Editor’s Note: Mark R. Anderson, FHIMSS, CPHIMS is the CEO of AC Group and a member of Innovaccer’s Board of Advisor, a Silicon Valley-based healthcare analytics company. Previously, he is a former CIO for 5 IDNs, an interim CFO, and CEO of Rural Hospitals. 

Policymakers and private industries have been pushing for a change in healthcare reimbursement policy. Back in January of 2015, several of the nation’s largest health care systems and payers, joined by the purchaser and patient stakeholders, announced a powerful new private-sector alliance dedicated to accelerating the transformation of the U.S. healthcare system to value-based business and clinical models aligned with improving outcomes and lowering costs.

Payers and providers have been challenged by the Health Care Transformation Task Force (which comprises of six of the nation’s top fifteen health systems and four of the top twenty-five health insurers) to join its commitment. They aim to put 75 percent of their business into value-based arrangements that focus on the achieving a Triple Aim of

●      Better health

●      Better care and

●      Lower costs by 2020. 

After the Secretary of HHS, Sylvia Mathews Burwell, made an announcement that 50% of the Medicare payments would be shifted to alternative payment arrangements such as ACOs or bundled payments by 2018, together, these two decisions are sending a clear message that focus of both the private and public sectors is to transition from fee-for-service model to alternative payment arrangement known as value-based reimbursement.

What is Value-based reimbursement?

To meet the increasing demands of aging population healthcare as a whole is making an effort to move from traditional fee-for-service (FFS) reimbursement to Value-based reimbursement. The Value-based Reimbursement process has been designed to improve the clinical outcomes and performance by shifting the reimbursement from “volume to value” by incorporating financial incentives.

But that might not be sufficient to achieve the targeted transformation; it requires a holistic approach to Value-based reimbursement that includes a new emphasis on population health, care coordination, new alliances between various healthcare organizations, physician offices/clinics, and investments in new tools and services promoting such activities. The provider organizations’ VBR transformations requires interoperable EHRs which are capable of capturing patient data from any clinical practice, normalize that data, and makes it easily accessible and usable for physicians.

Secondly, providers must create comprehensive care coordination and patient engagement programs designed to create real-time clinical for providers of care. For Health plans, the foundation is the development of strong next-generation clinical business intelligent tools to go along with the current claims adjudication systems plus the need to create real-time care coordination programs designed to engage their members and the treating physicians.

One of the major challenges in the VBR financing system is a lack of knowledge on what technologies are required and at what phase. The problem for most decision makers is that when you look at the offerings, you get about 60 different offerings and very few are designed around needs of today and the future. The problem today is in products or services that are needed in the industry without first defining the real needs of the specific organization. For example, it’s like selling “transportation” – do you need new shoes to walk, a skateboard, a two-passenger auto, a truck, a boat to go across water, or an airplane to move people and supplies across regions.  We must first determine our needs and then match those needs to the multiple suppliers.

Why implement VBR?

Clinical Decision Makers need the right information, provided at the right time, about the right patients, with the right clinical rules and guidelines, on the right devices (The 5 Rights of VBR). To assist both Payers and Providers, we came up with 15 different functionalities required to thrive in a VBR financial world, and “Population Health” is only one of the 15 categories. Starting from the bottom and working up, healthcare organizations interested in VBR financing models must have the ability to connect multiple EHR products together from multiple vendors in order to create a single-view of the patient’s condition over time.   

Of course, since providers use different patient naming conventions and do not always collect the right information, the healthcare organization needs the ability to match patient (Master Patient Index) and the ability to cleanse the data so that garbage is removed from the patient single 360 view of the patient’s record. Once you have the single view of the patient’s clinical and financial records, you can create patient registries, and you can start analyzing your population based on clinical rules and guidelines (Population Health). This is where 40% of the so-called “population health” vendors in the market stop. The vendors highlight patient populations, costs, outliners, and help determine which physicians follow protocols. However, most so-called “population health” vendors do not provide actionable items directed to care providers on what necessary steps are required to improve clinical outcomes.

Care Coordination

As far back as June of 2007,  the Agency for Healthcare Research and Quality (AHRQ)[1] identified over forty different definitions of ‘Care Coordination’ and related terminologies and developed a working definition drawing together common elements. Overall, AHRQ defined Care Coordination as:

“The deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery of health care services. Organizing care involves the marshaling of personnel and other resources needed to carry out all required patient care activities, and is often managed by the exchange of information among participants responsible for different aspects of care.”

This definition is adequate, but how does an organization implement Care Coordination without the right technologies. The simple answer is, “It Can’t.”  

Advanced Care Coordination requires a single source of patient data, risk stratification, clinic alerts and guidelines based on best practices and all of this information needs to be presented in a simple manner that notifies the Care Coordinators about gaps in care and high-risk patients that need action “today.” Care Coordinators do not need a list of 500 patients that meet certain criteria; they need daily worklist of high-risk patients that need intervention today based on selected criteria and a list of patients that need intervention tomorrow. A care Coordinator cannot interact with 500 patients in one given day, so the advance software most priorities the patients based on criteria established by the various paying sources – usually Medicare or Health plans.

 Once the Care Coordinators are provided a short list of patients to interact with on a daily basis, the Care Coordinators need instructions on what additional information is needed from either the patient or their family (Patient Engagement).  This could be in the form of online questionnaires and remote monitoring of patients via home monitoring devices or even new inventions like Fit-Bit. Once the additional patient related data is collected, the next generation VBR software should recalculate the patient’s risk score and should create an updated patient-specific care Coordination plan for the patient. Depending on the results, clinical alerts should be automatically electronically transmitted to the appropriate physician’s EHR software application in the form of a clinical message or alert.  For effective Transition of Care, the physician should not have to log into a separate software application.  The physician works within their EHR and should not have to leave their EHR to get clinical updates on their patients.

The current scenario

Now all of this might sound great, but do Care Coordination and VBR technology increase the chance of success?  First, let’s look at August 25, 2016, CMS announcement regarding the 2015 financial and quality performance results for 392 ACOs. The results showed:

●       There were 83 ACOs out of the one that had health care costs lower than their benchmark but still did not qualify for the annual shared savings because they couldn’t meet the minimum savings

●       An increasing proportion of ACOs has generated savings above their minimum savings rate each year. For the Performance Year ‘15, 120 out of 392 total ACOs (31%) generated savings above their Minimum Savings Rate compared to 92 out of total 333 ACOs (28%) in Performance Year14 and 58 out of total 220 ACOs (26%) in Performance Year 13.

●       Accountable Care Organizations like some in Pioneer Model who have more experience in the program were more likely to generate savings above their MSR. For the PY 2015, 42 percent of Accountable Care Organizations that started in 2012 generated savings above their MSR as compared to the 37 percent of 2013 starters, 22 percent of 2014 starters, and 21 percent of 2015 starters.

●       45 percent of Accountable Care Organizations participating in the Advance Payment model or ACO Investment Model tested by the CMS Innovation Center, which offers select Shared Savings Program ACOs pre-paid savings, generated more savings above their Minimum Savings Rate compared to 29 percent of all other ACOs.

The one factor that was missing from the discussion related to “how does advanced technologies drive financial and clinical improvements.” Our research indicates that the ACOs with the best results had advanced VBR software technologies that performed almost all of the 15 aspects of our VBR functionality table provided earlier.  We have been involved in numerous projects where Advanced VBR technologies were used to improve clinical quality outcomes while reducing overall costs. 

Success Stories

A Health Plan with 500,000 covered lives in Southern California decided that they wanted to create a pay-for-performance program for local providers based on reducing costs while improving quality outcomes for their higher risk patients with chronic diseases.   Before implementing and advanced VBR software application, the health plan relied on 90-day old adjudicated claims for their risk-adjusted evaluations.

They realized they need more data.  The operational plan called for the consolidation of real-time patient-specific clinical data from their active 2,300 providers including lab results, active medications, problem lists, allergies, vital signs, ER visits and Hospitalization, immunizations, and other data that could be collected from the National C-CDA interoperability standard.

The Health Plan applied technology that could provide:

●      One common view of risk stratified consolidated cleansed patient data from over 25 different EHRs with a Master Index to insure data integrity

●      Advance data analytics so that the healthcare plan could create disease registries so that they could identify gaps in care based on best practice clinical guidelines

●      Comprehensive Care Coordination program for identifying recently discharged patients from local Emergency Rooms and Hospitals and best practice guidelines for patients with COPD and Diabetes,

●      An interactive patient and family engagement program to encourage patient compliance with clinical protocols,

●      Last, the ability to passed clinical results back to individual physician’s EHR applications to gain trust within the physician population and to encourage physician interaction with the health plans Care Coordination program.

Within 12 months the health plan had integration of multiple structured and unstructured data streams to create one intelligent real-time view of the patient’s clinical data and current treatment plans and assignment to clinical care coordinators based on risk factors. It could better predict disease frequencies by mapping external factors at the city and county level using search trends, demographic patterns, and physical factors like obesity, smoking, etc. while identifying key factors over time that enabled data-driven intervention plans.

The results of all these in one year were:

1.     Reduced ER re-admission rates within 48 hours by 42%

2.     Reduced Hospital Readmission rates within 96 hours by 67%.

3.     Improved quality scores for COPD and Diabetes by implementing advanced clinical Care Coordination guidelines and working with local care providers.   Results included in a reduction of diabetes patients with uncontrolled H1C values > 9.0 by 38%, improved compliance with annual eye and foot exams by 78%, and through education and patient engagement, reduced BMI scores by 12.5% for patients with Diabetes.

4.     Health plan’s calculated return on Investment of increased by 300% within 12 months of implementation.

Another Health Plan with 325,000 lives covered in the Mid-West that wanted to reduce the costs of Emergency Rooms and Hospital readmission through the development of a predictive modeling program designed to foresee readmission based on patient conditions and home conditions through an advanced patient engagement care coordination program.  Prior to implementing and advanced VBR software application, the health plan relied on 90-day old adjudicated claims for their risk-adjusted evaluations. 

Like the prior case study, they realized they needed more data.  The operational plan called for the consolidation of real-time patient-specific clinical data from the 12 hospitals in their geographic area including the reason for admission, discharge plans, order results, discharged medications, and other clinical and operational data.  The Health Plan had Health IT that could provide solutions similar to the previous health plan.

Within 3 months the health plan had Integrated patient information from all six hospitals and created an intelligent real-time view of patient information and was able to assigned risk stratified patients to specific care coordinators based on their clinical expertise. The results were:

1.     Reduced ER re-admission rates within 48 hours by 23% within 6 months and by 37% within 12 months.

2.     Reduced Hospital Readmission rates within 96 hours by 18% within 6 months and 42% within 12 months.

3.     Reduced Medical Loss Ratio (MLR) by 34% for patients with risk of readmission.

4.     These improvements in financial performance created a 6x return on investment on their advanced VBR software costs within 12 months.

The Road Ahead

Advanced VBR software is not only necessary but required for both Payers and Providers in order to thrive under a VBR financial model. To thrive in this new market, payers and providers must start with data integration from multiple sources, implement advanced analytics and Care Coordination programs based on best practices and national care guidelines, and should implement patient and family engagement programs.

To accomplish these fundamental requirements and to thrive in the new VBR financial models, Payers and Providers should search for software vendors that meet all of the 15 components of VBR. Additionally, since you will need a minimum of 12 months of prior patient data for true risk stratification, the time implement advanced VBR software is today. Medicare VBR contracts will begin on October 1, 2017, followed closely by commercial insurance plans in early to late 2018. So the time to start evaluations is now and improve on quality metrics at a lower cost of care.

Able Health is a health IT company dedicated to making value-based care work for providers has launched an end-to-end MIPS solution enabling providers to improve performance and submit data to CMS with less time, money, and stress. The new platform can ingest patient data from electronic health records and data warehouses, calculate any MIPS registry quality measure or eCQM, and provide a dashboard for administrators to track and improve a group or provider’s MIPS Composite Performance Score.

Starting on January 1, 2017, the Merit-Based Incentive Payment System (MIPS) is a new CMS program that combines PQRS, Meaningful Use and other reporting programs into one performance-based payment system. The program is causing significant fear among providers due to the shift to value-based payment models and overwhelming reporting burden.  A Modern Healthcare survey found that three-quarters of healthcare leaders believe the administrative burden of MIPS will cause greater physician stress, and nearly half said more physicians will leave Medicare.

The dashboard was developed through a user-centered design process and educates users on program requirements in their day-to-day workflow, reducing training requirements. The technology platform includes a user-friendly way for providers to review, improve, and submit performance to CMS based on data from their EHRs. Able Health also facilitates data submission to CMS for all three reported performance categories: Quality, Advancing Care Information, and Improvement Activities.

Getting legislation through Congress—often a monumental battle, as demonstrated by recent efforts to pass the American Health Care Act—is one thing. But implementing new laws may be a greater challenge simply because they require so much sustained energy and attention.

Take mental health parity laws, for example.

Congress passed the Mental Health Parity Act (MHPA) championed by Sens. Paul Wellstone (D-MN) and Pete Domenici (R-NM) in 1996. The law prohibits employee-sponsored group health plans from charging more in a year or over a lifetime for mental health care than for medical or surgical care. The MHPA doesn’t make health plans cover mental health, it just says they can’t charge more if it is included.

In 2008 Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA) to cover the gaps in MHPA. A 2015 proposed rule related to MHPAEA requires Medicaid and Children’s Health Insurance Program (CHIP) managed-care plans to cover mental health and addiction treatment at the same level as medical and surgical care.

If you’re not keeping track, that’s almost 20 years between passing the initial MHPA legislation and a proposed rule suggesting a failure to treat mental illness and addiction damages lives and hampers the economy.

The troubling element of the Mental Health Parity saga is not that Congress and federal agencies have to keep going back and adding more layers. It’s common to revisit legislation and tweak it a bit. Rather, the disconcerting truth is that the legislation has not achieved its goal of actually treating the addicted and mentally ill. Yes, volumes of legislation have been unsuccessful, but this is a challenge we probably can’t afford to shrink from if we hope to truly provide holistic treatment and lessen the impact of healthcare on the economy.

The Mental Health Diagnostics Challenge

Closing a wound or treating cancer is pretty straightforward in terms of diagnosis. We can know that the problem exists. With mental illness or addiction, there is no hard evidence besides the patient’s behavior, which society can still attribute to personal flaws, bad choices, poor parenting, etc.

Writing in the online magazine Slate, psychotherapist Darcy Lockman describes being contacted by a patient’s insurance company about the projected duration of his treatment. When told that therapy could constructively last five years, the insurance company representative says, “he is certainly welcome to do that, but we are not going to pay for it.”

The response is understandable. Insurance is a business, and businesses must minimize costs. In the case of insurance, they do so by paying only for what is a “medical necessity.” And, of course, what seems absolutely necessary to a therapist appears much less so to the insurance company.

Lockman is not without perspective on this disconnect.

“One could certainly make a case for health insurance not covering psychotherapy at all,” she writes.  “Why should an insurer be obligated to pay for a treatment that relieves emotional suffering? Is that not a luxury, like massage, that could come out of pocket?”

What’s needed is an agreed-upon definition of equivalence of services between mental health/addiction benefits and medical/surgical benefits. Currently, there is no equivalency between an extensive addiction treatment program and anything in internal medicine. “Full parity demands that standards of evidence be applied consistently across mental health/substance use and medical/surgical treatments,” writes a team of policy consultants in a Health Affairs journal “Health Policy Brief.”

Legislation Without Representation

One great frustration for mental health parity advocates is that there is frequently no one to provide necessary treatment when a patient is diagnosed with some kind of behavioral health ailment. As he describes in a Health Affairs article, Peter Cunningham found that two-thirds of primary care physicians were unable to find a mental health professional to care for a patient after diagnosis.

In immediately dire situations, finding a facility to house the mentally ill is equally challenging, if not more so. In a series on mental illness in America by USA Today, Robert Glover, executive director of the National Association of State Mental Health Program Directors, says that states cut $5 billion from mental health services and eliminated at least 4500 public psychiatric beds between 2009 and 2012. For the most part, those numbers have no recovered to pre-recession levels.

According to a 2012 National Survey on Drug Use and Health by the Substance Abuse and Mental Health Services Administration (SAMHSA), almost 40 percent of adults with severe mental illnesses such as schizophrenia and bipolar disorder received no treatment in the previous year; among those with any kind of mental illness, 60 percent went untreated.

The Cracks Are Very Wide

The American healthcare system is as fragmented as an antique vase dropped from the third floor, and untreated mental illness is one price we pay for that fragmentation.

The solution, according to Health Affairs, must include these improvements:

– Integrate and coordinate mental health and substance use care with medical care, even when using separate benefits administrators

– Coordinate care among different health professionals and services

– Identify co-occurring physical disorders among the mentally ill, and correctly diagnose medical conditions that may place people at risk for mental disorders

In other words, coordinate, coordinate, coordinate … and then find time to coordinate some more.

And that coordination must reach across state lines and levels of government. Estimates of the number of homeless nationwide range from 610,000 by the U.S. Department of Housing and Urban Development (HUD) to a staggering 3.5 million by other homeless advocacy groups. According to HUD, roughly one-fifth suffer from a severe mental illness. Among the homeless, the emergency department is usually the only option for medical care, which means we are using the most expensive form of medical care to treat people with no insurance and negligible ability to care for themselves.

Creating an Actual System

The answers for America’s mental health challenges are neither simple nor immediate. In-depth studies showing dramatic cost savings by providing the mentally ill homeless with housing and support have prompted some states to construct apartment buildings and provide counseling. That’s one solution.

But housing and counseling are not panaceas because America does not have a healthcare system. There can’t be a single solution for a disjointed, patchwork approach to fundamental human need. Healthcare is a universal. We all have to have it, some more often than others.  

Mental Health Parity legislation is, characteristically, regulation of the insurance industry, not healthcare. Like the Affordable Care Act, which survives for now, it tells insurance companies what they can and cannot do without making associated changes in care provision.

America needs to integrate its healthcare and health insurance industries so that mandating something here makes it possible over there. Information systems must be integrated so ED docs know a patient is schizophrenic when he walks in with a broken hand and can refer him for treatment and perhaps an extended stay in a mental health facility. Of course, there needs to be a local facility to receive that referral.

And, at the ground level, families dealing with mental illness need support so members don’t end up on the streets, wandering and lost.  Yes, parity legislation is well-intentioned and necessary, but it requires an actual system to support it. We still have a long way to go. 

Irv Lichtenwald is president and CEO of Medsphere Systems Corporation, the solution provider for the OpenVista electronic health record.

Partners HealthCare and GE Healthcare announced a 10-year collaboration to rapidly develop, validate and strategically integrate artificial intelligence technology across the entire continuum of care. The vision of the collaboration includes co-development of open platform on which deep learning applications can be created, validated and seamlessly integrated into clinical workflows. Specific areas of focus span across multiple medical specialties including:

– Radiology

– Pathology

– Population Health

The collaboration will be executed through the newly formed Massachusetts General Hospital and Brigham and Women’s Hospital Center for Clinical Data Science and will feature co-located, multidisciplinary teams with broad access to data, computational infrastructure and clinical expertise.

The collaboration will be a featured project of the MGH & BWH Center for Clinical Data Science. GE Healthcare was chosen as the primary co-developer because of its shared commitment to digital health, its software and analytics capabilities, and its reputation for driving productivity gains.

The initial focus of the relationship will be on the development of apps aimed to improve clinician productivity and patient outcomes in diagnostic imaging. Over time, the groups will create new business models for applying AI to healthcare and develop products for additional medical specialties like molecular pathology, genomics and population health.

With the initial diagnostic imaging focus, early applications will address cases like determining the prognostic impact of stroke, identifying fractures in the emergency room, tracking how tumors grow or shrink after the administration of novel therapies, and indicating the likelihood of cancer on ultrasound.

“This is about creating digital tools that will have a profound impact on medicine,” said John Flannery, CEO of GE Healthcare in a statement. “By leveraging AI across every patient interaction, workflow challenge and administrative need, this collaboration will drive improvements in quality, cost and access.”

The applications are being developed based on three criteria:

1) Patient impact

2) Technical capability

3) Market appetite

This is to ensure that the solutions being developed are not solely dependent on the data that’s available but specifically target the top clinician pain points and the most critically ill patients. The goal is to bring the most promising solutions to market faster, so they can start making an impact for hospitals, health systems and patients globally sooner.

Spinal injury patients represent the types of cases where deep learning applications can help clinicians deliver faster, more efficient care, as the patients need to be treated immediately or run the risk of significant and permanent damage. For a single patient, a lumbar spine MRI may generate up to 300 images.

 In addition, a doctor may need to review prior scans and notes in a patient’s electronic medical record before making a diagnosis. A deep learning application could be leveraged to quickly analyze the data and determine the most critical images for the radiologist to read, shortening the time to treatment for trauma patients, and enabling the clinician to deliver more personalized and comprehensive care for all patients critically injured or not.

“We’re evolving the healthcare system to be able to take advantage of the benefits of deep learning, bringing together hospitals, data sets and clinical and technical minds unlike ever before,” said Keith Dreyer, DO, PhD, Chief Data Science Officer, Departments of Radiology at MGH and BWH in a statement. “The scope reflects the reality that advancements in clinical data science require substantial commitments of capital, expertise, personnel and cooperation between the system and industry.”

One topic that has been missed in the ongoing debate about health insurance has been the level of care that is available today. There has been very little discussion about the fact that people are routinely surviving unscathed when suffering illnesses or injuries that would have been fatal even just a few decades ago.

The point that could be made is that our high expectations of medical care today are a lot of the reason for the skyrocketing cost. The frontier doctor who would ride to a home on horseback and deliver a baby for a few dollars wasn’t just kind. He also had less overhead. He didn’t request ultrasounds, have a neonatal team on standby and he knew he wouldn’t be performing a Cesarean section.

Today, if an obstetrician’s fee was covered by insurance, but those other things were not, most people would agree that it was a travesty. It’s an issue that has been addressed extensively in end-of-life debates, but the reality is that the skyrocketing cost of care is also tied very closely to the expanding ability to intervene against even less serious injuries and illnesses.

Certainly, there are innovations that are affordable. Medical conditions that reduced mobility once meant a lifelong need for assistance with a wheelchair. Now there are power chairs that can be operated by people with even the most restrictive conditions. From Quingo scooters for arthritic seniors up to “sip and puff” chairs operated by quadriplegics, mobility has been an advancement that’s realistic and beneficial for health insurance to cover.

So, it’s clear that many of today’s innovations are not only beneficial but affordable. The debate, then, is centered around just how much we can afford to provide coverage for, and whether there is a good enough chance for recovery to make that investment worthwhile. This is of particular importance with a new POTUS in office promising to overhaul health care.

But is a simple cost-benefit analysis a realistic and humane way to talk about life? Many argue that healthcare should pay for any treatment that has a chance of saving a life. Yet the standard for what constitutes “saving” a life has been a difficult one to establish.

It is clear that certain options represent viable methods of saving lives that could not have been saved decades ago. Advanced treatments like implanted defibrillators, insulin pumps and organ transplants have proven to be effective for the world’s sickest patients, giving them both quantity and quality of life. They are expensive, but they definitely work.

But what about other treatments? Many things, like ventilators and pressor drugs, are intended to serve as stop-gap measures, techniques that can keep a person viable long enough for an underlying condition to be repaired. Yet these tools are often employed as last-ditch efforts to keep a patient alive with little or no prospect for a meaningful recovery. Even that term–“meaningful recovery”–is debated. 

Still other conditions present a perplexing scenario. Prostate cancer is a good example. It is widely believed in the medical profession that, beyond a certain age, treatment of prostate cancer is pointless. The reasoning is that the disease progresses so slowly that something else will probably kill the patient before the cancer will, and that the course of treatment is so difficult–often leading to incontinence and impotence–it’s not worthwhile. Consequently, blood work to detect prostate cancer is not covered after age 70.

The only thing clear in this whole debate is that a lot of things are unclear. We struggle as a society, and even as individuals, with what constitutes a worthwhile treatment, even without considering the cost. Once financial issues are brought into the discussion, the water becomes even murkier. What is clear is that there will be no satisfactory and effective solution to the national healthcare debate until these issues are addressed with an unanimity that currently seems unlikely.

Editor’s Note: Saqib Ayaz is the Cofounder at Workflow Management & Optimization, a services firm helping healthcare providers increase their collections and streamline their clinical & business workflow.

The entry of the MACRA proposed rule, a little more than a year back, flagged a solid and remarkable consent to move towards esteem-based care, yet up to this point, a hefty portion of the subtle elements encompassing how it would be executed stayed obscure.

In any case, a week ago, CMS discharged about 1,000 pages that shed light on how a doctor can improve their payments by following MACRA proposed rule.

History

Before MACRA proposed rule was introduced, specialists were paid for giving consideration to Medicare patients and liable to a repayment known as the Sustainable Growth Rate (SGR).

Introduced in 1997 to control the rate of increment in spending on doctor benefits, the SGR adds up spending among all Medicare, taking an interest to a general spending target. However, in this disaster of the hall, nobody profited from the great stewardship of social insurance assets.

Doctor burns through regularly, surpassing the general spending target, activating repayment rate cuts. Nevertheless, officials drove them off into the future through what was called doc fixes, conceding the rate cuts briefly. The pending slice rose to more than 21% before the introduction of MACRA because of aggravating doc fixes.

Advancement of MACRA proposed rule

When it was marked into law in 2015, MACRA took the place of the SGR, its cuts and numerous past installment motivation programs. In their place, MACRA proposed rule set up two general, installment plans for suppliers:

1. MIPS program, which includes three past installments and makes positive or negative changes in accordance with a doctor’s payment.
2. APM program, which grants a 5% reward through 2024 with higher yearly payments from that point for having a base level of Medicare as well as all-payer’s income through qualified APMs.

The doctor charge rates for all Medicare suppliers would be refreshed 0.5% for each of the initial four years, trailed by no increments until 2026, when base expenses would increment at various rates relying upon the installment motivation program in which a doctor partakes.

MIPS allows the suppliers’ longstanding objections that reveals that detailing under the current projects:

• The Physician Quality Reporting System
• The Value-Based Care
• Meaningful Use

Under the new program, doctors answer to the administration straightforwardly and get a reward or punishment in light of execution on measures of value, important utilization of electronic data and clinical practice change exercises. The reward or punishment for doctors may begin at 4% of the charge plan for 2019 and expands progressively to 5% in 2020 and so on. From 2026 forward, suppliers would get a yearly 0.25% increase in their payment on excellent performance.

Interestingly, the APM motivating force program grants qualifying doctors a settled, yearly reward of 5% of their repayment from 2019 to 2024, and gives their expense plan rates a growth rate of 0.5% faster than those of MIPS in 2026 and past, in acknowledgment of the hazard they expect in these agreements.

However, as indicated by MACRA proposed rule, not all systems are made equivalent. APMs qualified for this track must utilize quality measures like those of MIPS, guarantee electronic data is utilized and either be an endorsed, understanding- focused restorative home or require taking an interest substance bearing more budgetary hazard for over the top expenses.

At that point, keeping in mind the end goal to get the APM track extra, doctors must have at least 25% of their income from Medicare come through qualified in 2019, with the base expanding up to 75% in 2023. Another all-payer Advanced APM choice ends up noticeably accessible, permitting suppliers in APM contracts with different payers to partake in the Advanced care system in 2021.

To do as such, they should meet a similar least limit of 50-75%, through all supplier contracts, not exclusively Medicare income, while meeting an altogether bring down Medicare-particular edge.

By making a choice, MACRA proposed rule would like to empower more noteworthy supplier interest by enabling all payer income to check toward a similar least edge. Under the all-payer demonstrates in 2021, for instance, suppliers must have no less than 25% of Medicare income.

MACRA IMPLEMENTATION DETAILS REVEALED

The recently discharged proposed run has given answers to critical inquiries that had been left unanswered in the law encompassing the specifics of execution of MIPS. Finally, suppliers are understanding how MACRA proposed rule expects to execute APM track and MIPS. Given the quick movement toward MIPS execution, here are three key features suppliers need to know:

1-Qualifying for the APM motivation track

With a specific end goal to fit the bill for the reward, granting an Advanced APM assignment, APMs must meet the criteria, which will be measured in three ways:

• A peripheral rate sharing for misfortunes,
• Least ratio of loss, and
• Aggregate potential hazard

Clinicians should additionally have a base offer of income that comes in through the assigned APMs.

2-Providers will have fewer chances to see and enhance their execution on MIPS

Regardless of calls from supplier bunches for more regular detailing and input periods, MIPS announcing periods will be yearly, not quarterly. This is valid for execution input from MACRA proposed rule, too, however they may investigate more regular criticism cycles later on. Quarterly revealing and criticism periods could have made the motivating force programs more noteworthy for suppliers, cautioning them to their execution nearer to the time the administrations were rendered and giving more chances to enhance execution.

3-MIPS permits more prominent adaptability than past projects

Essentially MIPS is the motivating force program clinicians will take an interest in if not on the Advanced APM track. While convincing interest, the proposed MIPS execution additionally reacts to partner worries that prior execution programs were sometimes irrelevant.

Bottom line

Innovation in health policy is commencing a progression of work items that will concentrate daily on advance MACRA proposed rule execution issues and on making an interpretation of a complex arrangement into suppliers’ involvement.

MACRA proposed rule changes the payment methods for the doctors and they have to concentrate on their performance.  

A recent national study of state government programs finds more than 40 states strategically invested in value-based payment models, 23 with targets or mandates, and just 7 states trailing the trend. The study commissioned by Change Healthcare reveals 23 states have value-based targets or mandates that payers and providers agreed to achieve, 17 have or are considering adoption of ACOs or ACO-like entities, and 12 have or are considering episodes of care programs. Just 7 states have little to no activity around value-based payment models.

Report Background

Value-Based Reimbursement State-by-State is based on an analysis of publicly available information compiled from May through October 2017. The study relies on information gleaned from primary sources, including state resources, federal government resources, and contractors that participate in state-initiated value-based payment programs. In addition, data available from secondary sources was reviewed, including research reports from healthcare industry analysts; mainstream, business, and trade media; and think tanks, public policy institutes, and research institutes.

Readers can explore a wide range of approaches taken by the states as well as examine significant variation in levels of sophistication, leadership commitment, and resources devoted to the transition from fee-for-service to alternative payment models.

Infographic shown below summarizes findings of the Value-Based Reimbursement State-by-State report from Change Healthcare. The full report is available for download at StateVBRstudy.com. 

Einstein Healthcare Network and Humana Inc. have entered into a value-based agreement designed to offer a coordinated, patient-centered experience to help Humana Medicare Advantage members achieve their best health. The value-based care agreement, in turn, teams Humana with Einstein Healthcare Network’s Accountable Care Organization, Einstein Care Partners, toward enhancing both the patient experience and patient outcomes in the Philadelphia area.

Einstein Healthcare Network is a leading healthcare system with approximately 1,000 licensed beds and 8,500 employees serving the communities of Philadelphia and Montgomery County, Pa. Einstein Medical Center Philadelphia is the largest independent academic medical center in the Philadelphia region annually training over 3,500 health professional students and 400 residents in more than 30 accredited programs.

 The value-based care model emphasizes:

– More personal time with health professionals and personalized care that is tailored to each person’s unique health situation;

– Access to proactive health screenings and programs that are focused on preventing illness;

– Improved care for people living with chronic conditions with a focus on avoiding health complications

– Leveraging technologies, such as data analytics, that connect physicians and help them work as a team to coordinate care around the patient

– Reimbursement to physicians linked to the health outcomes of their patients rather than solely on the quantity of services they provide (fee-for-service)

“Humana is delighted to expand our ability to offer value-based care to our Medicare Advantage members in and around Philadelphia,” said Humana Regional Medicare Vice President Eric Bohannon in a statement. “This agreement further unites us with Einstein Healthcare Network as together we intensify our efforts to provide access to care that improves the well-being of Pennsylvanians.”

PwC’s Health Research Institute (HRI) outlines 12 defining healthcare trends to watch in 2018 that will be distinguished by persistent uncertainty and risk. 2018 will be distinguished by persistent uncertainty and risk for the US health industry. 2018 is likely to mirror 2017 – a year marked by raucous debates over health and tax reform and a series of crises triggered by natural disasters – in terms of volatility, according to the latest research from PwC’s Health Research Institute (HRI).  

The PwC HRI annual report, “Top health industry issues of 2018,” lists the 12 trends most likely to shape the industry next year. HRI developed its list of a dozen top issues through analyses of surveys of US consumers, provider, insurer and pharmaceutical executives, in-depth interviews with industry leaders and examination of data and policy trends. 

The top 12 defining healthcare trends to watch HRI identified include: 

1. The healthcare industry tackles the opioid crisis

Opioid overdoses are now the leading cause of death for US adults younger than 50. This is a phenomenon too big to solve by only one player – there is a role for everyone across the healthcare landscape, from prescribers, to payers, to the pharmaceutical industry, in order to reverse this trend.

2.  Social determinants come to the forefront

The US spends more on healthcare per capita per year than any other nation, but lags in outcomes. To improve health while saving money, the industry needs to expand the borders of healthcare. This means thinking beyond the four walls of the hospital and looking holistically at the full profile of a patient, beyond their specific health issue.

3. Price transparency moves to the statehouse

With no clear legislative path for federal action on health reform, states are starting to take matters into their own hands. Over 30 states are now considering legislation that would directly control drug prices and shine a light on cost changes. It is important to watch what happens at the state level, as past state healthcare reform efforts have been brought to the national stage.

4. Natural disasters create devastation that lasts long after the event passes

Natural disasters such as hurricanes and wildfires can wreak havoc on health systems, manufacturing supply chains, and financial operations both in the short and long-term. Health systems and pharmaceutical companies who conduct proactive scenario planning can increase the pace of recovery and avoid making premature decisions that could do harm in the long-term.

5. Medicare Advantage swells in 2018

Medicare Advantage is projected to cover nearly 21 million people in 2018, a 5% increase over 2017, providing a new competitive opportunity for health insurers. However, many eligible consumers don’t know these plans exist, so insurers must work to raise awareness of options, and tailor those options to best meet patient needs.

6. Health reform isn’t over, it’s just more complicated

While the chance to repeal and replace the Affordable Care Act (ACA) through a single piece of legislation may be dead, the Republican party will likely continue to pursue health reform in 2018 through a more fragmented approach. 2018 will likely bring continued efforts to reduce and cap federal Medicaid spending, expand access to lower-premium health insurance, loosen ACA consumer protections, soften the employer and individual mandates and repeal ACA taxes and fees.

7. Securing the internet of things

Following a year marked by major, industry wide cybersecurity breaches and a 525% increase in medical device cybersecurity vulnerabilities reported by the government, hospitals must take quick, decisive action to maintain data privacy, secure the thousands of connected medical devices on their networks and protect patients. Companies should treat cybersecurity incidents as a “non-natural” disaster, and invest more in planning, defensive measures and personnel.

8. Patient experience as a priority and not just a patient portal

Today’s consumer is used to sophisticated shopping experiences, in which retailers harness consumer information to tailor how they interact with customers. As the healthcare industry turns toward paying more for value instead of volume, health companies will need to take this same approach and make strategic investments to improve patient experience.

9. Meet your new coworker, artificial intelligence

Utilizing artificial intelligence (AI) could help put the human touch back into health by reducing bureaucracy and administrative duties that can take time away from personalized care. Companies are bringing in AI to make administrative tasks a lot quicker, such as screening drug candidates, streamlining finance processes, adverse event reporting and more.

10. Healthcare’s endangered middlemen

Under increased scrutiny, intermediaries such as PBMs and wholesalers must prove value and success in creating efficiencies or risk losing their place in the supply chain. To prove their worth and prevent having their businesses disrupted by new entrants such as Amazon, intermediaries must evolve to be more than just a pass-through serving a contracting function, by increasing price transparency and taking responsibility for more of the value chain.

11. Real-world evidence a growing challenge for pharma

Changes at the FDA will prompt pharmaceutical and life sciences companies to adjust their approach to collecting and using real-world data gathered outside of randomized controlled trials, something that could potentially save the system millions of dollars. As the 21stCentury Cures Act takes effect, the FDA will be required to consider additional uses of real-world evidence for drugs and medical devices, including incorporating this data to support new indications.

12. Tax reform moves forward

Changes such as a corporate tax rate reduction and a shift to a territorial system will require new strategies from health organizations, and may demand rethinking of business models and supply chains.

To adapt to these defining healthcare trends, HRI’s report identifies three strategies traditional health organizations and new entrants should consider in these uncertain times:

1. Cross-sector collaboration: The biggest challenges in healthcare cannot be solved by working in siloes. In order to tackle complex challenges, industry stakeholders must break down barriers and work together with an eye on what’s best for the ultimate end user: patients. Key challenges in 2018 include stemming the tide of opioid abuse and overdoses, the need for greater attention to the social determinants of health, state efforts to address rising healthcare costs through pricing and transparency initiatives and natural disasters that can wreak havoc on entire healthcare systems.

2. Strategic investments: Stakeholders must be proactive and think strategically about how the market is changing and where to invest now ahead of potential disruptions. Key areas of investment in 2018 include increasing uptake of Medicare Advantage, continued scenario planning in preparation for healthcare reform, bolstering protection against cybersecurity attacks and improving patient experience in order to change behavior and improve health outcomes.

3. Creating efficiency: In 2018, the healthcare industry will step up its pursuit of efficiency to improve performance and offset risks. Efficiency can be achieved through several key areas: harnessing artificial intelligence to streamline decision making and administrative tasks, pressing middlemen such as pharmacy benefit managers (PBMs) and wholesalers to prove their value, expanding use of real-world evidence to cut clinical development costs while bringing new drugs to market faster and rethinking business models and supply chains in light of new tax reform efforts.

For the full report, visit https://www.pwc.com/us/en/health-industries/top-health-industry-issues.html

Editor’s Note: Abhinav Shashank is the CEO & Co-founder at Innovaccer Inc., a datashop integrating complex data across multiple distributed sources to give healthcare organizations greater insights to provider better care.

With 2017 almost in the rear-view mirror, it is time to look forward to 2018 and how healthcare will evolve in this year. The last year has been an eventful one for healthcare, from the uproar in healthcare regulations to potential mega-mergers. Needless to say, it’s a time of transition, and healthcare is in a very fluid state- evolving and expanding. There are certainly going to be new ways to keep healthcare providers and health IT pros stay engaged and excited, and here are our top 10 picks:

1. The future of the GOP Healthcare bill

The Republican healthcare reform bill gained immense traction this year. In their third attempt at putting a healthcare bill forward, the senators and the White House officials have been working round the clock to gather up votes, but somehow, the reservations persist. The lawmakers have insisted that Americans would not lose their vital insurance protections under their bill, including the guarantee that the plan would protect those with preexisting conditions. However, as it so happens, even these plans have been put to rest. Perhaps sometime in 2018, the GOP may pass a budget setting up reconciliation for tax reform, and then pass tax reform. Then, they would pass a budget setting up reconciliation for Obamacare repeal, and then pass that- it all remains to be seen.

2. The ongoing shift to value from volume

Despite speculations, healthcare providers, as well as CMS have pushed for more value-based care and payments tied to quality, but it’s been going slow. Although providers have been slightly resistant to take on risk, they do recognize the potential to contain costs and improve quality of care over value-based contracts. And perhaps as data assumes a central role in healthcare, the increasing availability of data and smarter integration of disconnected data systems will make the transition easier and scalable. Notably, with a $3.3 trillion healthcare expenditure this year, there has been slow down the cost growth. 2018 is expected to be much more impactful as it builds on the strong foundation.

3. Big data and analytics translating data into real health outcomes

Big data and analytics have always brought significant advancements in making healthcare technology-driven. With the help of big data and smart analytics, we are at a point in healthcare we can make a near-certain prediction about possible complications a patient can face, their possible readmission, and the outcomes of a care plan devised for them. Not only it could translate to better health outcomes for the patients, it could also make a difference in improving reimbursements and regulatory compliance.

Related: 4 Leading Health IT Trends That Will Continue in 2018

4. Blockchain-based systems

Blockchain could arguably be one of the most disruptive technologies in healthcare. It is already being considered as a solution to healthcare’s longstanding challenge of interoperability and data exchange. Bringing blockchain-based systems will definitely require some changes from the ground up, but 2018 will have a glimpse of by innovation centered around blockchain and how it can enhance healthcare data exchange and ensure security. 

5. AI and IoT taking on a central role

2018 can witness a good amount of investment from healthcare leaders in the fields of Artificial Intelligence and Internet of Things. There is going to be a considerable advancement in technology, making the use of technology crucial in healthcare and assist an already unbalanced workforce. AI and IoT will not only prove instrumental in enhancing accuracy in clinical insights, and security, but could also be fruitful in reducing manual redundancy and ensuring fewer errors as we transition to a world of quality in care.

6. Digital health interventions and virtual care to improve access and treatment

In December 2016, many were suggesting that wearables were dead. Today, wearables are becoming one of the most sought-after innovation when it comes to digital health. And, the market is quickly diversifying as clinical wearables gain importance and as several renowned organizations integrate with each other. Not only wearables- there are several apps and biosensors that can assist providers with remotely tracking patient health, engage patients, interact with them, and streamline care operations. As technology becomes central to healthcare, 2018 will be the year when these apps and wearables boost the patient-physician interaction. 

Related: 5 Digital Health Innovation Trends That Will Matter in 2018

7. The increasing importance of security

We deal with a tremendous amount of confidential and critical information in healthcare. It’s not just patient health information- it goes from credit card information to digital footprints. As the plethora of devices and systems storing information grows in size, a focus on ensuring becomes extremely vital as a breach could range from something as slight as information being stolen to as dangerous as a person being physically harmed. 2018 may be high time we took a good, hard look at the security of our infrastructure.

8. Payer-provider collaborations

Over the years, healthcare insurers have been stepping into primary care delivery model, encouraging prevention and wellness. At the same time, we have also witnessed the trend of hospitals and healthcare systems getting into the insurance part to take control of the complete patient care process. 2017 saw a lot of merger activity and 2018 will continue to see this synergy focused on value-based care, direct primary care, chronic care management, and patient engagement.

9. Possibly stable healthcare costs

Analysts predict that the healthcare industry will observe a growth of 6.5% in 2018, only half a percentage point higher than in 2017. And, after the changes like copays and network sizes are made to benefit plan design, this growth rate could be as low as 5.5%. Healthcare has long waited for an inflection point, where the spending will take off. But as it so happens, healthcare seems to be settling into a ‘new normal,’ where the fluctuations are more attuned and the growth rate remains in a single digit, with providers seeking strategies that would improve care management, optimize resource utilization and bring the costs down.

10. The future of ACA

There have been several debates and speculations regarding the future of the Affordable Care Act. With a new GOP healthcare bill on the cards, some things will stay the same, but with differences- people can still sign up on healthcare.gov, but the sign-up period would be shorter. They can still get subsidies to help lower their premiums or reduce their deductibles and copays, but some plans will be much more expensive. The future of ACA is still cloudy, and the attempts to repeal and replace ACA have been laid to rest, for now, but one thing is certain- a lot fewer people will enroll for ACA in 2018, fearing a repeal. 

This is definitely an amazing time in the digital health world. There may be complexities and uncertainty, but for any healthcare system deeply passionate about realizing data-driven outcomes, looking for technology that can drive their core processes and help them win with value-based care- 2018 will be the year!

Related: 12 Defining Healthcare Trends to Watch in 2018

The United States currently spends more than $420 million per hour on healthcare, a number that is increasing by the minute and is expected to top $12 trillion in 2040, according to HealthCostCrisis.org, a new, interactive website and crisis clock that tracks and forecasts healthcare spending in America in real time. The site, developed by West Health, a family of nonprofit and nonpartisan organizations includes tools to gauge the impact of the escalating cost of healthcare on patients and their families, businesses, employees, critical government programs like Medicare and the U.S. economy.

Economic Impact of Healthcare Spending

The U.S. currently spends about twice as much as what other high-income nations do on healthcare — more than $3.6 trillion in 2018, according to the latest estimates from the Centers for Medicare & Medicaid Services. Despite the higher spending, the U.S. consistently ranks near the bottom on major health indices such as life expectancy and infant mortality.

The Burden of Costly Healthcare for Families

Health spending per person is growing 2X faster than household income driving more than 57 million Americans to cut back household spending to pay for healthcare or medicine. 45% of American adults fear that a major health event in their household could lead to bankruptcy. Even with employer health coverage, a family earning $45,000 a year must budget at least 20% of their income for health expenses including premiums and out-of-pocket costs.

“Americans are simply paying too much and getting too little for all they are spending on healthcare,” said Tim Lash, chief strategy officer for West Health. “The good news is we don’t have to discover our way out of this crisis. Common-sense solutions can be enacted that would have an immediate and meaningful impact on the health and wealth of every American.”

West Health Initiatives to Support Value-based Care

West Health supports measures that require providers to stop fee-for-service practices and move to value-based care; empower Medicare to directly negotiate drug pricing, which it is currently prohibited from doing; and create true price transparency for patients, businesses and the government.

The development of HealthCostCrisis.org is part of West Health’s initiatives to urgently address out-of-control spending on healthcare and empower voters, businesses, organizations, community leaders and patient advocates to demand and secure affordable care from elected officials and policymakers.

“Skyrocketing healthcare costs are threatening the health and financial security of millions of Americans and the consequences are not only costly but deadly,” said Shelley Lyford, president and CEO of West Health. “Every hour we don’t do something to change the cost trajectory of healthcare means more people are going bankrupt and even dying as lifesaving medicines become further and further out of reach for all but the wealthiest of Americans. The clock is ticking and time is running out.”

UnitedHealthcare announced this week it is expanding its use of bundled payment offerings to care providers participating in Medicare Advantage plan networks across more than 30 states to improve quality and lower costs. The expansion builds upon UnitedHealthcare’s existing work with the Centers for Medicare & Medicaid Services’ Bundled Payments for Care Improvement Advanced (BPCI Advanced) program for fee-for-service Medicare.

UnitedHealthcare Care Bundles Program Overview

The UnitedHealthcare Care Bundles Program will offer care providers in more than 30 states the opportunity to participate in bundled payment models for their patients enrolled in UnitedHealthcare Medicare Advantage plans for certain procedures, including hip and knee replacements, spinal fusions and coronary bypasses. This is in addition to the ability to participate with UnitedHealthcare in the BPCI Advanced program.

Benefits of Bundled Payments

Bundled payments emphasize high-quality, coordinated health care at a lower cost by setting price and quality standards for procedures and follow-up treatments, and then rewarding participating care providers for exceeding these standards. They are a shift away from the common fee-for-service model that pays for each treatment.

“Our extensive data and technology experience positions UnitedHealthcare to collaborate with care providers to support better health and better care, at a lower cost,” said Jeff Meyerhofer, president of bundled payment solutions, UnitedHealthcare Medicare & Retirement. “We are making it easier for care providers by managing both the fee-for-service and Medicare Advantage models, taking on the administrative burden and tailoring our services to their individual needs, so they can focus on caring for their patients.”

Scalable Services and Support for Partnering Care Providers

UnitedHealthcare will provide partnering care providers with scalable services and support, including care management solutions to help patients receive a quality experience from pre-operative education to post-acute care. The program also offers patient engagement tools, performance analytics and consulting, and payment administration services.

UnitedHealthcare’s Commitment to Value-based Care

The UnitedHealthcare Care Bundles Program is part of the company’s ongoing commitment to deliver value-based care. By the end of 2020, UnitedHealthcare expects to have $75 billion in care provider reimbursements tied to value-based arrangements annually. To date, more than 3 million people enrolled in UnitedHealthcare Medicare Advantage plans are treated by care providers in value-based models.

I am going to make a prediction here. No matter who we elect in 2020, Bernie or Trump or anything in between, Medicare For All is not going to happen in America. One can run an electrifying campaign on the promise of Medicare For All, or indignantly against it, but this is pure theater on both sides. I don’t know if God can make a rock so big and heavy that even He can’t lift it, but I do know that government can make corporations so big and powerful that even government itself can’t break them. 

For decades our government encouraged the healthcare industry to consolidate vertically, horizontally and obliquely so it can achieve “economies of scale” and therefore lower consumer prices. In the last couple of decades, the government also compelled the industry to computerize its operations, because technology makes everything better and cheaper. Once the resulting monopolistic behemoths were summoned into existence, it was time to nationalize the whole lot, into one super monopoly, with super technology and super economies of scale. The only other example of such government monopoly in America is the Military.

Obviously, our standing armies must be, by definition, a national monopoly, but note that the Navy is not building its own ships and the Air Force is not building its own planes and the Army is not manufacturing tanks. The government is contracting with private suppliers for pretty much everything, from butter to bullets. The Military Industrial Complex is a network of very large and utterly corrupt contractors for the government, yielding more power over foreign and fiscal policy than Congress, the President, and all citizens put together while delivering practically nothing either on budget or on time. A powerful Military is essential to America’s safety and global success, so we grind our teeth and keep paying. And medical care for hundreds of millions of people is at least as important.

I am not entirely sure how people think Medicare For All is going to work. Are you folks envisioning an angry President Bernie dragging Samuel Hazen into the Oval, wagging his finger at him and making an offer Mr. Hazen cannot refuse? Something like, “I will pay $50 per head and not a penny more, because healthcare is a human right, and if you want to be a disgusting millionaire or billionaire, go write a bestselling book, like I did…”, at which point Mr. Hazen will be hanging his head down in shame and gratefully take the $50 deal. Upon his return to Nashville, Mr. Hazen will immediately schedule book writing workshops for all HCA department chiefs to compensate for cutting all salaries in half. Yeah… no, that’s not how this works.

Go ask Northrup Grumman or Lockheed Martin or General Dynamics or even Boeing or Booz Allen or any other “beltway bandit” how getting money from the Feds really works. There are well-greased revolving doors between the Pentagon and its contractors. There are stock options and executive positions for high ranking Federal employees. There are 535 people in Congress responsible for allocating budgets, and all 535 are for sale. Most of this infrastructure is already in place for healthcare too and building the HHS Heptagon shouldn’t take very long. The American President has little to no power over Federal spending, and even less so when it comes to large procurement contracts, as the current occupant of the White House discovered the hard way, during the Lockheed F-35 kerfuffle.

Clearly, large health systems will survive and thrive under a Medicare For All law, but how about private health insurance? Future President Bernie says they will all be banned. Is that so? Currently, a full third of Medicare beneficiaries are insured and “managed” by a handful of large private health insurers. Medicare is paying those private contractors fixed amounts of money per head for their services. Medicaid is doing the same for most of its beneficiaries, and all military health insurance (TRICARE) is contracted out to the usual suspects. Basically, the vast majority of people covered by public insurance, are really insured by gigantic insurance corporations. Fact: under the hood, taxpayer-funded healthcare is the bread and butter of private health insurance companies.

When future President Bernie and the hordes of uninformed supporting characters in the 2020 elections festival say that private health insurance will be banned, they are lying to you. What will be banned under a Medicare For All law, is your ability or your employer’s ability, to purchase health insurance directly from a private company. Instead, the government will procure contracts in bulk as it sees fit, assign people to them as it sees fit, and pay for these contracts with tax revenue as it sees fit. Just like they pay for battleships, fighter planes, bombs, tanks and such.  The United States Military is known for lots of great things. Value-based purchasing, and cost-effectiveness, in general, are not among those things.

Depending on who you ask and what is included in the definition of healthcare, Medicare For All is projected to cost between three and four trillion dollars per year, which is five times the amount we spend on the Military. This number is calculated based on costs under current law, minus the waste generated by the cacophony of hundreds and thousands of different insurance plans, different healthcare facilities and their too many to count service and product vendors. The projections do not include the effects of the inevitable massive consolidation of everything healthcare into a dozen or so Federal contractors, able and willing to demand multi-billion dollars contracts for services worth a few million dollars at most on the open market. Remember the Obamacare marketplace website? Multiply that by orders of magnitude and you have Medicare For All.

Medicare For All is as egregious a misnomer for this plan as the Affordable Care Act was. When they say Medicare For All, they mean Federal government procured health insurance for all. When they say everything soup to nuts will be covered, they mean everything the heavily indebted Federal government thinks should be covered, and can afford to cover, will be covered. When they say healthcare will be better, more plentiful and much more affordable, they mean please vote for me in 2020. Medicare For All will be built on the largely immovable foundation our government chartered and nurtured for half a century. If you want a glimpse into a Medicare For All future, go look at any Medicaid Managed Care plan in any impoverished southern State, and look at the balance sheets of the associated contractors and sub-contractors.

It doesn’t have to be this way. We don’t need to bulldozer everything we have, and we certainly don’t need to pretend that we can, or that we must. And we need to remember that the proper role of government in a free country is not to manage the health or the care of all its citizens. Free people are not the wards of a State responsible for keeping them healthy, productive and happy. The role of a democratic government is to keep predators, foreign and domestic, including corporate ones, at bay, while providing a sturdy safety net for the few who cannot care for themselves. Let’s do that instead. It will be better, faster and cheaper than the fictional construct called Medicare For All.

About Margalit Gur-Arie 

Margalit Gur-Arie is the founder, BizMed. She writes regularly about the intersection of healthcare & technology on her site: On Health Care Technology. Follow her on Twitter at @margalitgurarie

Opinions expressed by HIT Consultant Contributors are their own.

– Alegeus report uses participant data to debunk four common misconceptions about health savings accounts (HSAs) that consumers have about HSAs.

Alegeus, a provider of consumer-directed healthcare (CDH) solutions unveiled part two of its research series on health savings account (HSA) participants, the 2019 Alegeus HSA Participant Profile. For the report, Alegeus conducted a survey of more than 1,400 U.S. healthcare consumers in order to:

• Measure the general understanding of HSAs among participants

• Gain perspective on real (versus perceived) account holder characteristics

• Understand how participants are using their accounts for current and future expenses

The premise of healthcare consumerism is that, if given more financial responsibility for healthcare and empowered to make more informed decisions, consumers will make better choices that lead to improved health outcomes and decreased overall healthcare costs. 

Debunking 4 Common HSA Myths

The research report reveals HSA participants to be America’s savviest healthcare consumers and uses the same data to debunk four common misconceptions about health savings accounts (HSAs) that include:

HSA-qualified health plans are only for the healthy and wealthy: HSAs support a diverse group of participants who have middle-class incomes ($72.4k is the average household income), families (52 percent have children), and even chronic conditions (10 percent consider themselves to be unhealthy).

HSAs lead consumers to avoid seeking care: Most HSA participants (80 percent) claim to make healthy lifestyle choices and smart healthcare decisions. In fact, only four percent of HSA participants say they avoid care.

HSAs are for short-term expenses, not long-term/retirement savings: Many consumers don’t realize that HSAs are more flexible and offer greater tax benefits than a 401(k). An optimized healthcare savings strategy will include both a 401(k) and an HSA.

Saving and investing in an HSA is not a top priority for account holders: Today, only 13 percent of participants say they invest their HSA dollars for growth; however, their balances are growing and nearly 60 percent say they may start investing soon. These are signs that HSA participants are beginning to understand the importance of saving for the future.

What The Key Findings Mean for Consumers

The report confirms that HSA participants are engaged in their healthcare decisions, and they will continue to get better value for every dollar they spend or save as they contribute and use their accounts. In addition, education, and guidance continue to be a central theme to drive HSA adoption and participant use.

HSAs Are The Foundation for Healthcare Dollars

“Health savings accounts are the foundation for Americans to get better value for their healthcare dollars,” said Steven Auerbach, Alegeus CEO. “That is why, earlier this year, we unveiled the industry’s first Smart Account that uses artificial intelligence (AI) and machine learning to meet consumers where they are – guiding them to save for the future and ultimately unlock the full tax advantages these accounts offer.”

Doctors and other healthcare professionals are entrusted with the responsibility of safeguarding the health and well-being of their patients, ensuring they receive the highest quality of care. While healthcare professionals are expected to provide a certain standard of care, any deviation from that standard that results in harm or injury to a patient may leave them exposed to a medical malpractice claim.

The consequences of medical malpractice can be severe, and in some cases, can result in permanent injury, disability, or even death. Patients harmed by medical malpractice may suffer from physical and emotional pain, financial loss, and other damages that severely impact their quality of life. This article will examine some of the causes of medical malpractice and outline steps to prevent its occurrence.

Causes of Medical Malpractice
There are many scenarios that can lead to a medical malpractice claim. Among the most common causes of malpractice are:

– Diagnostic errors: Misdiagnosis occurs when a medical professional fails to correctly identify a patient’s medical condition, resulting in the wrong treatment being administered or no treatment being provided at all. 

– Surgical errors: There are many types of surgical errors, such as damage to internal organs, incorrect incisions, operating on the wrong area, or leaving foreign objects behind after surgery.

– A failure to treat patients: A failure to provide adequate treatment to patients can encompass a range of issues, such as neglecting to administer necessary medical tests or failing to address a medical condition in a timely or appropriate manner.

– Birth injuries: These can result from various causes, such as the misuse of delivery tools, failure to perform a timely cesarean section, or inadequate prenatal care.

Medication errors: This may occur when a medical professional prescribes or administers the wrong medication or dosage.

If you have undergone a failed tubal ligation procedure you may be entitled to compensation for your injuries. You can speak with a specialist attorney such as those at The Tinker Law Firm PLLC to see if you have a claim.

Preventing Medical Malpractice 

The prevention of medical malpractice is critical to ensure patient safety and reduce the risk of injury or harm. The following steps can help in achieving this goal.

Effective Communication 

Medical professionals should communicate clearly with patients about their medical conditions, treatment options, and the potential risks and benefits. Patients should also be encouraged to ask questions and express their concerns about their treatment. 

Electronic Health Records 

Another vital way to prevent medical malpractice is through technology. EHRs can help to reduce the risk of medical errors by providing medical professionals with accurate and up-to-date information about a patient’s medical history, allergies, and medication use. EHRs can also help to ensure that medical professionals are following the correct guidelines and protocols for patient care.

Staying Current

Medical professionals can prevent medical malpractice by staying up to date with the latest research, information, and guidelines in their field. By participating in ongoing education and training programs they can ensure they are providing the most effective and safe treatments to their patients.

The steps outlined above can help to prevent medical errors and ensure that patients receive the appropriate care and treatment.