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How Doctors Improve Health Via 'Disruptive Technology'

How Doctors Improve Health Via 'Disruptive Technology' | Healthcare and Technology news |

From electronic health records and telemedicine to “internet-driven physical therapy,” Dr. Richard Rothman, founder of the Rothman Institute, says providers of medical care are embracing the promise of the digital age.

In an interview at the 2014 Forbes Healthcare Summit, Rothman talks about how a health care system with more than a half million patient visits annually is moving into the digital health space with “disruptive technology,” reducing costs by moving therapy online, conducting telehealth consults with patients and using eletronic health records to improve patient experience.

“We are very pro disruptive technology,” Rothman said in his interview, which can be seen in its entirety below.  “We are into disruptive technology that will lower costs and improve convenience for our patients.”

As insurance companies like Aetna (AET), Cigna (CI), UnitedHealth Group (UNH), Humana (HUM), and others push away from fee-for-service medicine to accountable care and bundled payments, Rothman said digital health can achieve what the insurers want in lower costs and better quality. As one example, the Rothman system is practicing “internet-driven” physical therapy that will reduce costs by 80 percent.

As the Affordable Care Act and trends in insurance payment move away from paying for quantity to reimbursement based on quality, Rothman believes health plans and government health plans will, in turn, embrace provider ideas in digital health.

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Burwell: Accountable Care to Stop Costs from Outpacing Progress |

Burwell: Accountable Care to Stop Costs from Outpacing Progress | | Healthcare and Technology news |
Accountable care, value-based reimbursement, and a concerted effort to raise quality are the building blocks of healthcare reform, Burwell says.
Providing more patient-centered, value-based accountable care is the only way to stop the rampant costs of the healthcare industry from continuing to vastly outpace its progress towards better health for all Americans, said HHS Secretary Sylvia Burwell during remarks at the CMS Quality Conference this week.  While the hospital quality improvement report released concurrently with the forum shows a significant advancement in the way healthcare providers focus on patient safety, the system as a whole continues to require a great deal more work before it can achieve its ultimate goals.
“For all the differences of opinion about how to move forward as a country when it comes to our health care, there is one area for which we have near unanimity – and that is in the sentiment that the health delivery system that’s been in place for the last 50 years has under-delivered on affordability, access, and quality,” Burwell said.  “You could almost sum up the past half century in a sentence: The prices we paid far outpaced the progress we made. Not only did we pay more, in some cases we also got more, too, but sometimes we got more of the wrong things: more unnecessary tests, more preventable read missions, more health care acquired infections.”
“Surely, we’d all agree that parts of our system simply did not make sense. We waited until patients got sick in order to treat them, rather than focusing on prevention,” she added. “Our payment models incentivized volume rather than value. It used to be that all too often government was over here, business was over there, nonprofits were someplace else. Today, we’re working together like never before, and we have some historic progress to show for it.”
Burwell noted that the 17% reduction in patient deaths due to preventable hospital-acquired conditions represents a significant leap forward in the way healthcare organizations have been working together to achieve quality improvements.  Along with approximately 50,000 fewer deaths since 2010, the industry has garnered around $12 billion in savings from more robust patient safety programs and data-driven accountable care.
“If you consider the progress we’ve made – and the progress we’re on the verge of making – the evidence suggests we could be at an important moment when it comes to the way we deliver health care in this country,” Burwell said. “But to get there, we need to make an even bigger push.”
HHS envisions a continued march towards value-based reimbursements that reward better patient outcomes and care coordination, and hopes that this accountable care ecosystem will supported by an infrastructure of health information exchange, analytics, and evidence-based clinical decision making.  HHS is taking the lead in policymaking and leadership, Burwell said, by fostering research, innovation, and grant opportunities.
Burwell concluded by asking healthcare stakeholders to continue driving the industry towards greater progress by thinking creatively and engaging in the development and deployment of best practices across the healthcare spectrum.  “As we move forward, I hope to continue our work together,” she said. “Together, let’s take this to the next level. Let’s improve quality. Let’s spend our dollars more wisely. Let’s save lives.”
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CMS’s Latest Move on ACOs: A Shift Towards Greater Realism Going Forward?

CMS’s Latest Move on ACOs: A Shift Towards Greater Realism Going Forward? | Healthcare and Technology news |

It’s still just hours after the news broke this afternoon—Monday, December 1—but as we and others across healthcare digest the latest developments out of the Centers for Medicare and Medicaid Services (CMS), some important points leap to mind. Indeed, two elements in particular hold major implications for the future of provider participation in Medicare’s accountable care organization (ACO) programs.

First of all, CMS is creating a new category of ACO, separate from the “regular” Medicare Shared Savings Program category and from the Pioneer ACO Program category. This new category has rules similar to those of the Pioneer ACO Program, but with a major set of differences. Known as “Track Three,” the new program, as a report in Kaiser Health News confirmed, “would allow ACOs to keep up to 75 percent of the money they save Medicare. But if they cost Medicare extra, they would be held responsible for 15 percent of the excess spending. Currently, ACOs cannot be held responsible for more than 10 percent.”

This new sub-program involves something akin to an extra carrot (a good share of “shared savings”) with an extra stick (a higher percentage of downside risk). In the coming weeks and months, it will be interesting to see how many current Pioneer ACO leaders shift into “Track Three.” And it will be even more interesting to see whether any regular-MSSP ACOs do so—or whether organizations or collaborative not currently participating in either the regular-MSSP or Pioneer-model programs join Track Three because of those incentives.

(Providers should also welcome CMS's change to its attribution procedure, with no new patients being attributed to ACOs in the middle of a calendar year, as currently occurs.)

Meanwhile, very importantly, as KHN report noted, “The new rule would give ACOs, both new and existing ones, an extra three years before they faced penalties, for a total of six years. Sean Cavanaugh, Medicare’s director,” the report noted, “said the change was one of many prompted by concerns raised by ACOs. ‘The notion that 36 months later you’re going to be at downside financial risk is pretty intimidating,’ he said in an interview,” the KHN report said.

“However,” the report continued, “the extra time would come at a price: ACOs that after their first three years decide to avoid penalties for the next three could keep no more than 40 percent of the money they save Medicare, rather than the 50 percent maximum they can keep during their first three years.”

Both of these new measures are gambles on the part of senior CMS officials: at this point in time, participation in both current programs, the Pioneer program and the MSSP program, is faltering. But the calculated risk being taken by CMS officials could potentially pay off. Provider leaders have repeatedly told us at Healthcare Informatics that the threat of downside risk remains too daunting a hurdle for many patient care organizations, as their senior executives and clinician leaders consider whether to participate in any of the Medicare ACO programs.

Indeed, even after praising CMS officials for the “proposal to waive certain fee-for-service payment rules that now inhibit clinicians from using their best medical judgment as to the best time and place for care,” as well as the fact that “CMS appears willing to revisit the instability of the financial benchmarks and the inequity of the risk adjustment methodologies,” the Charlotte-based Premier health alliance’s senior vice president Blair Childs said in a statement, “We believe, however, that CMS needs to do much more to improve the one-sided risk model In fact,” he said, “it proposes to reduce the already inadequate shared savings payments for ACOs extending their contract under Track 1 from 50 percent to 40 percent in year 4, stepping payment down an additional 10 percent each year to reach 20 percent in year 6. This will impede participation and inadequately recognizes the financial and transformational contributions made by participating providers.” The folks at Premier should know: some of their members are involved in both current ACO programs, and are leader organizations in the field.

Ultimately, only time will tell what comes of all this. But at least one thing is clear: CMS officials are apparently beginning to listen to provider concerns with regard to financial risk issues, and realize that the entire overall program could be in peril if changes aren’t made.

A next constructive step would be for senior CMS officials to consider taking another look at some of the core clinical outcomes measures in the ACO programs. But perhaps that will have to wait for another day.

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