Roji Intel Blog

Theresa Hush 0
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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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Robert McNutt, M.D. 0
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Future of Health CareMedical Decision-MakingPatient Empowerment
October 25, 2017

Medical Treatment Should Be Based on More Than Just “Doing Something”

Memory is malleable. This was made quite clear to me at my recent 50th high school reunion. Despite my fallacious recollections, I could not dispute the data of my forgotten activities, awards and foibles captured in pictures and written comments in my high school yearbook. Then there were the comments about my behaviors “back then,” interpreted or misinterpreted by my former high school comrades. These conversations reinforced for me how difficult it is to correctly intuit the motives and thoughts of others, when my own are occasionally tarnished or refurbished. None of us can truly read another’s mind. Even if…
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Robert McNutt, M.D. 0
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Future of Health CareMedical Decision-MakingPatient EmpowermentPerformance ImprovementPersonalized Medicine
October 4, 2017

Physician-Patient Interaction: Where We Should Begin to Measure and Improve Medicine

Data is not always the path to identifying good medicine. Quality and cost measures should not be perceived as “scores,” because the health care process is neither simplistic nor deterministic; it involves as much art and perception as science—and never is this more the case than in the first step of that process, making a diagnosis. I share the following story to illustrate this lesson: we should stop behaving as if good quality can be delineated by data alone. Instead, we should be using that data to ask questions. We need to know more about exactly what we are measuring,…
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Theresa Hush 0
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Future of Health CareMACRAPatient EmpowermentValue-Based Health Care
July 5, 2017

Who Will Fill the Leadership Void in Health Care Reform if MACRA Rolls Back?

Amidst the political cacophony over health care coverage for American consumers, a fundamental question has been relegated to a soundbite: How can we control cost? Everyone (in the industry or participating in the debate) knows that cost drives our health care system problems, including affordable insurance coverage. The fallacy at the heart of all the wrangling is that we can address coverage affordability without confronting cost. But doing something about cost in a de-regulation environment is exceptionally difficult. That is why we are finding ourselves in the midst of both a MACRA implementation and a likely MACRA Rollback. And no…
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Theresa Hush 0
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Future of Health CareMedical Decision-MakingPatient EmpowermentValue-Based Health Care
June 21, 2017

The Doctor Will See You Now, But Don’t Stay Long or Ask Too Much

Something has been happening with physician medical visits. Maybe I’m just noticing it because my doctor quit and I had to find a new one, which put me on a treadmill of repeat appointments—because, as my new physician told me, she was out of time for our visit. But here’s the rub: Apart from seasonal allergies, there is nothing wrong with me. I am, thankfully, extraordinarily healthy. I have no hypertension, diabetes, cardiac issues or auto-immune diseases. My lipids are normal and my weight hasn’t changed since I was 21. The only meds I take are for allergies. Yet so…
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Robert McNutt, M.D. 0
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Future of Health CareMedical Decision-MakingPatient EmpowermentResearch
June 7, 2017

Physician Comparisons Based on Performance Don’t Tell the Right Story

Medical decision-making requires a comparison. There is, most often, more than a single option for your care. New tests and treatments are constantly being added to the medical portfolio by scientific inquiry. The only way to advance care, in fact, is by comparing options. Comparing incites a difficult task, however: the compared option that is best for your disease-related outcome may be worse for your test- or treatment-related outcomes. For example, for men with early stage prostate cancer, surgery may reduce the chance of dying of prostate cancer from 8 to 6 percent over 10 years, but surgery increases, simultaneously,…
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Theresa Hush 0
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Future of Health CareMedical Decision-MakingPatient Empowerment
May 24, 2017

Can Consumers Help Reduce Rising Costs of Medical Technology?

In years to come, the current health care financial scene may seem like the “good old days” of health care for middle class Americans. Despite escalating consumer costs, proposed cuts in coverage, and an ever-rising cost of care, most Americans can still access health care services. They believe health care will be there for them, even if not everyone can get it. But the affordability of health care, regardless of coverage source, will soon be everyone’s problem. Medicare is projected to run out of money in only 10 years (some say less), and each year the cost of health care…
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Theresa Hush 0
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Future of Health CareMedical Decision-MakingPatient Empowerment
May 10, 2017

Can Consumers Get Essential Information to Make Good Health Care Decisions?

In the rancorous public debate about how to provide health care to Americans—and especially to vulnerable people with higher risks, lower income, or both—there is a common explanation for rising costs: it’s the patients’ fault. According to this argument, we need to stop the “overuse” of health care services by consumers that are causing our costs to skyrocket. But what if consumers really wanted to be excellent, cost-effective purchasers of health care. Could they actually do it? Could they legitimately question their physicians about recommended treatments? There is little argument that the system of financing health care has immunized both…
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Thomas Dent, M.D. 0
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Future of Health CareMedical Decision-MakingMedical EducationPatient EmpowermentPerformance ImprovementQualified Clinical Data Registry Reporting
April 26, 2017

Primary Care Physicians’ Ethical Dilemma: Meet Goals for Patients or Practice Owners?

Primary care physicians are on a collision course with health care consumers—their patients. While trying to deliver best clinical care, they must navigate a competitive business environment that encourages higher spending. The business of health care has undergone rapid consolidation in physician practice ownership. Spurred by the need to compete for patients, use EMR technology and manage within the heavily regulated health care industry, physicians have moved from smaller to larger group practices. Primary care physicians have made this transition faster than specialists by selling their practices, and are now more likely to be employed by a hospital. But this…
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Theresa Hush 0
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Future of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Patient EmpowermentPerformance ImprovementValue-Based Health Care
April 20, 2017

Can Value-Based Health Care Help Consumers Choose Doctors? 
12 Questions to Ask

Do consumers and other health care purchasers have the ability to choose providers based on quality and cost? That’s the assumption beneath attempts by Medicare and health plans to reimburse providers based on their ability to deliver better quality while constraining costs. Value-Based Health Care also includes programs by commercial insurance to offer “narrow” provider networks that select physicians and hospitals by performance. Choosing value presumes that consumers and employers have the right knowledge and information to select providers who deliver the best clinical results at lower cost. The need to provide that information has fueled efforts over the past…
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