« October 2017 | Main

5 posts from November 2017

11/17/2017

Dr. Jim Rickards Discusses His Recent Work, "Our Health Plan, Community Governed Healthcare That Works" (November 16th)

Listen Now

This, my 125th interview, will discuss Oregon's Coordinated Care Organizations (CCOs) that have received considerable attention nation-wide for their ability to provide Medicaid beneficiaries with coordinated care, moreover primary care services integrated with mental/behavioral and oral health.  The Oregon CCO model has also demonstrated over the past five years an ability to improve care quality while keeping spending below a targeted 3.4 percent annual growth rate via a capitated payment arrangement.  Oregon's CCO success is the subject of Dr. Jim Rickards recent work, "Our Health Plan, Community Governed Healthcare That Works.  The work details the experience of one Oregon CCO, Yamhill Community Care.     

During this 29-minute discussion Dr. Rickards provides a brief description Yamhill County, how the Yamhill County's CCO, Yamhill Community Care, was formed, what initial decisions or steps it took, how it organizes or coordinates care moreover between and among primary care providers, dentists, behavioralists, community health workers and a community paramedicine program.   The role Health Information Technology (HIT), or Oregon/Washington's Health Information Exchange (HIE) or EDIE, and quality measures play, what beneficiary spill over effects have resulted from the CCO's care delivery and how might Oregon's CCO model be adopted elsewhere.  

Dr. Jim Rickards is currently the Senior Medical Director at Moda Health in Portland, Oregon.  Previously, Dr. Rickards was the Rickards Chief Medical Officer of the Oregon Health Authority, where he provided clinical and policy leadership in managing Oregon's Medicaid population.  He received his B.S. from Indiana University Bloomington, MBA from Oregon Health and Science University, M.D. from Indiana University School of Medicine.  He completed his residency and fellowship training in radiology in Chicago at Cook County Hospital and Rush University Hospital.  Dr. Rickards currently resides in Mcminnville, Oregon.

For more information on Our Health Plan go to: https://www.prnewswire.com/news-releases/new-health-care-delivery-book-asks-is-community-healthcare-the-future-300501810.html.

For information on the Oregon Health Authority go to: http://www.oregon.gov/OHA/Pages/index.aspx.

A thorough review of 2016 CCO performance results is at: http://www.oregon.gov/oha/HPA/ANALYTICS-MTX/Documents/CCO-Metrics-2016-Final-Report.pdf

11/14/2017

"As the World Burns" (November 13th)

Listener's may recall my August 3rd interview with David Wallace Wells concerning his New York magazine essay, "The Uninhabitable Earth" and my posting a link to my June 13th essay that appeared on The Health Care Blog (THCB) and titled, "Medical Associations Non-Pulsed by Trump's Withdrawal From the Paris Accord."  Both addressed the problem of unambiguous global warming. 

Wallace Wells' essay is again at: http://nymag.com/daily/intelligencer/2017/07/climate-change-earth-too-hot-for-humans.html.

Yesterday, 3 Quarks Daily posted my essay, "As the World Burns," moreover about the professional medical community's inattention to the issue.  It is at: http://www.3quarksdaily.com/3quarksdaily/2017/11/as-the-world-burns-.html#more.  (The comments in the essay are my own.) 

 

11/10/2017

Dr. Ronald Epstein Discusses His Recent Work, "Attending: Medicine, Mindfulness and Humanity" (November 9th)

Listen Now

Over the past 20 years Dr. Ronald Epstein has published on the topic he terms "mindful practice."  "Mindful practice," he argues, enables physicians and other clinicians to have heightened self-awareness that allows in turn for greater attentiveness or greater presentness in caring for patients.  It is what makes good providers, he says, great.  

During this 26-minute conversation Dr. Epstein discusses his recent work, Attending: Medicine, Mindfulness and Humanity, or moreover what mindfulness is, how it improves patient care and outcomes by, in part, better addressing patient suffering and how it improves as well physician or provider satisfaction.    

Dr. Ronald M. Epstein is Professor of Family Medicine, Psychiatry & Oncology at the University of Rochester Medical EpsteinCenter, and board-certified in Family Medicine and Hospice and Palliative Medicine.  He is also the Director of the Center for Communication and Disparities Research and he directs the Dean's Teaching Fellowship program to promote excellence in medical education.  Among other accomplishments, he was named the first George Engel and John Romano Dean's Teaching Scholar at the University of Rochester. National honors include the Lynn Payer Award from the American Academy on Communication in Healthcare for lifetime achievement in research on communication and health and the Humanism in Medicine Award from the New York Academy of Medicine.  Dr. Epstein has been a Fulbright scholar at the Institute for Health Studies in Barcelona, Spain and a visiting scholar at the University of Sydney.  He is a frequent keynote speaker at major national and international conferences on medical education, communication, and mindfulness in health care.  He has published over 200 research articles.  Dr. Epstein graduated from Wesleyan University and Harvard Medical School.  

For information on Attending go to: http://www.ronaldepstein.com/.

For a complete list of related literature go to: https://www.urmc.rochester.edu/family-medicine/mindful-practice/publications-research.aspx.

11/03/2017

How Well Did Medicare Accountable Care Organizations Perform in 2016? (November 2nd)

For those interested in Medicare ACO performance, here is an overview of 2016 results via my essay titled, "Evaluating ACO Performance, 2016 Edition."  It is at: http://thehealthcareblog.com/blog/2017/11/02/evaluating-aco-performance-year-2016/

11/01/2017

Patient Safety Issues Associated with Electronic Health Records: A Conversation with Dr. David Troxel (October 31st)

Listen Now

Electronic Health Records (EHRs) were largely adopted after 2009, or after the Congress passed the HITECH Act that appropriated $30 billion in financial incentives for hospital and physicians to migrate from paper to digital records.   In theory the policy made/makes perfect sense.  Adopting information technology/IT would over time create efficiencies, drive better care coordination and overall improve care quality and reduce unnecessary spending or reduce spending growth.  However, for numerous reasons moving to widespread use of EHRs has presented/continues to present numerous challenges and problems, some anticipated and some not, that meant putting patients at risk of medical harm, or essentially swapped out one set of problems (associated with paper records) for another set of problems (associated with EHRs).    

During this 29-minute conversation Dr. Troxel offers his view why the medical industry comparatively lagged in adopting digital records, what are the more common EHR design flaws and what kinds of medical errors they cause, how prevalent are EHR-related errors or what did his report, cited below, conclude, why EHR-related errors or harm occur, what is the current status of a proposed federal Health IT Safety Center and what can patients do to improve the safety of their EHRs. 

Dr. Troxel is Secretary of the Board of Governors and Medical Director of The Doctors Company, a physician-owned medical malpractice insurer.  Dr. Troxel is also Clinical Professor Emeritus at the School of Public Health at the  Troxel
University of California at Berkeley.  He is past president of the American Board of Pathology and the California Society of Pathologists.  He serves as Chairman of The Doctors Company Foundation and as a member of the Patient Safety and Technology Committees at The Doctors Company.

Referenced during the discussion the report, "Electronic Health Record Closed Claims Study," is at: http://www.thedoctors.com/ecm/groups/public/documents/print_pdf/con_id_013553.pdf.

The 2011 IOM report, "Health IT and Patient Safety: Building Safer Systems for Better Care," also referenced during the discussion is at:  http://www.nationalacademies.org/hmd/Reports/2011/Health-IT-and-Patient-Safety-Building-Safer-Systems-for-Better-Care.aspx.

Information on the Doctors Company is at: http://www.thedoctors.com/