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Healthcare Milestones for 2013

Now is the time of year when we look back at the highs and lows from 2013. In healthcare, there is a lot to talk about, but today we will focus on three important healthcare objectives. In 2013, the Healthcare Reform Act focused on changing reimbursement models and laid the groundwork for health insurance exchanges to commence in 2014. These changes led to three main milestones.

First, in 2013, provider integration flourished because of reimbursement changes. The bundled payment demonstration program commenced while payments to primary care providers increased. Bundled payments require providers to work together to treat a patient under a best practice protocol to reduce the costs so the providers can split one payment for the full delivery of care provided to the patients. As with most of the demonstration programs, bundled payments also require providers to report quality data to the Centers for Medicare and Medicaid Services (“CMS”). Similar to other programs …

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2013: A Year of Debate and Delay

Historian Barbara Tuchman created Tuchman’s law: “The fact of being reported multiplies the apparent extent of any deplorable development by five- to tenfold (or any figure the reader would care to supply)”. That law applies directly to the events of 2013.

We started the year with tiptoeing away from a fiscal cliff. That political crisis would reappear later in the year, but the fear in January was that we would continue to kick this can of long-term budget deficits down the road. The problem is the major driver of Federal budget deficits is health care expenditures. Social Security, defense, and all other spending are projected to remain largely constant as a percentage of GDP. That means you could slightly lower future deficits by cutting other spending, but if health care costs aren’t addressed all long-term structural deficits will remain. Congress faces very few options in the current budget debate that would credited as reducing future Federal health …

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Spreading Holiday Cheer and Health IT Job Growth

A conversation with Navicure CEO Jim Denny on why Atlanta is a great place for health IT, and could be even better if the right kind of growth continues.

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What To Be Thankful For in Healthcare Reform

As we approach Thanksgiving, we focus on giving thanks. Notwithstanding the rough, confusing and troubling roll-out of Healthcare Reform, there are some benefits that we can be thankful.

First, Healthcare Reform is focused upon improving quality care for patients. Specifically, Healthcare Reform implemented new payment models that pay providers based upon healthcare outcomes for patients instead of a fee for each patient. One example is the shared savings program. Under this program, providers integrate together to deliver care based upon patient centered protocols. The providers then report on the quality metrics for their patients and if the costs are reduced and the patient outcomes improve, the providers will receive a share of the savings achieved by reducing the costs to the government. The integration of providers together with an agreed upon approach to treat the patient should improve communication between the healthcare providers.

Healthcare Reform is also …

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What is the most important focus for healthcare providers – reduce costs or improve quality outcomes?

The conundrum healthcare providers are facing is how do they financially succeed in an era of growing patient demand and shrinking reimbursement. Additionally, the financial model is changing where healthcare providers are being pushed towards assuming a higher level of financial risk based upon patient outcomes, and financial penalties for not improving their quality performance (e.g. Value Based Purchasing).

Therefore, where should healthcare providers focus their energy, reducing costs or improving quality outcomes? To most organizations, these two concepts are in direct conflict. If you reduce costs, there is the risk of quality being compromised. If you improve the quality of outcomes, there is an associated premium cost. For healthcare providers, there is a fallacy in this logic. Healthcare providers have the opportunity to reduce costs and derive the benefit of improved quality outcomes.

Some organizations have taken the approach of looking for peer reviewed best …

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ACA Questions and Answers

Nobody has signed up so the Affordable Care Act is a big failure, right?

The website is nice feature (or will be when and if it ever becomes fully functional): one stop for determining eligibility for tax subsidies, shopping for plans, and enrolling. However,  the most important part of the Affordable Care Act is not the website, it’s the change in the operation of the individual health insurance market.

The principals underlying the ACA were developed before there was an Internet. The original depictions of the marketplace for health insurance used as examples a farmer’s market, or a shopping mall, or the Sears catalog: a method that allowed consumers to compare plans and prices when shopping for health insurance. But consumers would be unable to shop for health insurance in that way until the individual health insurance market was reformed.

The proposal then and the law now prevents insurers from denying coverage or increasing premiums based on an individual’s health …

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The Case of Abuse and Health Information

Recent cases of child abuse in our community have struck a nerve with many. Most would agree that the idea of parents starving and murdering their own kids is incomprehensible. In this nation, there are over 4 deaths per day from child abuse with the most prominent form of child abuse being neglect. Eighty Percent of those who die from abuse are under the age of 4 years old and most of these deaths are not recorded as abuse on the death certificate. Unfortunately, in most cases the perpetrator is a parent.

There are many education and training programs out in the field that are helping abusers and the abused. Much help is needed not only with the abuse of children but for other forms of abuse such as spousal abuse and elderly abuse. Oh yes, there are abuses of every kind. It is amazing how depraved the human mind can get. In many cases, poverty along with mental and physical disabilities are associated risk factors. Somehow people get so angry and deranged that they have to …

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Lessons Learned from the Healthcare Marketplace Rollout

The Affordable Care Act’s centerpiece—the Healthcare Marketplace—has officially rolled out. Perhaps you’ve heard it hasn’t gone over with rave reviews. From IT woes to administration “miscommunication,” the end-users—consumers—have been vocal about their disappointment. Although I fully believe the marketplace technology will be fixed, unfortunately the damage has been done. But as with every misstep, there are valuable lessons to be learned. See below four marketing “T”enets—emphasis on the T—that were violated and how marketers need to uphold them at all costs.

Technology: The website wasn’t ready…and it launched anyway. Today organizations are interacting with an empowered consumer that is connected, mobile, juggling multiple devices and constantly moving in between their offline and online worlds. Oh yes, they also demand a great experience. Not only has technology given consumers more devices and platforms, but it has given them a megaphone …

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The Patient Protection and Affordable Care Act: Trick or Treat

The Patient Protection and Affordable Care Act (“Healthcare Reform”) is a complex law that has multiple components. At the end of the day the subparts are integrated and similar to a line of dominos. One part of the law will impact others. When one domino is removed or fails to fall correctly, the entire law is in jeopardy.

Today, there are two components of the law that are being implemented and having vastly different results. First, Healthcare Reform is focused upon expanding insurance coverage to millions of individuals to reduce the number of uninsured. However, one domino that is a key foundational component of expanding insurance coverage was pulled by the Supreme Court. When the Supreme Court determined that the Medicaid expansion language within the Healthcare Reform Act was unconstitutional, the states were granted discretion to either expand Medicaid eligibility benefits to individuals, who had an annual income of 133% of the federal poverty level or …

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What a Long Month it’s Been for Healthcare in Georgia

While October isn’t quite over, I think it’s safe to say it’s already been a long and unusual month as far as healthcare in Georgia is concerned. Yes, the federally run health insurance exchange opened to enormous demand, and even more finger pointing. What I’d really like to highlight is the fact that Georgia’s health information exchange went live …

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