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3 posts from September 2018


Utah's Alliance for the Derterminants of Health Initiative: A Conversation with Mikelle Moore (September 27th)

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Despite the fact social circumstances and environmental factors account for approximately 20% of an individual's health status, twice that of medical care at approximately 10%, social circumstances or social determinants of health are frequently unaddressed by health or medical care providers.  This is largely because medical care providers are neither trained to provide social service supports such as housing and transportation nor compensated for doing so.   As a result persons left with unmet health-related social needs suffer more disease burden leaving them to over-utilize or seek comparatively more health care services, for example ED visits, - or services that could have been avoided had their health-related social needs been initially addressed.      

During this 24 minute conversation Ms. Moore begins by noting the current state of Medicaid expansion efforts in Utah.  She proceeds to explain Intermountain's reasons or motivations for creating the Alliance, she provides an overview of the Alliance's programming activities in Ogden and St. George that will address, for example, housing, transportation, food security and behavioral health services related, in part, to interpersonal violence, the initiative's relation to Intermountain's Medicaid insurance plan, SelectHealth, to the Medicare program's Accountable Health Communities demonstration, and what the Alliance's evaluation will measure in tracking the initiative's progress or success.  

Ms. Mikelle Moore is the Senior Vice President for Community Health at Intermountain Healthcare.  Her work is moreover focused on prevention and population health.  Prior to her current position, she served as Administrator of the LDS Hospital.  She joined Intermountain as an Administrative Fellow in 1998, serving as Assistant Administrator and Operations Officer in the Moore  Mikelle-06Central Region.  She is a Fellow in the American College of Healthcare Executives and serves on the national Advisory board for the Association for Community Health Improvement. She is also active on other not for profit boards and community initiatives.  Ms. Moore earned her MBA in health services administration from Arizona State University and her undergraduate degree in physiology from the University of Arizona.  

For more information on the Alliance go to, e.g., https://intermountainhealthcare.org/blogs/topics/transforming-healthcare/2018/07/new-alliance-seeks-to-address-the-social-determinants-of-health/.



Accelerating Telehealth Adoption: A Conversation with Jonathan Shankman (September 21st)

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In the recent past the federal government has made several efforts to expand the use of telehealth and Remote Patient Monitoring (RPM) services.  Related provisions can be found, for example, in the 2017 CONNECT Act, the Bipartisan Budget Act of 2018 and in federal regulatory rule making, for example, the current 2019 proposed Medicare Physician Fee Schedule (PFS) rule, and in payment waivers for certain Medicare pay for performance models, for example, ACOs, where telehealth "originating site" and service area use restrictions are waived.  Even with these reforms telehealth/RPM spending in, for example, the Medicare program still amounts to approximately $30 million annually, or an almost immeasurable fraction of the program's $700 plus billion in annual spending.   Increased spending under Medicare (and Medicaid) aside, few are convinced adoption of these technologies should occur at the so called speed of government, where old or current IT solutions are largely validated, is adequate.   

During this 24 minute conversation Mr. Shankman briefly describes AMC Health's work, what explains the lag in telehealth/ RPM adoption and why now or what circumstances today hold promise for far more rapid adoption or use of telehealth/RPM.  He provides several examples or telehealth/RPM use and what outcomes are or can be achieved. 

Jonathan Shankman is currently Senior Vice President of Clinical Innovation at AMC Health, a New York-based remote and Jon Shankman Headshotreal time healthcare monitoring company.  Mr. Shankman has more than 25 years of experience as a research gerontologist, developing and analyzing new paradigms of chronic care delivery for the elderly and disabled across all segments of the care continuum.  At AMC Health, Mr. Shankman is responsible for development of products that weave technology and clinical best practices into virtual care solutions that address a broad array of chronic and acute illness challenges.  He also focuses on the application of analytics that support the development of clinical decision support tools.  Previously, at the Metropolitan Jewish Health System, Mr. Shankman held progressive leadership positions with the nonprofit, geriatric services organization serving the New York metropolitan area.  Mr. Shankman was graduated from Columbia University with a Masters of Public Health in gerontology, an MBA and a BA.  

For more on AMC Health go to: www.amchealth.com



Essay: Salvaging the Merit-Based Incentive Payment System (MIPS): August 28th

This past August 28th, the Health Affairs Blog posted my essay, "Salvaging MIPS."  Followers of this podcast may recall last August I wrote a related essay for Health Affairs concerning the problems with the high MIPS exclusion thresholds.  I certainly does not appear we are making any progress in moving Medicare Part B (physician reimbursement) closer to higher quality and greater value.

Last week's essay is at: https://www.healthaffairs.org/do/10.1377/hblog20180822.309498/full/

The August 2017 essay is at: https://www.healthaffairs.org/do/10.1377/hblog20170803.061372/full/