Health Spending: For What, To Whom, and Where It Is Heading

February 5, 2013 / Michael D. Miller MD / Economics & Financing, Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Medicaid, Medicare / 1 Comment

The data for 2011 US healthcare spending was reported in the January issue of Health Affairs. Below are some graphs showing how spending was distributed across the different categories of healthcare services in the years 2000, 2007, and 2011, as well as who paid for the spending. (My analyses and commentary follow these graphs. The source for all graphs is Health Affairs, 32, no. 1 (2013):87-99)

What Healthcare Spending Went For:

Where Healthcare Spending Funds Came From:Three highlights from the Health Affairs article are:

The distribution of healthcare spending for various services and providers has been relatively constant despite significant growth in total and per capita spending.

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Cutting Employer Healthcare Costs

November 26, 2012 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Economics & Financing, Health Policy and Communications Blog, Private-Employer Based Health Insurance, Public Health, Quality of Care & Safety / 1 Comment

Over the past 20+ years larger companies have tried many tactics to control the growth of their healthcare spending, including HMOs, consumer-directed healthcare, wellness programs, value-based insurance design, selective contracting for high-cost procedures, personal health assessments, etc. While some of those efforts temporarily reduced employers’ healthcare spending, they did not change the long-term trends, in part because they only targeted employees and did not focus on high or very high cost individuals – many of whom are not active workers. [A recent Health Affairs article analyzing conditions associated with employee healthcare spending reflects this “searching under the streetlamp” phenomenon.]

Company Health Benefit Costs Do Not Equal Employees’ Healthcare Spending

The cost of providing health benefits for most larger companies includes not only the health benefits for employees, but also costs for retirees, and spouses and dependents of active workers.…

Healthcare Turkey Talk

November 21, 2011 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Quality of Care & Safety, State-Level Healthcare Reform / 3 Comments

Thanksgiving is a great occasion for learning what people think about the future of the US healthcare system.* This year, I’m going to find out what people are thinking about some of the coming health delivery system changes – particularly Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMH).

I’ve conducted this two-question informal survey with handfuls of people and found their level of knowledge and positive reactions equivalent to Congress’s approval rating, i.e. 9%. This is worrisome, since if transforming the US healthcare system to increase value and quality will be partially based on ACOs’ and PCMHs’ superior care coordinating abilities, it will be hard to improve cost, quality, and access at the local level if the average person/patient doesn’t know what these organization are, there is inherent aversion to their names, or there is resistant to unexplained “changes.”…

Smoking is So Bad For You That……..It Makes Me Sick

October 13, 2011 / Michael D. Miller MD / Clinician-Patient Relationships, Health Policy and Communications Blog, Information & Communications, Public Health / 4 Comments

The evidence for the ill effects of smoking keeps getting stronger and scarier. If one were to construct a balance sheet of tobacco’s pros and cons it would look much worse than the one Bernie Madoff was hiding from his investors and the SEC.

Making the Risk of Smoking Personal

I was recently talking with one of my IT consultants and we started discussing tobacco use since he thought his smoking might have been one reason he’d been denied health insurance. What he – and many people – don’t realize is that the major health risk from smoking is not lung cancer, but how damaging it is to the heart and blood vessels, i.e.,…

Patient-Centered Care? Or Not?

July 11, 2011 / Michael D. Miller MD / Access to Healthcare, Clinician-Patient Relationships, Delivery of Healthcare, Health Policy and Communications Blog, Health System Reform, Innovation, Politics, Public Health, Quality of Care & Safety / No Comments

The term “patient-centered care” has increasingly been used to describe healthcare structures that deliver better quality care – as well as often doing so with lower costs. And today there was a news story about how some medical schools are assessing applicants’ interpersonal skills, something that is fundamental for being a patient-centric clinician.

While there are have been numerous articles demonstrating the value of patient-centered care and concluding that it is better and should be promoted – including those looking at the ill named “Patient-Centered Medical Homes” – I’ve found myself pondering the following questions:

“What type of care have clinicians been providing if it hasn’t been patient-centered?…

Cultivating Health Reform and Transformation

July 5, 2011 / Michael D. Miller MD / Delivery of Healthcare, Health Policy and Communications Blog, Health System Reform, Information & Communications / No Comments

Listening to various speakers at a two-day HIT/Delivery System Transformation Summit last week reinforced my thinking about the concept that reforming (or transforming) the US healthcare system is more like farming than business management.

Transforming healthcare is like farming because it involves cultivating collaborations and coordination among independent people, organizations, and stakeholders who all have varied interests and reporting/governance structures. In this way, “managing” or “leading” health transformation is like growing plants – the soil needs to be prepared, the plants (or seeds) need to be planted, and then they need to be watered, fertilized, weeded, pruned, etc…. And depending on the plant, (i.e.…

Health Law Is Reforming System Via Market Forces

April 3, 2011 / Michael D. Miller MD / Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Innovation, Medicare, Politics, Private-Employer Based Health Insurance, Quality of Care & Safety / 4 Comments

All the controversial rhetoric about the new health reform law is missing a huge reality: The law is driving dramatic changes in the real world. Almost every major health delivery system is preparing to reorganize how they provide care to hundreds of millions of Americans by becoming Accountable Care Organizations (ACOs).

Health Systems are Voting With Their Wallets
The magnitude and level of financial interest in ACOs – and proof that it is not just cautious planning – were dramatically illuminated by recent actions and a Washington Post article:

On Thursday, HHS released the long anticipated proposed rule for ACOs and Medicare “Shared Savings.”

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Rise of the Tea Party Machine (and I Am Back)

November 14, 2010 / Michael D. Miller MD / Health Policy and Communications Blog, Health System Reform, Politics / 3 Comments

Interpreters of the recent election results have been pointing fingers in many directions about alleged successes and failures of policies and messaging. Having run a consulting business for more than 10 years I see a parallel between how people vote and how people and organizations making hiring decisions. That is, people voting for their elected officials are essentially making decisions about who they want to hire to run their government.

Politicians certainly want the people who voted for them last time to vote for them the next time. This is a fundamental tenant of business success, i.e., getting your current clients to become repeat customers. …

Implementing Health Reform – The Long, Hard and Twisting Maze

April 13, 2010 / Michael D. Miller MD / Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Politics, State-Level Healthcare Reform / 3 Comments

Health reform is now the “law of the land,” and “written in law.” However, as people are quickly realizing, after a year of campaigning and more than a year of legislative action, implementing the new law will require navigating a long, difficult, and twisting path – even before any amendments are considered in this or subsequent Congresses.

Navigating the fast and slippery route to successfully implementing all the provisions of the PPACA will be daunting. Three relatively recent laws are examples of the time and steps required for such implementation – and each of these was much simpler than the PPACA:

The Medicare Part D law was signed in December 2003 and the new benefit started in January 2006.

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Preparing for Health Reform Summit (and More Snow)

February 24, 2010 / Michael D. Miller MD / Health Policy and Communications Blog / No Comments

Over the last week stakeholders and pundits have written and spoken exhaustively about tomorrow’s health reform summit and the President’s proposal released on Monday. All together this has been a bit overwhelming. What seems clear is that all sides and constituencies are trying to reiterate their goals and fundamental positions while still maintaining optimism that some significant reform can happen this year.

Today is like the lull before the storm – and Washington, DC is predicted to get another 5+ inches of snow starting late tonight – so rather than add to the cacophony of statements, opinions, and predictions, below is video about some favorite things that may help alleviate some angst and put people in a better mood for both the summit and the snow.…

New Year, New Decade, New City, New Health Reform

January 4, 2010 / Michael D. Miller MD / Health Policy and Communications Blog, Health System Reform / No Comments

For the new year and new decade I’ve relocated back to Washington DC to be more directly engaged with the implementation of health reform and related initiatives.

Packing, moving and unpacking took longer than expected – sort of like passing health reform legislation – and I apologize for my infrequent postings. Being back in more direct contact with policy makers, national advocates and others here in DC, I’ll be writing more frequently and in greater detail about the implications and expectations of health reform legislation, law(s), and implementation.

On the horizon is the development and passage of legislation combining the House and Senate health reform bills. …

Playing Poker with Health Reform

December 16, 2009 / Michael D. Miller MD / Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Politics, State-Level Healthcare Reform / 3 Comments

The National Journal’s December 5th issue has a very interesting article comparing President Obama’s approach to key issues to his poker playing style. (The issue cover states, “Obama as Poker Player.”)

Having played poker for over 45 years, I find the article’s discussion of his cautious approach and preference for standard games very enlightening. For many people today, poker is about Texas Hold’em, a game that is great for TV but rather simplistic in some ways because each player only has 2 cards and shares 5 others. The National Journal discusses the intellectual, strategic, and personality difference between this game, and more sophisticated games such as five-card draw and seven card stud – as well as more “wild” games such as baseball, although it doesn’t mention my crazed favorite, midnight baseball.…

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