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Above the Fold

Pulse Check: Value-based Care Models and the New Administration

Apr 5, 2017• 1

By GREG FULTON

From within the new leadership at Health & Human Services (HHS), some anticipated and current payment models tied to MACRA are advancing, while others not-yet-tied to MACRA are being delayed.

MSSP Track 1+ was officially unveiled post-election through a CMS webinar March 22, and CPC+ has moved to round two. Also, but prior to the presidential election, CMS put forth several new bundled payment models whose start dates have been delayed.

Track 1+

The CMS ACO Track 1+ is being designated as an advanced-alternative payment model (A-APM) for MACRA, meaning qualified participants would be eligible for the up-front five percent MACRA bonus, and would be exempt from MIPS scoring.

Track 1 will remain with its MIPS APM designation.

The difference is Track 1+ comes with downside risk, though less than that of Track 2 or Track 3 models, themselves also A-APMs.

Do Asians Have Harder Heads? On Sports Concussions and the Need For a Fairer, Medical Research Funding Policy

Apr 4, 2017• 4

By CHUNG, ZINK, BARR

At a January event on “The Future of Baseball” organized by the Sports and Society Program at NYU’s School of Professional Studies, Yankees executive Jean Afterman spoke to the superiority of baseball over football by noting that “at least our athletes don’t have to worry about their heads after they’re done.” It was an innocuous statement but one that points to a growing assumption that sports concussion is both (a) prevalent and (b) a debilitating disease to be feared.

But is it true that sports concussions are the public health scourge of our time? Media coverage would make it seem so, with countless stories dedicated to professional athletes suffering through pain and dementia, youthful athletes retiring for fear of brain injury, and billion dollar lawsuits against the NFL.

Key Mechanisms That Define Health City Cayman Islands’ Value Innovation

Apr 4, 2017• 17

By VIDAR JORGENSEN and BRIAN KLEPPER

Health City Cayman Islands (HCCI), less than three years old and located in the Caribbean just an hour’s flight south from Miami, is a 104-bed hospital outpost of Bangalore, India-headquartered Narayana Health (NH). HCCI has caught the attention of US health care professionals not just as a nearshore health care destination, but for having extremely high quality despite pricing that is a fraction of that in the US, as well as careful attention to the patient’s experience. HCCI is not only a competitor to traditional US health systems, it is potentially a radical disruptor. It’s model is so different that it could significantly change the standards by which health systems are judged.

HCCI’s performance is the culmination of a deep commitment to access, efficiency and excellence. NH’s Founder, Dr. Devi Shetty, began with a mission-driven awareness that health care is an essential need and must be affordable to be accessible. He then spearheaded an enterprise-wide focus on process optimization to deliver the best care possible at the lowest possible price. The results have been remarkable. Fifteen years ago, NH’s bundled costs for open heart surgery in India averaged about $2,000. Now they are about $1,400, or about 1% of average US cost. Interestingly, Dr. Shetty believes that better results are within reach and has set a five year target of $800 for those services.

The Secret Sauce of Successful Pilots

Apr 4, 2017

By CHELSEA POLANIECKI PARTNER CONTENT

Ever wish you could tell the future? Well, you can’t- but a pilot study can certainly help. Pilots are instrumental in helping organizations learn how a technology application might work in practice, or, more specifically, in their practice. By conducting a pilot, you get a chance to test out your technology, predict what might occur when you expand your reach, and most importantly, learn how to tweak your business model to support a large system. Eric Conner, Co-founder & Chief Revenue Officer of Healthify learned that, “Piloting de-risks trying out new technology… and forces both the host and the innovator to be more innovative.” Conner also adds that after piloting, “… you’re ready to implement your technology in a large health system [since] you have the kinks all worked out” and your company is prepared with the tools they need for large-scale growth.

National Coordinator 6.0: A Blueprint For Success

Apr 3, 2017• 48

By JACOB REIDER, MD

Now that it’s public, I’ll offer my thoughts on the next steps for Don and ONC. Don Rucker is a good pick for the nation, and will be a great National Coordinator. I’ve gone on record as saying that some others are not qualified, and as many of you know – I don’t mince words. Don is smart, focused, thoughtful, intentional, and will make good decisions for ONC and HHS. I have known Don for 20 years. He’s got a long track record of integrity, he’s a nice person, he deeply understands the challenges, limitations, and opportunities of Health IT. I have no doubt that he’ll do a good job. He’s got a lot on his plate.

Where should he focus?

Stay the course with health IT certification. I disagree with the growing meme that ONC has broadened its certification scope too far. Certification has one purpose: to provide consumers with a way to be confident that the product they are purchasing will do what the seller says it does. Some people seem to have forgotten (or don’t know) that some of the companies that sell health IT solutions have claimed that the products do things they do not do. There needs to be a process by which these claims are tested, verified and, yes, certified. If this program is scaled back, health IT systems will be less safe, less interoperable, less usable, and less reliable. #KeepCertification.
2.Keep the Enhanced Oversight Rule in place. My former colleagues (and Don’s former colleagues) in the vendor community will disagree, as do some of the house Republicans. As Don will learn first hand in his initial few weeks as NC, some of the companies that have been selling certified health IT products have been misbehaving. In some cases, products have been de-certified. In other cases, there have been investigations and resolution of problems without de-certification. ONC is protecting the public by doing what Congress asked it to do initially. The certification program is more than testing of products in a petri dish, it’s about what happens with the products in the real world. Surveillance is therefore a necessary part of making sure that the products do what they were certified to do. #KeepOversight.Continue reading…

Who Won When the AHCA Failed?

Apr 3, 2017• 19

By ANISH KOKA, MD

You may have heard that repealing and replacing Obamacare recently failed. The analysis of what went wrong comes from many corners. Andy Slavitt, former insurance executive and most recent director of CMS, writes that the ‘failure of Trumpcare can be seen as a rejection of policies that Americans judged would move the country backward.’ Apparently, the theory goes, moderate republicans, especially in states that expanded heavily and rely on Obamacare Medicaid expansion, were skittish of a repeal and replace plan that endangered the healthcare of millions of constituents. The conservative David Frum writes in the Atlantic that most Democrats and Republicans have accepted the concept of universal health care coverage – and that the idea of a repeal of the right to healthcare is sheer anathema. And if the Republicans were wavering, town halls filled with angry constituents were sure to provide an extra dollop of pressure.

The effort to get the messaging right is clearly important to many, but I find most of it functions as a smoke screen seeking to obscure the real battles being fought over your healthcare.

It is certainly true that Obamacare insures millions of Americans. But it is also true that having health insurance and having health care are two very different things. To be clear, the folks attempting to preserve the status quo want to preserve the ability to force all Americans to buy health insurance that costs hundreds of dollars per month. Put another way, the folks attempting to preserve the status quo want to force Americans to give a monthly fee to health insurance companies. Remember, these plans have deductibles so high that most of the cost of care delivered during the year in the form of labs, copays, and imaging studies falls on the hapless patient. The insurer, for the average healthy person, doesn’t pay a dime.

Interview to Michael Seres, Patient Advocate and Founder of 11Health

Apr 3, 2017

By JOSE L. CÁNOVAS PARTNER CONTENT

Patient and Advocate and Founder of 11Health, Michael Seres is considered one of the strongest patient voices around the world, Michael Seres is involved in developing and implementing patient engagement strategies using digital technologies.

(Interview with Michael Seres by Smart Health)
At the age of 12, you were diagnosed with Crohn’s disease, an incurable bowel condition. Could you explain us your experience and how have you became a leader patient advocate?

At the age of 16 I was told by my gastroenterologist that the only way he would treat me is if we did this together as a team. I learnt very early on that I needed to take responsibility for my health. That led me to understand more about my blood levels, the important markers and what I needed to do next to assist my recovery. In the last 5 years, post my intestinal transplant, I really decided that I have a responsibility to give back to the surgeons who saved my life. The best way I could do that was to live my life. I started mentoring patients with IBD and intestinal failure and then started talking to the new transplant patients. From there I understood more the power of the patient and the role we can play in healthcare in the future. At Stanford Medicine X we have a philosophy of everyone included which is around the fact that everyone, including the patient, has a role to play and each role has to be based on mutual respect and empathy.
Continue reading…

Solutions That Will Be Essential for the Future of Healthcare

Apr 3, 2017

By ROBERTO ASCIANO PARTNER CONTENT

We are living in an age where thousands upon thousands of individuals and companies are trying to find faster, better and cheaper ways to get things done leveraging the latest digital technologies. We are so completely surrounded by efforts to innovate, disrupt and accelerate, that it may come as a surprise to find out that “innovation” has been around ever since our earliest ancestors shed their body hair and started walking upright.

Since those early days, our ancestors have sought solutions to their everyday problems and the “technology” they leveraged was whatever the environment around them gave them to use. These early humans started to make tools and weapons out of stone and thus came up with a clever solution to help them hunt, grind grains, start fires and build shelters. It may however come as a surprise to find out that, even in the stone age, our earliest ancestors applied their latest innovation to also find solutions to their health problems!
Continue reading…

Calcium Scan and Subtractive Medicine

Apr 3, 2017

By SAURABH JHA MD

Being a radiologist, I rarely speak to patients, but I was asked to counsel Mrs. Patel (not her real name, so calm down HIPAA totalitarians), who was worried about the risks of radiation from cardiac calcium CT scan. Because of her risk factors for atherosclerosis, her cardiologist wanted her to take statins for primary prevention, but she was reluctant to start statins. They eventually reached a truce. If she had even a speck of calcium in her coronary arteries she would take statins. If her calcium score was zero she wouldn’t. This type of shared decision making is the most frequent reason why cardiologists order calcium scans at my institution.

Health Care: What Should a Populist Do Now?

Mar 31, 2017• 1

By CLARK HAVIGHURST

Why not a plan that would actually help the forgotten folks who voted for change—and even attract some liberals’ support?

How can the Trump administration and the Republican Party make history forget their embarrassing failure to “repeal and replace” Obamacare? Interestingly, their best strategy—if they can withstand the political heat from all those who prosper under health-care business-as-usual—would be to embrace an explicitly populist program aimed at correcting the numerous and serious economic injustices deeply embedded in American health care today. The victims of these injustices include many of the lower-income Americans who in 2016 voted against elite interests in both political parties and in favor of fundamental, not just incremental, change. A program to right their wrongs should appeal even to some liberals, specifically those whose principal concern is the welfare of the people themselves, not just aggrandizing government or restoring the Democratic Party’s rightful dominance.

The political chances of the reform program outlined below would depend on making a direct, explicitly populist appeal to the many millions of Americans whom the health-care system currently exploits economically almost entirely without their knowledge.

Health-Sector Monopolies and Those Who Pay Their Prices

In the great populist era around the turn of the last century, the people’s anger was directed not, as now, at political elites or government itself but at huge private monopolies, the “trusts.” Teddy Roosevelt’s trust-busting effort broke up large agglomerations of market power while also establishing competition as America’s fundamental mechanism for inducing private businesses to satisfy consumers. If today’s populists are truly serious about protecting ordinary Americans from abuse by elite interests, they should begin by declaring a similar war against monopoly in health-care markets. Liberals should be invited to join this effort.