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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The Health System of Tomorrow – More Guts, Not More Information

I had the pleasure of attending the US News Hospital of Tomorrow conference last week in Washington, DC. Right in the midst of the heated debate around the failures and successes of the Accountable Care Act and the less than stellar rollout of Healthcare.gov, leaders from many of the top health care provider systems across the US congregated to share their insights about how the health care delivery system will look in the future. While there was passionate dialogue about how to best solve our current problems, the common consensus was clear amongst most of the top executives – the shift from volume to value based care will ultimately reduce costs, improve quality, and expand access.

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What is a Patient-Centered Medical Home (PCMH)?

Guest Blogger:  Wayne Hoffman, MD – Healthcare Consultant

Many of us grew up getting our health care through our family doctor or pediatrician – the doctor who knew everything about you and your family, and helped keep you healthy. He or she was the one you went to see no matter what was wrong with you, and for your annual check-up. Somewhere along the way we have lost that ideal. Health care now is fragmented, illness (not wellness) focused, expensive, and doesn’t always deliver the best outcomes. There is now an exciting new model of care that is beginning to sweep the country – the Patient-Centered Medical Home or PCMH. The term was first coined by Pediatricians in the 1960s, but has only recently been expanded to all of Primary Care. In 2007 the four main primary care organizations (American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and the American Osteopathic Association) got together and developed the joint …

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So What If You Like Your Health Insurance Plan?

obamacareKyle Wingfield was one of the very first to be right. The AJC opinion page editor hit the nail directly on the head in his column on October 31, 2013 entitled, “Real-life Trade-offs Belie ‘If You Like Your Plan’ Claim.”

Most of us clearly remember President Obama saying, “If you like your health insurance plan, you can keep it.” Truth of matter is that it is simply not the case for millions of Americans and an estimated 400,000 Georigians.

Whether it is employers who have decided to get out of the health insurance business entirely or individual health insurance plans that some federal bureaucrat has determined does not pass ObamaCare’s muster, the reality is: If you like your health insurance plan, you may NOT be able keep it.

More reprehensible is the fact that we now know that the president knew what he was saying was not the truth while he was saying it.

So while the president has thrown everyone from Verizon to House Republicans under the bus for the …

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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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Keeping Score

Is the Affordable Care Act a disaster, another step in the evolution of health care or a godsend? Well, the answer still is unclear, but that hasn’t stopped analysts of all stripes from trying to assign a score, or at least an adjective, to the law. In fact the law, three and half years after its passage, is still at least a year away from full implementation.

Information technology troubles lead to the postponement until 2015 of the requirement that employers offer affordable coverage or pay a fee and a reduction in choice in the SHOP exchange for small employers. Under the law employers with over 50 employees who did not offer coverage were subject to pay a fine for each employee (after the first 30). Employers who offered coverage that was deemed unaffordable paid a fine for any employee who received a subsidy in the exchange. The difficulty of developing the appropriate information technologies to allow that choice have forced SHOP exchanges run by the Federal …

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