Population Health, Social Determinants & the ‘All Hands on Deck’ Race to Matter

by Gregg A. Masters, MPH

Population Health Alliance (PHA) Executive Director and current Board Chair Fred Goldstein and I just finished chatting with Rain Henderson, the CEO of the Clinton Health Matters Initiative (CHMI) a project of the Clinton Global Foundation.

Rain covered quite a bit of ground from the mission of the Foundation to it’s current relevance and impact given recent signs of less than optimal hand offs between the public health community and umbrella acute care American Medicine infrastructure. We also learn more about CHMI and the broader goals of the Clinton Global Foundation.

To access this timely exchange click here.  pha keynotes2

Rain will provide the introductory remarks at the PHA member session in advance of Esther Dyson’s keynote presentation on ‘The Way to Wellville’, an initiative of HiCCUp.

This will be a powerful gathering of data driven and best practices supported participants in the general pursuit of a sustainable U.S. health care ecosystem and economy aka ‘the triple aim’.

For more information on the PHA Forum see full agenda and schedule.

The State of Accountable Care: Evidence to Date and Next Steps

by Gregg A. Masters, MPH

Brookings Med: ACOfuture

So I registered for the webcast version of this Brookings event titled: ‘The State of Accountable Care: Evidence to Date and Next Steps‘ which noted at 9AM start time. My assumption was Pacific time, so when I dialed in (really logged onto twitter to monitor the webcast hashtag #ACOfuture), the first tweet I saw was thanking everyone for a great program. Yup, the start time was 9AM Eastern, so I missed the live stream. The good news is this event was recorded and is now available for archived replay.

The full program agenda is here and principal deck here.

The line up is impressive and well worth watching for continuing insights into the accountable care theater. What’s working, what’s not, and why?

Enjoy this timely event!

Ebola: What’s Accountable Care Got To Do With It?

by Gregg A. Masters, MPH

I proudly display the ‘MPH” (master of public health) tag awarded by the School of Public Health from UCLA (a long time ago) and have both tweeted and blogged about the ‘we need more MPH’s and less MBA’s’ to solve America’s pressing healthcare challenges (access, affordability and quality imperative or ‘triple aim’) to which we now need to apparently add more robust ‘communicable disease control’ to the ‘value prop’ calculus.

Earlier today I tweeted:

Rick Santelli et al

I meant it…. minimally it’s about your lens, but more importantly ‘values’ in this scramble for purposeful behavior.

It use to be career minded and service oriented professionals where drawn into clinical medicine, the allied health professions (collectively ‘the helping professions’) and healthcare administrative services (their enablers) out of a sense of mission and giving back. So when I enrolled at UCLA in the School of Public Health the ‘route’ into hospital or health services administration was principally via the ‘MHA’ (Master of Health Administration), the ‘MPH’ (Master of Public Health) or even ‘MPA’ (Master of Public Administration) graduate degree programs.

The ‘MBA psychology’ had yet to infect the career progression glidepath, albeit that fire was in part stoked by the emergence of the proprietary hospital management industry (where I spent a fair amount of my time) intent on driving both revenue and share gains, but principally by deploying ‘secret sauce’ (superior management chops) operating efficiencies in exchange for quarterly earnings growth. Yet, since those early days the MBA strain seems to have dominated the current cultural pool of professionals entering the ‘admin’ or professional manager theater. Unfortunately, and while I generalize, most MBA students/graduates are really good at the profitability thing (sometimes squeezing out the last bit of profit from failing business models or burning platforms) and usually from an investor exit frame of reference. Rarely do we see a ‘community benefit’ or ‘sustainability of the healthcare delivery ecosystem’ sit on top of the MBA cultural indoctrination.

So as we watch the systemic exposure of the operational and worse yet horrific cultural gaps on display between the acute care health system and the ‘clean up crew’ as represented by ‘public health types’ i.e., both state departments of health or public health and their federal overlords at CDC, one must wonder about the viability of these apparently ‘parallel worlds’ with different incentives, values and cheerleaders.

Perhaps via this historically rationalized ‘financial class’ disconnect we’ve reached a teachable moment? Might we actually think about how public health and acute care medicine can work together for the greater good?

I think so! Will you join me?

Originally posted at PublicHealthHQ



ACO Alignment: The Holy Grail?

By Gregg A. Masters, MPH

So one view holds, ‘the more things change, the more they stay the same’ (i.e., it’s deja vu all over again), while the present day, ‘enlightened’ [or perhaps event horizon naive] view suggests, ‘no this time, things really are/can be different’. Just enter the key enabler: [ _________ ] e.g, technology, ubiquitous internet/device access, healthcare costs are now threatening countries, not just industries, patient empowerment, better ‘skin-in-the-game’ plan design, pure desperation, you name it, etc.

ACO Alignment Summit MastheadEven at this late stage in the early implementation of the Patient Protection and Affordable Care Act (ACA) we still find ourselves in a muddled and often confusing if not selectively implemented [or waived] regulatory market with respect to the ability of the Act to achieve its ends via the proscribed means. Yet, ACA is the law and most of us ‘on the ground’ [or closely following the action] are either muddling though and/or boldly going forward amidst a vague and ambitious yet mandatory journey – enabling the ‘triple aim‘.

One large moving part of the ACA that disproportionately bears the burden of the Act’s efficacy, that is mission critical and must be interstitially infused inside delivery system [and financing/risk sharing if not assumption] transformational efforts is ‘the ACO’ – including it’s many non Federal derivatives operating in the commercial space.

Unfortunately once you’ve seen an ACO, well, you’ve seen one ACO

[NOTE: For some context see 'More or Less Confusion in ACO World: Who Really 'Certifies' ACOs?'Accountable Care: In Search of Anchor Business Model(s) for the 'All In' Healthcare Eco-system', and 'IPA 2.0 the Preferred ACO Chassis?'].

Other then some broad brush guidance in the ACA and the regulatory follow-up via rules implementation, there is much room for variation on how the ‘Ark’ is to be built, governed and operated. Ergo the continuing conversation around one key pillar in the launch of a viable ACO, i.e., physician alignment with enterprise and market goals, or by proxy achieving the underlying clinical integration essential to seamless, coordinated, efficient and appropriate delivery of evidenced based care.

While there is much to learn, there are principles in evidence on which to build, i.e., successes in the market. If you want to learn more from an eclectic mix of players in the space, consider attending the ACO Alignment Summit.

Details of the panel session on alignment are here:ACO Alignment Summit

I am pleased to say that I will be moderating the Keynote Panel Discussion:
Drive Towards the Development of Tomorrow’s Accountable Health Care Delivery System’ with some talented colleagues from different markets around the country.

Joining me in this deep dive are: Nicole Bradberry, Chief Executive Officer, Florida Association of ACOs, President and Co-Founder, Citra Health Solutions; President, MZI Healthcare, Diwen Chen, Executive Director, Payment Innovation and Accountable Care, Dignity Health, and Bruce Miller, FACHE, Vice President, Network Development, Baylor Quality Alliance, Baylor Scott and White.

This is a unique blend of talented thought leaders and host business models from three different domestic U.S. markets all with distinctly different geo-political healthcare footprints. Nicole sits atop a member based association of ACOs in Florida (in addition to her leadership role at MZI Healthcare a vendor, consultant and health IT infrastructure play), while Diwen hails from a progressive institutionally managed integrated delivery system with hospital DNA Dignity Health, and Bruce stewards Network and Quality Management issues for an integrated group medical practice/IDN Scott and White that recently merged with the flagship Baylor Health System to combine two trophy properties (with distinctly different cultures, imj) in the Lonestar state.

This will be a ‘roll up your sleeves’ exchange on lessons learned in ACO alignment as well insights into the ‘how do I navigate the white waters of clinical integration’ given the local market considerations I face?



Your Comment is in Moderation: ‘Why ACO Savings Aren’t About Location.’

By Gregg A. Masters, MPH

We’re having an interesting exchange over at The Healthcare Blog where Health Care Policy Lead at Aledade, Inc. Travis Broome posted a piece titled: ‘Why ACO Savings Aren’t About Location.’

I chimed in with some ‘contextually pro’ ACO thoughts with some significant push back by industry veteran, author, consultant, economist and President of HealthFutures, Jeff Goldsmith fka ‘tcoyote’.

Thanks Jeff… lovin’ the exchange! Just sayin’ metrics, metrics. depends on lens….
Bottom-line is we still live on a production driven healthcare ecosystem – ‘capitation’ (PMPM) still a fraction of total contract spend (even if you include ‘lite versions’ ie, bundled payment, DRGs, or ambulatory case rates, or OWA’s [other weird arrangements]).
Share of GDP has been and continues to disproportionately claim an obscene allocation of the U.S. (public, private) spend and growing; all while a grand COST SHIFTING CHARADE proceeds under the convenient ‘consumer directed/skin in the game’ brand play by payors/health plans/or more aptly put ‘benefits solutions providers’.
There are no more ‘health insurers’ per se. they’ve collectively failed to manage clinical risk. PERIOD. They are ‘transaction processors’ increasingly living off of ‘fees’ and investment returns as ‘banks’, with the great hope that ‘technology plays’ (mhealth, digital health, tech-enabled patient engagement), etc… can cure the beast.
So yes, today and in the near term, clever (and well paid) managers’ are subject to production incented growth or share objectives (even amidst declining units primarily due to the slowing (and cost shift) economy and reduced discretionary spending for elective services).
The handful of creative ‘comp plans’ that scaled the transformative shift from volume to value remain a fraction of total [see my piece 'Eating Glass' http://acowatch.me/2014/08/14/eating-glass-a-davita-healthcare-partners-hiccup-or-physician-integration-implosion/ about Craig Samitt's abrupt departure from DaVita/Healthcare Partners ] are at least on the table given the ACO triple aim sustainability mission. If units decline, skilled managers find ways to drive UP price. Consolidations are precisely that, no?
I remember when per diems and case rates were first introduced back in the 80s. The CFO calculus was pretty simple: budget revenue requirements divided by projected units of service and voila, you got your case-mix adjusted average basis for both service tiered or global per diem contracting. Pretty simpleton, but true!
When shift to ambulatory from inpatient began, Outpatient surgery/procedure case rates were benchmarked to historical inpatient revenue yield. Only growth of physician owned ASC’s forced some competitive restraint to price [ and that theme remains alive today via OIG report: http://www.beckershospitalreview.com/finance/oig-says-bring-down-hopd-rates-for-surgery-to-asc-rates-cms-disagrees-11-things-to-know.html ]. That the aggregate trend UP is rather obvious, no? It has not abated from a total cost of care perspective – the only measure that really matters.
Thanks for sharing Jeff. I am not an economist, just a grunt in the c-suite who negotiated a fair amount for global (hospital, physician, ancillary and pharma) full risk downloads (from licensed entity to risk bearing delivery system) via multiple health plans in different states.
Things don’t seem to change much in the ‘healthcare borg.’

Please consider offering your thoughts as well! The original blog post is here.


Farzad Mostashari MD Unbundles the ‘Healthcare Borg’ at Engage

By Gregg A. Masters, MPH

I have been following the career of Dr. Mostshari since his tenure at ONC as Director of the Office of the National Coordinator for Health Information Technology.

Upon learning of his launch of the startup ACO management company Aledade, we posted some thoughts here and here.

Yesterday at MedCity Media’s ‘ENGAGE’ conference in Bethesda, Maryland he literally tutored the in-person audience as well as many others following the feed via Google Hangouts, or the twitter stream tagged #mcENGAGE. Mostashari illuminated both the burning platform nature of the ‘business as usual’ through a prism of ‘good for doc’, ‘good for patient’, ‘good for society’, as well as probable indicia of the likely solutions. This is a masterful performance by a physician executive turned entrepreneur worthy of widespread distribution. Apparently there’s quite a bit more to Mostshari than EHR adoption and the national e-connectivity backbone.