California HealthCare Foundation

Mark Smith

Mark Smith, MD, MBA, was the founding CEO of the California HealthCare Foundation; he served in that role for 17 years before stepping down last year. I’ve known Mark since we were residents together at UCSF in the mid-1980s, and both of us were influenced by training at the epicenter of the AIDS epidemic. Mark continues to see AIDS patients at San Francisco General Hospital one day each week. He was the lead author of Best Care at Lower Cost, a major Institute of Medicine report, published in 2012. Mark is one of those rare people who can take complex and politically charged concepts and distill them into sensible nuggets – while managing to be hilarious and profound at the same time.

In the continuing series of interviews I conducted for my upcoming book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Agehere are excerpts of my interview with Mark Smith, conducted on July 24, 2014.

Bob Wachter: Put yourself back about 10 or 15 years ago when you were thinking about the promise of healthcare IT. As you’ve watched the last 15 years play out, what’s been surprising to you?

Mark Smith: As with most of life, it’s a lot harder in fact than in theory. My first hint of this came with the implementation of computerized order entry at Cedars-Sinai in 2002. [In a story I tell in the book, Cedars’ physicians all but threatened to go on strike after they turned on the clunky system. Within a month, they pulled the plug on the system, a hiccup that cost the organization $34 million in 2002 dollars.] That was my first window into the gap between what sounds lovely in a policy paper, and what it means in practice to implement this stuff. Continue reading “Reality-Based Policy and the Digital Doctor: An Interview with Mark Smith”

California-HealthCare-FoundationI am excited to announce that the California Health Care Foundation (CHCF) has just published a report, authored by me, about the state of healthcare Accelerators in the U.S. and around the world. For those of you who don’t know CHCF, it is a very large not-for-profit endowment that has a mission to improve the quality, cost and efficiency of healthcare delivered to the underserved populations of California. In so doing, they also provide a very valuable educational service to the overall healthcare community and fund the creation of reports like this one about Accelerators.

The new report, entitled Survival of the Fittest: Healthcare Accelerators Evolve Towards Specialization is available for download HERE.

This report is intended to update the report that CHCF released two years ago entitled “Greenhouse Effect: How Accelerators are Seeding Digital Health Innovation” about the then emerging field of healthcare Accelerators.   I would have to say that two years later in 2014, these programs have definitely emerged.

Continue reading “Healthcare Accelerators Evolve Towards Specialization”

Do we live in times of barbarism?Healthy Communities Data Summit

While I imagine many reading this would disagree that we live as a primitive culture based on our technological progress, I contend that how we operate as a community may be vastly improved in supporting the health and well-being of everyday citizens. Furthermore, I believe that one day we’ll look back on ourselves as society and marvel at how primitive the tools were to improve the health of communities.

On a daily basis, our individual health is driven by countless decisions. Where we shop for food, how we commute, where we choose to live and spend our time outdoors are all contributors to our health and wellbeing. Each of these actions can be improved—optimized so they contribute to a maximum level of health—if adequate data is available.

Continue reading “Healthy Community Data Summit — A Call to Action”

After a seemingly endless presidential campaign, we’re just days away from the Nov. 6 election. And to be sure, health care issues remain at the forefront.

Both Barack Obama and Mitt Romney have tried to claim the high ground as Medicare’s number one defender. In his latest column, the New York Times’ Paul Krugman argues that next week’s vote “is, to an important degree, really about Medicaid.” And writing on Bloomberg View, columnist Ezra Klein takes an even broader stance, concluding that “this election is all about health care.”

But health care isn’t all about the election, despite politics’ seeming ability to draw every sector into its gravitational pull.

In fact, many of the most significant stories in health care from the past two months haven’t come from the campaign trail — where candidates have mostly rehashed their existing policies — but from the private sector, as employers and providers have made aggressive, and sometimes unexpected, deals and changes. Reforms that will continue regardless of who’s sitting in the Oval Office next year.

Here are some of those stories.

Top Employers Move to Defined Contribution

As previously discussed in “Road to Reform,” Sears Holdings and Darden Restaurants have made plans to shift away from their current “defined benefits” — where they choose a set of health insurance benefits on behalf of their workers — and roll out “defined contribution” instead.

Under that model, firms pay a fixed amount for employees’ health benefits and allow workers to choose their coverage from an online marketplace, such as the Affordable Care Act’s health insurance exchanges or the emerging number of privately run exchanges.

In theory, the model would slow employers’ health costs while allowing employees to have more control over their own health care spending. And Sears and Darden’s announcements aren’t wholly unexpected, given that many employers have signaled their interest in making a similar shift.

But given the long-entrenched employer-sponsored health coverage model, some employers needed to be the first movers before the rest would be ready to follow.

Will they? That will be a major industry issue to watch across the next months.

Continue reading “How Health Care Changed While You Were Watching the Election”

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