Former HHS Secretary The Honorable Tommy Thompson on the Affordable Care Act, Prevention and Wellness


On the Wednesday, September 2nd, 2015 at 12 Noon Pacific/3PM Eastern our special guest is the Honorable Tommy Thompson.

Tommy Thompson served as Governor of Wisconsin from 1987
to 2001, and is the longest serving Governor in State history. From 2001 to 2005 he served as the Secretary of Health and Human Service (HHS) under President George W. Bush. After his time in the Bush Administration he served as a partner with the law firm Akin-Gump and the Chairman of Deloitte’s Global healthcare practice. He has also served on the Board of 22 organizations.Tommy_Thompson_headshot

Governor Thompson has a wealth of knowledge regarding health care, Medicare, and prevention.

While Secretary, he launched initiatives to increase funding for the National Institutes of Health, reorganized the Centers for Medicare & Medicaid Services to encourage greater responsiveness and efficiency, and clear the backlog of waivers and state plan amendments. He approved 1,400 state plans and waiver requests and thereby provided health insurance to 1.8 million lower-income Americans. In the aftermath of 9-11 he also worked on strengthening the nation’s preparedness for a bio-terrorism attack, by stockpiling smallpox vaccines and investing heavily in state and local public health infrastructure.

With the continued drone is some camps of calls to ‘repeal and replace’ the Affordable Care Act, including the most recent ‘The Day One Patient Freedom Plan‘, proffered by current sitting Governor and Republican Presidential Candidate Scott Walker, Thompson a moderate Republican voice weighs in on the realities of health reform in the U.S.

Join us for what will be a fascinating journey into the heart and mind of this seasoned politician and healthcare policy giant. We’ll explore his thoughts on the Affordable Care Act, Prevention and Wellness and more.

 

 

Month End Wrap Up and Re-cap: ACOs, Population Health and Stuff

By Fred Goldstein, MS and Gregg Masters, MPH

This week join PopHealth Week hosts Gregg Masters, Doug Goldstein and Fred Goldstein for our month end review. This month’s cFarzad Mostashari MD Health Datapaloozaommentary will touch upon what we learned from our first two ACO guests, Farzad Mostashari of physician led ACO management company Aledade and Gerry Meklaus of Accenture (more on tap for September as the interest level in un-bundling the model types and sharing this experience to date has been quite substantial). phw_aledade

We also discuss a recent interview of Ronald Bayer where he had some pretty strong thoughts on Precision Medicine versus Population Health- see: ‘Precision Medicine a Threat to Population HealthIs it a binary choice and might there be a need for some definitional guidance?

And as is typical Doug (@efuturist) is gallavanting around the world and we’ll get an update from him on his travels, connections and insights from ‘Digital Health España‘ aka Digitalhealth.es. Innovation is NOT limited to the domestic conversation. Doug will fill us in on his discoveries to date.

Katherine Schneider MD | Population Health Colloquium | Delaware Valley ACO
For some insights from the largest ACO in the Delaware Valley, check out Doug’s interview with Katherine Schneider, MD,  President and CEO of Delaware Valley ACO.

And for a developing resource in the digital health space courtesy of Health Innovation Media, check out DigitalHealth.domains an emerging digital health library of sorts.

 

 

 

 

Meet Gerry Meklaus Managing Director, Accenture

by Gregg A. Masters, MPH

Before there was ‘accountable care’, the current full court press towards innovation – whether digital health app, platform or service delivery model, an emerging culture of transformation or the attendant pursuit of the triple aim, not to mention the most recent obsession with ‘retail as cure’ for that which ails healthcare, the best and the brightest minds (both clinical and administrative guided by thoughtful health policy wonks) convened in the grand theater of ‘managed care’ or managed competition.

The model and industry writ large (both public and private sectors), variably expressed as HMO, PPOs and derivative strains of contracting models stimulating the development of IPAs, PHOs, PPMC’s, MSOs and DPOs (direct purchasing organizations) had a run from the mid 70s until its abandonment as the official vehicle to restrain the rising cost and variable quality of healthcare in the late 90s. What followed was somewhat of a meandering decade of incremental tweaks here and there to an otherwise burning platform of fee-for-service healthcare delivery and financing.

In 2015 with healthcare costs now approaching 20% of the U.S. Gross Domestic Product and the viability of the entire U.S. Government at risk to projected costs increases and unfunded liabilities of the Medicare and Medicaid programs (estimated at $64 trillion), business as usual fee-for-service medicine is no longer an option and the many cathedrals of medicine built by ‘do more to earn more’ largesse are clearly at risk in the shifting sands of value based care.

While the ‘value’ v. volume agenda has been around for a while via risk based contracting including case rates, bundled payment and even capitation – both global and professional only versions – their penetration of mainstream medicine was relatively modest – until now. That is if you can believe the growing prevalence and penetration of risk bearing ACOs arrangements, a tapestry of bundled payment participation via Federal programs and a less transparent portfolio of privately negotiated ‘value based arrangements’.value based care meklaus

Into this theater steps one of the trophy consulting companies with both wide (global) and deep (extensive client penetration into the health plan, provider and IDN communities) aka Accenture Health (follow via @AccentureHealth).

Developing the narrative with a ‘value tutorial’ of sorts is Gerry Meklaus, the Managing Director of Accenture North America for Clinical & Health Management Services. We speak with Gerry Wednesday at 12 Noon Pacific/3PM Eastern at Pophealth Week where my colleague and co-founder Fred Goldstein, President of Accountable Health, LLC will engage Gerry in the value conversation and the many touch points between a value framework for ACOs and population health strategies of provider organizations.

Key terms to un-bundle and digest are the ‘Big Three’: 1) to ‘improve outcomes’ via emerging best practices, the reduction in variation and effective engagement of the patient in shared decision making, 2) the effective lowering of costs from a ‘total cost of care’ perspective (not just niche wins – if you will), and 3) the well known challenge to de-silo the many silos in the healthcare ecosystem driving fragmentation, redundancy and a less that patient centered experience.

Join us as we gain insight into the challenges and successes in the market to date!

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Originally posted to ACOwatch.com.

 

Another Milestone Marker in Favor of the ACO Model? Meet Farzad Mostashari, MD

by Gregg A. Masters, MPH


I awoke this morning to an email from a PR rep who supports outbound news for one of the emerging ACO management companies enabling physician led participation in the Medicare Shared Savings Program (MSSP) aka Aledade (@AledadeACO).

I then copy, pasted and tweeted the headline: ‘Aledade Creating New Medicare Accountable Care Organizations in Seven States.

I usually ignore ‘PRs’, yet this announcAledade newsement is material as it lends support via a growing body of evidence on the viability of the ACO model and its enabling ‘consciousness’ if not ‘sentiment shift’ in the prevailing market narrative.

While some still slam the ACA – and by proxy it’s ACO ‘workhorse’ – via relentless yet ‘diminishing returnsimpact of the ‘government takeover‘ fear mongering fueled by strategically sourced oppositional research, there is a building steady body of evidence supporting both the model and the broader context of efficacy of the competitive dynamics the ACA has unleashed on the stewards of our at risk (some say collapsing) healthcare economy.

Ergo my tweet:

Aledade news tweet

Ever since the Senate Finance Committee took up the debate and relentless series of ‘amendments‘ proffered by the ‘Rs’ trying to ‘improve‘ the proposed legislation that eventually emerged as the Patient Protection and Affordable Care Act (I NEVER use the pejorative term ‘Obamacare’), I’ve been a voice in the narrative of trying to get the facts of competitive market dynamics into the post political conversation around reforming our complex healthcare economy.

This is no easy task as the complexity of both the political process and objective reporting of how legislation becomes law including its contextual historical narrative is addressed in ‘A Legislative History of the Affordable Care Act: How Legislative Procedure Shapes Legislative History.

A challenge recognized upfront via admittedly ‘apolitical’ or ideologically agnostic ‘law librarians’ (yeah, you know those agenda driven bullies):

“Using the health care legislation passed in 2010 as a model to show how legislative procedure shapes legislative history, this article posits that legislative procedure has changed, making the traditional model of the legislative process used by law librarians and other researchers insufficient to capture the history of modern legislation. To prove this point, it follows the process through which the health care legislation was created and describes the information resources generated. The article concludes by listing resources that will give law librarians and other researchers a grounding in modern legislative procedure and help them navigate the difficulties presented by modern lawmaking.”

Since social media was starting to pick up in 2009 – 2010 time-frame, and given the angst associated with the public’s consumption of the ACA, I started ACO Watch and latter the hashtag #healthreform to track tweets associated with ACA consideration.

None-the-less, 5 years later the disinformation campaign persists though some of the pieces of the ACA are starting to show some promise of the law’s original intent. ACOs often referred to as a flawed model, perhaps an ACO lite if you will or too little too late to make a difference, the emerging datasets (both government and private market tea leaves) are building a case that the law is working.

Tomorrow on PopHealth Week, join my colleague, co-host and co-founder Fred Goldstein as we chat with Aledade Founder and CEO Farzard Mostashari, MD. This month we’re conducting a series on Population Health and ACOs talking to leadership from each ACO type: physician led, hospital sponsored and health plan enabled.

Listen here! We’re live 12 Noon Pacific/3 PM Eastern, and on demand thereafter.

Original posted on ACOwatch.com.

Population Health Management Framework: Identification of Your Population

by Gregg A. Masters

In this PopHealth Week‘s edition of FredTalk, Fred Goldstein @fsgoldstein highlights the critical first step in the the Population Health Alliance‘s (PHA) Population Health Management Framework, “Identification” of your population….

Population Health and ACOs: A Deep Dive Into Model Type and Results To Date

by Gregg A. Masters

As we continue our journey into population health and it’s relationship to and ACO Watch @ACOwatch @ACOalliancesynergies with all forms of innovation enabling the broad brush outcomes of the ‘triple aim’, better health outcomes, improved user experience and lower per capita costs, we shift our focus to the accountable care industry and ACOs in particular.

The month of August we’ll chat with executives from each of the following types of ACOs: physician led, hospital sponsored and health plan enabled.

On the first broadcast at 12 Noon Pacific/3PM Eastern we’ll provide an overview of the space and touch on the history and origins of ACOs, the motivations of the Affordable Care Act (ACA), then pivot to the pros and cons of the various models in the market and to the extent we can compare and contrast results, we’ll offer up data posted to the public domain.

Join Fred Goldstein @fsgoldstein and Gregg Masters @2healthguru for this exploration into an timely and relevant topic.

 

 

Announcing ‘FredTalk’ with Fred Goldstein

by Gregg A. Masters

In addition to our programming at ‘PopHealth Week‘ (@PopHealthWeek), we’re launching a new series tagged ‘FredTalk‘ with our co-founder Fred Goldstein, Founder & President of AccountableHealth, LLC (@fsgoldstein).

In this session Fred outlines a high level framework for ‘Population Health Management’:

Paul Grundy, MD the “Godfather”of the Patient Centered Medical Home

by Fred Goldstein and Gregg Masters

This week on PopHealth Week, in our continuing focus on primary care and population health we are pleased to welcome Paul Grundy, MD, (@Paul_PCPCC) Global Director of Healthcare Transformation IBM, (@IBMHealthcarePresident PCPCC and Ambassador Healthcare Denmark. Paul is known as the “Godfather” of the Patient Centered Medical Home (PCMH). IBMhealthcare

Paul’s work at IBM is directed towards shifting healthcare delivery around the world towards data driven, accountable, consumer-focused, primary-care based systems through the adoption of new philosophies, primary-care pilot programs, new incentives systems, and the information technology required to implement such change.

The Patient Centered Primary Care Collaborative (@PCPCC) is a not-for-profit membership organization dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home

Considering the challenge laid before all healthcare stakeholders, and especially healthcare leadership, to re-tool and transform an ecosystem remarkably resistant to the change – if not, the revolution – imperative, join us for a ‘tour de force’ review of the current state of healthcare transformation, the center core nature of primary care leadership and the many strands that attach to if not energize the re-emerging focus on population health.

 

 

 

Meet Rushika Fernandopulle MD Co-founder/CEO iora Health

by Fred Goldstein and Gregg Masters

This week on PopHealth Week, in our continuing focus on primary care and population health we are pleased to welcome Rushika Fernandopulle, MD, the Co-Founder and CEO of iora health a growing and disruptive force in the direct practice (including membership and retainer practice medicine) market.rushika pose

Rushika has spent more than ten years involved in efforts to improve the quality of healthcare delivered to patients.  He was the first Executive Director of the Harvard Interfaculty Program for Health Systems Improvement, and served as Managing Director of the Advisory Board Company. He serves on the faculty and earned his AB, MD, and MPP from Harvard University and completed his clinical training at the Massachusetts General Hospital.iora health value prop

iora health believes that better health care starts with primary care. The foundation of their practice philosophy and delivery system infrastructure is built upon three core principles:

  • Payment Focused on Outcomes
  • Patient at the Center; and
  • Technologies that Enable Care

One of iora Health‘s goals is to empower the individual and they utilize care teams and health coaches as the connection.  iora health also places a focus on integrating behavioral health. Rushinka Fernandopulle MD Population Health Colloquium 2015

Join Dr. Rushika Fernandopulle as our guest on PopHealth Week and learn more about this growing and innovative primary care model.

For a previous interview courtesy of our colleague Douglas Goldstein (@efuturist) with Fernandopulle MD sourced from the Population Health Colloquium 2015 organized by the Jefferson College of Population Health (@JeffersonJCPH), click here.

Sun Health, CMS, Population Health and Jennifer Drago

by Fred Goldstein

PopHealth Week will be featuring Jennifer Drago EVP of Population Health at Sun Health. This week’s show will focus on some of the innovative programs that Sun Health offers in the seniors market including their Care Transitions Program  which has a CMS Community-based Care Transitions Program (CCTP) contract. CMS just  Community-based Care Transitions Programrenewed the Sun Health CCTP contract and increased the number of patients to be managed.

The CCTP  “tests models for improving care transitions from the hospital to other settings and reducing readmissions for high-risk Medicare beneficiaries.”  There are currently 72 sites participating in the CCTP pilot.

Per CMS:

  • Approximately 2.6 million seniors, or 1 in 5 are readmitted within 30 days
  • The cost of these readmissions is over $26 billion per year
  • The goal is to reduce readmission 20% per year
  • The program is to run for 5 years
  • The budget was estimated at $300 million over 5 years

To date 29 of the total 101 CCTP-funded sites have withdrawn or been ended.

The CMS First Annual Report stated that of the 48 programs started in 2012 only four programs made statistically significant gains in reducing the ratio of readmissions to discharges from the participating hospitals.

PopHealthWeek-logo-TWTTR-sqBut there is more to this story.

As with other CMS programs there are some concerns regarding the study methodology. The argument against the current methodology, which measures re-admissions within 30 days as a percent of discharges may penalize hospitals, or communities that have worked to reduce hospital discharges in total. Because of the reduction in discharges, these initiatives may not show a reduction in 30 day readmits as a percent of discharges but would better reflect this changes by looking at a population based measure of re-admissions.

Some reference posts on the program are noted below:

  • http://www.medicaringcommunities.org/medicaring-blog-cms-cctp-metrics-have-seious-flaws/
  • http://medicaring.org/2014/12/16/protecting-hospitals/
  • http://www.n4a.org/blog_home.asp?display=16

Join us as we discuss Sun Health and their innovative approach to Senior Health, Care Transitions and the CCTP program.