Accomplishments v. Activity in Healthcare

January 9, 2013 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Health System Reform, Information & Communications, Innovation, Public Health / No Comments

The phrase “Paying for Value not Volume” has been health reform’s mantra for several/many years. But the concepts embodied in “Paying for Value not Volume” are problematic on two levels. First, the term “Value not Volume” doesn’t convey a clear picture of the specific changes health reform is trying to achieve. This creates problems communicating the benefits of health reform and healthcare transformation to people who are not steeped in health policy, including most clinicians and patients.

And second, the “Paying for” part of the phrase indicates that the focus is on financial reforms. This creates a barrier to people (i.e.,…

Health Reform is Right On Target

January 7, 2013 / Michael D. Miller MD / Delivery of Healthcare, Economics & Financing, Federal Healthcare Reform, Health System Reform, Politics / No Comments

Support for the Patient Protection and Affordable Care Act (aka ACA or “the health reform law”) has never been very high since it was signed into law on March 23, 2010. As can be seen in the Kaiser Family Foundation’s Tracking Poll interactive graphic below (assuming the embedded link is working) the percentage of individuals with favorable and unfavorable opinions of the law have remained relatively close.

Public policy is often said to be in the right place if approximately equal numbers of people agree and disagree with the implementation of new laws and programs. The Heartland Monitor Poll described in a December 8^th National Journal article paints a slightly more complicated picture of the health reform law, i.e.…

Doctors are Not Terrorists, But…….

July 23, 2012 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Economics & Financing, Health System Reform, Information & Communications, Miscellaneous, Quality of Care & Safety / 1 Comment

Changing behavior is very complex. Many management books, philosophical tomes, and academic psychology articles have been written on this subject, so I’m going to simply and quickly get to the connections among doctors, terrorists, and health reform.

1. Changing people’s behavior requires appealing to basic motivating factors. Different individuals have different motivators, but everyone has them.

2. Physicians are a key part of the healthcare system. Improving quality and controlling healthcare spending will require physicians to do some things differently – particularly how they work with other clinicians (i.e., in teams), prescribe treatments, order tests, make referrals, and interact with patients and their families. …

8 Variables Fueling Increasing Healthcare Costs

July 20, 2012 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Health System Reform / No Comments

At a recent meeting about implementing the ~~Accountable~~ Affordable Care Act, Karen Ignagni, (President and CEO of the America’s Health Insurance Plans), listed 8 variables that are fueling increasing healthcare costs – and thus need to be addressed to “bend the cost curve”:

Prices of services (Not insurance premiums, which mostly reflect input prices, i.e., the cost of healthcare services and products.)
Variations in care delivery practices and how that impacts safety (She also suggested that transparency and reporting measurements for 10-12 key conditions would significantly help reduce care variation – which can improve quality and drive down costs)
Measurement (Alignment between public and private sector reporting requirements to make #2 more feasible for healthcare delivery systems already struggling with data collection, analysis, and reporting.)

…

Health Reform’s 7 Lively Concerns (Not the 7 Deadly Sins)

July 20, 2012 / Michael D. Miller MD / Delivery of Healthcare, Federal Healthcare Reform, Health System Reform, Information & Communications, State-Level Healthcare Reform / 1 Comment

At a recent meeting about implementing the ~~Accountable~~ Affordable Care Act, Don Berwick, (the recent CMS Administrator, and the Founder and former CEO of the IHI), listed 7 areas that worry him about continuing with successful health reform and the implementation of the ACA. (Note – I’ve rephrased some of these into question form and added some summary comments.)

Will Care Change? (After payments change to incentive value rather than volume.)
Will Costs Actually Be Reduced? (It is too early for much data, but can we get to a sustainable level of GDP spending on healthcare, e.g. 15%?)
Will the Mechanics of Coverage Be Successful?

…

Healthcare Reform in One Slide – Bridge to the Future

June 18, 2012 / Michael D. Miller MD / Delivery of Healthcare, Federal Healthcare Reform, Health System Reform, Politics / 1 Comment

At a recent panel on health and education reform Toby Cosgrove, the Cleveland Clinic’s CEO, stated that two of the most important things for improving the US healthcare system are: 1. transparency about quality, and 2. transparency about costs. This reminded me of a March 2009 Grand Rounds presentation I gave at a Boston Hospital titled “Health Reform 2009 and Beyond.” My core message was that Accountability and Transparency are the forces driving health reform because the stakeholders paying for healthcare services and products are focusing on the value-centric question, ”What are we getting for what we’re paying?”

Below is a slide from my presentation that highlights some of the key transparency and accountability factors for practicing physicians.…

Why Healthcare Spending is Slowing – A New Normal?

June 1, 2012 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Economics & Financing, Federal Healthcare Reform, Health System Reform, Innovation, Medicare, Nutrition, Public Health / 3 Comments

The growth in healthcare spending has slowed in recent years. Many experts and pundits have sought to explain why – while also worrying, (or predicting), that this slowing is only temporary, i.e. past performance will predict the future.

Healthcare Delivery and Financing are Dynamically Evolving

The future will be significantly different than the past because our healthcare system, society, and economy are evolving into what might be called a “New Normal” state. Assuming current priorities and pressures continue, public and private sector organizations at all levels will increasingly emphasize value¹ in their decisions about spending and preferences for healthcare services – including choices about substituting one treatment option for another. …

Predicting the Future is Easy

May 23, 2012 / Michael D. Miller MD / Economics & Financing, Federal Healthcare Reform, Health System Reform, Medicare, Politics / No Comments

Predicting the future is easy. Predicting the future accurately, is hard.

Public policy deliberations about initiatives for improving healthcare delivery and financing are often handcuffed by an over-reliance on the accuracy of projections. This happens because estimates of costs, disease prevalence, utilization rates, etc. are embraced as descriptions of inevitable futures, rather than as well-executed analytical projections with inherent probability ranges. This metamorphosis from estimation to “factation” occurred though a predictable sequence:

Quantitative analyses yield estimates;
Estimates are published or presented;
Summaries of estimates are extracted from tables and slides;
These summaries – or “bottom lines” – are rhetorically converted by the media and others from “projections” and “estimates,” to what “will happen,” as in, “healthcare spending will be….”

…

Health Insurance Security Creates Jobs

April 22, 2012 / Michael D. Miller MD / Delivery of Healthcare, Federal Healthcare Reform, Health System Reform, Politics, Private-Employer Based Health Insurance, State-Level Healthcare Reform / No Comments

People feeling secure that their health insurance will continue (or be easy to get) creates an often overlooked societal benefit, i.e., it promotes job creation – particularly for entrepreneurs. Because this value is hard to quantify, it is seldom seen in policy or political rhetoric. (It is also overshadowed by the general “job lock” phenomenon of employment-based health insurance.)

This week’s National Journal has a great article on this topic (“The Other Jobs Bill”) that examines Massachusetts’ experience with their insurance reforms and coverage requirements: The expert consensus is that these reforms have boosted Massachusetts’ economy and job growth compared to other states.…

Accountability in Healthcare – What People Think of the Coming Changes

December 16, 2011 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Health System Reform, Information & Communications / 2 Comments

Following up on my pre-Thanksgiving post, I’m reporting back on what friends and relatives think about some of the terms for new healthcare delivery entities, e.g., Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMH).

What I heard is consistent with my previous conversations: People think that ACOs are like HMOs, and Medical Homes might be nursing homes, home health, or hospice, etc. One great insight came from my cousin who is a teacher. She told me that teachers react negatively to the word “accountability” because of the No Child Left Behind (except those who don’t measure up) law – which according to a RAND analysis from the summer of 2010 is “encouraging teachers to focus on some students at the expense of others, and discouraging the development of higher-thinking and problem-solving skills.”…

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.”…

Era of Accountable Care

October 24, 2011 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Federal Healthcare Reform, Health System Reform, Medicaid, Medicare, Private-Employer Based Health Insurance / 1 Comment

For many months I’ve been talking about the array of health transformation initiatives the Department of Health and Human Services has been deploying as both demonstrations and programmatic changes. I’ve been characterizing this strategy to create more accountability as an evolving menu, buffet, or map – sort of like those magical Harry Potter maps where the lines keep appearing on the parchment to create a recognizable image.

As part of releasing the final rules for the Medicare Shared Savings Program, HHS also put forth a document subtitled “Menu of Options for Improving Care,” which is a list of some of the landmarks in the future map of an Era of Accountable Care.…

‹1 2 3 4 ›»