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04/28/2016

Daniel Dawes Discusses His Recent Book,"150 Years of Obamacare" (April 27th)

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Since, in part, April is recognized by DHHS as National Minority Health Month (this year's theme is "Accelerating Health Equity in the Nation") it is thoroughly appropriate to discuss Professor Daniel Dawes's recent work, "150 Years of Obamacare."  Professor Dawes's work begins with a discussion of efforts since the Civil War to reform national health care policy beginning with the 1865 Freedmen's Bureau Act.  The work moreover provides an accounting of his and others efforts to lobby successfully for health equity provisions in passing the 2010 Affordable Care Act ( ACA).  

During this 31-minute conversation, Professor Dawes discusses passage of the ACA, i.e., "Obamacare,", e.g., Republican opposition to the legislation and moreover the importance of the sixty plus health equity-related provisions in the legislation and what are his priorities for furthering health care equity or reducing disparities in health care delivery and outcomes - that sadly remain pronounced.   

Attorney and Professor Daniel E. Dawes is the Executive Director of Health Policy and External Affairs at the Morehouse Dawes_daniel_credit_brigette_martin_mackSchool of Medicine and a Lecturer within Morehouse's Satcher Health Leadership Institute and the Department of Community Health and Preventive Medicine.  He founded and chairs the Working Group on Health Disparities and Health Reform and is the co-founder of the Health Equity Leadership and Exchange Network (HELEN).  Previously, Professor Dawes held positions with the Premier Healthcare Alliance, the American Psychological Association and served on the Senate HELP (Health, Education, Labor and Pensions) Committee under Senator Edward Kennedy.   He is the recipient of numerous award including the Congressional Black Caucus Leadership and Advocacy Award.  He earned his JD from the University of Nebraska and his BS from Nova Southeastern University.

For more information concerning Professor Dawes's work, go to: https://jhupbooks.press.jhu.edu/content/150-years-obamacare.  

04/21/2016

Operational Challenges Associated with Accountable Care Organizations (ACOs): A Conversation with Dr. Richard Morel (April 21st)

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As a follow up to my April 1st conversation with Jim Gera concerning bundled payments, during this podcast Dr. Richard Morel discusses Medicare's other major payment reform program, Accountable Care Organizations (ACOs), or WESTMED Medical Group's three year experience as a Track 1 ACO.   The Medicare ACO program is a creation of the 2010 Accountable Care Act and participation in the program began in 2012.   Currently, there are 434 ACOs (over 90 percent participating in the "no risk" Track 1) caring for approximately 7.5 million Medicare beneficiaries.  The program to date has been a mixed success.  After two performance years (2013 and 2014) only 25 percent of participants have been successful, i.e., have earned shared savings.  (Performance year three or 2015 performance will be made known this September.)  CMS is currently in the process of revising how the agency calculates an ACO's reset financial benchmark.  It is anticipated these changes will improve program performance, or improve both provider interest in participating (or continuing to participate) in the program and participant success in earning shared savings.   

During this 21-minute conversation Dr. Morel provides an overview of WESTMED, explains the organization's interest in becoming a Medicare Shared Savings Program or ACO participant in 2013, WESTMED's experience under their first three year agreement, what explained their success, challenges they've found with the program, how the program could be improved and their expectations now as a second agreement period Track 1 ACO.

Dr. Richard Morel is the Co-Medical Director of WESTMED Medical Group in Yonkers, New York.  Prior to joining WESTMED in 2008 Dr. Morel WESTMEDDr RichardMorel (2)was in private practice affiliated with Columbia-Presbyterian Riverdale Hospital for 12 years.  Dr. Morel is board certified in internal medicine.  He received his medical degree from Columbia University College of Physicians and Surgeons, did his postgraduate training at Columbia-Presbyterian Medical Center and  received his masters of medical management from Carnegie Mellon.  He is a fellow of the American College of Physicians and a member of the American College of Physician Executives.  

For information regarding WESTMED go to: http://www.westmedgroup.com/.

 

04/11/2016

What Might We Expect in the MACRA Proposed Rule? (April 11th)

For those following Medicare payment reform last April the MACRA (Medicare Access and CHIP Reauthorization Act) was passed by Congress and signed into law by the President.  Title I of the law reforms how Medicare physician payments are annually updated, i.e., the law replaces the 1997 Sustainable Growth Rate.  The proposed MACRA rule, that CMS will publish sometime over the next few to several weeks, is highly anticipated because beginning in 2019 physicians and other eligible professionals can face significant increases or decreases in their annual payment update depending how they perform on quality and/or value under the two MACRA-created payment update pathways: MIPS (the Merit-based Incentive Payment System) and APMs (Alternative Payment Models).  If you're interested in theses provisions of the law and what we might see in the proposed rule, feel free to read this essay posted April 6th on The Health Care Blog.  

http://thehealthcareblog.com/blog/2016/04/06/what-might-we-expect-in-the-macra-proposed-rule/

 

 

04/05/2016

Accountable Care and Elective Joint Replacement Comment Letters (April 5th)

If you're interested in the Medicare Accountable Care Organization program, CMS published a proposed rule in January to revise how the agency calculates ACO financial benchmarks.   And/or, if you're interested in bundled payment arrangements for hip and knee replacement surgeries  (the topic of the Jim Gera interview), here are two related comment letters.  The first is addressed to CMS in response to their ACO proposed rule and the second is addressed to the HCP LAN (Health Care Plan Learning Action Network) concerning their elective joint replacement white paper.  I drafted these for the AMGA. 

http://www.amga.org/wcm/Advocacy/cmtsProposedACOBenchmarkRule.pdf

http://www.amga.org/wcm/Advocacy/ltrLANCJR.pdf

 

  

04/04/2016

How Orthopedic Bundled Payments Are Being Operationalized: a Conversation with Jim Gera (April 1st)

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Today, CMS launched the agency's second bundled payment demonstration, a mandatory five-year initiative in approximately 800 hospitals nation-wide.  It's titled, the Comprehensive Care for Joint Replacement (CJR).  The CJR essentially reimburses hospitals a predetermined amount for a 90-day hip or knee surgical and rehab episode of care.  CMS is emphasizing hip and knee replacement surgeries because they account for the single largest Medicare dollar amount and highest percent of annual 30 day episode spending.  This demonstration follows CMS's voluntary Bundled Payment for Care Improvement (BPCI) demonstration that provides bundled payments for 48 care episodes (including hip and knee replacements) via four care model designs.  How successfully hospitals, orthopedic surgeons and various post acute providers manage these care episodes will be important if CMS is to better control Medicare spending growth.   (Listeners will recall I discussed moreover the theory of bundled payment arrangements with Harold Miller this past September 23rd.)  

During this 29 minute conversation Mr. Gera provides and overview of Signature Medical Group and their orthopedic bundled payment work under both CMS's BPCI and CJR demos.  More specifically, he discusses how hip and knee replacement surgical patients are identified, how the bundled payment care team is assembled, how the care episode is manged, how quality is measured, profit sharing conducted and moreover principles his organization has developed to succeed under these capitated payment arrangements.  

Mr. Jim Gera is the Senior Vice President of Business Development for Signature Medical Group, Inc., a multi-specialty group Searchof physicians located in St. Louis and rural Missouri.   Among other related activities Mr. Gera co-authored an Advanced Payment Medical Accountable Care Organization application and a successful CMS Strong Start for Mothers and Newborns grant award.   Recently he has also served as a Chair for several CMS innovation grant reviews.  Mr. Gera's previous experience includes working with other physician group practices, in outpatient facilities and in managed care both in Medicare Advantage and Special Needs Plans.  Mr. Gera received his MBA from Southern Illinois University at Edwardsville.

For more on CMS's CJR demonstration see:  https://innovation.cms.gov/initiatives/cjr

For more on Signature Medical Group see: http://www.signatremedicalgroup.com/ 

02/22/2016

CMS Is The Reason We Have So Little Useful ACO Research (March 3rd)

If you're interested in how this statement gets unpacked please feel free to see my essay using this title posted on The Health Care Blog last month.  At: http://thehealthcareblog.com/blog/2016/02/19/cms-is-largely-why-we-have-so-little-useful-aco-research/

David 

02/19/2016

Payment Reform, California Style: A Conversation with Dr. Jill Yegian (March 2nd)

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California has been long known for health care delivery and payment reform (think, for example, Kaiser Permanente).   With efforts nation-wide to better align health care quality and patient outcomes with reimbursement or savings efficiency, related efforts in California are carefully watched and studied.     

During this 23 minute conversation Dr. Jill Yegian briefly outlines the work if the California Integrated Healthcare Association (IHA), provides an overview of the California healthcare payment reform landscape, discusses specifically IHA's value-based pay for performance work involving 10 health plans, 200 physician organizations and nine million Californians, discusses quality measurement including "resource use" and "total cost of care" and identifies lessons learned from IHA's activities.     

Dr. Jill Yegian, is the Senior VP for Programs and Policy at the California Integrated Healthcare Association where she Jilloversees IHA's work regarding care integration, performance measurement and reporting and payment innovation.   Previously, she co-directed the American Institutes for Research Health Policy and Research Group, a team of over 70 health services research professionals.   Prior still Dr. Yegian worked with the California Healthcare Foundation where her focus was on improving the state's healthcare financing and delivery system.  Dr. Yegian is the author of numerous peer-reviewed articles and is a frequent conference speaker.  She was graduated from the University of California at Berkeley with a Ph.D. in health services and she earned her undergraduate degree in human biology at Stanford. 

For more on IHA's work go to: www.iha.org

 

02/12/2016

The Senate Finance Committee Proposes Policy Options to Improve Chronic Care (February 11th)

If you're interested in Medicare policy options the Senate Finance Committee is proposing to improve chronic care delivery, outcomes and spending efficiency, please see my assessment titled, "What to Make of the Senate Finance Committee's Chronic Care Policy Options," posted yesterday (February 11th) on the The Health Care Blog, at http://thehealthcareblog.com/

 

01/29/2016

The Oral Health of Seniors and Medicare Coverage Thereof: A Conversation with Marko Vujicic (January 28, 2016))

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The Medicare program, now in its 51st year, still does not cover oral/dental health care such as exams, X-rays, cleanings, fillings, tooth extractions and dentures.   (Medicare will cover an oral health procedure if it is incent to a serious accident or disease, for example, for surgery to treat fractures of the jaw or face or if you have oral cancer and need dental services necessary for radiation treatments.)  This is unfortunate when you consider for example: poor oral/dental health worsens overall health; less than five percent of older Americans have dental insurance of any kind; one-third of adults over 65 have untreated dental caries and over 40 percent have periodontal disease; the Affordable Care Act did not name adult oral/dental benefits as an "essential health benefit"; an overwhelming majority of adults believe dental coverage should be part of overall health coverage; for all of CMS's "innovation" demonstrations (now numbering well over 50) there are none that address improving oral/dental health for seniors; and, oral/dental health disparities are, according to the CDC, "profound."  

During this 20-minute conversation Dr. Vujicic provides his assessment of the oral/dental health of American seniors, his understanding of why the Medicare program still does not cover routine oral health care and what can be done to improve access and (insurance) coverage of oral health for seniors or Medicare eligible individuals.

Dr. Marko Vujicic is the Chief Economist and Vice President of the Health Policy Institute at the American Dental Association Vujicic(ADA).  Prior to joining the ADA Dr. Vujicic was a Senior Economist at The World Bank and also a Health Economist with the World Health Organization in Geneva, Switzerland.  Dr. Vujicic is the lead author of the book, "Working in Health" and has authored additional essays and book chapters on various health policies.  He is published in the New England Journal of Medicine, Health Services Research, Health Affairs and other policy and scholarly journals.  Dr. Vujicic is also a visiting professor at Tufts University in Boston.   Dr. Vujicic earned his Ph.D. in Economics from the University of British Columbia and his undergraduate degree at McGill University in Montreal.

For more on the work of the ADA's Health Policy Institute go to: http://www.ada.org/en/science-research/health-policy-institute

12/28/2015

The Secretary's Medicare Quality and Value Payment Goals, MACRA, MA and ACOs (December 28th)

If you're interested in how or how could Secretary Burwell weave together her Medicare payment goals, provisions under MACRA, the Medicare Advantage program and Medicare ACOs, feel free to read this essay I drafted earlier this month for Health Affairs.  It's titled, "Synchronizing Medicare Advantage and ACOs to Support the Secretary's Quality and Value Payment Goals." 

Happy Holidays!

It's at: http://healthaffairs.org/blog/2015/12/28/synchronizing-medicare-advantage-and-acos-to-support-the-secretarys-quality-and-value-payment-goals/