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care management
What’s the Best Way to Get Hospitals Involved in Care Coordination?
Pay them to do it, take money away when they don’t — make hospitals accountable for their role in avoiding unnecessary readmissions.
Mark E. Miller, Ph.D., Executive Director, Medicare Payment Advisory Commission testified recently in front of the U.S. Senate Committee on Finance. He opened his remarks by stating:
The health care delivery system we see today is not a true system: care coordination is rare, specialist care is favored over primary care, quality of care is often poor, and costs are high […]
Megatrend Spotting: Collaborative Care Management Networks
“Why can’t we all just get along?” Rodney King
The Megatrend: Collaborative Care Management Networks (CCMNs)
It’s been quite a while since I spotted a new Disease Management Megatrend, but here’s one that’s long overdue:
Collaborative Care Management Networks will be necessary to achieve optimal care coordination.
The trend in a nutshell:  payers (and others) are recognizing that optimal care coordination will require collaboration among health care stakeholders. This CANNOT be achieved with yesterday’s proprietary IT and business models.
CCMNs will share many — perhaps all — […]
Details “Emerge” on the Medicare Medical Home Demonstration
Where would one expect to find CMS’ latest thinking on the upcoming Medicare Medical Home Demonstration project? The obvious answer would be “on the Official CMS MMHD home page ”, but you’d be wrong.
CMS has issued a Medicare Medical Home Demonstration Payment Contractor RFP available on the Federal Business Opportunities website. Thanks to the Google Alert service for digging this out.
For the casual reader, the details of the MMHD are taking shape nicely. CMS and its advisors have obviously […]
The Medical Home: Pull the RUC Out
This third and final post in the series addresses questions about the future of the Patient Centered Medical Home (PCHM):
What’s problematic about using the RUC methodology with the PCMH?
What’s the optimal level for a PCMH care management fee?
Should primary care leaders pull the RUC out? How?
What’s Problematic About Using the RUC Methodology with the PCMH?
There are at least two reasons for not having the RUC methodology seen anywhere in the same county country as the PCMH. First, the RUC methodology doesn’t […]
The Medical Home Hits the RUC
Today’s post (#2 in a series) tackles several questions:
What is the American Medical Association/Specialty Society RVS Update Committee (RUC)?
What is the RUC’s role in the Medicare Medical Home Demonstration project?
How are people reacting to RUC recommendations for PCMH reimbursement levels?
What is the American Medical Association/Specialty Society RVS Update Committee (RUC)?
The AMA formed the RUC to act as an expert panel in making recommendations to CMS on the relative values of Current Procedural Terminology (CPT) codes using the Resource Based Relative Value […]
The Medical Home: Confusion Over Care Management Fees
The honeymoon is over.
Prior to April 29, 2008, reviews of the Patient Centered Medical Home (PCMH) model had been uniformly enthusiastic and positive.
Today the PCMH model is hitting reality — someone’s going to have to bring home money to pay the bills. On April 29 the American Medical Association/Specialty Society RVS Update Committee (RUC) released a  report making recommendations relating to payment levels of care management fees for the PCMH.
This report has stirred cries of confusion and outrage. I’ll elaborate on these cries in the second posting of […]
Perspectives on the Upcoming 5th Annual Healthcare Unbound Conference
 The Healthcare Unbound Conference is a highlight of my year and I always look forward to it!
What’s so special about this conference?
First, the caliber of the people attending.  It’s a stimulating mix of high-level clinical, technical and business types. The energy is flowing and many people have told me how much they like to go just for the networking.
Second, the caliber of the conference organizer. I’ve worked with many conference planners, and Satish Kavirajan is not your ordinary conference organizer.
Satish […]
4 Reasons Why Health Plans Struggle with PHRs
Aetna recently made another big announcement relating to their PHR. While the concept of what they’re doing is very appealing, it strikes me that health plans in general face an uphill battle in getting consumers to adopt and use personal health records (PHRs).
I’ll describe 4 factors behind my thinking:
Lack of Trust
Lack of Access to Clinical Data
Lack of Permission
Lack of Convenience in Consumer Workflow
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.Â
Here are a few highlights from the report:
Medicare Health Support: “Do not go gentle into that good night”
Vince Kuraitis and Thomas Wilson, PhD, DrPH
“Do not go gentle into that good night.
Rage, rage against the dying of the light”
Dylan Thomas
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Despite CMS’ recent cocktail hour pronouncement that Medicare Health Support (MHS) is on its last legs, many are fighting to prolong its life.
Recent Developments
DMAA is working with Sen. John Kerry to introduce legislation mandating the continuation of Medicare Health Support (MHS). Dr. Jaan Sidorov’s Disease Management Care Blog reprints the full announcement from the February 12 issue of […]