MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'care management'. Sat, 03 Sep 2011 02:20:21 +0100 http://www.medworm.com/index.php?rid=5159301&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F6e23a3ZIUP8%2F by Jaan Sidorov MD, MHSA, FACP and Vince Kuraitis JD, MBA Physicians face great uncertainty. According to a survey conducted by The Physicians Foundation, the great majority of physicians (89%) believe the traditional model of independent private practice is either “on shaky ground” or “is a dinosaur soon to go extinct.” In the face of this uncertainty, many physicians are jumping to a conclusion that “I have to sell my practice to the hospital.” In this post of our series on The 100 Year Shift, we will examine physician practice.  We’ll show that the economic and clinical environment  is changing rapidly and that selling to the hospital is one option. However, it is not the only option. (more…) Article Series - The 100 Year Shift? Strategic ... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=5159301 Mon, 22 Aug 2011 15:26:12 +0100 5159301 http://www.medworm.com/index.php?rid=5107892&cid=t_116117_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2Fk0gsqWimymU%2F A bill in New York to prohibit health insurers from requiring their customers use mail-order pharmacies was criticized by the Federal Trade Commission as a well-intentioned effort that, nonetheless, could have an anti-competitive outcome, according to a letter written by the agency to one of the sponsors of the legislation. The bill has passed both the state senate and assembly, and awaits a signature from New York Governor Andrew Cuomo. In explaining its position, the FTC acknowledged that the bill (which you can read here) was designed to increase consumer choice and limit the ability of pharmacy benefit managers, or PBMs, from penalizing consumers who do not purchase their meds from mail-order pharmacies. You may recall that the largest PBMs, including CVS/Caremark, Express Scripts and ... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=5107892 Tue, 09 Aug 2011 12:09:09 +0100 5107892 http://www.medworm.com/index.php?rid=5050811&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FtS3SgTYmYeY%2F by Vince Kuraitis JD, MBA and Jaan Sidorov MD, MHSA, FACP In our introductory posting of this series, we noted that economic incentives previously aligning doctor-hospital interests were changing. This creates the potential for The 100 Year Shift – physicians awakening to possibilities for stronger partnerships with payers than with hospitals. In this post, we will zero in on the changing economic position of hospitals and the effect this is having on physician-hospital relationships. We will examine the trend of hospital employment of physicians and point out challenges and tensions for the future. [This is a long post...so now might be the time to refill your coffee cup.] (more…) Article Series - The 100 Year Shift? Strategic Realignment among Physicians, Hospitals and Payer... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=5050811 Tue, 19 Jul 2011 19:28:14 +0100 5050811 http://www.medworm.com/index.php?rid=5008372&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FXIWnixTJ1Vs%2F by Jaan Sidorov MD, MHSA, FACP and Vince Kuraitis JD, MBA In our introductory posting, we suggested that a huge shift is underway in the health care industry.  Decades of hospital-physician cooperation are not only eroding, we suggest this trend could accelerate.  Instead of a natural clinical and economic affinity with hospitals, we foresee the potential for physicians forming a new dyad with insurer-buyers. In this post, we will examine what we and many other commentators view as inevitable: the demise of volume-based payment systems and how the drive for greater value will cause physicians and insurers re-examine their normally antagonistic relationship. (more…) Article Series - The 100 Year Shift? Strategic Realignment among Physicians, Hospitals and PayersThe 100 Year Shift?... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=5008372 Thu, 07 Jul 2011 20:42:41 +0100 5008372 http://www.medworm.com/index.php?rid=5008373&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FIJUiE1aXZqA%2F by Vince Kuraitis JD, MBA and Jaan Sidorov MD, MHSA, FACP Gazing at the horizon, we foresee the potential for a tectonic realignment among physicians, hospitals and payers. Here’s a quick visual representation: This essay is the first of a seven part series. In this first post we will capsulize our vision of this potential 100 Year Shift, answer initial FAQs, and lay out the structure for the rest of the series. The Lynchpin — Changing Economic Incentives In the past, physicians and hospitals have benefited from mutually supportive economic interests. (more…) Article Series - The 100 Year Shift? Strategic Realignment among Physicians, Hospitals and PayersThe 100 Year Shift? Introduction and OverviewPayment Transformation: From Volume to Value Next in series Tags: 100 Yea... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=5008373 Tue, 05 Jul 2011 17:26:33 +0100 5008373 http://www.medworm.com/index.php?rid=4945194&cid=t_116117_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2FR9N3q5e2SFU%2F In a preliminary vote, the Maine legislature yesterday moved to repeal a 2003 law that was created to protect consumers from rising drug prices and prevent fraud by pharmacy benefit managers. The vote was prompted by industry lobbying over charges that transparency requirements had discouraged PBMs from doing business in the state, which was resulting in less competition and higher drug costs. The controversial law, which is called the Unfair Prescription Drug Practices Act, prevents PBMs from switching patients to more expensive drugs while also protecting consumers from co-payments when the actual drug price is cheaper. And PBMs are also required to pay independent pharmacies promptly and negotiate prices in good faith (here is the 2003 law and the bill to repeal the law). Those who foug... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=4945194 Fri, 17 Jun 2011 13:37:52 +0100 4945194 http://www.medworm.com/index.php?rid=4684485&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FsIIYXgtP5I8%2F Healthcare IT News just published its list of top issues for health plans in 2011: 1. Administrative Mandates (Compliance HIPAA 5010, ICD-10, etc.). 2. Care Management, Data Analytics, and Informatics. 3. Health Insurance Exchanges and Individual Markets. 4. New Provider Payment & Delivery Systems (ACOs, PCMHs, etc.). 5. Bend the Cost Trend. 6. Medicare and Medicaid. 7. Health Information Exchanges and EMRs. 8. Consumer’s Role in the Modernization of Healthcare. 9. Reform Uncertainties. 10. Payer/Provider Interoperability. Dear health plan colleagues, Wake up! The order of this list is totally out of whack. #2: Care Management, Data Analytics, Informatics. Good…sounds about right. However, #2 can’t happen before you address: #7: HIEs and EMRs #10: Payer/Provider ... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4684485 Tue, 05 Apr 2011 18:15:37 +0100 4684485 http://www.medworm.com/index.php?rid=4664299&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2Fjh9IAmR8VZs%2F 429 p. Proposed ACO Rule ACO Fact sheet from HHS Medicare Fact Sheet: What Providers Need to Know HHS press release Don Berwick’s article on ACOs in the NEJM ACO Quality Performance Standards Summary FTC/DOJ Joint Antitrust Statement on ACOs TheHill article “Leaked memo reveals Dem strategy for defending healthcare reg” The leaked memo No tag for this post. (Source: e-CareManagement) e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4664299 Thu, 31 Mar 2011 17:32:50 +0100 4664299 http://www.medworm.com/index.php?rid=4478158&cid=t_116117_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2F4zPu4D1nOpc%2F A behind-the-scenes battle is brewing in nearly a dozen states where legislation has been introduced to more closely regulate e-prescribing. And a trade group for pharmacy benefit managers claims that brand-name drugmakers are trying to use the proposals to restrict access to lower-cost generics. The bills would, essentially, prohibit docs from seeing messages from third-party information providers as they write an e-prescription. In doing so, info about other prescribing options, including drug interactions, would not be displayed on screens. “By removing the third party message, the legislation doesn’t allow the technology to get to the doctor,” a spokesman for the Pharmaceutical Care Management Association tells us. Legislation is pending in 11 states, including Indiana, K... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=4478158 Mon, 14 Feb 2011 16:36:47 +0100 4478158 http://www.medworm.com/index.php?rid=4372108&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F2LlHAo67_oQ%2F The Health IT Policy Committee has published proposed Stage 2 and 3 Meaningful Use Recommendations and they’re open for public comment until February 25. I’ll share a couple of particularly useful and well written analyses and commentaries by colleagues. Health IT guru and thought leader Dr. John Halamka writes about The Proposed Stage 2 and 3 Meaningful Use Recommendations in his blog. This is a great article to get a thumbnail overview of all the proposed recommendations. John lists 38 criteria and provides a quick commentary on how challenging he sees each of them. (Keep in mind that he’s CIO at one of the most HIT-advanced health systems in the country — your definition of “easy” and his might not be alike.) (more…) Article Series - Stages 2 and 3 of ... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4372108 Wed, 19 Jan 2011 22:16:13 +0100 4372108 http://www.medworm.com/index.php?rid=4272371&cid=t_116117_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2010%2F12%2F20%2Fhow-to-develop-the-ability-to-think-strategically%2F What is strategical thinking? A key leadership requirement. Strategic thinking is an individual thinking activity that benefits organizations. Its purpose is to discover competitive strategies to position the organization significantly differently from the present. Experiences contributing to the development of strategic thinking in order of importance according to a survey in individuals who attended ten educational events sponsored by the American College of healthcare Executives (ACHE) in various U.S. cities. Participating in organizational strategic planning was the most important experience contributing to the development of strategic thinking. Starting a major organizational project. This experience involves a complex project that lasts one year or more and affords the executive s... Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4272371 Mon, 20 Dec 2010 06:42:34 +0100 4272371 http://www.medworm.com/index.php?rid=4265923&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FMJs5VvLnXPs%2F Will ACO (accountable care organization) IT models be walled gardens or open platforms?  i.e., will ACO IT platforms focus on exchanging information within the provider network of the ACO, or will they also be able to exchange information with providers outside the ACO network? (If the question still isn’t clear, click here for a further explanation.). (more…) Article Series - Accountable Care Organizations: Cure-du-Jour or Real Collaborative Care?The Big Idea in Understanding “Accountable Care Organizations”The Achilles Heel of ACOs? Shared Savings Payment Model Unlikely to Motivate HospitalsA Dark Horse in ACO Formation: Large Physician Groups“Does This ACO Thing Really Mean We Need to be ‘Accountable’”Will ACO IT Models Be Walled Ga... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4265923 Thu, 16 Dec 2010 00:45:16 +0100 4265923 http://www.medworm.com/index.php?rid=4225414&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2Fuw7kIPbTkeY%2F Medicare has (finally) recently released a report showing home run results for a disease/care management demonstration project! Evaluation of Medicare Care Management for High Cost Beneficiaries (CMHCB) Demonstration: Massachusetts General Hospital and Massachusetts General Physicians Organization (MGH) Remind Me Again About the CMHCB Medicare Demo… The CMHCB started in 2005. My recollection is that the demo requirements were extremely similar to the Medicare Health Support (MHS) project, with a few exceptions: 1) Applicants had to include direct care providers (delivery systems, physicians) in their program design, 2) patient populations were significantly smaller than MHS.  Please comment on anything I’m missing. I’ve included an addendum at the bottom providing more... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4225414 Fri, 03 Dec 2010 00:35:05 +0100 4225414 http://www.medworm.com/index.php?rid=4125106&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FiVKcHAfiCcc%2F The American College of Physicians (ACP) just released a well-reasoned and thorough position paper, The Patient-Centered Medical Home Neighbor: The Interface of the Patient-Centered Medical Home with Specialty/Subspecialty Practices. As I’ve written before, the Big Idea behind ACOs (Accountable Care Organizations) is the notion of accountability, not the specifics of organizational structure. The purpose of the ACP position paper is to address the gaps that exist in care coordination when a physician refers a patient to a specialist. The obvious and logical answer proposed is to develop “Care Coordination Agreements” between primary care physicians and referring specialists, and the position paper takes 35 pages to explain why and how. A simplified way of thinking about Care... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4125106 Mon, 01 Nov 2010 17:28:08 +0100 4125106 http://www.medworm.com/index.php?rid=4065439&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FR13qXxm3a_c%2F “Track who is on a care team — and share info with the patient.” That’s just one of the summary recommendations coming from expert testimony given in a recent public hearing on how to improve care coordination through the use of health information technology. The Meaningful Use workgroup and Quality Measures workgroups are now wrestling with how to translate this recommendation into meaningful use criteria for HITECH Stages 2 and 3. Seems like a good idea — simple, straightforward — perhaps even obvious. The EHR (electronic health record) could be a great tool for keeping care team members in the loop and on the same page about a patient’s care. But then I thought about this for a few minutes, and the complexities started dawning. This seemingly simple recomme... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4065439 Thu, 14 Oct 2010 02:14:40 +0100 4065439 http://www.medworm.com/index.php?rid=4036758&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FdrvBwJYXAbs%2F Last week I attended and participated in an excellent conference — the National Reducing Hospital Readmissions Forum sponsored by World Research Group. One of my main take aways is to observe a simple — yet huge — difference in mindset between hospital executives and vendors. Over the past few months I’ve heard many vendors with diverse health care offerings talking about building readmission avoidance “programs” that they want to sell to hospitals.  Their idea here is to put together a soup-to-nuts offering of technologies and services — a “program” that hospitals would mostly outsource to a 3rd  party vendor. This concept has never quite sat right with me. Having spent the first 15 years of my career in and around the hospital world, I’ve often observe... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4036758 Wed, 06 Oct 2010 00:35:58 +0100 4036758 http://www.medworm.com/index.php?rid=4018247&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FMFllEgfzgTU%2F Care management software is intended to help patients make critical connections across the health care delivery system.  Today it’s used primarily by 3rd party care managers who are typically either employed directed or indirectly by payers. While not surprising, the state-of-the-art of care management software is that it continues to function as disconnected islands of information. The  2010 Health Information Technology Survey (available at no charge) provides an insightful yet sobering snapshot of care management software. The study was sponsored by TCS Healthcare Technologies, the Case Management Society of America, and the American Board of Quality Assurance and Utilization Review Physicians. The study consists of answers from 670 respondents who chose to fill out to a ... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4018247 Thu, 30 Sep 2010 00:37:07 +0100 4018247 http://www.medworm.com/index.php?rid=3965524&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FW7-Cvm8tO98%2F Who has the most comprehensive data about YOUR clinical conditions? For most people, the answer today is “your health plan”, but it’s not at all clear that health plans will continue to have this role in the future. As physicians and hospitals adopt EHRs, it’s foreseeable that clinical data about patients will be far more available and accessible. Will patient data become: A jockeying point for control and business advantage between health plans and care providers, A collaborative opportunity to optimize clinical care and care coordination, or Both? (more…) Article Series - Stages 2 and 3 of HITECH: The Golden Era of Care Coordination or Bureaucrats Practicing Medicine?Overview: Here Come Stages 2 and 3 of HITECH!Megatrend Spotting: Health Plan Role of Having “Best Data... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=3965524 Mon, 13 Sep 2010 23:23:38 +0100 3965524 http://www.medworm.com/index.php?rid=3750276&cid=t_116117_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2FFeKyFOTq8gk%2F In a potential setback to states looking to squeeze more disclosure from pharmacy benefit managers, a federal appeals court late last week struck down provisions of a District of Columbia law that would have designated PBMs as “fiduciaries” of employer sponsored health plans. The law required PBMs to disclose conflicts of interest, limit drug-switching activities and require passing rebates back to clients. The ruling comes amid years of courtroom and legislative wrangling over these issues. A similar law in Maine was upheld by the courts, and Maryland and Vermont have laws that have gone unchallenged, according to the National Legislative Association on Prescription Drug Prices, or NLARx. And as of last fall, 14 states enacted some form of PBM regulation, and another 10 states have re... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=3750276 Tue, 13 Jul 2010 12:03:39 +0100 3750276 http://www.medworm.com/index.php?rid=3726598&cid=t_116117_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fevidence-based-medicine-do-patients-understand-it%2F2010.07.05 Doctors trying to help patients understand a course of treatment must teach them new terms such as “medical evidence,” “quality guidelines” and “quality standards.” Patients might not be willing to accept that language lesson. A study in Health Affairs concluded that 41 percent of patients didn’t ask questions or tell doctors about problems. The main barriers were that patients didn’t know how to talk to doctors, or their physicians seemed rushed. Only 34 percent of patients recalled physicians discussing medical research in relation to care management. But, physicians say, that’s only half the problem. Sometimes, patients demand to see specialists when they don’t really need to. Or, they don’t accept it when evidence show... Better Health blogs http://www.medworm.com/rss/comments.php?id=3726598 Mon, 05 Jul 2010 14:00:00 +0100 3726598 http://www.medworm.com/index.php?rid=3714288&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F1pHczcOEMmE%2F Conclusion: Think Twice Before Signing Up 1) The Promise The sandbox metaphor was first used by the National Academy for State Health Policy: For the 10 or more states that are active stakeholders in multi-payer medical home initiatives, the promise of Medicare getting in the sandbox with them and playing (a.k.a. paying) is an exciting proposition. The addition of Medicare as payer to some of these state initiatives may be the critical tipping point that results in widespread primary care delivery system reform in states by involving more practices, payers and patients. (more…) Article Series - Medicare's New Direction for the Medical HomeCMS Shelves Medicare Medical Home DemonstrationMedicare’s Biggest Change in 40 Years on the Horizon?Three Years Of Medical Home Demonstrat... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=3714288 Wed, 30 Jun 2010 16:11:45 +0100 3714288 http://www.medworm.com/index.php?rid=3659033&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FohrVhtm1xe0%2F (click on the graphic to download the document) Depending on the nature of the payment changes which are made, physicians may need to enhance their capabilities in some or all of the following sixteen areas: 1. Achieving sufficient patient volume to support a new or improved service. 2. Having sufficient upfront capital to design and implement a new or improved service. 3. Having the skills/experience to efficiently/effectively implement a new/improved service. 4. Having the ability to obtain and analyze data on the quality of services. 5. Having the skills/experience to improve the quality of services. 6. Having adequate resources to support high-quality service delivery. 7. Gaining access to external resources to support patient adherence and health improvement. 8. Obtaining and analyzin... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=3659033 Sun, 13 Jun 2010 18:08:52 +0100 3659033 http://www.medworm.com/index.php?rid=3359212&cid=t_116117_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2F1uEtOjqcfck%2F In his latest attempt to probe the pharmaceutical industry, US Senator Chuck Grassley has written two big pharmacy benefit managers, as well as a trade group, asking them to provide information about their financial relationships with drugmakers. This week, he sent letters to Express Scripts, CVS Caremark and the Pharmaceutical Care Management Association (click on name to see letters). In explaining his action, Grassley - who is the ranking Republican on the Senate Finance Committee - wrote that the Medicare Payment Advisory Commission (MedPAC) recommended in a report last year that Congress should require drugmakers to report their financial relationships with pharmacy benefit managers, pharmacies, health plans, and others, but not rebates or discounts (look here). And so he asks for det... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=3359212 Fri, 12 Mar 2010 15:05:05 +0100 3359212 http://www.medworm.com/index.php?rid=3067156&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FmEkR3q1jQvs%2F Atul Gawande’s most recent New Yorker article “Testing, Testing” addresses the critics who lament that there is no master plan to curb delivery system costs in pending health reform legislation. Gawande retorts: “Is that a bad thing?” …and he answers his own question by describing the value of pilot programs contained in both the Senate and House versions of health reform legislation. Is Gawande correct?  Yes and no…. (more…) Article Series - Medicare's New Direction for the Medical HomeCMS Shelves Medicare Medical Home DemonstrationMedicare’s Biggest Change in 40 Years on the Horizon?Three Years Of Medical Home Demonstration Preparation Down the Drain?The Real Secret Sauce of Medicare’s Participation in Regional Collaboratives — Network EffectsIs Gawan... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=3067156 Tue, 08 Dec 2009 00:45:40 +0100 3067156 http://www.medworm.com/index.php?rid=3003871&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FE-Jk96eOPWk%2F Last week I asked whether Medicare’s Biggest Change in 40 Years is on the horizon. That post described and discussed implications of Medicare’s new direction for the medical home — the shelving of Medicare Medical Home Demonstration (MMHD) and the refocusing on the recently announced Multi-Payer Advanced Primary Care Initiative (MAPCI). In that post I touched briefly on the potential for MAPCI to create effective networks at multiple levels — contracting networks, health IT networks, social and collaborative care networks.  I’d like to expand a bit today… So, why is Medicare’s participation in MAPCI  and other regional collaboratives such a big deal? Here’s my hypothesis: Medicare’s non-participation (to-date) in regional payer/provider collaboratives has been a rate... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=3003871 Wed, 18 Nov 2009 00:53:23 +0100 3003871 http://www.medworm.com/index.php?rid=2981183&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FaeujPdqyGRU%2F The King of the Cats has just acknowledged that indeed cats and dogs should co-exist peacefully. Dr. John Halamka — Vice Chair of the HIT Standards Committee of the ONC and one of the most vocal and influential figures in health IT — writes a blog post this morning entitled “The Genius of AND”. Halamka reasonably summarizes the essence of the debate about standards and interoperability as being between “the healthcare informatics crowd” (cats) and the “Internet crowd” (dogs): He notes that the debate shouldn’t be about one or the other POV prevailing (“either/or”), but about integrating both points of view (“and”): ..we need to embrace both approaches – the right tool for the right job depending on what you want to achieve. For provider to provider communi... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2981183 Tue, 10 Nov 2009 17:39:16 +0100 2981183 http://www.medworm.com/index.php?rid=2943908&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2Fsny5F8u6dgs%2F Earlier this week CMS issued a typically cryptic Announcement indicating that they were shelving the Medicare Medical Home Demonstration (MMHD) and instead would focus on the recently announced Multi-Payer Advanced Primary Care Initiative (MAPCI). My blog post from Tuesday provides details and asks the question “What does all this mean?” Today’s blog post will tackle: Medicare’s biggest change in 40 years? The rise of MAPCI The fall of MMHD Implications/discussion Medicare’s Biggest Change in 40 Years? (more…) Tags: business model, care coordination, care management, conference, EHR, health plan, health reform, HIE, hospital, meaningful use, medical home, Medicare, Medicare Medical Home Demonstration, multipayer, network effect, primary care, readmission (Source: e-C... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2943908 Fri, 30 Oct 2009 00:35:37 +0100 2943908 http://www.medworm.com/index.php?rid=2904964&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F0_vhnMGH51k%2F BrightTALK is sponsoring a complimentary Electronic Health Record Summit this Tuesday, October 20, 2009. David C. Kibbe MD, MBA and I will be presenting “Introduction to Clinical Groupware and the Clinical Groupware Collaborative” Clinical groupware is a new and evolving model for the development and deployment of health information technology (HIT) platforms and applications having the following characteristics: Use of the Internet and the web for EHR technology. Explicit design for information sharing and online communication among providers and patients/consumers. A modular or component architecture upon which applications can be aggregated to meet specific clinical and workflow tasks. Patient/consumer engagement tools that facilitate ongoing health management and care coo... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2904964 Mon, 19 Oct 2009 00:03:18 +0100 2904964 http://www.medworm.com/index.php?rid=2865730&cid=t_116117_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F10%2F06%2Fphone-psychotherapy-helps-depression%2F Imagine a treatment that was so powerful and useful, it could even be delivered by the telephone. That treatment? Good old psychotherapy. We’ve previously discussed the benefits of using web-based self-help programs for depression based upon proven cognitive-behavioral therapy techniques. And we’ve noted previous studies that showed the benefits of telephone therapy for depression. But this new 600-person study is the largest to date of psychotherapy by phone — and one of the largest studies of psychotherapy ever. Subjects in the study were randomly assigned to one of three groups — treatment as usual, telephone care management, and telephone care management + psychotherapy. People in the treatment as usual group continued to receive any treatments normally available... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2865730 Tue, 06 Oct 2009 14:53:49 +0100 2865730 http://www.medworm.com/index.php?rid=2862604&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FNHWsxnws2mA%2F Here’s the big idea: accountable care organizations (ACOs) are about creating accountability. ACOs of various types are being proposed in national health reform legislation. For all you ever wanted to know about ACOs, read How to Create Accountable Care Organizations from the Center for Healthcare Quality and Payment Reform.   I spent an hour and a half poring over the details of this excellent report written by Harold Miller. My mistaken impression has been to focus on the organizational form of ACOs, rather than their objectives.  Organizational form is relevant in understanding ACOs, but primarily as a means toward creating accountability, not the end in itself.  Thus, expect to see many varying types of ACOs emerging based on local needs and characteristics. I initially a... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2862604 Mon, 05 Oct 2009 18:26:29 +0100 2862604 http://www.medworm.com/index.php?rid=2804028&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FX87R6YOmFcE%2F by Steve Adams, CEO, RMD Networks and Acting President, Clinical Groupware Collaborative   I’m writing to extend a warm personal invitation to learn more about the Clinical Groupware Collaborative (CGC).  To-date, purely through word-of-mouth over 40 companies have expressed interest in the CGC, and we expect that you’ll be hearing a lot more about us over the coming months. Our meeting will take place next Tuesday, September 22, 6 PM in conjunction with The Forum 09, the annual meeting of DMAA: The Care Continuum Alliance.  More details are provided at the bottom of this post. I’ll address a few questions that might be on your mind. Q. What is Clinical Groupware?  (more…) Tags: care management, clinical groupware, conference, DMAA, EHR, EMR, platform (Source: e-CareMa... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2804028 Wed, 16 Sep 2009 22:46:36 +0100 2804028 http://www.medworm.com/index.php?rid=2790321&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2Fqn6AlRE1xgg%2F By Vince Kuraitis and Steven Waldren MD, MS.  Dr Waldren is Director of the Center for Health Information Technology at the American Academy of Family Practice (AAFP). Two issues have rightfully surfaced front and center in the public’s understanding of HITECH Act implementation: ” definition of “Meaningful Use” of EHRs, and ” definition of “certification” process for EHRs …and we applaud the progress of the workgroups and the HIT Policy Committee in addressing these issues constructively. However…a THIRD issue lurks – “Data harmonization at the expense of data liquidity“, or put another way – “misplaced pursuit of one (and only one) language at the expense of practical communication.” On August 20, the HI... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2790321 Sat, 12 Sep 2009 18:18:03 +0100 2790321 http://www.medworm.com/index.php?rid=2761973&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FcUFc7zNwVKs%2F In Part I of my guest post on The Collaborative Forum blog, I wrote that the Medicare Medical Home Demo is in BIG Trouble. Here’s a recap: Political reality dictates that the MMHD must save costs. As currently structured, the MMHD cannot achieve cost savings In any given year, only a small percentage of patients account for the vast majority of costs Lessons from previous Medicare disease/care management demonstrations has shown that effective care coordination interventions must be targeted at this population Medicare has structured the MMHD so that any patient with one or more chronic condition is eligible; this includes 86% of all Medicare patients. Physicians will be paid risk-adjusted care coordination fees for this entire population — the 86% of patients with one or more chron... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2761973 Thu, 03 Sep 2009 17:39:20 +0100 2761973 http://www.medworm.com/index.php?rid=2737833&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FbH0pN3YZ4vc%2F This post is a foundational overview of characteristics of network industries.  Much of the terminology will deserve deeper discussion, but we have to start somewhere. In his book The Economics of Network Industries, Professor Oz Shy lists four characteristics of network industries. The main characteristics of these markets which distinguish them from the market for grain, dairy products, apples, and treasury bonds are: Complementarity, compatibility and standards Consumption externalities [network effects] Switching costs and lock-in Significant economies of scale in production In this essay, I’ll quote from Dr. Shy in explaining each of these characteristics.  I’ll also offer a few thoughts as to how these characteristics apply to healthcare. More specifically, I’ll dis... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2737833 Wed, 26 Aug 2009 23:01:13 +0100 2737833 http://www.medworm.com/index.php?rid=2719776&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2Fjp_2OUrAwoQ%2F   “We need to make care linkages a core competency of American health care.”  George Halvorson, Chairman and CEO, Kaiser Foundation Health Plan, Kaiser Foundation Hospital   There’s a double meaning to the title of this new series: Healthcare Crosses the Chasm to the Network Economy At the level of technology, it’s a reference to Geoffrey Moore’s bestselling business/technology book — “Crossing the Chasm”. The Chasm here is the huge gap between early adopters of technology and mainstream users. The book describes the process of bringing specific technologies into mainstream usage. At the level of clinical care, its a reference to the landmark 2001 report by the Institute of Medicine — “Crossing the Chasm”.  Here, the Chasm is a reference to the quality/safety... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2719776 Fri, 21 Aug 2009 01:09:37 +0100 2719776 http://www.medworm.com/index.php?rid=2699695&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2Fno1LFrhNDCM%2F by Vince Kuraitis, Steve Adams, and David C. Kibbe MD, MBA Over the past several years, many diverse initiatives have arisen offering partial solutions to systemic problems in the U.S. health care non-system.  We see Meaningful Use Criteria recommended by the HIT Policy Committee as a unifying force for these previously disparate initiatives. These initiatives have included: Patient Centered Medical Homes (PCMHs) Regional Health Information Organizations (RHIOs)/Health Information Exchanges (HIEs) Payer Disease/Care Management Programs Personal Health Record Platforms — Google Health, Microsoft HealthVault, Dossia, health banks, more to come State/Regional Chronic Care Programs (e.g., Colorado, Pennsylvania, Improving Performance in Practice) Accountable Care Organizations — the n... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2699695 Thu, 13 Aug 2009 20:41:48 +0100 2699695 http://www.medworm.com/index.php?rid=2664008&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F9FbayybjEJQ%2F                 Economists call it “The Penguin Problem”  — No one moves unless everyone moves, so no one moves.  The role of user expectations is crucial in getting penguins to move off of ice floes and in the successful adoption of new network technologies.  I’ll cover two main points in today’s essay: How “The Penguin Problem” Helps Explain Low EHR (electronic health record) Adoption To-Date How Recent Federal Actions Are Setting Higher Expectations for EHR Adoption The Penguin Problem and Low EHR Adoption To-Date While not the only factor, the role of user expectations is a crucial element in explaining the adoption of new network technologies. Harvard Business School Professor Tom Eisenmann explains: (more…) Tags: business model, care management... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2664008 Sun, 02 Aug 2009 23:37:24 +0100 2664008 http://www.medworm.com/index.php?rid=2639627&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FL62uVsfWwlE%2F A subtle but profound shift is occurring in the world of RHIOs/HIEs (Regional Health Information Organizations/Health Information Exchanges). …and the title of the eHealth Initiative’s Sixth Annual Survey of Health Information Exchange says it all: Migrating Toward Meaningful Use What’s happening here? (more…) Article Series - The Dog Manifesto: A Disruptive Innovator's Guide to Health ITWill HITECH Lead to Innovation? The Continuing Cat/Dog DialogueDogged Optimism: Five Innovative Aspects of HITECHFeline Foot-Dragging: Three Non-Innovative Aspects of HITECHWait and See: What’s Unclear or To-Be-Determined (TBD) About HITECH.Can Cats Think Outside the Box? Here’s a Role Model.Stand for Quality Group: “Link HIT Investment to Quality Improvement”EHR 2.0: ... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2639627 Sat, 25 Jul 2009 18:15:48 +0100 2639627 http://www.medworm.com/index.php?rid=2598314&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F_Qrq2SSm6Pk%2F I know — you’re thinking that using “geek” and “wisdom” in the same sentence is an oxymoron. Bear with me — I’m trying to make a really important point in today’s posting. Interoperability has multiple dimensions — and I’d bet that most of us have never thought of interoperabilty as involving “process” — people working together and collaborating; I know I hadn’t. The Interoperability Work Group of HL7’s Electronic Health Record (EHR) Technical Committee was formed in April 2005 to attempt to define the concept of interoperability. The group examined 100+ definitions of interoperabilty. Their work is summarized in their report: Coming to Terms: Scoping Interoperability for Health Care, February 2007. 3 Types of Interoperability: Technical, Semantic, Process ... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2598314 Mon, 13 Jul 2009 23:07:35 +0100 2598314 http://www.medworm.com/index.php?rid=2398875&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FWnaePHnPrt4%2F by Tom Doerr, MD and Randy Bak, MD, JD What if the health care payer were re-imagined as a service to the primary care doctor - supplying the tools, information and funding primary care physicians needed to meet the call to reform health delivery? The structure of physician payment is considered one of the most problematic aspects of our health care system.  Driven by volume instead of coordinated, proactive care and favoring procedures over cognitive work, the payment system has driven primary care into decline and stifled improvements in quality and efficiency.  Indeed, primary care physicians are overstressed and demoralized by demands, coming from every direction, that drive them only to see more patients, as quickly as possible.   In this state, primary care cannot attract new phy... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2398875 Thu, 07 May 2009 19:06:03 +0100 2398875 http://www.medworm.com/index.php?rid=2580279&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FWnaePHnPrt4%2F by Tom Doerr, MD and Randy Bak, MD, JD What if the health care payer were re-imagined as a service to the primary care doctor – supplying the tools, information and funding primary care physicians needed to meet the call to reform health delivery? The structure of physician payment is considered one of the most problematic aspects of our health care system.  Driven by volume instead of coordinated, proactive care and favoring procedures over cognitive work, the payment system has driven primary care into decline and stifled improvements in quality and efficiency.  Indeed, primary care physicians are overstressed and demoralized by demands, coming from every direction, that drive them only to see more patients, as quickly as possible.   In this state, primary care cannot attract n... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2580279 Thu, 07 May 2009 16:19:14 +0100 2580279 http://www.medworm.com/index.php?rid=2365195&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F7gtTQvi2XCg%2F What’s stunning about this deal is who its NOT with.  The AMA chose NOT to partner with any of the incumbent electronic medical record (EMR) companies, e.g., Allscripts, GE, Epic, NextGen, or many others. For those of you who have not seen earlier posts in this series, please understand that the reference to “goes to the dogs” is a great compliment. In a joint press release, the American Medical Association and Covisint unveiled an agreement yesterday: Compuware Corporation (NASDAQ: CPWR) announced today that its Covisint subsidiary signed an agreement with the American Medical Association (AMA) to deploy an innovative health information exchange solution delivering value to its 240,000 member physicians and the physician population at large…. Covisint will enable AMA physicia... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2365195 Thu, 23 Apr 2009 21:42:57 +0100 2365195 http://www.medworm.com/index.php?rid=2580281&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F7gtTQvi2XCg%2F What’s stunning about this deal is who its NOT with.  The AMA chose NOT to partner with any of the incumbent electronic medical record (EMR) companies, e.g., Allscripts, GE, Epic, NextGen, or many others. For those of you who have not seen earlier posts in this series, please understand that the reference to “goes to the dogs” is a great compliment. In a joint press release, the American Medical Association and Covisint unveiled an agreement yesterday: Compuware Corporation (NASDAQ: CPWR) announced today that its Covisint subsidiary signed an agreement with the American Medical Association (AMA) to deploy an innovative health information exchange solution delivering value to its 240,000 member physicians and the physician population at large…. Covisint will enable AMA physicia... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2580281 Thu, 23 Apr 2009 21:21:43 +0100 2580281 http://www.medworm.com/index.php?rid=2580290&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FkBeDK-VyyFs%2F Download a copy here .  Excerpts from the Executive Summary: Effective Interventions Three types of interventions have been demonstrated to be effective in reducing hospitalizations for Medicare beneficiaries with multiple chronic conditions who in general are not cognitively impaired: Transitional care interventions in which patients are first engaged while in the hospital and then followed intensively over the 4 – 6 weeks after discharge Self-management education interventions that engage patients for 4 -7 weeks in community-based programs designed to “activate” them in the management of their chronic conditions Coordinated care interventions that identify patients with chronic conditions at high risk of hospitalization in the coming year, conduct initial assessments and care... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2580290 Tue, 24 Mar 2009 13:00:58 +0100 2580290 http://www.medworm.com/index.php?rid=2288961&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FkBeDK-VyyFs%2F Download a copy here .  Excerpts from the Executive Summary: Effective Interventions Three types of interventions have been demonstrated to be effective in reducing hospitalizations for Medicare beneficiaries with multiple chronic conditions who in general are not cognitively impaired: Transitional care interventions in which patients are first engaged while in the hospital and then followed intensively over the 4 - 6 weeks after discharge Self-management education interventions that engage patients for 4 -7 weeks in community-based programs designed to “activate” them in the management of their chronic conditions Coordinated care interventions that identify patients with chronic conditions at high risk of hospitalization in the coming year, conduct initial assessments and care plann... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2288961 Tue, 24 Mar 2009 13:00:58 +0100 2288961 http://www.medworm.com/index.php?rid=2211210&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F8CNlOodxzOM%2F We have learned that coordinating care of patients — particular care of Medicare patients — is complex and time consuming for physicians. A breakthrough study quantifies just how complex and challenging care coordination really is.  The study is reported in the February 17 issue of Annals of Internal Medicine and is entitled Primary Care Physicians’ Links to Other Physicians Through Medicare Patients: The Scope of Care Coordination : We found that in a single year for just fee-for-service Medicare patients, the typical primary care physician needs to coordinate care with 229 other physicians working in 117 different practices…. The number of peers was greater for physicians treating patients with higher chronic illness burden, who may benefit the most from coordination. My m... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2211210 Thu, 19 Feb 2009 00:12:52 +0100 2211210 http://www.medworm.com/index.php?rid=2580298&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F8CNlOodxzOM%2F We have learned that coordinating care of patients — particular care of Medicare patients — is complex and time consuming for physicians. A breakthrough study quantifies just how complex and challenging care coordination really is.  The study is reported in the February 17 issue of Annals of Internal Medicine and is entitled Primary Care Physicians’ Links to Other Physicians Through Medicare Patients: The Scope of Care Coordination : We found that in a single year for just fee-for-service Medicare patients, the typical primary care physician needs to coordinate care with 229 other physicians working in 117 different practices…. The number of peers was greater for physicians treating patients with higher chronic illness burden, who may benefit the most from coordination. My m... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=2580298 Thu, 19 Feb 2009 00:06:43 +0100 2580298 http://www.medworm.com/index.php?rid=1815619&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F400405909%2F “Why can’t we all just get along?”  Rodney King The Megatrend: Collaborative Care Management Networks (CCMNs) It’s been quite a while since I spotted a new Disease Management Megatrend, but here’s one that’s long overdue: Collaborative Care Management Networks will be necessary to achieve optimal care coordination. The trend in a nutshell:  payers (and others) are recognizing that optimal care coordination will require collaboration among health care stakeholders. This CANNOT be achieved with yesterday’s proprietary IT and business models. CCMNs will share many — perhaps all — of the following elements: (...)Read the rest of Megatrend Spotting: Collaborative Care Management Networks (528 words) © | Permalink | No comment | Want more on these topic... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=1815619 Tue, 23 Sep 2008 03:35:31 +0100 1815619 http://www.medworm.com/index.php?rid=1763962&cid=t_116117_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F382345746%2F I don’t pretend to be an expert on patient compliance, and have found most of the studies I’ve read on how often and how well patients follow their doctor’s orders to be confusing and inconclusive. I’m sure others do, too. It’s a tough subject. In a world where many people — including me — believe the system tends to over-treat people to begin with, some non-compliance is probably not a bad thing. In addition, defining non-compliance — versus poor communication, wrong clinician/wrong situation or four or five other issues that might impede care delivery and/or recovery — is no easy task. But as I recover from my idiotic vacation accident, in which I tore ligaments in my right foot, bruised bones in my ankle and damaged a boatload of cartilage, I&#8217... HPHC blogs http://www.medworm.com/rss/comments.php?id=1763962 Wed, 03 Sep 2008 13:42:32 +0100 1763962 http://www.medworm.com/index.php?rid=1742781&cid=t_116117_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F378143772%2F There was a story in the Wall Street Journal last week-end about how “a growing number of health plans offer specially trained case managers to help patients during a major illness…”  The story goes on to say that these people “take our very fragmented health-care system and put some glue on it to ensure that a patient with a complex condition does not fall through the cracks.” Umm…Harvard Pilgrim has been providing these kinds of services to our members for about THIRTY YEARS — and I know that many other carriers have been doing it for more than ten. In fact, if I wanted to, I could post a blog on this site almost every day about a letter or an email or a phone call I’ve gotten from one of our members about how one of our case managers has lit... HPHC blogs http://www.medworm.com/rss/comments.php?id=1742781 Fri, 29 Aug 2008 14:52:41 +0100 1742781 http://www.medworm.com/index.php?rid=1739217&cid=t_116117_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F376201403%2F For the past year or so, I’ve been listening to and participating in a conversation in New England and nationally about the rising cost of health care. It’s a sticky wicket, to be sure, with no obvious, simple solutions. But I must say, I’ve been surprised that at least one pretty good idea hasn’t generated more traction. Intensive Care Unit checklists — which I’ve written about before — have already demonstrated that they can save lives, money and time, reduce variation, and improve quality, but they remain the exception instead of the rule in ICU care. In June, the World Health Organization shared preliminary data on a demonstration it’s running using a “Safe Surgery Checklist” that showed reductions in deaths, complications and ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1739217 Wed, 27 Aug 2008 13:44:02 +0100 1739217 http://www.medworm.com/index.php?rid=1596471&cid=t_116117_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F329907798%2F For The Record — I am a member of the Board of Trustees of Beth Israel Deaconess Medical Center (BIDMC). The Board of Trustees is NOT the same as the Board of Directors. The Board of Directors is the governing body that has fundamental oversight responsibility for the hospital. The Trustees serve as an ancillary board to the main board, and serve as members on various sub-committees of the Board. That makes me, I suppose, an “interested party.” Nonetheless, I thought it worthwhile to comment on the big story in our health care marketplace these days — which is the wrong side surgery at BIDMC. The Boston Globe pretty much covered the incident, and BIDMC CEO Paul Levy has blogged on it several times in the past couple of days, so I won’t spend a lot of time re-hashing t... HPHC blogs http://www.medworm.com/rss/comments.php?id=1596471 Tue, 08 Jul 2008 15:26:01 +0100 1596471 http://www.medworm.com/index.php?rid=1451936&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F293236048%2F This third and final post in the series addresses questions about the future of the Patient Centered Medical Home (PCHM): What’s problematic about using the RUC methodology with the PCMH? What’s the optimal level for a PCMH care management fee? Should primary care leaders pull the RUC out? How?  What’s Problematic About Using the RUC Methodology with the PCMH? There are at least two reasons for not having the RUC methodology seen anywhere in the same county country as the PCMH. First, the RUC methodology doesn’t account for technology and services needed for optimal care management. Second, the RUC methodology is conceptually flawed. 1) The RUC methodology doesn’t account for technology and services needed for optimal care management. Here’s what the RUC recommended meth... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=1451936 Mon, 19 May 2008 04:49:20 +0100 1451936 http://www.medworm.com/index.php?rid=1446363&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F291286227%2F Today’s post (#2 in a series) tackles several questions: What is the American Medical Association/Specialty Society RVS Update Committee (RUC)? What is the RUC’s role in the Medicare Medical Home Demonstration project? How are people reacting to RUC recommendations for PCMH reimbursement levels? What is the American Medical Association/Specialty Society RVS Update Committee (RUC)? The AMA formed the RUC to act as an expert panel in making recommendations to CMS on the relative values of Current Procedural Terminology (CPT) codes using the Resource Based Relative Value Scale (RBRVS). The RUC is composed of 29 members, only 5 of whom are primary care physicians. The RUC  has come under severe criticism as being an enemy of primary care. For example… (more…) Shar... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=1446363 Fri, 16 May 2008 00:14:28 +0100 1446363 http://www.medworm.com/index.php?rid=1439973&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F289763443%2F This report has stirred cries of confusion and outrage. I’ll elaborate on these cries in the second posting of this series, but if you can’t wait, read here, here, here, here, here, here, here, and here. Welcome to a series of three blog postings discussing the PCMH, care management fees, and the RUC report.  I can’t claim to smooth the uproar, but I hope to frame the issues so that they can be understood and discussed constructively. The series will address numerous questions. This first post: What is the PCMH care management fee? Why is the PCMH care management fee important? Why are people confused? The second post: What is the American Medical Association/Specialty Society RVS Update Committee (RUC) ? What is the RUC’s role in the Medicare Medical Home Demonstration... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=1439973 Tue, 13 May 2008 23:00:48 +0100 1439973 http://www.medworm.com/index.php?rid=1419690&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F283643493%2F  The Healthcare Unbound Conference is a highlight of my year and I always look forward to it! What’s so special about this conference? First, the caliber of the people attending.  It’s a stimulating mix of high-level clinical, technical and business types.  The energy is flowing and many people have told me how much they like to go just for the networking. Second, the caliber of the conference organizer.  I’ve worked with many conference planners, and Satish Kavirajan is not your ordinary conference organizer. Satish really knows his stuff and he’s a pleasure to work with.  I’m impressed how from a year in advance of the first Healthcare Unbound in 2004 he delved into the substance of the topics.  He read every link and every report I sent him, he talk... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=1419690 Mon, 05 May 2008 02:47:45 +0100 1419690 http://www.medworm.com/index.php?rid=1300456&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F250829885%2F Aetna recently made another big announcement relating to their PHR.  While the concept of what they’re doing is very appealing, it strikes me that health plans in general face an uphill battle in getting consumers to adopt and use personal health records (PHRs). I’ll describe 4 factors behind my thinking: Lack of Trust Lack of Access to Clinical Data Lack of Permission Lack of Convenience in Consumer Workflow (more…) Share This Related posts (and # of comments) A First Comparison of Google Health and MS HealthVault (5) Four Misconceptions About HealthVault and the Emerging Personal Health Information Ecosystem (PHI-Ecosystem) (7) Connecting the Dots…Google Health Promises to Create AND Dominate Next Generation PHRs (44) Birth Announcement: th... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=1300456 Thu, 13 Mar 2008 16:53:02 +0100 1300456 http://www.medworm.com/index.php?rid=1298804&cid=t_116117_113_f&fid=35744&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F250451981%2F About three weeks ago Cain Brothers Investment Bankers released a report that foreshadowed the collapse of HMO stock prices that has occurred over the past few days.  The report was entitled: FAREWELL TO A TIME OF PLENTY? Health Plan Strategies for Growth in a More Challenging Market.  Here are a few highlights from the report: (more…) Share This Related posts (and # of comments) Resources (1) e-Newsletter archives (0) Disease Management and the Medicare Health Support (MHS) Project: “Houston, we have a problem.” (4) The Medical Home: Advancing, But Still Many Questions (1) Medicare Health Support: “Do not go gentle into that good night” (0) (Source: e-CareManagement) e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=1298804 Wed, 12 Mar 2008 23:03:04 +0100 1298804 http://www.medworm.com/index.php?rid=1298758&cid=t_116117_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F250352409%2F Well, sometimes the federal government can surprise us all. Many of you probably know by now that the Office of Human Research Protections (OHRP) — which is part of the U.S. Department of Health and Human Services — has reversed its position prohibiting the use of health care checklists unless every patient signed a waiver permitting their use. Since the primary use of these lists to date had been in ensuring safe and effective use of C-lines in ICUs, that seemed like kind of a high standard. And more importantly, they appear to improve safety, save lives and reduce costs — a triple play that’s often hard to find in today’s health care world. I wrote about this hoo-hah in two previous blogs (part I and part II). I’m happy to report that the feds not only permit the ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1298758 Wed, 12 Mar 2008 21:02:56 +0100 1298758 http://www.medworm.com/index.php?rid=1261578&cid=t_116117_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2008%2F02%2F27%2Fhealth-services-management-research-volume-21-number-1-february-2008%2F The new issue of the Health Services Management Research is now available online. If you want to access the full text of the journal you’ll need your Athens password from the Liverpoo PCT. (If you don’t have an Athens password and are eligible you can get one here). Physician perceptions of managed care strategies, and impact of these on their clinical performance, in the South African private health sector pp. 1-13(13) Author: Pillay, Rubin Trend and variation of prescription drug cost in the veterans health-care system pp. 14-22(9) Authors: Gao, Jian; Campbell, James The influence of teamwork culture on physician and nurse resignation rates in hospitals pp. 23-31(9) Authors: Mo... Fade Library blogs http://www.medworm.com/rss/comments.php?id=1261578 Wed, 27 Feb 2008 14:14:27 +0100 1261578 http://www.medworm.com/index.php?rid=1134005&cid=t_116117_150_f&fid=35777&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FPharmalot%2F%7E3%2F212770529%2F The trade groups representings both independents and chains object to a proposed class settlement with First DataBank, which publishes prescription drug prices, according to the Pharmaceutical Law & Industry Report*. The publisher was accused of illegally conspiring to raise markups between what pharmacies pay wholesalers and reimbursement paid to pharmacies by health plans and insurers. The Pharmaceutical Care Management Association and the National Community Pharmacists Association, which aren’t parties to the case, say the proposed deal will drastically alter the marketplace. “It took a very, very wrong-headed proposal for NCPA and PCMA to unite in opposition,” John Rector, the NCPA’s general counsel and senior vice president for government affairs, told the... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=1134005 Mon, 07 Jan 2008 20:07:49 +0100 1134005 http://www.medworm.com/index.php?rid=1133893&cid=t_116117_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F212743372%2F Last month, I posted a blog on work being done by researchers at Johns Hopkins University that had demonstrated tremendous success using checklists in ICUs to reduce C-line infection rates. I referenced an article by Brigham and Women’s Surgeon Atul Gawande in The New Yorker as the source of my information. Imagine my disappointment when I read an op-ed in the New York Times two weeks ago by Dr. Gawande that indicated that the federal government has shut down this research project. His op-ed pretty much speaks for itself. This decision by the federal government, and the lack of screaming outrage from the medical community that has followed it — pretty much says it all. To reiterate the Hopkins researcher’s previous comments — ‘The fundamental problem with the quality ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1133893 Mon, 07 Jan 2008 19:01:44 +0100 1133893 http://www.medworm.com/index.php?rid=1106245&cid=t_116117_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F202986210%2F I’ve written before about the negative impact Medicare payment policy — which favors specialization and procedure-driven health care — has had over time on primary care. And since Medicare is the driving force behind all provider payment policy in this country, what Medicare does really matters. Someone sent me a blog the other day on this topic that makes for fascinating reading. It’s written by Brian Klepper. I don’t want to spill the beans on Klepper’s post — but suffice it to say that he does a better job of explaining why Medicare payment policy has been so detrimental to primary care. He also makes a pretty compelling case that if CMS and Medicare just keep doing what they do now, primary care — as a profession — will simply go away. (Source: ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1106245 Wed, 19 Dec 2007 21:33:40 +0100 1106245 http://www.medworm.com/index.php?rid=982570&cid=t_116117_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F175598684%2F This morning, U.S. News & World Report and the National Committee for Quality Assurance released their third annual “America’s best health plans” list*. Harvard Pilgrim, for the third year in a row, finished first in the country. Three surveys - three #1 finishes. Pretty cool. Every health plan takes a lot of heat about what’s wrong with health care. Some of the time, we deserve it. I hope we acknowledge our mistakes, try to correct them, and try not to repeat them. And I know we spend a lot of time on getting the small stuff right - because it’s often the small stuff that makes people nuts. But sometimes, we get the big things right, too.Take “Frank.” He was an older, but apparently healthy Harvard Pilgrim member who was admitted to Lowell Gen... HPHC blogs http://www.medworm.com/rss/comments.php?id=982570 Fri, 26 Oct 2007 23:16:51 +0100 982570 http://www.medworm.com/index.php?rid=903387&cid=t_116117_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F161103023%2F “Patients, providers and payers would benefit from getting better information on what works in health care and how treatments compare to one another. Little is known about how these procedures stack up, so we end up paying for them all, even when they may do nothing to improve health. Researchers at Dartmouth have found that more care is not better care, and that inefficient care may do more harm than good. Health care providers and patients are being bombarded with information. In the past decade, there has been an 80 percent growth in the number of drugs prescribed, 100 percent growth in new device patents, 300 percent growth in teaching hospital procedures, and 1,500 percent growth in diseases with gene tests.” This is a direct quote from Hillary Clinton’s Presidential... HPHC blogs http://www.medworm.com/rss/comments.php?id=903387 Tue, 25 Sep 2007 14:53:28 +0100 903387 http://www.medworm.com/index.php?rid=801408&cid=t_116117_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F144528168%2F I have been, and always will be, a huge fan of Judy Norsigian - the founder and ED of Our Bodies Ourselves.  She recently co-authored an op-ed in the Boston Globe called “The Folly of 1 Percent Policy” that reminded me about why I find her so interesting.  She and her co-author argue that by focusing on the possibility that one percent of the time something might go wrong, we apply overly invasive - and expensive - health care solutions to people who don’t need them.  In this case, they were writing about the rising C-Section rate in the U.S., which they argue is being driven not by clinical necessity, but by a care delivery system that’s using a very invasive and expensive procedure to eliminate the one percent chance that something might go wrong if a bab... HPHC blogs http://www.medworm.com/rss/comments.php?id=801408 Wed, 15 Aug 2007 20:38:00 +0100 801408 http://www.medworm.com/index.php?rid=775410&cid=t_116117_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F140027356%2F About two weeks ago, I spent most of the day shadowing Family Practice Physician Steve Golden at his main office in Cohasset, MA. This was a follow-up to the discussion some of us had at a Harvard Pilgrim Physicians Association meeting about six weeks ago in which several folks suggested I needed to get out more. It was a very interesting day, and from it, I’d offer the following thoughts.  First of all, Steve loves his patients, and they love him.  No surprise there.  But what was quite interesting to me was the rapport they have with one another.  He speaks, they listen, they speak, he listens.  Sounds simple enough, right — but when you’re talking to the mom of a brand new baby, and she’s working with the child while you’re talking to her and she’s... HPHC blogs http://www.medworm.com/rss/comments.php?id=775410 Thu, 02 Aug 2007 18:03:13 +0100 775410 http://www.medworm.com/index.php?rid=713187&cid=t_116117_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F130200587%2F As part of our efforts to keep in touch with practicing physicians, Harvard Pilgrim formed a group about ten years ago called the Harvard Pilgrim Physicians Association (HPPA).  HPPA has a Board - made up about 12-15 practicing docs (to be on the Board, you have to be a practicing clinician - seeing patients, etc. - no administrative leaders) - and the Board meets with senior management about 5-6 times a year to discuss what’s up with the plan, and what’s up with health care generally.  In my eight years with Harvard Pilgrim, I’ve missed one or two HPPA Board meetings, and most members of senior management have similar attendance records.  The meetings are informative, constructive and helpful. We had one a week or so ago in which we asked the folks from Minute ... HPHC blogs http://www.medworm.com/rss/comments.php?id=713187 Tue, 03 Jul 2007 20:30:40 +0100 713187 http://www.medworm.com/index.php?rid=683189&cid=t_116117_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F125904337%2F Lots and lots of chit-chat throughout the health care and political communities these days about how electronic medical records (so-called “EMRs”) are going to reduce the cost of health care and improve quality.  By themselves, they mean nothing, and we should all get a grip on ourselves about this before it gets completely out of hand.  In simplest terms, an EMR is just a hammer.  It’s the quality of the carpenter that determines whether or not it makes a difference. Do I think health care is under-invested in clinical information technology?  Yes.  Do I think more EMRs could make a positive difference?  Yes.  Do I believe that EMRs, all by themselves, will assure cheaper, better health care?  No.  Absolutely not.  Even in theory, this is a big lift.  It&#821... HPHC blogs http://www.medworm.com/rss/comments.php?id=683189 Mon, 18 Jun 2007 21:26:41 +0100 683189 http://www.medworm.com/index.php?rid=579769&cid=t_116117_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F113225474%2F Believe it or not, some of the “fan mail” I get from Harvard Pilgrim members is pretty positive.  I certainly hear from people who think we’re not living up to our #1 in the country J.D. Power rankings, but I also hear from people who think we’ve made a positive difference.  I got a letter a couple of weeks ago from a 35 year-old woman who’s been battling cancer.  She wrote a long letter to me about Harvard Pilgrim and Donna C., her nurse care manager.  She starts the letter by saying it is a hard letter to write, and it’s way overdue – mostly because she doesn’t know where to begin.  “I have had such a difficult time finding the right words to express my gratitude and appreciation for Donna’s help through what I hope to be the worst time in ... HPHC blogs http://www.medworm.com/rss/comments.php?id=579769 Tue, 01 May 2007 01:06:08 +0100 579769