In the 2018 proposed Medicare Access and CHIP Reauthorization Act’s (MACRA’s) rule, published earlier this year, HHS has again proposed to exclude two-thirds of physicians, or 900,000, from participation in the Merit-based Incentive Payment System (MIPS). MIPS was created under 2015 MACRA legislation to incent financially Medicare physicians and other Medicare Part B clinicians to improve care quality and reduce Medicare spending growth. HHS is choosing to exclude smaller-sized physician practices because, it is believed, MIPS reporting requirements place too high a burden on less resourced practices. However, MACRA legislation includes a “virtual group” provision that allows for solo and small group practices to partner in meeting MIPS reporting requirements. For technical reasons the Centers for Medicare and Medicaid Services (CMS) was delayed in implementing the provision. The first year in which providers can participate in MIPS as a virtual group will be 2018. Designed correctly, virtual groups offer substantial advantages that include greater MIPS participation, more competitiveness, higher financial reward and more opportunity for small practices to keep their independence.
Above the Fold
Adapting Behavioral Health Integration to 21st Century Needs
At the start of my career, the standard of care for behavioral health integration was in-person, face-to-face interaction. As new ways to communicate have surfaced, the way we deliver care has also evolved. Today, both as a result of access but also now convenience, behavioral health treatment is often done virtually.
To keep on top of the trends, and in light of the access challenges inherent in our region, at Carolinas HealthCare System, we turned to technology to help alleviate these problems and reach more patients. Through a virtual care platform and telehealth services, patients from North and South Carolina can connect with a behavioral health provider from the comfort of home or during a visit with a primary care physician. By moving beyond the walls of the hospital and into the home and primary care setting, our dedicated team of behavioral health experts is able to help thousands of people access the quality behavioral health support they need.
I have always said that if we can save one life through this program, it is worthwhile. Two recent stories from our team prove to me that this approach is working:Continue reading…
Why Competition In the Politics Industry Is Failing America
Year after year, Congress fails to reach consensus on important issues, the electorate screams for change, and voters become more polarized along party lines and ideology. These struggles aren’t causes of America’s political malaise, says Michael E. Porter, co-chair of the U.S. Competitiveness Project at Harvard Business School; they’re symptoms of a much larger problem. U.S. “democracy” is a weak, uncompetitive industry controlled by a duopoly that pursues private interests at the expense of public good.
“To fix our political system, we must see politics as the major industry it has become, the major economic benefits it provides for its participants, and how today’s political competition is not serving the public interest,” as Porter explains in “Why Competition in the Politics Industry Is Failing America,” a just-released groundbreaking study co-authored with business leader and former CEO Katherine M. Gehl.
Experts in the benefits and drawbacks of competition in the private sector, Porter and Gehl describe the four fundamentals of a healthy political system:
- Practical and effective solutions to solve our nation’s important problems and expand opportunity
- Legislative action to advance those solutions
- A reasonably broad-based public consensus on policy
- Respect for the Constitution and the rights of all citizens
Measured by these success factors alone, America’s system has already failed. But Porter and Gehl are adamant in their belief that we can recover our former sense of bipartisanship and dynamism.
Read Porter’s and Gehl’s paper to learn more about their poignant perspective on our nation’s most urgent problems and how business, strategy and competition can help solve them.
Danny Stern is Managing Director of the Stern Strategy Group
Lessons From Massachusetts’ Failed Healthcare Cost Experiment
Massachusetts passed a massive medical cost control bill in 2012, a “Hail Mary” effort to make health-care more affordable in the nation’s most expensive medical market. The problems of the Massachusetts’ law offer invaluable lessons for the nation’s health-care struggles.
Driven in part by a Boston Globe investigation that exposed the likely collusion of the Partners Healthcare hospital system (including several Harvard Medical School teaching hospitals) with Blue Cross/Blue Shield, the largest healthcare insurer in the state, the law marked the biggest health reform since Romneycare in 2006. While most agree Massachusetts needed cost controls, there’s no evidence that the 2012 law has accomplished its goal—and these same failed policies have been folded into the national Affordable Care Act.
Romneycare, Massachusetts’ universal health-care law, already lacked effective rules to control the rapid growth of state medical costs. That, paired with the Boston Globe’s exposure of the likely collusion between Partners Healthcare, the largest hospital system in New England, and Blue Cross Blue Shield to raise health care payments to hospitals and doctors by as much as 75 percent, led to passage of a hefty, 349-page cost-control law in 2012. The legislation included a dizzying number of committees, an uncoordinated “cost containment” process, and dubious quality-of-care policies, like “pay-for-performance,” a program that pays doctors bonuses for meeting certain quality standards, like measuring blood pressure. These incentives might make sense in economic theory, but have failed repeatedly in well controlled studies. They’ve even created perverse enticements, such as some doctors avoiding sicker patients. The cost control law also encouraged widespread use of expensive electronic health records, even though there’s no evidence that they save any money.
Hi, I’m Rob. I’m a Recovering Doctor
Yeah, I know I used that line once before, but it’s a special day for me today. Humor me. Five years ago today I earned my last money from an insurance company. Yep, today is my five year sobriety date.
Five years.
That was before the Affordable Care Act, before the Cubs won the World Series. Before anyone knelt for the national anthem, and if they had, people would’ve probably not minded. It was before the election of a reality TV star to our highest office, before “fake news” became a thing (there was plenty of it, but nobody called it that). It was before half of the rock legends died, before Anthony Wiener went to jail, back when Hamilton was a guy nobody knew much about who was on the 10 dollar bill, when the world wasn’t quite this warm, when Oprah hated me. Actually she still does. I’m not sure why.
I left my old practice because of “irreconcilable differences” with my ex-partners. Instead of going to the VA, joining another practice, or moving to New Zealand, I started a different kind of practice. My Yoda, Dave Chase (who wrote a book that you MUST read) told me about “Direct Primary Care,” where doctors don’t charge a lot, but are able to see a lot of people and give good care because they are paid by their patients. It made sense to me. There were a few folks doing it, and I talked to a couple (I’m looking at you, Ryan) who made it sound possible.
So I did it. I dumped all insurance and started charging people a flat monthly fee. People were skeptical and only my most loyal patients followed me (about 200). It took a while, but we figured out how to make it work, and my patients figured out that this was the best experience they ever had in healthcare.
Big Names, Big Ideas at Health 2.0 Fall Conference
The Annual Health 2.0 Fall Conference has harnessed the creativity and passion of health care’s brightest professionals to tackle the industry’s most intractable problems and leverage technology-enabled solutions to drive more compassionate, more accessible patient-centered care.
Check out the full agenda of our eleventh show, Oct. 1-4, in the heart of Silicon Valley.
Our killer line up of speakers covers the full spectrum of healthcare, and includes:
Innovative leaders, including Jason Pyle, CEO of Base Health; Simon Kos, CMO of Microsoft; Aashima Gupta, Global Head, Healthcare Solutions, Google; Brian Otis, CTO of Verily Life Sciences; Daniel Kraft, Founder and Chair of Exponential Medicine; and Jeff Margolis, CEO of Welltok.
Policymakers, such as HHS CTO Bruce Greenstein; ONC National Coordinator Don Rucker; former ONC Director David Brailer; and former U.S. CTO Aneesh Chopra.
Patient advocates, including Dave DeBronkart (e-Patient Dave) and Patient Power President Andrew Schorr.
Representatives from more than two dozen major health systems, including UPMC, Mount Sinai, Dignity Health, UCSF, and more!
Major healthcare investors, including Providence Ventures, Merck Ventures, GE Ventures, and more!
Check out our full line up of speakers.
Limited amount of tickets are available. Register Today to secure your place at the Fall Conference-event starts this Sunday.
Graham-Cassidy is Dead. It’s Back to the Drawing Board. Why Not a Two-Tier System?
Remember back in 2012 when then Vice-President Joe Biden told us, “Bin Laden is dead, General Motors is alive”? The good old days. Also around the time Senators John McCain and Lisa Murkowski promised to repeal Obamacare. Along with a bunch of other Republicans seeking reelection to Congress.
Fast forward to 2017. The new catchphrase is “GOP is dead, Obamacare is alive.” At least their credibility is dead. Buried in the rubble of broken campaign promises. Not only Obamacare repeal, but also tax cuts, immigration enforcement, balanced budgets, reduced spending, and so on.
Repeal and replace, as a promise was simple enough on the campaign trail. We heard this promise in 2010, when voters gave the House to Republicans. We heard it again in 2012, when voters gave them the Senate. Despite controlling Congress, Obamacare remained alive and well. Candidate Donald Trump, along with most Republican members of Congress, promised repeal and replace last year.
Eight months into the Trump administration, Obamacare is still kicking. Congress had three bites of the apple this year and each time came up with a worm instead. This week was their third attempt to fix Obamacare. Not the promised repeal, instead only financial window dressing to keep Obamacare alive in some shape or form.
How health IT organizations are using security as a competitive advantage
When speaking with our health IT clients, I’m hearing a distinct shift when it comes to cybersecurity. They no longer view it as an IT cost; they understand how it can facilitate growth, create competitive advantage and build trust in their products and brand.
Their executive management is on board with this thinking, too. They don’t want to hear about fear, uncertainty and doubt when it comes to data breaches, hacks and cyber threats, but rather how cybersecurity can help ‘protect the house and the product’ while at the same time enabling the business, customers and partners.
As more products and services in the healthcare continuum are connected, the need to proactively address cybersecurity increases. And as more consumer and business information is generated and shared, data privacy becomes a critical business requirement. This explains why we’re seeing forward-thinking health IT organizations moving to a new model of cybersecurity – one that’s adaptive to evolving risks and threats plus aligns with overall business objectives, such as increased revenue.
The one unifying thing we see with most health IT clients is the cloud. They need to design, build, assess, test and validate architectures and products on the cloud to confidently go to market with secure solutions. They’re finding that as they address cybersecurity in the design and development of products and services, they experience new ways to innovate and move faster. These cloud-integrated solutions can also enhance data privacy and boost customer trust and brand reputation. These are crucial safeguards as consumers are more concerned than ever about how their data is collected and shared.
Organizations aren’t waiting to hear that security program elements to demonstrate customer data protection are a requirement to closing a deal, they’re getting proactive by using cybersecurity as a sales strategy.Continue reading…
How Wellness Become the Wrong Word
What do employers want more than anything? Healthy, engaged, productive, energized, and thriving employees who provide great customer service and high quality products. What they have is all too often the antithesis of that.
This article is about why and how to move away from “wellness” to “wellbeing.” Wellness is one dimensional—the absence of illness. But for employees to thrive, they need so much more. The essence? They need to be happy with what they are doing and where they are doing it. Without that, good physical health, engagement, and productivity are almost impossible. It’s as simple as that, and with happiness comes success on multiple levels for the employee and the employer. And yet the all too many of today’s American employees are dreadfully unhappy with their jobs and bosses. It’s time for that to change.
The companies that successfully address the deteriorating health (both physical and mental/emotional) of their employees have a huge competitive advantage, and not just from reduced healthcare coverage, but in cultivating more enthusiastic, productive, and engaged employees which drive competitive and financial success through better products and better service.
Dee Edington confirmed this in his book Zero Trends when he wrote: “Our mission is to create shareholder value. We create shareholder value because we have innovative, creative, and quality products and services. We have innovative, creative, and quality products and services because we have healthy and productive people.”
This is, as we say in Massachusetts, “wicked important.” Yet most American CEOs do not yet see it as even rising to their level of attention. That is nothing short of astonishing given how much they pay for healthcare coverage and the truly poor value they receive in return. Starbucks pays more for employee coverage than for coffee. GM pays more for coverage than for steel. Businesses don’t realize it, but they are truly in the healthcare coverage business whether they like it or not. And that doesn’t even begin to total up the costs of disengagement, absenteeism, and turnover.Continue reading…
Bringing Behaviorial Health Into Primary Care Settings
The integration of behavioral health into the primary care setting has resulted in a number of benefits. Traditionally, behavioral health and medical health operated separately, but in recent years, the integration of these two systems has improved access to care, ensured continuity of care, reduced stigma associated with seeking care and allowed for earlier detection and treatment of mental health and substance abuse issues. By bringing behavioral health specialists into primary care facilities, healthcare systems have streamlined care and brought down costs, working collaboratively and reducing the number of appointments and hospital visits.
At Carolinas HealthCare System, we use technology to take behavioral health integration one step further. A robust behavioral health integration project was developed through myStrength, using virtual and telehealth technology to ensure that every primary care practice has the capabilities for early detection of mental illness and substance abuse and upstream intervention, easing the connection between behavior health specialists and patients who might otherwise be averse to seeking professional help.
