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4 posts from December 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/


The Unavoidable Interaction Between ACOs and CMS's Recently Announced Hip & Knee Replacement Bundled Payment Demonstration (December)

If you are interested in how CMS resolved, or not, the interaction between the ACO program and the agency's recently finalized CJR (Comprehensive Care for Joint Replacement) demonstration the trade publication, Accountable Care News recently published my essay, "Missed Opportunity: CMS Fails to Address the Interaction Between the CRJ Demo and the ACO Program." This is a truly in-the-weeds issue since both the ACO program and CJR demo operate under very complicated and detailed regulations amounting to well over 500 Federal Register pages.  Here, I'll just note my conclusion.

"CMS believes the CJR demo will operate in isolation or "alongside" the ACO program having no spillover effects. The agency just simply needs to (literally) account for financial overlap when the CJR and ACO beneficiary are one in the same. This is the same silo-ed thinking the agency used in creating the BPCI. In the ecology of Medicare program however CMS can never do one thing. Providers in the demo and the ACO program interact and this interaction will be competitive if not antagonistic. What ACO providers generally will see is a flawed solution to a contrived problem. They'll see a demo that will either increase utilization and/or reduce their ability to earn shared savings. Had CMS thought synthetically or cast the CJR demo to complement the ACO program, the agency could have likely tempered over utilization, improved shared decision making and care coordination and moved a reluctant ACO provider community to gradually accept downside financial. Instead, the Medicare program, as a program, will be left compromised."



How Do Accountable Care Organizations (ACOs) and the Medicare Advantage (MA) Program Compare? (December)

How these two Medicare payment and delivery reform programs compare is important since the federal government needs to curb Medicare cost growth via Alternative Payment Models (APMs), moreover via ACOs, and since MA plans are not, or at least are not currently, defined as an APM.  For a discussion of how the two compare please see my essay titled, "The Need to Level The Playing Field Between Accountable Care Organizations and Medicare Advantage," recently published by AJAC, at: 



Iora Health's Novel Approach to Delivering Primary Care: A Conversation with David Judge (December 23rd)

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Much of the health care industry's effort to improve health care payment and delivery centers around improving primary care. This is largely because Americans suffer more disease/disease burden throughout their life spans compared to individuals in other industrialized countries.   This therefore makes obvious sense since primary care is the foundation upon which an effective and efficient health care/medical care program is built.  When done well primary care promotes wellness, prevents disease onset, progression, exacerbation and prevents premature death.  Primary care also moderates the need for higher cost specialty care and improves population health.  For numerous reasons, not least of which is inadequate reimbursement, primary care delivery has been sub-optimal.   New models of primary care are emerging, one termed direct primary care (noted in the ACA under Section 1301 (A) (3) and now recognized in 13 states) is showing promise in improving quality, improving patient satisfaction and lowering cost growth.      

During this 21 minute conversation Dr. Judge discusses moreover the impetus for the creation of Iora Healh, how Iora's primary care delivery model works or how it is different from traditional primary care delivery, how Iora's model is staffed, IT supported and reimbursed, with whom and how it contracts and what Iora's performance data demonstrates to date. 

Dr. David Judge serves as Iora Health's Chief Medical Officer.  Dr. Judge joined Iora in 2014 to continue his work in improving and redesigning of primary care.  Priorto , he helped found and was the David-JudgeMedical Director of the Ambulatory Practice of the Future at Mass. General Hospital.  David received his undergraduate degree in biomedical engineering and public health studies at Brown University and attended University of  Mass. Medical School.  He completed his residency training in internal medicine at Columbia Presbyterian Medical Center in New York City. 

For more on Iora Health go to: http://www.iorahealth.com/