Roji Intel Blog

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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Theresa Hush 0
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Clinical Data RegistryFuture of Health CarePatient EmpowermentValue-Based Health Care
May 3, 2017

Health Care Providers Need Performance Data Audits to Market Trust

Health care systems once thought it was crude and undignified to use marketing to attract patients. No more. Now they use qualitative anecdotes to promote status at a time when data is king and consumers view comparative quality data on the Internet. Why not use quantitative evidence? Because their data doesn’t promote their cause—and even they don’t believe it. That avoidance behavior is a huge mistake. Health care organizations need to take steps now to turn performance data into valid indicators of both quality and cost. Otherwise they will risk losing control over their stories as providers of excellence. Consumers…
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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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Theresa Hush 0
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Alternative Payment Models (APM)Future of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Patient Empowerment
April 12, 2017

Why MACRA MIPS Cost Episodes Make Good Products for Health Care Consumers

Here’s a radical idea: What if providers re-envisioned MIPS as a patient marketing initiative, not a regulatory response? Yes, I’m serious. From the beginning of PQRS and Meaningful Use to MACRA, health systems considered these efforts to be merely “compliance” with regulations and not market initiatives. But this view is shortsighted. As outlined in MACRA rules, all of the MIPS initiatives parallel changes that consumers, employers and health plans have been demanding: lower costs, quality, improvement and value. Analyzing the MIPS component of Cost provides a good way to evaluate how providers could use Medicare data to help remap their…
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Theresa Hush 0
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MACRAMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry Reporting
April 5, 2017

Do Centers of Excellence Lose Under New MACRA MIPS Episodic Cost Measures?

Health systems’ Centers of Excellence that attract patients through clinical prowess may be heading for an upset. Under the MACRA MIPS program now entering its first year, physicians will be scored for cost performance in some of the same clinical areas that they have promoted to distinguish their care—and compared against their peers. Since Centers of Excellence are likely to be higher cost in comparison with other providers, associated episodic cost measures may possibly be used to penalize their providers. The impact won’t be felt immediately, however; in 2017 the MIPS Cost component is scored but not calculated in the…
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Theresa Hush 0
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Future of Health CareMACRAPatient EmpowermentPerformance ImprovementValue-Based Health Care
March 29, 2017

Why Bundled Payments Are a Win-Win for Specialists and Health Care Consumers

Bundled payments, a health care payment innovation that has been widely praised for controlling costs, recently got a bad rap. Secretary of Health and Human Services Tom Price  has delayed implementation of the final Medicare rule for several bundled payment programs that were set to start this year. He has criticized the bundled payments initiative for moving too fast and “experimenting with patients’ health.” Other industry experts disagree. They strongly favor the concept for both improving care and cutting costs. Bundled payments reimburse physicians and hospitals according to a set fee that includes all care associated with a procedure or…
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Theresa Hush 1
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Future of Health CareMedical Decision-MakingPatient Empowerment
March 22, 2017

Health Care Price Transparency for Consumers Starts with Provider Action

“Consumer choice” is at the heart of the national health care debate. This presumes access to accurate information about costs. While consumers woke up to health care costs a few years ago as their share began to rise, they lack the necessary facts to make intelligent decisions about the quantity and quality of what they are purchasing. As costs continue skyward, this crucial information, especially price transparency, is what consumers are now demanding. But health care pricing remains a mystery that can’t be solved by consumers, on their own. While “pricing” to consumers includes insurance premiums and payments to providers, only…
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Theresa Hush 0
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Future of Health CareMedical Decision-MakingPatient Empowerment
March 14, 2017

Fast Forward: Why Patients Should Own Their Medical Records

Up to now, who owns patient medical records hasn’t been a big issue. In fact, the “who owns” question has been largely confined to provider purchasing discussions regarding health care data analytics or other sharing of patient records, when providers want to assert their ownership of the data. Patients have had no voice in this conversation. Few people question the provider’s ownership of a patient’s record, which is supported by state statutes (only one state grants ownership to patients) as well as the rare case of litigation. All that changes going forward. Why? Because big revisions in health insurance will…
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Theresa Hush 0
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Future of Health CareMACRAMedical Decision-MakingPatient Empowerment
March 7, 2017

The Problematic “A” in the ACA Repeal and Replace

Last week, my sister sent me a copy of an email that she had sent to her inner circle. It began, “I am writing you today as a metastatic breast cancer patient . . . and also as your friend or relative who wants you to have the best resources and care if this disease ever affects your life or loved ones.” It was a plea for women to understand what would happen to breast cancer patients if the Affordable Care Act (ACA) was repealed, linked to an article. She was hoping to reach across a divide to raise consciousness about…
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