Roji Intel Blog

Theresa Hush 0
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ACOsAdvanced Alternative Payment ModelsFuture of Health CareMedical Decision-Making
March 14, 2018

Can Provider-Led ACOs and AAPMs Deliver Health Care Transformation?

“In times of rapid change, experience could be your worst enemy,” said J. Paul Getty. He might have been giving us advice on how to transform health care. We have reached the tipping point for broader adoption of ACOs and other Advanced Alternative Payment Models (AAPMs) to organize health care and payment under both Medicare and commercial insurance. But our recent experience cannot tell us whether these approaches will work. This, despite the fact that an estimated 10 percent of insured individuals—32 million people—were already covered by private and public ACO services in mid-2017. And we reached that point even…
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Theresa Hush 0
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Future of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Value-Based Health Care
March 7, 2018

Who Wins and Loses If CMS Kills MIPS?

Last month, the new Health and Human Services (HHS) Administrator, Alex Azar, tolled the death knell on MACRA MIPS quality reporting. Even as the MIPS program just began its second year, Azar reinforced what MedPAC (Medicare Payment Advisory Commission) has been suggesting since June 2017: trash MIPS quality reporting and speed up provider transition to APMs (Alternative Payment Models). MedPAC is so eager to engineer this that it recently suggested even more incentives to help physicians make the switch. If you believe the hype, both providers and patients will win if MIPS is eliminated or vastly rewritten. Certainly, the notion…
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Consumers & PatientsFuture of Health CareMedical Decision-Making
February 28, 2018

Shared Decision-Making May Be the Next Consumer Health Movement

Consumers are rapidly mobilizing around all aspects of health care—affordability, access to the system and choices about their care. As changes in health insurance shift more and more cost onto consumers, patients want to be involved in decisions that will affect their finances as well as their health. Yet they face a dilemma: The only way to really affect their costs is to be involved in decisions about how much and what kind of health care they use. That means being involved in medical decisions. But when prices are hidden and consumers don’t know the facts about alternative—and uncertain—outcomes, they…
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Theresa Hush 0
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Academic Medical CentersConsumers & PatientsFuture of Health Care
February 21, 2018

How Safe is Medicare? What To Know About White House Budget Proposals

Health care providers may be lulled into believing that Medicare budget cuts proposed by the White House last week won’t happen. Media reports have repeatedly emphasized that the budget is simply a policy proposal. Congress alone has the authority to determine spending limits and allocate funds. But labeling this budget—and the Medicare proposals in it—as “dead on arrival” is a mistake. For one, the proposal includes efforts aimed at reducing drug prices and fighting the opioid epidemic. But these are minor political enticements, compared to the proposed Medicare cuts labeled as “Reducing Wasteful Federal Spending.” Those are the most significant ideas…
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Thomas Dent, M.D. 0
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Consumers & PatientsFuture of Health CareMedical Decision-Making
February 14, 2018

Don’t Just Check the Box: Capture the Patient’s Story to Define Meaningful Goals of Care

What does Shared Decision-Making between doctor and patient really look like? I spent four decades as a primary care physician, as well as 27 years teaching medical students and residents. Looking back on my treatment of patients, I now question whether my management was driven by what the patient wanted—or by what I wanted for the patient. Certainly, I wanted to do what was in the best interest of the patient, and I sincerely hope that our interests were often well aligned. In certain specific cases, I acted against the stated desires of the patient, a necessary call (discussed below).…
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Consumers & PatientsFuture of Health CareValue-Based Health Care
February 7, 2018

Five Lessons from Big Business on Value-Based Health Care

Last year we predicted that CMS would step back from the complex requirements of its Value-Based Health Care initiative, in favor of reducing provider burdens for quality reporting and reducing regulation, in general. While MACRA MIPS and the move toward financial risk still remain, we correctly anticipated that Medicare would focus its efforts on its own beneficiaries—and less on leading the charge for cost control in health care. We hoped that providers would seize the opportunity to take ownership of making health care work better, rather than respond to external requirements. Instead, despite several organizations that have pushed the agenda…
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Consumers & PatientsFuture of Health CareMeaningful MeasuresValue-Based Health Care
January 31, 2018

What Does #MeToo Have to Do With Value-Based Health Care?

Are we measuring the right things in Value-Based Health Care? That’s the question I am asking myself while reviewing recent efforts by CMS to create better measures of health care value, called Meaningful Measures. Given current, widespread reports of sexual abuse and my recent reading about the dismal state of elder health care, I can’t respond affirmatively. A Value-Based Health Care System should curtail rising health care costs and promote better health for individuals. But we can’t miss the forest for the trees. If we focus on the minutia of medical processes or even outcomes of moderate value, yet miss…
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Alternative Payment Models (APM)Bundled PaymentsFuture of Health CarePerformance ImprovementValue-Based Health Care
January 24, 2018

BPCI Advanced Means Financial Risk Is Coming for Specialists

In case you missed Medicare’s messages about its reimbursement direction in recent years, CMS just reminded us that financial risk is well on its way. If you’re developing strategies that assume the status quo, it’s time to reassess your organization’s financial footing. CMS has already stated its intention to shift 50 percent of Medicare provider reimbursement into Alternative Payment Models (APMs) by the end of this calendar year. And those APMs are quickly transitioning toward putting providers at financial risk, because CMS is rewarding them to do so. CMS’s goal to impose financial risk was front and center again this…
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Thomas Dent, M.D. 0
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Future of Health CareMedical Decision-MakingPerformance ImprovementQualified Clinical Data Registry ReportingValue-Based Health Care
January 17, 2018

Time Out! How Strategic Pauses Can Enhance Medical Decision-Making to Improve Outcomes 

Health care providers are under increasing pressure to improve outcomes for patients with chronic conditions. There is pressure to meet quality measures, to establish programs that improve outcomes, to decrease costs for these conditions (utilization as an outcome)—or a combination of goals. At issue: what works, what is affordable, what is acceptable to patients and clinicians. The answers are elusive because there are many factors involved in the care of patients who have numerous chronic conditions, co-morbidities and medications, as well as multiple healthcare professionals providing their care. Adding to this complexity, any outcomes improvement for patients with chronic conditions…
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Theresa Hush 0
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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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