An accountable care organization (ACO) is type of managed care organization in which physicians, hospitals and other providers takes responsibility for the health and wellness of a population of patients, including responsibility for high quality, appropriateness, and efficiency of the care provided.
Groups matter When working as a consultant, leader, analyst or designer, the work requires a mix of individual contributions and group contributions. Group processes are required to (1) generate ideas, (2) vet ideas, and (3) achieve consensus, which is often a pre-requisite to buy-in and approval of initiatives to improve or build something. Group processes
The recent nominations of science-disrespecting people to lead HHS and CMS should be a wake-up call. Growing up, I naively believed that antipathy to science was relevant in Galileo’s time, but not modern times. Scientists as people were sometimes treated with disdain — as nerdy, awkward people wearing beanies with propellers, pocket protectors with slide-rules,
In the November 1, 2024 issue of JAMA, Ciara Duggan and others from Harvard and Brigham published a paper evaluating the utilization of “low value services” across major Medicare Advantage insurers and Traditional Medicare. Low value services utilization was defined based on the Choosing Wisely campaign and the US Preventive Task Force, and incorporated in
A JAMA study reports that PCPs are contractually held accountable for 57 unique quality metrics and asserts that is “oversaturation.” I have disagreed with the premise that we need fewer measures. On the contrary, I believe that we actually need a lot more measures to finally convince health care provider organizations to stop trying to “study for the test” and to actually learn the subject and improve the core processes that drive health care quality.
There are many good people at the CMS Innovation Center (CMMI). They mean well. They are our friends. But friends need to call out friends when they are out of line. I received an email this morning from CMS announcing the launch of their new “Value-Based Care Spotlight” website. Right near the top of the
This month, disappointing evaluation results call for re-thinking of our approach to improving specialty care. Nancy Keating and 12 of her colleagues from multiple medical schools and consultancies working with the CMS Center for Medicare and Medicaid Innovation (CMMI) published the results of their formal evaluation of the Oncology Care Model (OCM), a three-year large-scale
The Biden administration’s CMS Innovation Center 5-year vision conspicuously lacks mention of what I consider to be necessary course corrections to reverse a disappointing first decade.
What is missing from the CMS Innovation Center five year vision? Read More »
In a recent health policy viewpoint article in JAMA, Drs. Don Berwick and Rick Gilfillan noted that, although the CMS Center for Medicare and Medicaid Innovation (CMMI) has done some good during its ten+ years of existence, it has failed to “become the engine that it could be for transforming the nation’s health care finance
To meet post-pandemic expectations of consumers, healthcare providers need a strategy for consumer-focused care processes, supported by consumer-friendly provider networks and enabling technology.
3 steps for executing an effective consumer-driven physician strategy Read More »
Paul Krugman recently wrote an article in the New York Times posing the question: if repealing Obamacare is off the table (for now), should people on the “progressive” end of the political spectrum push for a single-payer “Medicare for all” system or just advocate for incremental improvements to the privatized Obamacare model? He says if
