Week of November 2-6, 2015


Strategy and the Health Care Marketplace
In this paper from the National Academy of Medicine, we will share our perspectives—shaped by our collective experiences in public health, private health delivery organizations, and academic medical centers—on the theme of multi-sector collaboration: why it is imperative, obstacles that can impede it, and some thoughts about how these obstacles can be addressed.  A Perspective on Public–Private Collaboration in the Health Sector,

The three examples included in this article demonstrate that with visionary leadership, a commitment at all levels to driving clinical and financial improvement and the right technology platform, Population Health Management has the ability to help nearly any organization manage its patient population more effectively.  Population health done three ways,

Healthcare’s second curve is coming fast. Hospital and health system leaders know they won’t survive it without improving alignment, collaboration and trust with physicians.  The first curve was all about pay for volume.  The same won’t hold for the second curve. It will be about pay for performance, outcomes, population health management, the Triple Aim and other forms of pay for value. 7 steps to achieve physician-hospital alignment, collaboration and trust

With the rise in patient financial responsibility, healthcare is being viewed as any other commodity, with consumers asking how to get the best quality for the best price. During an Oct. 13 webinar, hosted by Becker’s Hospital Review, three leaders from Ascription Medical Consultants detailed how healthcare providers can harness healthcare consumerism to establish a direct-to-consumer marketing plan, which builds a pool of reliable referrals. Build a reliable referral stream with direct-to-consumer marketing: 5 key points, 

Major advances in medicine and technology have tested the ability of providers and systems to keep pace with the need for corresponding care delivery redesign. The acceleration of payment reform, which emphasizes value over volume, has challenged healthcare systems as they transition to managing populations while continuing to operate in a primarily fee-for-service environment.  The Institute for Healthcare Improvement, 10 New Rules to Accelerate Healthcare Redesign,  

In the last six years, a Harvard Business School team has worked with dozens of health care organizations to help them understand the true costs of their treatments for many medical conditions. These efforts were part of the providers’ quest to increase the value of their care delivery — in other words, achieve better outcomes at the lowest-possible cost. The HBS team has been using Time-Driven Activity-Based Costing(TDABC), an approach initially proposed by one of us (Bob Kaplan) and Michael Porter, to help providers pursue the value-based delivery of care.  One of the team’s central findings is that TDABC cannot be delegated to the finance function. The Mayo Clinic Model for Running a Value-Improvement Program, 

In all of the loud and necessary debates over how to reform health care in the United States before it bankrupts the country, there is one element that has been continually overlooked: the management systems employed by hospitals. Leaders at good hospitals around the country are working hard on cutting waste and added cost and improving the quality of care and patient satisfaction.  However, old-fashioned management-by-objective systems often work to actually undermine all of the good works by those frontline improvement teams.  Hospitals Can’t Improve Without Better Management Systems,

The shift from volume-based to value-based health care is inevitable. Although that trend is happening slowly in some communities, payers are increasingly basing reimbursements on the quality of care provided, not just the number and type of procedures. But because most providers’ business models still depend on fee-for-service revenues, reducing volume (and increasing value) cuts into short-term profits. How, then, are innovative providers redesigning care so that, despite financial pain in the short term, they achieve long-range success?  Turning Value-Based Health Care into a Real Business Model,

ACA Implementation
Americans with incomes between $11,770 and $47,080 (100% to 400% of the federal poverty level) who enroll in a marketplace plan are eligible for a premium tax credit. Recent survey research by The Commonwealth Fund has found that these subsidies make marketplace plan premiums comparable to premiums paid by those who have employer coverage. Financial Assistance for Marketplace Health Plans: What Consumers Should Know, 

After nearly two years in operation and millions of dollars spent in development, the small business health insurance exchange created by the Affordable Care Act is struggling to catch on. Small Businesses Snub Obamacare’s SHOP Exchange, 

Discussions of health care policy generally involve two broad topics—insurance coverage and costs. I will talk about both today, but in rather different ways. For insurance coverage, I think federal policy has established the right framework, and rather than describe specific next steps within that framework, I will explain why I think we should keep that framework. For health care costs, I think federal policy has made less progress, and I will propose a set of significant changes. Douglas W. Elmendorf former director, Congressional Budget Office (CBO) at Brookings,

Across the states, Preferred Provider Organizations are being dropped from insurance marketplaces, or greatly reduced, in 2016.  Two-thirds of the 131 carriers that offered silver-level preferred provider organization plans in 2015 will either drop them entirely or offer fewer of them in January.  Burnt Offerings? PPOs DECLINE in Marketplace Plans, 


New Medicare Rule Authorizes ‘End-of-Life’ Consultations, New York Times
Obama Administration Plans Forum on High Drug Prices, New York Times,   
GOP Views of Medicaid Expansion Differ From Conventional Wisdom, WSJ, 
Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century, PNAS, 
Medical Societies Seek ‘Meaningful’ Relief From Congress, Medscape, 
UK healthcare ‘lagging behind other rich nations’, BBC News, 
Health Co-Ops’ Failures Spur Finger-Pointing, WSJ, 
Gilead, AbbVie Asked by U.S. for Hepatitis C Pricing Options, Bloomberg News, 
The percentage of American adults in recent years who took at least one prescription drug increased to nearly 60%, up eight percentage points from about a decade earlier, according to a study published Tuesday in JAMA, Trends in Prescription Drug Use Among Adults in the United States From 1999-2012,



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