There’s a lot going on with healthcare reform. The thousands of pages that outline the Affordable Care Act are intimidating for any lay person and even some experts to understand. Its aim though is relatively simple: better patient care, improved population health, and lower costs. But how do you really achieve that?
There are a number of exciting initiatives that are underway to reach this triple aim. Yet, from my perspective, I would argue that the secret sauce of healthcare reform centers on case management. Case management can be defined as the coordination of health services across different providers and locations to promote quality, cost-effective outcomes for patients. At its heart is a case manager or care navigator. (Not to be confused with “exchange navigators”; the Feds released a proposed rule last week that defined the eligibility of people who are tasked with providing guidance to people enrolling in the federal health insurance
In 1955, Dr. Jonas Salk announced to the world that he had developed a vaccine for poliomyelitis (or polio) and the world was forever changed. No more would there be the need for polio wards or iron lungs. Innovation is hugely important in healthcare.
Just 25 years ago, if a patient came to a hospital with a heart attack, the best that could be done for the patient was to inject morphine for pain and lidocaine, which doctors believed would prevent dangerous irregular heartbeats … and hope and pray for the best. Now, as a result of medical breakthroughs like statin therapy to treat the progression of atherosclerosis, the American Heart Association indicates that we have seen a near 40 percent reduction in deaths due to coronary artery disease since 1998.
In 1989, at the International AIDS Meeting, Dr. Samuel Broder declared that AIDS was a chronic condition and that treatment of the disease meant that AIDS was no longer an automatic death sentence. Medical breakthroughs are
The healthcare industry is dramatically changing. It’s happening because of technology, politics, economics, and empowered consumers. Today’s consumer is connected, juggling multiple devices, on the go, and want their voices heard. They crave information and connections—practically in real-time. This is every organization’s new business reality.
Experts and pundits have coined it the “Relationship Era.” As empowered consumers access social and digital platforms to voice opinions, the days of mass, one-way marketing are gone. It’s a two-way relationship now. The healthcare industry, ironically, hasn’t exactly been the best in developing “relationships” with patients, members or consumers. It’s been a bit of a machine pushing you through the process. Whether its doctors with increasingly limited face time or the cloud of uncertainty over insurance fees and processes, the healthcare industry hasn’t gotten high marks in personal relations. But that’s
Community hospitals are at the center of the reimbursement changes driving changes in the delivery of care. On April 1, 2013, the Centers for Medicare and Medicaid Services (CMS) will cut Hospital Periodic Interim Payments (PIP), Critical Access Hospital (CAH) and Cancer Hospital interim payments, and pass-through payments for Graduate Medical Education, Organ Acquisition, and Medicare Bad Debts by 2%. This 2% cut is an addition to the 1% cut that was initially instituted for acute care hospitals under the American Taxpayer Relief Act which was intended to correct the fiscal cliff in January. This additional 2% cut is due to the sequestration cuts that automatically go into effect. Many hospitals rely upon the PIP payments from Medicare to be able to cover costs and often times provide funds for day-to-day operations. Accordingly, on Monday, hospitals will be suffering a 2% cut on their operating revenues.
In addition to the CMS budget cuts, the third-party insurance
The HealthFlock team of experts has done an excellent job of outlining the factors that constrain, as well as offering solutions to help cure, our healthcare system. While the adaptation of technology in healthcare has been slowed due the fractured core of our healthcare ecosystem, inevitably, it will be technology that will drive forward the changes necessary for it to survive – and thrive. Building a more connected healthcare network will drive down costs and improve the overall delivery of care – from the hospital to the home to a free-standing pod.
At the recent HIMSS trade show, six large healthcare IT companies (McKesson, Cerner, athenahealth, Allscripts, Relay Health, Greenway Medical Technologies) announced the formation of a not-for-profit company called CommonWell Health Alliance. The purpose of this organization is to create frictionless movement of patient-centered data across all settings of care and among all health care IT systems.
This is a profound announcement from companies that did not embrace the frictionless movement of data across systems within an acute care setting let alone outside the four walls of a hospital. This is great news for all of those organizations that lacked the clout or financial assets to interface their best of breed systems with the large name brand solutions. Historically, the price and effort of sharing data with the larger acute care vendors was cost prohibitive. The price and effort became a barrier to entry keeping best-of-breed competition out of a healthcare provider’s
Only twenty-five states are electing to expand the Medicaid program under the Affordable Care Act. The rest of the states have either elected not to expand or have not acted.
There are three principal reasons given by Governors and other state leaders for not expanding Medicaid:
• We can’t afford it
•We are not putting money into a broken system
•the Federal match may someday go away.
None of these reasons can be supported by either facts or logic.
We simply can’t afford it.
There simply is no “we” that makes that a true statement. Costs to every group in the state are higher without Medicaid expansion. It certainly isn’t true if “we” are the state and local taxpayers. In Georgia the cost of care for the uninsured is well over $2 billion dollars annually. That care is often given in the most expensive places (emergency rooms) and often given at the most expensive time (late in an episode of illness). Expanding access to insurance coverage reduces
Several healthcare IT companies – many of them located in Georgia and all of them competitors – recently announced they will now begin to work even harder to advance this effort. Executives from Allscripts, athenahealth, Cerner, Greenway Medical Technologies, McKesson and RelayHealth have come together to form the alliance as an independent, not-for-profit organization that will “support universal, trusted access to health care data through seamless interoperability.
There has been a lot of discussion this week in the national media about this story: http://www.ajc.com/ap/ap/health/police-investigating-death-of-woman-denied-cpr/nWgbh/ If you are not familiar, the synopsis is an elderly lady living at an assisted living facility went into cardiac arrest. The nurse on duty would not perform CPR on the lady, despite the pleas of the 911 operator, because it would be a violation of the policy of that facility. Much of the discussion has centered on medical and legal ethics. However, no one has talked much about why a facility would such have a policy preventing its nursing staff from performing CPR.
CPR is actually a very dangerous medical maneuver for a person to receive. Broken ribs are a very common result of CPR- especially in elderly patients. These broken ribs can puncture lungs, spleens, and livers leaving the person with many more problems, which are especially hard to recover from in an elderly patient. If you do not break ribs, there
A friend of mine once said, “The only thing that likes change is a 6-month-old baby with a dirty diaper.” That friend is Andrew von Eschenbach, MD, a former FDA Commission and Director of the National Cancer Institute. Andy knows a thing or two about being a “change agent.”
Another friend of mine said, “Real change requires real change.” That friend is Newt Gingrich. He too knows a thing or two about leading transformation. As the founder of the Center for Health Transformation, he helped advance ideas including health information technology and electronic medical records to create an individually-centered healthcare system.
Newt also lead a virtual revolution in the early 1990’s with his “Contract with America” campaign which ushered in one of the largest freshman classes of Congress. Changing “business as usual” in the Washington proved to be a very tough.
So why is change so difficult?
First of all, it is so much easier to say “no” than to embrace