Browsed by
Author: Chris Hadley

Healthcare Reform Across State Lines Exploring differences by state

Healthcare Reform Across State Lines Exploring differences by state

Healthcare Reform Across State Lines Exploring differences by state

 

A recent webinar examined how different providers approach the opportunities and challenges
brought by the Affordable Care Act (ACA). Industry leaders in Florida, Massachusetts, Mississippi,
New Jersey and Pennsylvania shared their views. Below are highlights.

 

Visit our Healthcare Reform Across State Lines webinar replay for more insights.


ACCESS VARIES SIGNIFICANTLY STATE-BY-STATE

Each state interprets the ACA in its own way, driving provider strategy and impacting coverage,
rates and costs. Massachusetts decided early on to maximize access via state health reform.
Access in some other states has been more challenging, with physicians not accepting
Medicaid or Federal Exchange beneficiaries. For Florida, one solution has been proactively
negotiating out-of-network rates for unique services.


EARLY ADOPTER STATES SEE COST BENEFITS

Massachusetts’ early adoption of Medicaid expansion in 2006, plus coverage expansions that
served as a precursor to the ACA, have seen reductions in uninsured individuals and lower costs:

 

  • Per capita health spending growth is lower than the U.S. generally
  • Expansion enabled preventative care and reduced per-member per-month costs when
    compared to other states
  • Insurance participation is more stable than in other parts of the country

STRATEGY/TECHNOLOGY INNOVATION

  • Massachusetts’ early healthcare expansion allowed it to focus on costs and prices as far
    back as 2008. By 2012, its strategy focus was reducing expenditure and encouraging
    alternative payment methods
  • In Mississippi, over 60 hospitals came together to form MississippiTrue, the first
    multi-provider plan in the state
  • Innovations have also emerged in response to the Mississippi Telemedicine Parity Act,
    which mandates that all health insurance and employee benefit plans must provide r
    emote care

UNCERTAIN STATE AND FEDERAL REIMBURSEMENT

Some states have taken pre-emptive measures to cope with a lack of clarity. For example,
53,000 Mississippi residents rely on the Federal Exchange for their health insurance.
There’s uncertainty over whether Cost Sharing Reductions (CSR) will end, which could
increase premiums by 25% in 2018. In response, the state has taken a number of measures:

 

  • It’s allowed exchange providers to submit two sets of rates, one assuming CSR continues,
    and one assuming it doesn’t
  • It has issued waivers to ensure the continuation of coverage through 2018 and to curb
    increases in rates for children under 14


 

ONGOING CHALLENGES

 


A key challenge for providers nationwide is the uncertain outlook for the ACA.
The House of Representatives passed the American Health Care Act (AHCA) to
“repeal and replace” the ACA. It is estimated to achieve more than $100 billion
in Medicaid reductions by 2027.
Being informed and formulating strategies is now more important than ever.

KEY TAKEAWAYS

  • Each state interprets the ACA differently, impacting strategy, coverage and costs
  • Challenges have led to strategy and technological innovation
  • Uncertain state and federal reimbursement, and regulatory changes to the ACA
    make being informed more important than ever

YOU MAY ALSO BE INTERESTED IN:

Insights into Risk-Based Reimbursement

Insights into Risk-Based Reimbursement

Healthcare leaders discuss impact and opportunities

Bank of America Merrill Lynch

 

Five technologies set to transform the healthcare industry

Five technologies set to transform the healthcare industry

Five Technologies Set to Transform the Healthcare Industry

Written by John Hesselmann, Specialized Industries Executive, Global Commercial
Banking at Bank of America Merrill Lynch

The future of healthcare will streamline the way we diagnose and treat health problems. We are already seeing signs of that today: from patients who receive diagnoses and treatment at home via
telemedicine and heart-monitoring wearables, to artificially intelligent therapists diagnosing
PTSD in veterans. Innovation in healthcare can decrease our
dependency on physician availability. To that end, we’re seeing emerging technologies that
deliver diagnoses directly from an app, such as MobileODT, a mobile cancer screening tool,
and Biomeme, which aims to conduct genetic testing for certain diseases within an hour.
Investors should be aware of the innovation set to transform the healthcare industry in the
next few years. Here are five areas expected to undergo tremendous growth:
1. Robotic Surgery: According to WinterGreen
Research, annual sales of robotic surgical
assistants are expected to rise from $3 to
$20 billion over the next five years. While the
notion of a robotic surgeon seems frightening,
it may actually be safer. Robot-assisted surgery
is typically faster and smoother, making
more precise incisions and reducing blood
loss. Currently, the machinery costs a million
dollars or more, however, the advancements
are expected to trim healthcare costs due to
reduced patient stay and aftercare.
2. Genomics: According to MarketWatch, the
international genomics market is estimated to
grow from $12.5 billion in 2015 to $20 billion
in 2020. Advanced genetic testing can help
people discover whether they have inherited
diseases so they can begin treatment before
symptoms occur. Advanced gene editing
has the potential to fight cancer and other
diseases by altering genetic instructions at
the cellular level. Genetic Engineering and
Biotechnology News reports that in the next
10 years it will be possible for every new baby
to have their genome sequenced and stored
with other health records.

Bank of America Merrill Lynch

HOW TODAY’S M&As ARE PREPARING HEALTHCARE ORGANIZATIONS FOR A NEW FUTURE

HOW TODAY’S M&As ARE PREPARING HEALTHCARE ORGANIZATIONS FOR A NEW FUTURE

HOW TODAY’S M&As ARE PREPARING HEALTHCARE ORGANIZATIONS
FOR A NEW FUTURE

Brent McDonald
Head of Healthcare Strategic Advisory,
Managing Director
Bank of America

In the face of seismic industry shifts, challenging
regulations, and constant uncertainty in Washington,
providers are reshaping the healthcare
landscape themselves by entering into strategic
mergers, acquisitions, and partnerships. Today’s
deals are reflective of the times, says Brent
McDonald, head of healthcare strategic advisory
and managing director at Bank of America Merrill
Lynch. “Most providers who are looking to merge
are focused on achieving powerful and costly
objectives such as transitioning to a value-based
payment model, growing a population health initiative,
and improving clinical integration,” notes
McDonald. “They are seeking partners with the
right combination of capital, infrastructure, intellectual
property, and technology.” McDonald discusses
the benefits of integration and how providers are
structuring today’s complex M&As.
What types of strategic partnerships
are common in the current
healthcare climate?
Brent McDonald: We are seeing mergers that
have clear built-in synergies. Oftentimes, the two
organizations don’t just mirror, but rather they
complement each other in strategic ways. When
they merge, it becomes one plus one equals three,
allowing them to more effectively meet the Triple
Aim. For example, one hospital may have spent
more time developing an urgent care network, a
freestanding emergency room, or a micro-hospital
network, while the other recruited and invested in
developing a network of high-acuity specialists.
It’s common to see an urban or academic medical
center that has invested in tertiary subspecialists
integrate with a successful community hospital that
is associated with more primary care physicians.
And it isn’t necessarily that they have economies
of scale available, but they are a very complementary
clinical fit. Partnering with an organization that
has built scalable competencies makes it easier
to justify the execution risk of integrating. If you
merge with a hospital that has spent the time and
resources on a clinical integration network that is
already functioning with the governance, accountability
measures, and physicians in place, then you
don’t have to take on that risk in building your own
network, which could fail.
What are the primary financial benefits
in a merger or acquisition?
McDonald: Overhead is still the most straightforward
and nonclinical financial economy of scale.
Organizations formed through a merger or acquisition
can expect to gain efficiencies in accounting,
human resources, revenue cycle, supply chain, and
other back-office services. These deals also allow
you to spread the cost of investment in health
information technology and population health over
a broader set of hospitals and a larger net revenue
base. Moreover, there may be clinical core competencies
that benefit the two parties post-merger,
including complementary service lines and geographic
ambulatory access points.
What do leaders hope to gain clinically
when entering into a new partnership?
McDonald: Quality is always top of mind. Without
quality and a reputation of quality, your earnings
and growth will suffer, as well as your ability to
reinvest and continue to be a high performing
organization. That being said, when considering a
partnership today, providers are often looking for
specific clinical competencies. For example, having
expertise in case management and physician
integration, as well as having advanced technology
is desirable. Simply having an electronic medical
record (EMR) isn’t enough anymore. How you use
the EMR to make a difference in providing care
is important to a potential partner. An organization
that has mature physician integration and is
advanced in how it uses its EMR system to impact
care likely has physician leaders who have worked
through the data sets to create best practices,
and has clinical care decision matrices embedded
in the medical record, which enables greater standardized
care.
“Without quality and a
reputation of quality, your
earnings and growth will
suffer, as well as your ability to
reinvest and continue to be a
high performing organization.”
How are mergers and acquisitions
helping organizations meet advanced
population health goals?
McDonald: Achieving population health requires
an investment, and if you are precarious from a
balance sheet or a profit-loss perspective, meaning
you don’t have enough margin to reinvest in the
hospital, then you won’t be able to execute on key
initiatives. Infrastructure and technology are the
two critical components that make up the backbone
of population health. They allow a hospital to
measure clinical information and present cohesive
and timely information back to its clinicians. Both
of these competencies require heavy capital investment
and know-how. Having a strong internal
framework and state-of-the-art IT are not something
that smaller, community hospitals can generally do
alone—typically, because they don’t have sufficient
margin to invest in such initiatives across their
subscale network. For example, if a community
hospital is trying to create a center of excellence
in a clinical service line, they may have trouble in
areas such as recruiting the key specialists and
subspecialists. A larger partner will typically have
the technology, case management, and a better
4 Bank of America Merrill Lynch I Sponsored Material
pipeline of doctors. Our Bank of America Merrill
Lynch analysis reflects that there is a correlation
between scale (or size) of an organization and higher
investment-grade credit ratings.
The goals of MACRA include radically
shifting payment models from fee-forservice
to value-based payment. How
does a merger or acquisition support
and accelerate this shift, as well as
help an organization bear
downside risk?
McDonald: MACRA adds more complexity, which
will probably cause more physicians to organize into
larger groups. Clearly, being able to handle value-based
payment is a different way of practicing.
It requires different skill sets. But, the model is still
being shaken out. Will it be hospitals, physician-organized
super groups, or a hybrid of the two that
will be best positioned to transition physicians to
value-based care? We still don’t know.
In the meantime, a traditional independent physician
practice that has to rely on a high volume of
patients just to keep their office open does not
have a lot of excess capacity in their day to deal
with changing payment and care models. It is an
almost impossible task for independent physicians
to influence the health of their patients when they
leave their office and go to the hospital or to an
urgent care center. It requires competencies they
don’t have to compete in this advanced care and
payment system, including an optimized EMR and
the ability to undergo a care redesign. Therefore,
it is difficult to manage downside risk. You will be
more successful having scale and leverage for
these considerations and, also, for weathering the
unexpected revenue ebbs and flows of value-based
care. In a merger or alignment with a larger, capable
organization, physicians become part of a
larger entity that has a sophisticated EMR and
other advantages. These advantages include case
managers and other staff who are available specifically
to follow and enhance that patient’s journey
across different care environments. A larger system
can track someone who visits the ER, making sure
they receive the right follow-up care, do not have
an unnecessary hospital readmission, and have
a positive experience with their provider and the
healthcare system.
Improving the patient experience is
important in a merger or acquisition.
As organizations come together, how
can they address common challenges?
McDonald: There are betterment and integration
hurdles in this area. Most hospital systems are
constantly working toward a better position when
it comes to improving the patient experience. To
get there requires having the right skills to invest in
all of the resources you need. On the other hand,
mergers are disruptive and patient satisfaction
can be damaged as you integrate to a new culture
or platform. It’s important to have a plan for key
patient perception areas such as scheduling, registration,
and medical records. You need a unified
approach when integrating the patient experience.
For example, patients will be frustrated if the process
is disorganized and they have to register three
times in a visit to the hospital. It requires vigilant
attention to get this right.
Bank of America Merrill Lynch

https://www.bofaml.com/content/boaml/en_us/home.html

US spends too little on social welfare: Fact or fiction?

US spends too little on social welfare: Fact or fiction?

US spends too little on social welfare: Fact or fiction?

As we had alluded to previously (see comments section here), we have been hearing the argument “we don’t spend enough money on social services in the US” for quite some time now. So, let’s dissect this argument one step at a time.

First, what exactly do we mean by social spending and how does the US compare with other developed nations? Since good international comparative data on the topic of social spending are hard to find, it is very easy to adjust available data to suit one’s argument. Thus, rather than trying to come up with a single definition and measure of social benefit expenditures, below we highlight some key categories of spending that fit (at least in our minds) into the broad definition of social welfare expenditures.

In the US, it is politically correct and convenient to count social spending as only public/ government spending. Taking the OECD definition of social expenditures, which includes the following social benefit areas:

“old age, survivors, incapacity-related benefits, health, family, active labour market programmes, unemployment, housing and other social areas…public spending on early childhood education and care up to age 6”

and looking at public expenditures as a percentage of GDP, we find that the US ranks #24 out of 35 OECD members, but still above both Australia and Canada, countries often cited as doing more for their citizens than the US (see Figure 1 here). Moreover, when looking at sub-categories of general government spending, we find that in 2015, US spending as percentage of GDP is ranked (among OECD members) as 1st in health; 2nd in defense; 7th in public order and safety; 8th in education – quite a bit better than our overall ranking.

Moreover, social spending is actually more than public/ government spending alone. Interestingly, when both public and private social spending (as defined above by OECD) are accounted for and include the full range of social benefit transfers, the US ranks second only to France in total net social spending as a percentage of GDP (see Figure 4 in same OECD report).

Since spending on health is included in the OECD definition of social expenditures and the US is a known outlier in terms of healthcare spending, a follow up argument we often hear is: “We spend too much on healthcare and not enough on other social services.” While we absolutely agree that US healthcare is in dire need of improvement (both in terms of effectiveness and efficiency), a look at the available data shows that even if we subtract out healthcare expenditures, total spending on “other” social services in the US stands at roughly 13% of GDP and again above some comparison countries (Australia, Canada, Switzerland).

So, maybe the question we should be asking ourselves is not, “are we spending enough on social services?”  Maybe what we should be asking instead is, “are we getting what we are paying for in social solutions?” This is a question of value, that in many ways parallels the one being asked about the state of US healthcare.

Unfortunately, whether one uses broad measures (e.g., overall social spending vs. income inequality) or more specific examples (e.g., spending on education vs. secondary and tertiary graduation rates), Figures 7 and 9 here suggest that we are not getting good value for all the money we spend. Moreover, while the US government spends more on public safety as a percentage of GDP than many OECD nations or the EU28 (see Table 1 here), our rates of incarceration are some of the highest in the world, with some US states spending more money on incarceration than higher education. And while directing some of the “waste” away from healthcare into other social services seems like a sound idea, simply pouring more money into the existing system without any regard for how it is being spent, is unlikely to generate better social outcomes whether the benefit in question is education or income assistance programs.

Rather than spending more money, the US has to look at existing social expenditures as an INVESTMENT and manage these expenditures on an ongoing basis to continuously improve social outcomes, by relentlessly learning from both international and within-US success stories (does that sound familiar?). Social spending needs to be built into a balance sheet (which the US does not currently keep), otherwise everyone will continue to ignore how the funds are managed with no expectations for measurable ROI. This, in turn, will require a shared vision, a shared reality that recognizes the evidence above, and strong leadership from policy makers – all sorely missing in Washington, DC at this time.

Coming to grips with the value of social welfare expenditures is particularly important due to the profound demographic shifts happening around the world over the coming decades. As the OECD social spending report highlights (see Figures 1 and 2) – the vast majority (79%) of public social spending comes in two categories: health and pensions, both heavily influenced by demographics. Thus, rather than focusing simply on the absolute levels of social spending, both the US (with its aging Baby Boomer population) and the EU27 (projected to see a 68% increase in the number of adults over age 65 over the next 50 years) could benefit from a closer evaluation of: a) the sustainability of government social welfare expenditures, given that working age populations will be increasing much less than the older beneficiaries and b) what we get in return for the significant funds already being spent on social welfare.

Leave a Reply

Your email address will not be published. Required fields are marked *

“What Maryland’s All Payer Rate Setting Tells Us About Traditional Medicare Payment Rates”

“What Maryland’s All Payer Rate Setting Tells Us About Traditional Medicare Payment Rates”

What Maryland’s All Payer Rate Setting Tells Us About Traditional Medicare Payment Rates

With some political leaders calling for the US to move to Medicare-for-all and California weighing a proposal to have all patient care reimbursed at Medicare rates, it is worth taking a step back to examine the level of traditional Medicare’s provider payment rates. Specifically, do the current payment rates ensure high quality and access for Medicare beneficiaries, while keeping high-value providers in business. Our review of the latest MedPAC report to Congress and statements made by the Medicare Actuary paints a pretty grim picture, as far as delivering on the above objectives.

The March, 2018 MedPAC report shows that aggregate hospital margins from Medicare have gone from -4.9% in 2010 to -9.6% in 2016, and are projected to be -11% in 2018. It is of interest to note that MedPAC looks only at Medicare ‘allowed’ costs – which removes many other expenses incurred by hospitals such as private rooms for patients, telephones and TVs in patient rooms, marketing communications, interest on certain borrowed funds, etc. Thus, true Medicare margins, that are based on total costs, are actually worse than those reported by MedPAC.

Low Medicare payment rates and their implications for both beneficiaries and providers have also been the subject of repeated commentary by the Medicare Actuary, e.g.,

  • “Limiting (Medicare) cost growth to a level below inflation would represent an exceedingly difficult challenge… Providers for whom Medicare constitutes a substantial potion of their business…might end their participation in the program”
  • “…the prices paid by Medicare for most health services will fall increasingly short of the cost of providing such services. If this issue is not addressed by subsequent legislation, it is likely that access to, and quality of, Medicare benefits would deteriorate over time for beneficiaries.”

The CMS Maryland experience
So, how can we estimate the true magnitude of the problem with current Medicare provider payment rates? One state in the US, Maryland, has had all payer rate setting for over 40 years. The Health Services Cost Review Commission (HSCRC), an independent agency established by the Maryland legislature in the early 1970s, is charged with setting uniform hospital service rates. As such, all Maryland payers are charged the same rates approved by the commission (with a modest discount allowed for Medicare and Medicaid). While Maryland can certainly work on improving efficiency (and is moving in that direction with the recent transition to global budgets), one would presume that the present rates are set to meet the following goals of the commission:

  • “Ensure that hospitals have the financial ability to provide efficient, high quality services to all Marylanders
  • Increase the equity or fairness of hospital financing”

If the above presumption is true, then Maryland’s all payer rates can shed light on the adequacy of traditional Medicare’s payment rates to accomplish the same two objectives.

Fortunately, CMS-commissioned evaluation reports of the Maryland All-Payer Model have done some detailed work on this particular topic. Specifically,

  • “The analyses compared the weighted average payment per inpatient admission in Maryland and a comparison group for the same mix of admissions… also examine the weighted average payment per hospital outpatient visit. Using the same mix of admissions and hospital outpatient visits controls for utilization differences between Maryland and the comparison group so the comparison only reflects payment rate differences.”

The latest evaluation report shows that between 2011 and 2016, Maryland Medicare rates for inpatient admissions were 33-40% higher than in the comparison group paid at traditional Medicare rates. The payment gap was even wider for outpatient hospital services, with Maryland Medicare payment rates (FY2013-2016) coming in at 55-62% higher than those of the matched comparison group paid at traditional Medicare payment rates. Clearly, the present policies of increasing traditional Medicare payment rates by less than inflation, have created a major Medicare payment shortfall, which (absent major changes) will get even bigger in the coming years. The rate gap further suggests that the under age 65, privately insured patient population, is currently subsidizing the care of Medicare beneficiaries. Thus, trying to put all patients on traditional Medicare payment rates would make the Medicare Actuary’s worrisome conclusions even more dire. Conversely, assuming Maryland is doing a good job setting payment rates, going to Medicare-for-all using the Maryland model, would require massive increases in rates over what Medicare presently pays everywhere else. Unless there was a change in provider efficiency, there would need to be ~40% increase in what Medicare pays for inpatient admissions and ~60% increase in payment for outpatient hospital services.

Medicare payment policies could benefit from a major overhaul
Based on the various sources of evidence presented above, we believe that Medicare payment rates are too low and getting worse every year. That said, we also believe that it is incumbent on the delivery system to improve efficiency and thus get better value. While providers would certainly welcome increases in Medicare payment rates, changes in payment rates alone will not be sufficient to drive improvement in healthcare delivery.

As we think about what providers should be paid, it would behoove us to remember a Commonwealth Fund blog by Dr. Stuart Guterman and others, which stated that: “… payment levels must be carefully calibrated to ensure providers’ financial viability while providing incentives to reduce costs and safeguards to ensure high quality.” Unfortunately, our conclusion is that traditional Medicare payment rates and policies fall short of the Commonwealth Fund recommendations. The financial viability of the US healthcare provider depends heavily on private payers (and thus the younger and employed population), while traditional Medicare is characterized by wide variation in service utilization, costs, and patient outcomes.

We believe that accomplishing the objectives described by Guterman et al., can best be accomplished by payment structures that ensure the financial viability of high value providers – those getting better patient outcomes at lower than average costs. In turn, the rates should be based on the real costs of doing business by these highest value providers (and not what Medicare currently pays them) plus a 2-4% margin, since even non-profit organizations need reserves to address changing staffing needs, replace aging equipment, etc. With regard to the need for a positive margin by providers, it is of interest to note that the Maryland HSCRC agrees. It has established hospital profitability targets of 2.75% operationally and a 4% total margin.

While we have detailed such value-based payment approaches in previous publications, it may be worth re-iterating a couple of the key components. Again, taking the state of Maryland as an example, Figure 1 shows the distribution of risk-adjusted quality index (based on the 90-day complication rate for hip/knee replacement) vs. the corresponding cost per episode of care. A base payment rate could be set at the 80thor 90thpercentile of the delivery organizations that are in the high value quadrant (i.e., those that get better than average quality at lower than average cost). A further quality withhold (e.g., 5%) could be used to ensure that providers don’t sacrifice effectiveness in the name of efficiency or that we do not reward low quality providers for simply being low cost. HSCRC has an objective establishing “rates sufficient to meet ‘full financial requirements’ of efficient/effective hospitals.” The pay for value approach we outlined above would create a strong incentive for providers to move to high value. If we truly desire a high value healthcare delivery system, we would be more likely to get it, if we actually paid for value.

2 thoughts on “What Maryland’s All Payer Rate Setting Tells Us About Traditional Medicare Payment Rates”

  1. Excellent piece – and the last sentence is so critically important.

    “The pay for value approach we outlined above would create a strong incentive for providers to move to high value. If we truly desire a high value healthcare delivery system, we would be more likely to get it, if we actually paid for value.”

  2. Denis and Bob:

    A great reminder that the Medicare for All advocates do not really understand the financial implications of their aspirations…there also is a hope that administrative savings will arise as marketing, customer service and claims processing needs diminish–really? Hope your summer going well…keep the conversation going…

Leave a Reply

Your email address will not be published. Required fields are marked *

Single-Payer Health Care in California: Here’s What It Would Take

Single-Payer Health Care in California: Here’s What It Would Take

“California Voters are Thinking about the Fundamental Values Associates with Single-Payer but Almost Zero Voters have Thought About the Policy Implications.”

I have been out of the loop the past two weeks on vacation back to my “roots”. While I was gone, some news came out from the New York Times on May 25th. The article summarizes political talk in California about Single-Payer Health Care in California.

It brings back some memories of the 2016 Amendment 69 here in Colorado.  The concept is frequently titled “Medicare for All”. It is interesting reading to hear what could happen in California if it becomes reality there.

To check it out click the link below:

https://mobile.nytimes.com/2018/05/25/business/economy/california-single-payer.html

Chris Hadley
President and Founder
Denver Medical Study Group
denvermedicalstudygroup@gmail.com

“Leading Though Learning—-Healthcare Innovation & Reform”

 

June 27th, Benjamin F. Miller, Psy.D., Chief Strategy Officer, Well Being Trust

June 27th, Benjamin F. Miller, Psy.D., Chief Strategy Officer, Well Being Trust

“Systems Wanted: Programs Need Not Apply”

Benjamin F. Miller, Psy.D., Chief Strategy Officer, Well Being Trust
Former Associate Professor, Department of Family Medicine, University of Colorado School of Medicine, Founding Director, Eugene S. Farley, Jr., Health Policy Center

The problems that exist in health care are so pervasive that new programmatic solutions are not going to solve them. Simply put, programs matter, but we need more thoughtful connection of these programs into a true system of care that can take into account the various pieces of health that health care has fragmented. Consider the problem our nation is facing with addiction – specifically, the opioid crisis. If all we did was to create a new program to decrease the amount of opioids on the street (supply side) we have done little to address the underlying issues driving our disease of despair, which are predominately social in nature (demand side). To this end, the last thing we need are more disconnected programs in this country without first creating a true system where people do not fall through the cracks.

This presentation will highlight some of the problems, elevate solutions, and most importantly help underscore the importance of making thoughtful systemic decisions for how we begin to address health. Using examples from business, health care, and on the ground experience, a framework will be proposed to help evaluate how we approach complex solutions to complex problems.

  • Attendees will be able to describe some of the problems around fragmentation in health care, specifically the impact this has on mortality;
  • Attendees will leave able to explain some of the solutions to addressing mental health and substance use in the larger context of health and community; and,
  • Attendees will be able to list the elements associated with a National Resilience Strategy and specific actions we could take together

WHEN: Wednesday, June 27th from 12 noon to 2 p.m.

WHERE:  COPIC offices, 7351 Lowry Blvd., Denver, CO 80230

REGISTER:   RSVP for this month’s event by clicking the appropriate button below.

Click Here to Register

I will not attend this month’s event     

Sponsored by:   

Hosted by:

COPIC

Our Evening with Glenn Steele, MD, PhD on April 4, 2018

Our Evening with Glenn Steele, MD, PhD on April 4, 2018

Our Evening with Glenn Steele, MD, PhD Talking about Value-Based Healthcare: What It Looks Like, What it is, How to Achieve it.

Dr. Steele shared with the group how Geisinger developed its “Warranty” or “Money Back Guarantee”, and it’s effectiveness through Proven Care, systematic implementation of surgical procedures from one provider to another. He also spoke about xG Health Solutions that Geisinger developed to help other health systems develop more effective healthcare strategies.

With Dr. Steele’s role as Vice Chair of Health Transformation Alliance (HTA), Glenn talked about the efforts the 46 of the country’s largest employers working together to take population health management innovations out to markets where Geisinger has not expanded its provider component.

Sponsors, Key Bank (Melissa Whitmer) and Eide Bailly (Bruce Kirkpatrick) join Dr. and Mrs Steele (and Chris) for a photo of the speaker during the reception hour prior to the meeting.

We thank both Melissa and Bruce and their employers for their support of the Denver Medical Study Group this year. They are greatly appreciated!

Glenn and Chris listening intently to one of our attendees who is asking question about the HTA program and its similiarity to the recently publcised announcement of JP Morgan, Amazon and Berkshire Hathaway announcement of their intent to form their own health insurance plan for their employees.

 

Bobbie Kite and Dave Baker, DMSG Advisory Board members welcoming guests in the Children’s Hospital lobby.

 

 

Jennifer Brin and Dea Robinson, DMSG Advisory Board members, registering guests before they join the rest of our group in the reception lobby for hot appetizers and drinks.

 

 

Below: DMSG guests intently listening to Dr. Steele’s presentation about how HTA is going to expand its clinics in other parts of the country during 2018. They currently have clinics open in six different cities in the eastern part of the U.S. Their plan is to expand into six more cities in central and southwest U. S. in 2018.

Below: DMSG guests visiting about Dr. Steele’s presentation after the meeting. Dr. Marjie Harbrecht on the left is a long time supporter of the DMSG and has spoken to the group at previous meetings.

The meeting was a success and our guests left with a greater understanding of what can be done to provide effective value-based healthcare in Colorado.

The Bridge Across the healthcare delivery chasm, from where we are, to where we want to be

The Bridge Across the healthcare delivery chasm, from where we are, to where we want to be

Denis A. Cortese, MD, joined Arizona State University (ASU) in 2010 as Foundation Professor, Director of ASU’s Healthcare Delivery and Policy Program, and President of the non-profit Healthcare Transformation Institute based in Phoenix, AZ. He is an Emeritus President and CEO of the Mayo Clinic, and former head of the Mayo Health Policy Center.

Professional activities as a staff member of Mayo Clinic were in the field of pulmonary medicine including interventional bronchoscopy, critical care, with special interests in early and advanced stage lung cancer, liver and lung transplantation. Activities in education included the medical school and director of the pulmonary-fellowship training program.  Research was focused on NIH funded endoscopic laser photodynamic therapy for early stage lung cancer and on NdYAG-laser phototherapy of advanced stage airway obstructing cancer.

In addition to his current ASU academic position, Dr. Cortese currently serves on the board of trustees of Dartmouth-Hitchcock, and the boards of directors for Cerner Corporation, Essence Global Holding Corporation, and Pinnacle West.

Dr. Cortese is a member of the Institute of Medicine of the National Academy of Sciences, where he served as the original chair of the Roundtable on Value and Science-Driven Health Care; a National Associate of the National Research Council; an honorary member of the Royal College of Physicians (London) and the Academia Nacional de Medicina (Mexico).

He formerly served in the following positions: member of the health advisory board of RAND; member, and served as the chair of the board, of the Health Care Leadership Council in Washington, DC.; member of the Harvard/Kennedy Health Policy Group; member of the Division on Engineering and Physical Science (DEPS) of the National Academy of Engineering.

Dr. Cortese received his undergraduate degree from Franklin and Marshall, an MD from Temple University, and completed residency training in Internal Medicine and Pulmonary Diseases at the Mayo Clinic. He is a recipient of an Ellis Island Award (2007) and the National Healthcare Leadership Award (2009).

Robert K. Smoldt, MBA is Chief Administrative Officer Emeritus of the Mayo Clinic and currently serves as Associate Director of Arizona State University’s Healthcare Delivery and Policy Program. He served as a member of the Mayo Clinic Board of Trustees and Mayo Clinic Executive Committee from 1990 through 2007, and is presently pursuing U.S. health reform in close partnership with Dr. Denis A. Cortese. Mr Smoldt served two terms on the Board of Catholic Health Initiatives and continues as a member of its Finance Committee.

Mr. Smoldt earned a BS from Iowa State University and an MBA from the University of Southern California. He has given numerous presentations and is a recognized speaker on the healthcare environment. Mr. Smoldt has provided leadership at Mayo Clinic facilities in Rochester and Scottsdale. He has completed two terms as secretary of the Mayo Clinic Rochester Board of Governors and served on the Mayo Clinic Scottsdale Board of Governors as a senior advisor from 1998 to 2000.

He has been involved in healthcare administration for over 30 years — both with the U.S. Air Force and the Mayo Clinic. Mr. Smoldt joined Mayo in 1972, and he has worked in a variety of administrative positions in both medical and surgical departments. Prior to his CAO role, he served as chair of the Department of Planning and Public Affairs.

Mr. Smoldt has also been active in Medical Group Management Association, along with other members who manage and lead medical facilities across the nation — and work together to improve the knowledge, skills and the effectiveness of medical group practices. He has chaired the organization’s research and marketing committees and has acted as moderator of its international conference in London, UK. Most recently, he was a member of the Medical Group Management Association National Awards Committee, which honors those who make significant leadership contributions to healthcare administration, delivery or education in medical group practice and presents the following awards: Harry J. Harwick Award for Lifetime Achievement Award, Physician Executive Award, Fred Graham Award and Medical Practice Executive of the Year Award.

The views expressed on this website are our own and do not reflect the views of our current or former employers.

Copyright © 2018 The Bridge — Primer WordPress theme by GoDaddy