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.

 

 

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….

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.

PopHealth Week Explores Full Risk Medicare Advantage with Roy Hinman MD, Founder of Island Doctors, a Pioneering Primary Care Physician

by Fred Goldstein and Gregg Masters

On the Wednesday July 1st, 2015 broadcast at 9 AM Pacific and 12 Noon Eastern PopHealth Week pivots to a progressive physician operation in North Florida innovating via Medicare Advantage risk arrangements with major health plans, including Humana.

PopHealth Week’s guest on July 1 is Roy Hinman, MD the founder and CEO of Island Doctors which employs more than 50 people within 14 offices in Florida stretching from Jacksonville to Interlachen and New Smyrna Beach. He opened his first family practice office in 1991 on Anastasia Island in St. Augustine, Florida.PopHealthWeek-logo-TWTTR-sq

Dr. Hinman is a ‘back to basics’ pioneer and began to take full risk Medicare Advantage in 1998. Since then, Dr. Hinman’s practice has grown to approximately 16,000 capitated Medicare Advantage patients in Florida. He anticipates having 20 offices by the end of 2015 to meet the demand. In addition to his owned offices, they also manage a network of 32 affiliated providers.

With innovative programs targeting diabetes, COPD, cholesterol, smoking and weight loss, he understands keeping patients healthy and how to manage capitated contracts.  His comments may surprise you.

phw_hinmanHere’s some of Dr. Hinman’s bio.

Dr. Hinman was raised in Tulsa, Oklahoma. He is a graduate of Oklahoma Military Academy, received his Bachelor’s Degree in Psychology from Tulsa University, and his Master’s Degree in Human Resource Management from Pepperdine University in Malibu, California. He completed medical school at Universidad Technologica de Santiago in Santo Domingo, The Dominican Republic. He served his family practice residency with the University of Florida Medical Program at the University Medical Center in Jacksonville, Florida and worked as an emergency room physician at Bradford County Hospital in Starke, Florida and at Ed Fraser Memorial Hospital in Macclenny, Florida.

Commissioned as a Second Lieutenant in the U.S. Armored Cavalry in 1975 at Oklahoma State University, Colonel Hinman ultimately retired from the U.S. Army Reserve in 2014 as a Medical Corps officer, after 37 years of military duty in the United States, Germany, Korea, Kuwait, Nicaragua, Panama, Saudi Arabia, Ecuador, the Dominican Republic, and Iraq where he served three combat tours. He recently served as the Territorial Surgeon of the U.S. Virgin Islands.

Dr. Hinman is Board-Certified in Family Practice and is a member of the Florida Medical Association, the American Association of Family Practitioners, the Florida Association of Family Practitioners, the St. Johns County Medical Society and the American Academy of Anti-Aging, and has full Family Practice admitting privileges at Flagler Hospital in St. Augustine, Florida where he has been an active staff member since 1991.

So join PopHealth Week’s guest, Dr. Roy Hinman and gain valuable insights into how he has been doing what many have, and or will be trying in the not to distant future, full risk capitation.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PopHealth Week Month End Wrap-Up: Wednesday June 24th

by Fred Goldstein, Gregg Masters and Douglas Goldstein

In our second month end ‘news/e/um‘ style PopHealth Week Review Wednesday June 24 at 9 AM PT/12 PM ET we’ll feature hot topics in the news. Our regular panel of Fred Goldstein @fsgoldstein, Gregg Masters @2healthguru and Doug Goldstein @efuturist will identify newsworthy stories and offer commentary along the way.
The initial slate of stories in the news includes:

  • Healthways revised guidance
  • Fitbit’s IPO and Garmin’s lawsuit
  • Ochsner Health System
    • What they are been getting news about Apple Watch – Chronic Care Management
    • News B4 the Release – what they are working on the New Mission Control”
  • The physician led ACO management company Aledade’s VC raise
  • Insights from the Personalized Medicine Coalition Study
  • Anthem’s sparring bids for CIGNA (and Aetna’s pursuit of Humana) Could the ‘Big Five’ be reduced to the ‘Big Three’?

Here’s some background:

Healthways: A Perennial Disappointment?

PHW_healthwaysThis company just reported revised downward guidance and their stock was hammered.  Last month, on May 18th their longtime CEO Ben Leedle stepped down and last year a group of dissident sharedholders filed to take over the Board, though they ultimately came to an agreement with a few of them joining the Healthways Board.  As one of the largest population health companies, with unique programs like Silver Sneakers, the Gallup-Healthways Well-Being Index, and relationships with Blue Zones and Dean Ornish, how can they miss?  Well the irreverent 3 have some thoughts you don’t want to miss this.

We’re sourcing our discussion from recent news: ‘Healthways Revises Financial Guidance for 2015‘ and Healthways (HWAY) Stock Sinks on Lower Full Year Revenue Guidance.

Fitbit: The Wallstreet Darling of the Wearables Industry?

Fitbit went public, Woohoo! Lets take a walk as we discuss:phw_fitbit

  • the opportunities for wearables
  • Fitbit’s first day pop (can you say JUMP) you know, we can get them to exercise, but hey its only the first month, is it sustainable?; and
  • the recently announced Garmin lawsuit (what? So they hired employees from a competitor….. but maybe… they took more than their minds with them)

The company narrative is here, and recent discussions found via CNBC ‘Fitbit soars 20% on second trading day‘.

The good here, and some questions, here and here. And then there’s the ‘always-in America’ litigation angle via ‘Fitbit Sued by Jawbone for ‘Plundering’ Employees, Secrets‘ with all the gory details of the complaint here.

Ochsner Health System: The New Normal?

Doug Goldstein recently visited Ochsner Health and has some interesting insights to bring us. Perhaps more interesting is this announcement:phw_ochsner

Ochsner Health System First in Nation to Manage Chronic Disease with AppleWatch….’

We all know how much buzz the product (better yet, platform) has produced in the digital health and exploding apps market, we’ll lean into the real world implications for its deployment to population health via Ochsner’s first mover vision inside their EHR (uh, can you say EPIC?).

Select Highlights:

…it’s not about the wearable – it’s about the “new mission control” being built into the EPIC workflow that will change how doctors support patients in life, fitness, health and healthcare.’ Douglas Goldstein

Aledade: The Physician Led ACO Management Company “ACOcor” Revisited?

phw_aledadeAledade just completed a $30 million series B raise, see; ‘Bethesda health tech company raises $30 million‘. What implications if any can we draw from this continuing investor confidence in the approach and ‘secret sauce’ enabling the transformation of the U.S. healthcare ecosystem from volume to value? What does this say about the ACO market writ large and the continued embedding of the ACA’s moving parts as the new normal for American healthcare? For discussion of this milestone event, see: Leading the Transformation: Aledade’s Growth authored by Aledade CEO Farzad Mostahari, MD.

Themes: ACOs continue their market penetration, and the need for physician led ACOs can only be expected to continue to grow as well. Someone need fill that void. Aledade intends to be a front runner.

ACA repeal types are increasingly irrelevant and the King V Burwell trial decision –  which could hit this week – is likely to only affirm the continued availability of Federal subsidies within the broad intent of the law and ‘language issues’ notwithstanding.

Physician led ACOs are another shot at the bow of traditional hospital system led innovations including any ACOs the sponsor.

Personalized Medicine Coalition Study 

phw_personalizedmedMost of us have heard about the 17 year time-line for innovation to transfer from ‘bench to bedside’ into mainstream medicine. Clearly in days past, we could tolerate such a delayed ‘on-ramp’. Yet in the Internet age, with Moore’s Law, the explosion medical information and informatics/big data analytics, plus opportunities for crowd sourcing and the connected global village are within the means of anyone carrying a smart-phone, laptop or traditional PC access, such a delay is, well so 1900’s…

Yet, there’s more in the way of ‘innovation uptake’, you know that ‘calcified hairball’ so aptly tagged by the powerhouse Esther Dyson (@edyson). A recent study by the Personalized Medicine Coalition outlines some of these concerns, particularly as it relates to ‘alternate payment models’ (APMs):

“..as APMs continue to develop and these, and other alternate models are proposed, it will be important to consider what effect changing incentives and payment systems will have on the decision by interested stakeholders to invest in personalized medicine. The Report concludes that “if new incentives begin to hamper access to personalized medicines in a meaningful way, the ability to invest in research and development of highly personalized therapies and diagnostics will likely shift to align with the inflexible payment systems.”

“Understanding the dynamics and challenges facing the industry as payors move toward APMs is the first step to ensuring that these therapies can continue to be developed and made available to patients. This Report is an important first step to raising the awareness of these issues as payment models continue to evolve.”

Practical Impact or ‘Reading the Tea Leaves’

As the challenge of integrating the promise of precision medicine (utility of biomarkers and better understanding of disease pathology and associated risk management opportunities) informing and guiding to day to day lifestyle (including health) choices, another potential uptake inhibitor are the hoops payors or risk bearing organizations may require before deeming the application of such technology to better patient outcomes. So in a way, it’s not just about tech innovation adding value to medicine and healthcare, but also the bureaucracies we create to protect the public while stimulating innovation.

PM remains an on the come potential to current medical practice. The theory is compelling, but the 17 year bench to bedside standard is not likely to step aside any time soon. Perhaps incentives [and compelling outcomes studies] can accelerate an otherwise glacial pace of [tech transfer] adoption.

Anthem’s Determined Dance to Acquire CIGNA

Are we revisiting the Big 6, then Big 4, and ultimately fill in the ____ of the too big to fail accounting firms [RIP Arthur Anderson] but now squarely laid at the feet of America’s Health Insurance Industry market leaders….?phw_anthem

This is a story on a number of levels! See: Anthem continues $47B Cigna takeover battle and Anthem offers $47 billion to buy Cigna.

Themes: Is health plan consolidation the antidote to counter the recent and persistent wave of hospital, health system and medical group mergers? One CEO’s post merger standing in way of merger. Will investors stand by and watch a premium bid sit idle?

Bottomline? Might market consolidation for price leverage (and oh yeah, scale and operating efficiencies) enable the construction of a virtual single payor (or Ellwood vision of “SuperMeds”) via acquisitions or arrangements? Is this scale required by ACA as some opine? Or just more opportunity to generate fees and exit packages for senior executives? When has scale reduced costs?

So pull up a chair, get out on a walk, put on your headset, and tune in to PopHealth Week!

 

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.

PopHealth Week: The Monthly Wrap with Fred, Doug and Gregg

By Fred Goldstein

Join Gregg Masters @2healthguru, Doug Goldstein @eFuturist, and me @fsgoldstein as we discuss recent news and issues in population health. This week’s show will focus on Evolent Health and their recently announced IPO as well as the Quantified self and health care data, who’s using it, and what are some of the issues the industry and we face.

Here’s some background on the two topics:

Topic 1 – Evolent Health Announces Their IPO

Evolent Heath announced their IPO this past month. Here is some information on Evolent from their website (www.evolenthealth.com)

A PARTNERSHIP DRIVEN BY A GREATER PURPOSE

Evolent Health helps progressive health care systems lead, build and own the path to value-based care. No matter your current state of transition, we partner with you to drive real, lasting transformation from the inside out.

OUR COMPANY

Founded in 2011 by UPMC Health Plan and The Advisory Board Company, we are a high-growth firm headquartered in Arlington, Virginia. Across multiple Evolent and partner system sites, our 750-member team of experts works shoulder-to-shoulder with provider leadership to shape the future of health care. Evolent is proud to partner with leading providers and physician organizations in over 25 markets across the country.

OUR OFFERING

Evolent provides the integrated technology, tools and team to advance value-based care. Our work begins with the Blueprint, an immediately actionable strategic roadmap that defines target markets, assesses needed clinical and operational capabilities, and is supported by a detailed business case. We implement the Blueprint through our Market Facing Solutions, which accelerate the path to value and embed and connect crucial capabilities through a Value-Based Services Organization:

  • Tailored clinical programs, patient engagement tools, quality and risk coding, and specialized care teams to deliver Population Health Performance
  • High performance network optimization and management, backed by proven physician compensation models and integrated specialty partnerships foundational to Delivery Network Alignment
  • Leadership, scalable back-office infrastructure, and analytics and reporting teams required for Financial And Administrative Management
  • Organizational governance and design, physician-led practice transformation, and change management to drive “inside-out” System Transformation
  • Data integration, clinical and business content, EMR optimization, and value-business applications through our purpose-build technology solution—IdentifiSM

From Evolent’s S-1:

Financials

2013               2014

Revenue         $40.3M           $100.9M

Loss                 $32.8M           $52.3M

Assumptions

They believe the current market opportunity is $10B and will be $46 by 2020, that health expenditures will increase from $2.1T to $3.2T by 2020, value based care will increase from 10% to 50%, the provider sponsored health plan market will grow to 15% of the total health plan market and they estimate $1T in waste in the system.

A good blog on the topic was posted by Stephanie Baum of MediCity News: ‘6 Takeaways from Evolent Health $100 Million IPO Registration

Also an interesting piece from Rock Health on who might be next for an IPO.

Topic 2 – Quantified Self, Data, Privacy and Meaningful Use

The second issue we’ll discuss is the quantified self, and the incredible growth in personal data that is being gathered and used from wearable devices and other sources.

The Washington Post had a recent article entitled ‘The Revolution will be Digitized‘ by Arianna Eunjung Cha, posted May 9, 2015.

And from the Kojo Annamdi Show on NPRThe Digital Fingerprints We Leave Behind Online’ with some interesting information and statistics.

There have been numerous data breaches including this one: ‘CareFirst Data Breach.’

And the recent hacking of an adult dating site and sharing of intimate details online.

Issues like who owns the data, whose using it, its value, the ‘No MU without Me‘ campaign and others will be addressed. So join us at 12 pm Eastern at www.pophealthweek.com and follow us on twitter @pophealthweek.

==##==

Frederic S. Goldstein is President and Founder Accountable Health, LLC, Past Board Chair, Board of Directors, Population Health Alliance, and co-founder of PopHealth Week.