In this week’s WWBR, lots on pricing transparency and payment reform in the health system, and some new thoughts on whether all this excitement is really warranted. On a slightly different note, Brian shares a very important IOM article addressing one of those topics people rarely talk about – end of life planning. This is something that our dear friend Alex Drane, founder of Eliza Corp and Engage with Grace, has made a key part of her life mission after experiencing some of the difficulties discussed in the report. And plenty of other great reading too. Enjoy the articles and have a great weekend!
-John 3
Medicare’s Pioneer program down to 19 ACOs after three more exit
Melanie Davis for Modern Healthcare
“While some may see this as doom and gloom for the CMMI Pioneer ACO program, it is important to remember that this whole program was structured as a pilot to see how HCOs might be ACO conditions. Innovative pilot programs fail, that’s part of the learning process. Now we just need to wait and see how CMS redefines ACO metrics for the future.” – John
Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life
Institute of Medicine Report
“The care continuum has an endpoint. Press coverage of IOM’s report on end-of-life care was a little more subdued than it should have been. While the list of players afraid of this topic is long, PCPs are at or near the top. End-of-life planning should be part and parcel of a variety of care processes. Sadly, it is not. Clinician vocabulary is oblique (i.e. code status, DNR) and designed to make it easier for everyone but the principal. Hopefully, this report has the kind of influence that other IOM reports have.” – Brian
Win-Win? CVS Joining Forces With Hospitals, Doctors
Shefali Luthra for Kaiser Health News
“Article points to the growing reliance that HCOs will have on care extenders, including your local pharmacy based clinic. Not too surprising that CVS chose Epic as their MinuteClinic EHR allowing them to readily share records with major HCOs such as MedStar. Question remains as to how much an HCO will gain in such a relationship.” – John
Bundled Payments: Do They Put Innovation At Risk?
Rebecca Paradis in Health Affairs Blog
“Health Affairs blog article that looks at the current state of bundled payments including the issues of the lack of sufficient and robust public quality metrics that will allow patients to evaluate providers on quality and cost. Increasingly providers are starting to disclose bundled payment pricing on their websites and this past weekend Elliot Hospital in Manchester, N.H., ran an ad in the Sunday paper advertising ‘CareBundles’ with all-inclusive fee prices for colonoscopies, hernia repair, and knee arthroscopy.” – Matt
“The type and scope of bundled payment arrangements continues to expand. But there is a concern that the quality measures embedded in these arrangements could be forcing providers to do things one way, effectively eliminating any incentive to innovate. This blog from Health Affairs talks about how quality measures should focus on effectiveness and be responsive to the need for innovation rather than being simply tools for weeding out costly interventions.” – Brian
After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know
Elizabeth Rosenthal for The New York Times
“Yet another expose about the exorbitant surprise fees that are hidden away in medicine, in this case when visiting (i.e. out of network) physicians and surgeons see admitted patients without prior notice and charge hefty fees for it. Useful to understand how some doctors in private practice have turned nickel and diming into a lucrative side business, complete with legal teams and innovation consultants.” – Naveen
Reference Pricing is Not a Substitute for Competition in Health Care
Keith Brand, Christopher Garmon, and Martin Gaynor for the FTC
“This post from a team at the FTC makes an interesting argument regarding reference pricing models coming to the conclusion, that such models only benefit consumers where there is existing competition among provider orgs. Pity those in smaller communities with only one dominant provider in town.” – John
Healthline’s New HealthData Engine Turns Unstructured Data Into Actionable Insights
Press Release
“Of all the headlines and press releases issued at health2.0, this was one of the more noteworthy. Healthline’s new technology will go to market in 2015, and uses a combination of NLP, keyword identification, and a proprietary risk scoring framework to digest doctor’s notes and other free text fields about patients into insight. They intend to sell to EHRs and other HIT vendors as well as directly to larger delivery systems.” – Naveen
Premier, Inc., eHealth Initiative Survey Suggests Many ACOs Lack Mobile Applications and Face High Costs
Press Release
“Timely survey update (based upon responses gathered in July-August) of 62 ACOs who are members of the Premier PACT Collaborative. Most of the issues that have challenged ACOs including data aggregation and operationalizing analytics back into a provider’s workflow remain significant barriers even for maturing ACOs. While ACOs report improvements on quality processes and outcomes due to technology investments, there is still a real question about the ultimate ROI of these investments.” – Matt
Early Cancer Hospitals Were Modeled on French Castles, Served Champagne
Roman Mars on 99% Invisible
“Cancer care was apparently something most hospitals avoided in the 1800s. A popular quality measure at the time – death rate – caused most hospitals to turn away cancer patients for fear of looking less than effective. This article about the precursor to Memorial Sloan Kettering makes you wonder how durable our current crop of CQMs will be.” – Brian
Affordable Care Act Reduces Costs for Hospitals, Report Says
Robert Pear for The New York Times
“Medicaid expansion will have arguably the biggest impact on future efforts to manage population health.This report from the Feds points to data that shows some of the impacts expansion will have on the delivery system, notably reduced charity care expenses. However, the politicization of insurance expansion remains a sticking point, in some of the neediest, disease-burdened states across the deep south.” – Naveen
Kaufman Hall Point of View: Decline in Utilization Rates Signals a Change in the Inpatient Business Model
Mark Grube, Kenneth Kaufman, Robert York for Kauffman Hall
“Although it was based on a small sample size, Kaufman Hall found inpatient utilization rates either unchanged or down for a majority of nonprofit hospitals through the first 2 quarters of 2014. Also noted that there appears to be a correlation between the level and pace of a market’s shift toward value-based care and the level and pace of utilization decline although this was only based upon 2 markets (Chicago and Minnesota).” – Matt
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