical groupware is a new and evolving model for the development and deployment of health information technology (HIT) platforms and applications having the following characteristics:

Use of the Internet and the web for EHR technology.

Explicit design for information sharing and online communication among providers and patients/consumers.

A modular […]

The Big Idea in Understanding ā€œAccountable Care Organizationsā€

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

ACOs of various types areĀ being proposedĀ in national health reform legislation. For all you ever wanted to know about ACOs, read How to Create Accountable Care OrganizationsĀ from theĀ Center for Healthcare Quality and PaymentĀ Reform.Ā Ā Ā 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 onĀ the organizational form of ACOs, rather than their objectives.Ā  Organizational form is relevant […]

Meeting Announcement: ā€œIntroduction to the Clinical Groupware Collaborativeā€

by Steve Adams, CEO, RMD Networks and Acting President, Clinical Groupware CollaborativeĀ Ā 

I’m writing to extend a warm personal invitation to learn more about the Clinical Groupware Collaborative (CGC).Ā  To-date, purely through word-of-mouth over 40 companies have expressed interest in the CGC, and we expect that you’ll be hearing a lot more about us over the coming months.

Our meeting will take place next Tuesday, September 22, 6 PM in conjunction with The Forum 09, the annual meeting of DMAA: […]