The Collaborative Forum » Healthcare reform

The Correct Approach to Care Management

Randy Williams — Sat, 13 Nov 2010 00:47:46 +0000

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: (more…)

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Post tags: Care management, eHealth, EHR

Tags: Care management, eHealth, EHR

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The Future of Medicare Advantage

Randy Williams — Fri, 29 Oct 2010 13:21:34 +0000

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. (more…)

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A Beacon of Light in Transforming Healthcare Delivery, Part II

Randy Williams — Wed, 20 Oct 2010 22:06:34 +0000

In May, I first wrote a post that discussed the Beacon Community Program, the new program from the Office of the National Coordinator for Health Information Technology (ONC) that’s designed to actually encourage innovation to transform and improve healthcare delivery in this country.

As part of the program, the ONC has allocated $235 million to develop cooperative agreements with communities to build and strengthen their health IT infrastructure and health information exchange capabilities. Looking for measurable improvements in health care quality, safety, efficiency and population health, the ONC is funding 17 of these awards to different communities across the country.

The challenge with past chronic care management pilots/demonstrations is that even with the best of intentions, the stringent design and methodology actually stifled innovation and destined many of these projects to fail. However, through the advanced use of IT the Beacon Communities are set to tackle specific goals of improving health care and population health status.

Next week, in partnership with the Care Continuum Alliance, Pharos Innovations is presenting a webinar on Wednesday, October 26, at 1 PM, EDT that carefully discusses and considers the Beacon Community Program. As the newly elected Chair of the Government Affairs Committee of the Care Continuum Alliance, I am honored to be participating in this webinar. (more…)

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The Responsibility Falls to Us All

Randy Williams — Thu, 16 Sep 2010 18:37:16 +0000

Just a few days ago, Donald Berwick, MD, in his first major speech since taking the helm of the Centers for Medicare & Medicaid Services (CMS) two months ago, urged insurers, employers, professional groups, and communities to come together to advance healthcare reform goals. We applaud Dr. Berwick’s sentiments and agree that none of us can “do this alone.” He warned that those who are interested in preserving the status quo would not be considered “constructive contributors to our nation’s future.”

He went on to say, “All of us have to change the way we do business…CMS can’t do this alone. Government can’t do this alone. We will either build a new healthcare system for our country together…or we’re not going to build it at all.”

In an article Dr. Berwick co-authored two years ago—long before being named to head CMS—he and his colleagues said the “The Triple Aim” of health care would be simultaneously “improving the experience of care, improving the health of populations, and reducing per capita costs of health care.”

That’s been our aim since founding Pharos Innovations: providing better care, with improved outcomes and reducing healthcare costs. We looked at an existing problem—high readmissions for heart failure—and developed a disruptive solution: Tel-Assurance. (more…)

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Moving the Needle in Transforming Our Healthcare System

Randy Williams — Tue, 10 Aug 2010 21:22:03 +0000

Healthcare reform is a hot topic. And rightly so. If done right, it has the potential to truly transform our healthcare delivery system. Recently, Secretary of Health and Human Services Kathleen Sebelius, posted a piece on the Commonwealth Fund website which discussed the need to approach healthcare delivery in a coordinated and patient-centered way that focuses on keeping patients healthier.

Secretary Sebelius cites the statistic that two-thirds of Medicare spending goes toward beneficiaries with five or more chronic diseases. Yet under the current payment system, doctors are paid for quantity of individual services instead of for managing and coordinating the care of their patients across time and location. She writes, “Dysfunctional incentives create fragmentation and fail to address the underlying drivers of disease.” And there are ways to create open communication between patients and care managers to address the drivers of disease and keep patients healthier, all at significant cost savings to Medicare. We’ve seen it work. (more…)

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Underserved Populations and Hospital Pay-for-Performance

Randy Williams — Wed, 21 Jul 2010 01:17:30 +0000

In the healthcare reform debate, hospital pay-for-performance has received plenty of discussion—how it could impact health outcomes, how it could promote efficiency, how it could change care coordination. In 2013, we’ll see the first step toward hospital pay-for-performance: hospitals will have some revenues withheld by Medicare and then returned if they meet specific clinical targets.

According to a new study published in the Journal of Public Library of Science, there are economic and human resource issues that may hinder some hospitals from meeting those pay-for-performance targets. And if that happens, the study’s authors are concerned that funding will be taken away from hospitals that provide care in poor and underserved communities.

The study’s lead author, Jan Blustein, MD, PhD, a New York University professor of health policy and medicine, analogizes hospital pay-for-performance with the “No Child Left Behind“ initiative for education that was started several years ago. In an interview earlier this month with HealthLeaders, Dr. Blustein said, “’One of the problems is we know very little about what helps and what works.’ In education, schools are told to do better—‘but there is no science there.’”

Dr. Blustein goes on in the interview, “’And the same thing is true in healthcare. We know a lot about what works to improve a patient’s health, but we really don’t know about what works to improve organizational performance.’”

And this is where I part ways with Dr. Blustein and her colleagues. (more…)

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Post tags: Care coordination, CMS, Healthcare reform, Medicaid, Medicare

Tags: Care coordination, CMS, Healthcare reform, Medicaid, Medicare

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Quality Can Be Improved and Measured Meaningfully

Randy Williams — Thu, 27 May 2010 03:16:42 +0000

I’ve been in the healthcare field for over 20 years now, and I still believe that the vast majority of those involved—whether on the payer or provider side—truly want what’s best for their patients or members. After all, healthcare quality and cost affects everyone.

In an editorial published earlier this week in the New York Times entitled “The Gaming Begins,” the editors point out the difficult struggle over how to calculate medical loss ratio under the new healthcare law and discussed concerns that insurers could “game” medical loss ratio by spending money on administrative costs, rather than on meaningful measures to improve quality.

Beginning in 2011, the new law requires health insurers to spend 80-85 percent of the premiums they collect on medical services or activities that improve the quality of care (the medical loss ratio). Insurers can then use the remainder of the premiums for things such as marketing, overhead, salaries, and profit. (more…)

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A Week to Remember

Randy Williams — Mon, 22 Mar 2010 19:28:06 +0000

In the busyness of life, sometimes we need to be reminded to stop and take stock in the moment. This past week is one such time in the history of our nation, and in the history of our company.

For most of us, the passage of healthcare reform has broad political implications but lately the political process seems to have taken control of the deeper and more relevant meaning of health reform. Whichever way the politics play out on this, one thing is certain: Healthcare in America is about to embark on widespread change. (more…)

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