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.

 

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’:

Population Health and Primary Care Leadership

by Fred Goldstein and Gregg Masters

In July we focused on Primary Care and Population Health and we had quite the line up.  From some extremely well known experts to hard working physicians in the trenches ‘walking the talk’ of innovation via transformative primary care leadership for over a decade.phw_hinman

We started with Roy Hinman, MD of Island Doctors in St. Augustine Florida.  Island Doctors has been serving global risk Humana Medicare Advantage since 1998 and now manages approximately 18,000 patients! Roy focused on keeping it simple, building out a network of like minded partners, leveraging mid level practitioners at the ‘top of their license’ in the care team, aligning financial incentives, grasping and developing core competencies in clinical risk management and a hospital agnostic approach to prudent utilization of institutional healthcare resources.

We then moved to direct practice pioneer with the CEO and Founder of iorahealth (@iorahealth), Rushika Fernandopulle, MD (@rushika1).  Rushika decided to ‘rebuild primary care from the ground up’ and created a care team model in some respects similar to Roy’s that ‘dis-engages’ from  a volume based, fee-for-service compensation plan. Iorahealth has been experiencing strong growth in the traditional mrushika poseembership or retainer model direct practice milieu where there is no intermediary between the patient and the medical practice. Yet, continuing to innovate in non-traditional direct practice terms iora health as also engaged in the direct employer space via global contracts with Humana. Rushika believes that establishing a dis-intermediated and  thus ‘direct relationship’ with the patient via a coordinated care team is their ‘secret sauce’ and key market differentiator.

Week three’s guest was Jay Lee, MD (@FamilyDocWonk)of MemorialCare Medical Group (@MemoricalCareMG), a historically proactive physician organization based Jay Lee MD @FamilyDocWonk | HiMSS SoCal with Douglas Goldstein @eFuturistin Long Beach, California with a service area reaching into south Orange County established to provide advanced comprehensive, effective and efficient healthcare.  Jay’s primary role is as the Associate Medical Director of Practice Transformation at MemorialCare Medical Group and Director of Health Policy at the Long Beach Memorial Family Medicine Residency Program. He also serves as the President of the California Academy of Family Physicians (@cafp_familydocs). Jay brought some unique insights into physician acceptance of population paul_grundy headshothealth and training of residents, stating that changing the culture and aligning  both docs and payment incentives were mission critical to success in the transition from one-off episodic care to a population level world view.

The fourth week featured the “Grandfather” of the Patient Centered Medical Home, Paul Grundy, MD, MPH (@Paul_PCPCC & @IBMhealthcare), Global Director of Healthcare Transformation IBM, President PCPCC, Ambassador for Healthcare Denmark.  Paul discussed the history of the PCMH and stated that the original concept was based not on being the ‘primary care home’ for the patient per se, but the home for the data about the patient which would allow for better management of the patients condition.  In fact the original PCMH was the transplant surgeons who needed to be sure that they had all the data and could coordinate all of the patient’s healthcare needs.

So what did we learn?

Fee-for-service payments and its inescapable production oriented ‘do more, to earn more’ incentive basis is a hindrance to implementing population health, and perhaps contrary to emerging ‘conventional wisdom’ that tipping point may not be so close (the best intentions of Secretary Burwell et al at CMS).

Many experts say we are near a tipping point in the approach to medicine and population health, that as soon as we implement just a bit more value based payment methods, we will reach it.  Unfortunately and given the weight of historical inertia, they may be wrong (again?).

In our discussions, there was real and evidence based concern that to do population health requires getting completely away from FFS payments.  Rushika takes none, and Roy claimed to only have a handful of patients on this burning platform. They both stated that FFS payments were a problem and hindered behavior change, as well as not allowing for the justification of many population health approaches. Interestingly at MemorialCare Medical Group , Jay stated they still measure physician productivity using RVU’s; so any work that does not have a billing code (think pop health related activities) has ‘no measure or worth’ (my words).  The point that stuck out most for me is that if MemorialCare Medical Group has 60 to 70% capitated business, yet they still measure using FFS related codes, making it hard to justify population health services, when do we reach the tipping point?

Paul on the other hand felt that we would incrementally reach the inevitable pivot and felt that the recent CMS announcements regarding the more rapid shift to value based payments would be the impetus. Although he felt there were examples of successful capitated contracts he did bring up the fact that this type of payment can lead to an underutilization of appropriate services, while clearly FFS can lead to an over-utilization.

Bringing Joy into Practice

Both Rushika and Jay independently discussed the need to bring “joy” back into the physician experience, a common theme first posited by senior leadership at ACO management company Lumeris as ‘the triple aim, plus 1’ , where the plus 1 is ‘physician satisfaction’. They talked of the drudgery of having to practice in the current system driven by fee-for-service payments, and the well know productivity formula of 30+ patients a day with an average per patient visit in the 7- 8 minute range. Both felt that practices that introduced a patient centered model, focused on relationships and had global payments allowed doctors to practice in a manner that aligned better with why they had called them to medicine in the first place.

Keeping it Simple

Rushika and Roy discussed how they have very simple systems to manage patients, in fact Rushika felt that EMR’s which had been built upon the FFS model and the need to create a bill, were a hindrance and he did not use one. iora health had instead developed their system from scratch.  Roy too discussed how his practice focused on the ‘low hanging fruit’ and that by having no copays for office visits, seeing all walk-ins that day, managing cholesterol, weight and other simple things, they were able to drastically reduce hospitalizations and ER visits.  As Roy said and I’m paraphrasing, you don’t need 15 consultants and a big IT system to do this.

Paul stated that IBM had also gone to a no co-pay model for primary care visits for their employees and wanted to be sure their employees had a relationship with their PCP.

Utilizing your staff based upon their expertise

All of the guests had created systems or discussed having specific roles for each team member in particular to maximize the physician by having them focus on

The Role of Technology

While not all of the guests discussed technology, it was clear from Paul and his work both with providers and one of the strongest IT companies in the world that technology and in particular advanced data analytics combined with mobile will lead to a sea change in health and health care. Moving us to the realm of personalized medicine, providing specific services to a specific person to maintain and or improve their health.

What a fantastic month of guests!

Next month, we’re dedicating our series on ACOs, and diving into one of each entity type: 1) physician led, 2) hospital sponsored and 3) health plan enabled to contrast and compare structural characteristics and the relative market success (or failures) reported to date.

Join us!

Primary Care Innovation and Population Health: A Conversation with Jay Lee, MD @FamilyDocWonk

by Fred Goldstein and Gregg Masters

In our continuing series on innovation in primary care and population health join PopHealth Week co-hosts Fred Goldstein and Gregg Masters Wednesday, July 15th 2015 at 3 PM Eastern/12 PM Pacific for another deep dive into the role of primary care.

Our special guest is Jay Lee, MD, (@FamilyDocWonk) Associate Medical Director of Practice Transformation at MemorialCare Medical Group and Director of Health Policy at the Long Beach Memorial Family Medicine Residency Program. Dr. Lee was also recently honored by his peers and elected as incoming President at California Academy of Family Physicians (cafp_familydocs).Jay Lee MD @FamilyDocWonk | HiMSS SoCal with Douglas Goldstein @eFuturist

Dr. Lee is an innovative Primary Care Physician. As Associate Medical Director of Practice Transformation at MemorialCare Medical Group, Dr. Lee is responsible for leading implementation of the Patient-Centered Medical Home (PCMH) model in practice locations from Long Beach to San Clemente.

As Director of Health Policy, his role is to educate residents and medical students about the policy world that lives “upstream” from the world of patient care and how to integrate this understanding into clinical practice so that the health and well-being of patients and communities are optimized.

So join us on Wednesday July 15 on PopHealth Week to hear from Dr. Lee.

For a recent interview with Dr. Lee courtesy of our colleague Douglas Goldstein (@efuturist) click here.

 

 

Meet Kaveh Safavi MD Accenture

Join PopHealth Week Wednesday June 10 at 12 PM Eastern/9AM Pacific with our special guest:

kaveh_safavi-21

Kaveh Safavi, MD, JD managing director for global healthcare business at Accenture. Dr. Safavi is responsible for developing and driving a growth strategy that differentiates Accenture’s offerings for providers, health insurers and public and private health systems across the globe. PopHealthWeek-logo-TWTTR-sq

Accenture Health Management Services offer solutions to help patients, providers and risk-bearers coordinate and manage population health and wellness across care settings in a way that ensures optimal health outcomes, efficient healthcare spend and drives affordability.

We’ll be discussing some of Kaveh’s thoughts on population health and where he believes providers should be focusing their efforts.