Roji Intel Blog

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Future of Health CareMedical Decision-MakingValue-Based Health Care
January 10, 2018

Reining In Medical Costs Might Work If We Could All Agree What “Cost” Means

A few days ago, a couple of providers commented on my recent posts about cost performance improvement in health care. The first of these posts reviewed obstacles to provider strategies for managing costs and how to overcome them, and the second addressed technology that providers would need to both measure and improve performance. One commenter took issue with my statement that providers have not embraced cost reduction because the reimbursement system rewarded growth and more services. Another stated that providers have undertaken cost control for years, and they have invested heavily in accounting and financial systems, as well as aggregation of…
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Future of Health CareMedical Decision-MakingPatient EmpowermentValue-Based Health Care
January 3, 2018

Can the New Year Bring A Real Solution to Affordable Health Care–From Providers?

Every New Year, we commence another round of solutions to fix our expensive health care system.  2018 will be no different.  A predicted 5.5 percent increase in medical costs over last year will no doubt spawn new efforts to contain direct payments to providers or transfer costs to consumers—or both. No solution has appeased health system stakeholders, including employers, health plans, consumers and providers. No matter where the system is pinched, another part reacts, and costs continue to outpace inflation. Most solutions, however, have been implemented by payers—government and commercial health plans, as well as employers—against providers and consumers. Why…
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Future of Health CareMedical Decision-MakingPatient Empowerment
December 20, 2017

The Crux of Shared Decision-Making: Who Is Actually Deciding?

Shared Decision-Making is an emotionally charged topic for both physicians and patients. Physicians believe they have their patients’ best interests at heart by guiding them into better health through therapies to improve their conditions. Physicians may believe, in fact, that by explaining health status and treatment alternatives (followed by asking the patient to decide), they are already using a Shared Decision-Making process. Patients, in turn, are facing a higher share of costs, yet an ever-worsening health status that requires improvement to avoid financial disaster. Imagine a typical physician-patient discussion about an important medical decision or the path for improving outcomes…
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Future of Health CareMedical Decision-MakingPatient EmpowermentPerformance Improvement
December 14, 2017

Is Shared Decision-Making the Path to Improved Provider Performance?

As an escalating percentage of Americans (including children) are diagnosed with diabetes and hypertension, the health care system is straining to control costs and demonstrate good clinical outcomes. No surprise that providers blame patients for lack of compliance with therapies or lifestyle changes that will improve their health status. Hence the uptick—some say warranted—in incentives or penalties assessed by insurers or employers on patients who don’t “behave.” But this punitive finger pointing is neither equitable nor productive. Just as it’s unfair to hold physicians, alone, to be fully accountable for patient outcomes in quality reporting and cost, without giving them…
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Clinical Data RegistryFuture of Health CareMedical Decision-MakingValue-Based Health Care
November 15, 2017

Choose the Right Strategies and Technology to Improve Cost Performance in Health Care

Fee for Service (FFS) reimbursement is going the way of the dinosaurs, but many providers are ignoring the signals. Here are two clear indicators: Medicare’s adoption of episodic cost models and the planned movement to financial risk models for both Medicare and Medicaid. Indeed, most Medicaid plans have now transitioned the majority of beneficiaries into managed care plans. Private health plans, many of which were burned by capitated HMO plans in years past, are aligning with providers to develop ACOs and moving again toward risk. Recent health care mergers and acquisitions evidence a blurring of lines between health plans and…
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Future of Health CareMACRANarrow NetworksPerformance ImprovementValue-Based Health Care
November 1, 2017

Providers Should Believe in Health Care Cost Control Now—If They Want to Stay in Business

Despite MACRA and other Value-Based Health Care efforts, many health care providers believe that controlling health care costs is impossible to do. They cite lack of comprehensive data about their patients and where they obtain services, and lack of control of patients’ decisions. But the real issue that providers have with cost control is much simpler: Why give up revenues under Fee for Service by reducing volume of services? That system has rewarded them well, fueling the growth of consolidated health systems, technology expansion and purchase of physician practices by ensuring a patient base. Controlling costs is now a relatively…
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Patient EmpowermentPerformance Improvement
October 18, 2017

What the Dog Show Taught Me: Performance Improvement Is Not Just Science, But Art

Last week I attended the Bearded Collie Club of America National with my two highly energetic and driven dogs, along with about two hundred other competitors. A calm vacation it was not. My dog athletes enjoyed multiple days of performance competition, capped off by show competition. For people who believe dogs are pets and don’t have emotional lives, let me introduce you to my beardies. They have goals. It’s my job to help them achieve those goals. To do that I need to understand how to get performance, and to improve it. I have learned a lot about meeting goals…
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Future of Health CarePatient EmpowermentPerformance Improvement
October 11, 2017

If Federal Policy Can’t Improve Health Care, What’s Next? 5 Trends to Track

Health care has been extraordinarily resistant to change. Escalating costs have been at issue since the early 1980s—think about it!—but continue to rise unabated. Ask anyone participating in the system, be they physicians or other health care providers, payers or patients, and you will be inundated with complaints about health care economics, outcomes or processes. If you ask most health care executives about the future, chances are you’ll be met with a shrug. The fact is, however, that an undercurrent of change is already beginning to transform health care. It is gaining momentum, but the health care system and providers…
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Future of Health CarePatient EmpowermentValue-Based Health Care
September 27, 2017

Redesigning Health Care for the New Consumer

A consumer-driven culture shift is emerging in health care that will change the dynamics of health care purchasing decisions and impact providers’ bottom line. It is being fueled by policies that are increasing the share of health care expenses paid by consumers. Benefit plans with higher deductibles and copayments, choices narrowed to providers who demonstrate lower cost, restriction of medical services, and higher percentages of premium sharing are just some of the tactics used to control and redistribute costs from health care payers to consumers. Much of the discussion focuses on the need for consumers to be “better purchasers” of health…
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Future of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Performance Improvement
September 20, 2017

Physicians Aren’t Engaged in Performance Because Measure Results Aren’t Real

According to management guru Peter Drucker, “If you can’t measure it, you can’t fix it.” Quality measurement and reporting have been rooted in similar reasoning. The idea is that we find out what’s wrong, and then we launch programs to improve it. That’s the linear route mapped out by Medicare starting with Meaningful Use, PQRS quality reporting, Value Modifier comparisons, and moving into current MACRA MIPS and APMs. But physicians have known something for a while that others have been unwilling to accept: quality reporting measures don’t give you a foundation for improving outcomes. Why? Because performance measurement does not…
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