Countdown to the PHA Forum 2015: Meet Peter Goldbach MD

by Gregg A. Masters, MPH

In the full court press for the pursuit and implementation of the many moving parts associated with fulfilling the triple aim, it’s advisable to dial into and take heed from those who’ve been at the table – both in terms of strategy and hands on implementation.Peter Goldbach headshot

Today we hear from one of those accomplished physician thought leaders and key executives with a holistic view of the complex ecosystem of American healthcare delivery and finance.

Peter Goldbach, MD is the Chief Medical Officer of Health Dialog, ‘a total population healthcare services provider that offers risk-bearing entities (health plans, employers and providers) an integrated suite of services driven by powerful analytics.’.

Dr. Goldbach’s journey into the healthcare ecosystem includes a ‘Zeitgeist’ fueled via both medical administration as well as the core granularity associated with operating a primary care and fellowship fueled pulmonary practice, plus powerful insights forged from hands on the forward leaning Blue Cross Blue Shield of Massachusetts ‘pay for performance‘ initiative into value based contracting.

Sourced from Dr. Goldbach’s Health Dialog bio, he brings…:

…more than 30 years of medical experience to Health Dialog’s management team, including 15 years in medical administration and 17 years maintaining a primary care and pulmonary disease practice.

He is also the Chief Medical Officer for Health Dialog’s sister company RediClinic, a retail clinic service provider. Prior to joining Health Dialog and RediClinic, Dr. Goldbach served as President and Chief Executive Officer of Med-Vantage Inc., a healthcare informatics and engagement company.

Earlier in his career, he served as Medical Director for Blue Cross Blue Shield of Massachusetts, where he provided medical direction for the company’s “Pay for Performance” and eHealth programs, and held CEO, trustee, and medical staff president positions with two Boston-area community hospitals. Dr. Goldbach received undergraduate and master’s degrees from UCLA before earning his medical degree from SUNY Downstate Medical Center College of Medicine. He completed his Internal Medicine internship and residency at George Washington University Hospital, and his Pulmonary Disease fellowship at Cedars-Sinai Medical Center a teaching affiliate of the UCLA School of Medicine.

Peter, his colleagues and many industry peers will be attending and participating in the PHA Forum 2015 (see keynote line-up here) in the Nation’s Capitol from November 2nd-4th, 2015. The PHA Forum is the go-to gathering of the best and brightest minds in the emerging if not re-engineered population health management space.

For some of Peter’s earlier work on ‘shared decision making‘ courtesy of our friends at the American Journal of Managed Care see: ‘Peter Goldbach, MD, Talks About Shared Decision Making Practices‘, and via the World Healthcare Congress, here.

Hope to see you in D.C!

==//==

This post is sponsored by the Population Health Alliance (PHA).

 

 

Population Health and the Hearst Health Prize

by Gregg A. Masters, MPH

We’re in the midst of the emergence of a profession and outright industry. ‘Population Health‘ congeals and integrates healthcare stakeholders across a continuum of healthcare infrastructure (acute, chronic, post acute/long term care) spanning public health, the emerging digital health ecosystem (including telehealth and telemedicine), accountable care or clinically integrated, risk bearing delivery systems and the triple aim – better experience of care, improved outcomes at lower per capita costs.

With limited committed academic infrastructure – the Jefferson College of Population Health (JCPH), follow via twitter @JeffersonJCPH, is the sole stand alone academic, degree granting institution in the U.S., and the Journal of Population Health Management a go-to source of empirical knowledge and evidence based best practices are two noteworthy assets.

Enter the collaboration between Hearst Health (follow via @HearstHealth) and JCPH. For context on the Hearst Health Prize for Excellence in Population Health, checkout the interview with Gregory Dorn, MD, President, Hearst Health sourced at the Population Health Colloquium 2015 in Philadelphia earlier this year via our colleague Douglas Goldstein (@eFuturist).

On PopHealth Week this Wednesday, September 16th 2015 at 10:30AM PT/1:30PM ET our special guests include David Nash, MD, MBA Dean of the Jefferson College of Population Health and Gregory Dorn, MD, President of Hearst Health @HearstHealth. PopHealthWeek-logo-TWTTR-sq

Per Hearst Health and JCPH joint announcement:

Population health is essential to transforming from an illness-centered healthcare system to one focused on protecting and improving health.  We created this prize to help promote promising new ideas in the field that will help to improve health outcomes, and thus proliferate best practices more rapidly.  Our goal is to discover, support and showcase the work of an individual, group, organization or institution that has successfully implemented a population health program or intervention that has made a measurable difference.

On the broadcast today, we’ll discuss Population Health and the innovative Hearst Health Prize for Excellence in Population Health. For more information about this competition including eligibility, terms and the application download, click here.

The winner will receive a $100,000 cash prize in recognition of outstanding achievement in managing or improving population health. This award is a combined effort of Hearst Health and the Jefferson College of Population Health.

Join us!

 

Countdown to PHA Forum 2015: Meet Sam Glick @OliverWyman

by Gregg A. Masters, MPH

‘Population health’, ‘accountable care‘, ‘personalized or precision medicine’, or more recently ‘consumer centric healthcare’ – a veritable potpourri of themes du jour or perhaps decades – and the responsible stewardship of U.S. healthcare assets are in a heightened state of dynamic tension. Some with limited ‘event horizons‘ may claim that this contemporary experience of acrimony if not industry disequilibrium, drifting and unrelenting internecine warfare centered on ‘health policy’ (i.e., the American healthcare delivery and financing ecosystem) can be laid at the doorstep of the consideration, passage and now implementation phase of the Affordable Care Act.

PHAForum_keynotesYet for those of us who have been at the strategy table and at the implementation helm for multiple decades, know the truth is a considerably more complex series of questions and answers than the pandemic of sound byte slams via ideological prisms.

So today in our series titled ‘Countdown to the Population Health Alliance (PHA) Forum 2015‘ we dive into that conversation with a seasoned executive and thought leader in the innovation space.PHA Forum 2015_OliverWyman_Consumer_Power

For timely context and consideration of the state of the healthcare ecosystem and our chat with Sam, check out Oliver Wyman’s thoughtful report: ‘The Patient to Consumer Revolution: How High Tech, Transparent Marketplaces and Consumer Power are Transforming U.S. Healthcare‘.

The broadcast will be live and via on demand replay thereafter at PopHealth Week at 1PM PT/4PM ET. Our special guest is Sam Glick, Partner in Oliver Wyman’s Health and Life Sciences practice, and the San Francisco Office Leader. Sam will keynote at the PHA Forum onSafely Navigating the Consumer Healthcare Evolution‘.

His indicated interests include: consumer-centric healthcare, working with leading providers, health plans, employers, ‘enablement companies’, retailers, and venture capital firms to find innovative, engaging ways to bend [the cost] trend.

Sam is an author of several recent Oliver Wyman points of view, including ‘A Billion-Dollar Decision: Charting a New Course for US Healthcare Benefits and ‘Private Exchanges Change the Game. Sam also leads many of Oliver Wyman’s healthcare commercialization research and intellectual capital development efforts.

According to bio copy on the Oliver Wyman site:

‘Sam has been invited to speak at a number of events for healthcare senior executives and board members, including the American Hospital Association (AHA) Leadership Summit, the AHA Center for Healthcare Governance Symposium, the Council on Employee Benefits Annual Conference, the Accountable Care Congress, the Integrated Healthcare Association annual board retreat, the CAPG Healthcare Conference, the Leadership Institute roundtable, and the UnitedHealth Group Smart Circle series. He is quoted regularly in both the industry and popular press.’

Join us for an informative conversation with an industry visionary. We invite you to check out the agenda for the PHA Forum 2015 and consider joining us in the Nation’s Capital for the go-to industry gathering of population health thought leaders, executives and stakeholders on November 2nd – 4th, 2015.

If you are tasked with innovation in service delivery (and financing) strategy at your health system, health plan, physician network, MSO or ACO, please follow us on twitter via @PopHealthWeek and do consider subscribing to PopHealth Week.

==##==

Disclosure: this post is sponsored by PHA.

Countdown to the PHA Forum 2015: Meet Christobel Selecky and Sean McNamany

by Fred Goldstein and Gregg Masters, MPH

Join our guests, Christobel Selecky, Chair of the Board and Sean McManamy Board member and Chair of the Population Health Alliance Forum Program committee as we discuss the Population Health Alliance Forum . The Forum now in its 16th year will be held November 2-4 in Washington D.C., is the ‘go to’ event in Population Health for executives, providers, physicians, researchers and population health practitioners. PHAForum_

Chris and Sean discuss the forum theme Welcome to Health: Population One, which underlines all of the presentations and tracks, introducing the concept that changes in a population occur one person at a time.

This year’s keynotes will focus on the upcoming national elections and their potential impact on health care, the 50th anniversary of Medicare and Medicaid and their future, and Consumerism in health care.

Currently announced Keynote Speakers are:

Eleanor Clift (@eleanorclift), a Washington correspondent for the Daily Beast, where she covers the White House and writes about politics and Policy. She also appears on “The McLaughlin Group” and MSNBC.

PHAForum_keynotesMark A. Siegel, (@msiegel271) former executive Director of the Democratic National Committee.  His career has spanned academics, government, politics, the private sector, print and electronic media and film-making.

Dr. William Rogers, Director of the Physicians Regulatory Issues Team at the Centers for Medicare and Medicaid Services (@CMSgov).

Sam Glick, a partner in Oliver Wyman’s Health and Life Sciences Practice (@OliverWyman).

Lucia Savage, the Chief Privacy Officer at the Office of the National Coordinator for Health IT (@ONC_HealthIT).  Her role is to foster interoperability in healthcare while ensuring security and privacy is maintained.

There will also be various tracks targeted toward supplying providers, payers and employers with practical, usable information on all aspects of Population Health. Monday afternoon will include the Executive Institute with a broad array of topics including a surprise session that will be a must attend for those in the employer wellness space.

You can learn more and register for the conference here and keep up with the conference via twitter handle @PHAVoice and conference hashtag #PHAF15. For transcripts, analtics and reach metrics check our the conference digital dashboard.

 

 

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!

==##==

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’:

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.

 

 

 

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!

 

Meet Steven Blumberg AtlantiCare Health Solutions

by Fred Goldstein

This week on PopHealth Week oPopHealthWeek-logo-TWTTR-squr special guest is Steven Blumberg, Senior Vice President and Executive Director of AtlantiCare Health Solutions, AtlantiCare’s accountable care organization. A member of AtlantiCare’s executive leadership team, he has responsibility for development of population health models, programing and delivery. Blumberg works with payors and employers to bring value-based purchasing of health services to the marketplace. Blumberg’s more than 25 years of health care leadership experience includes strategic planning, business development, joint ventures, group practice leadership, risk model development and operational integration. He has worked with both large group practices as well as major health systems.

AtlantiCare, located in New Jersey is the region’s largest healthcare organization and largest non-casino employer with more than 5,170 employees and 600 physicians in nearly 70 locations.atlanticare

AtlantiCare Health Solutions is an accountable care organization (ACO). Services offerd through their ACO includes Primary Care Plus, data analytics and information sharing through an EMR, integrated care managers, a hospitalist program and an employee engagement, prevention and wellness program.  The program also offers a patient portal, mobile app and Well4Life, whose mission is to build healthy communities.  So join PopHealth Week as we discuss ACO’s, population health and some of the innovative services offered by AtlantiCare Health Solutions.

== ## ==

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.