The Collaborative Forum

Are ACO’s and PCMH’s destined to fail? My respected colleague, Dr. Regina Herzlinger of the Harvard Business School thinks so. And one would find many reasons to suggest that she might be right. For one, she often is on these things!

But in her recent article in the April 2012 issue of Managed Care, Dr. Herzlinger points out several reasons that, with the right approach, could be avoided. Regarding ACO’s, she argues that ACO’s might be just another version of 1990′s style capitation. She refutes arguments that “things are different this time around”, but points out several reasons that they may not be.  OR MIGHT THEY ACTUALLY BE DIFFERENT THIS TIME? Read the rest of this entry →

A couple of weeks ago, I had the pleasure and honor of moderating a webinar, sponsored by the Care Continuum Alliance, which included Aaron McKethan, PhD, Beacon Community director, Department of Health and Human Services, Office of the National Coordinator for HIT; and Patrick Gordon, Colorado Beacon Consortium director. I wrote favorably about the Beacon Community Program when it was announced in May, because I view this program as a true Beacon for change in healthcare IT in this country.

As a quick refresher, the Beacon Community Cooperative Agreement Program provides funding to selected communities to build and strengthen their health information technology (health IT) infrastructure and exchange capabilities. The program supports these communities at the cutting edge of electronic health record (EHR) adoption and health information exchange to push them to a new level of sustainable health care quality and efficiency. The program also will show how other communities can use health IT to achieve similar goals.

 The purpose of this federally-funded pilot is to provide selected members of the healthcare community with the potential to define HIT’s influence on the future of healthcare delivery as we push toward accountable, evidence- based, community-focused care. During the webinar which discussed the program at length both from an administrative perspective as well as an “on the ground” perspective, I was particularly struck by one of Dr. McKethan’s slides: Read the rest of this entry →

Earlier this month, CMS announced that enrollment in Medicare Advantage plans will climb an estimated 5 percent next year. Conversely premiums are expected to drop on average.

It’s really no surprise to any of us in the healthcare industry that with reform come significant challenges to health plans. Health plans are being forced to dramatically change how they do business to remain profitable.

In my ongoing conversations with health plan leaders, they confirm that Medicare Advantage plans, Special Needs plans (SNPs) and Medicaid are faced with a very large challenge: How to maintain profitability in this new era of healthcare.

It seems to us that taking the correct approach to medical management is the key. Read the rest of this entry →