Roji Intel Blog

Robert McNutt, M.D. 0
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Consumers & PatientsMedical Decision-MakingResearch
June 20, 2018

Deciphering Outcomes: Thirty Percent More of Nothing Is Still Nothing

Trying to pass a Bill through a legislature demands a hardy disposition. I have been involved in three attempts on different issues—one bill passed, one is still in limbo, and a third, the most salient for me, failed. In the latter case, I was the sole proposer of the Bill. My idea captured the imagination of a state representative who said she would sponsor it, but, first, she wanted to get some other views. Eleven lobbyist conversations later, my Bill was dead. Something about the legislator being worried that my Bill would be taking on the First Amendment, which allows…
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Theresa Hush 0
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ACOsAlternative Payment Models (APM)Consumers & PatientsMedical Decision-MakingValue-Based Health Care
June 6, 2018

Where’s the Value for Physicians in VBHC? Four Strategies for ACOs and Other APMs

When we talk about “value” in Value-Based Health Care (VBHC), we’re referring to the high-quality/lower-cost services that buyers want from health care providers. Who are the buyers? Health plans, Medicare and other governmental purchasers, plus employers (for the most part, the term is notably not interpreted to include patients). What do buyers want? “Truth in purchasing” for the best health care they can get. Indeed, the very term “Value-Based Health Care” implies that buyers are on a righteous quest for good care from irresponsible providers. Provider organizations, in turn, have sometimes adopted a similar attitude toward physicians. The generation of…
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Theresa Hush 0
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Consumers & PatientsFuture of Health CareMedical Decision-MakingValue-Based Health Care
May 30, 2018

Why Patients Should Ask Questions—and Physicians Should Listen

For health care providers and payers, Value-Based Health Care (VBHC) is a hot topic, with most all payers pressing a shift toward financial risk contracts and ACOs based on quality and cost performance. But if you ask consumers about the trend, chances are you’ll get a blank stare. Why? They’re not really part of the conversation. That’s a major problem, because consumer involvement is essential for VBHC success. When outcomes fall short, providers may complain about poor “patient compliance” with physician orders, and ACOs may bemoan lack of “patient engagement.” But they are minimizing patients’ preferences and concerns, or perhaps…
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Robert McNutt, M.D. 0
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Consumers & PatientsMedical Decision-MakingResearch
May 2, 2018

Patients Deserve Truth-based Medicine—But Most Aren’t Getting It

“I have breast cancer; I read that I should not drink wine because it may cause my cancer to return. I always wanted to be a sommelier, but that dream is dashed!” People, sensibly, read about their medical conditions, searching for things that might help or hurt them. However, patients are vulnerable. Their vulnerability may cause them to overestimate concerns, or, alternatively, hopes after learning of a medical advance. Physicians and medical reporters have a daunting, yet crucial obligation to give people information that is credible; strategically, we also need to thwart information that is useless. Giving poor, non-science information…
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Theresa Hush 0
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ACOsConsumers & PatientsPerformance ImprovementValue-Based Health Care
April 25, 2018

Four ACO Development Decisions That Will Impact Return on Investment 

“It’s not how you start, but how you finish” might be the way some ACOs must navigate a difficult path to success.  But for organizations planning a new ACO venture, that rocky path may be avoidable. The early days of ACO development are behind us, and ACO models to take on financial risk are now underway. Achieving a return on ACO investment has proven to be elusive for most providers. There is progress, but no victory yet in sight. So ACOs and industry watchers are searching for the keys that allow some ACOs to experience more success than others. Whether…
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Dave Halpert 0
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ACOsConsumers & PatientsFuture of Health CareValue-Based Health Care
April 18, 2018

Unify ACO Quality and Cost Initiatives to Boost Long-term Results

Let’s face it. There’s a pretty low bar to meeting Medicare’s ACO Quality requirements. Most ACOs have achieved acceptable quality performance for Medicare Shared Savings Plans (MSSPs).  They have not, however, achieved the savings needed to be successful. ACO supporters point to the “Triple Aim” of achieving higher quality, cost savings and good patient experience through an ACO. To fulfill that tripartite goal, we must look past the hype and execute quality-cost initiatives that go well beyond CMS requirements. Recognize the Gap Between Quality Reporting Requirements and Quality Care Demonstrating quality and reducing costs are not mutually exclusive. While there…
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Thomas Dent, M.D. 0
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ACOsAdvanced Alternative Payment ModelsConsumers & PatientsMedical Decision-MakingValue-Based Health Care
April 11, 2018

ACOs Must Create Learning Environment for Physicians to Be Partners in Change

The idea behind ACOs sounds simple enough: Build a network of primary care physicians, specialists, hospitals and other health care organizations that share risk and responsibility to provide coordinated care for each patient. Medicare or private insurers offer financial incentives to ensure that ACOs provide quality treatment while limiting unnecessary spending. Primary care physicians serve as key liaisons for each patient’s care. But ACO reality is much more complex and daunting. Shared savings have proven to be elusive. Quality benchmarks do not always accurately measure what’s medically relevant. Patient attribution to specialists, rather than primary care physicians, skews costs. Nonetheless,…
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Theresa Hush 0
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ACOsAlternative Payment Models (APM)Consumers & PatientsFuture of Health Care
March 28, 2018

Reluctant Providers Can Benefit from Fresh Approach to ACOs

It’s no secret that CMS wants to move providers away from MIPS and the Fee-for-Service payment system, toward an Alternative Payment Model (APM) like an Accountable Care Organization (ACO). This past January’s announcement of an additional 124 new ACOs implies that we have reached a tipping point, with ACOs becoming more prevalent than standard Fee-for-Service payments. But that optimism overstates the status of ACOs, both in terms of numbers and success. Despite a steady increase of new ACO approvals and ACO provider participation—including an attractive 5 percent bonus for providers who participate in an Advanced APM (AAPM) with financial risk—the…
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Theresa Hush 0
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Consumers & PatientsFuture of Health CareMedical Decision-MakingValue-Based Health Care
March 21, 2018

Five Ways Medicare’s Patient Data-Sharing Will Rock Health Care

Medicare came closer to fulfilling its promise of patient data-sharing last week with the announcement of bundled initiatives to connect health care consumers with their health care data. First, the Trump administration announced the launch of myHealthEData, a government-wide initiative designed to permit patients to control their healthcare data and determine how it can be used. Several federal agencies will be involved: CMS, Veterans Affairs, ONC and the National Institutes of Health, all under the direction of the White House Office for American Innovation. The effort is designed to break down barriers that limit or block patients’ access to their…
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Theresa Hush 0
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Consumers & PatientsFuture of Health CareMedical Decision-Making
February 28, 2018

Shared Decision-Making May Be the Next Consumer Health Movement

Consumers are rapidly mobilizing around all aspects of health care—affordability, access to the system and choices about their care. As changes in health insurance shift more and more cost onto consumers, patients want to be involved in decisions that will affect their finances as well as their health. Yet they face a dilemma: The only way to really affect their costs is to be involved in decisions about how much and what kind of health care they use. That means being involved in medical decisions. But when prices are hidden and consumers don’t know the facts about alternative—and uncertain—outcomes, they…
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