The @Aetna and @Humana Marriage: Will It Be Different This Time?

by Gregg A. Masters, MPH

Wow! Ahead of the 4th of July weekend Mark T. Bertolini (@mtbert) and Bruce D. Broussard (@BruceDBroussard) both savvy and seasoned managed health care industry players and visionary captains at @Aetna and @Humana respectively, announced their marriage via a $35 billion, see Bloomberg story: ‘Aetna-Humana Deal to Lower Consumer Costs, CEOs Say deal. aetna humanaYet the initial market reaction to this presumptive value added union has been somewhat of a Vulcan mind mood disappointment.

When the Bloomberg reporter Betty Liu inquired about the initial (and continuing as of the date of the post) bearish investor response to the transaction, Bertolini posited:

‘I don’t think its all investors Betty, I actually think it’s the ‘Arbs’ (arbitrageurs) that got in the deal looking for opportunity and I’m not quite sure they know how to do this trade.  This is a longer term strategy. This is a very big combination that is going to have a longer term impact on the quality of healthcare, the cost of healthcare in an evolving consumer marketplace [emphasis mine, more later].. once the noise settles down we’re going to do just fine.’

Then the billion, perhaps trillion dollar question was lobbed to Broussard via Liu:

‘Ok Bruce so is it going to lower healthcare costs for consumers?’ 

To wit the Humana chief noted:

‘very much so, I think as you see the transition from a more employer based to a consumer based model and a value based reimbursement model from a fee-for-service model, these combined organizations will have the capability to meet both of those trends. Both in the way of our clinical capabilities on the Humana side and the deep, deep employer relationships that Aetna has on their side.’

Now lets step back a minute and first breathe in this fact: nowhere in evidence has the aggregate cost of healthcare, nor health insurance premiums as proxy, declined (except for a brief period in the 90s when the medical care cost (MCC) index actually fell temporarily into negative territory), then as risk was pushed back by providers to the health plans, resumed their inexorable movement UP. So on a trend basis, health care costs ALWAYS rise as a multiple of CPI. Only recently has that rate of growth fallen from high single or the double digit rate of increases witnessed historically to low single digits – perhaps due more to the economic meltdown (declining demand and higher deductibles/copays) than any proactive contribution via improved health plan clinical risk management, direct or delegated).

Yet in offering documents filed with the SEC and investors as to the rationale for the combined company merger that ‘benefit’ is always posited as an outcome of the transaction. We always hear about ‘scale’, ‘operating efficiencies’ and even better management as a byproduct of the combination.

Secondly, some ‘de-coding’ is in order here. Both Bertolini and Broussard two men I admire as exemplary disruptor’s of ‘legacy healthcare’ inertia, i.e., Bertolini grew up in the HMO industry back in the day when even though his experience was forged in the for profit side of the business, it was none-the-less a mission oriented member focused sector (more MHAs, MPAs, and MPHs than MBAs) much like the community based operators in the non profit sector (RIP).

Broussard on the other hand is not your typical health plan executive as his roots are forged on the provider side with senior roles as U.S. Oncology (the successor to Physician Reliance Corp and ‘TOPA’ Texas Oncology, P.A.), Sun Health (the hospital group) and Continental Medical Systems (a rehab company). So his zeitgeist is firmly rooted in the provider culture with which his company buys, contracts for or joint ventures with to bring products to market.

Now back to the ‘code phrases’ used as rationale outlined for the inked merger/acquisition. Bertolini referred to ‘an evolving consumer marketplace‘ which means as more costs are shifted from the plan (Aetna, Humana and all other health plans writ large) to the member or insured, we (the consumers) will demand more ‘accountability’ from the provider world and thus somehow restrain aggregate healthcare costs via transparency tools or so called ‘skin in the game’ as a result of the shift to ‘consumer directed’ (i.e., high deductible) health plans.

This strikes me as a somewhat disingenuous argument bordering on perhaps naiveté (though it is highly unlikely that this characterization can stick to either of them). But ask yourself, if Aetna, Humana, United, Anthem or the member licensees of the Blue Cross and Blue Shield Association as aggregate wholesale buyers of hospital and physician services, leveraging millions of members or ‘covered lives’ (insurance speak), backed by seasoned provider contracting staffs can’t restrain the cost of healthcare, how can an ‘app empowered’, health literate enabled retail ‘shopper’ (you and me) for health services do better? I don’t think so… There is just too much of a power differential to overcome. We, empowered or not, are generally ‘screwed’ with more or less support from our ‘friends’ at the health plan.

The second but related theme was outlined by Broussard:

‘as you see the transition from a more employer based to a consumer based model and a value based reimbursement model from a fee-for-service model’

The two strands here are movement from the employer sponsored model which retains some vestiges of ‘defined benefits‘ at least for union negotiated plans, to a ‘consumer based model‘ more akin to the ‘defined contribution‘ practice of limiting the plan’s liabilities by capping what it pays for on behalf of its members or insureds. The kicker and perhaps ‘game changer‘ here is the near unanimous recognition in the health wonk, including health plan world that fee for services medicine is a burning platform on a dying paradigm – yet, arguably 80-90% of the money in the healthcare eco-system today remains in a predominant FFS book of business – HHS Secretary Burwell’s value based healthcare announcement notwithstanding) so don’t hold yer breath.

So there you have it. Will it, can it be different this time? Can two demonstrated champions of patient centric healthcare in an industry valued slightly higher than tobacco companies get it done when ALL of their predecessors have tried and failed? The carnage is plain to see, but only if you have an event horizon beyond the 24/7/365 current headline news cycle. I don’t know, but maybe the market knows and may even be paying attention to what came before?

For those who want some academic consideration of the broader strategic question, industry history,  if not possible glide-path in the consolidation orgy we are currently witnessing (both provider and health plan/payor/benefits solutions providers) with an exquisite dissection and analysis of the rise, fall and rise again (post Aetna/U.S. Healthcare acquisition), check out: ‘From Managed Care To Consumer Health Insurance: The Fall And Rise Of Aetna‘ by James Robinson, PhD, MPH the Leonard D. Schaeffer Professor of Health Economics and Director, Berkeley Center for Health Technology at my alma mater U.C. Berkeley.

The Transformation Continues – PopHealth Week’s Focus in July

by Fred Goldstein

The role of Primary Care Providers is changing and much of this is for the better. With the Triple Aim of improving the patient experience, improving the health of populations and reducing per capita costs; along with new payment methodologies, quality measures, organizational structures, and the like, primary care providers are being asked to to play an expanded role in the healthcare system; but what is that role and how can they ensure success?

PopHealthWeek-logo-TWTTR-sq (2)During the month of July PopHealth Week will focus on Primary Care and Population Health, interviewing primary care providers and thought leaders who have developed innovative new ways to practice. We’ll explore patient centered medical homes, capitated contracts, team based care, meeting patients needs, are the incentives in ACOs large enough to change behavior, and where these trend setters believe primary care is headed.

Join PopHealth Week for the following shows:

July 1, 12 PM ET/9 AM PT

Roy Hinman, MD, Island Doctors @Island_Doctors. To listen to the broadcast click here

Roy H. Hinman, II, M.D. is the founder of Island Doctors which employs more than 50 people within 14 offices in Florida stretching from Jacksonville to Interlachen and New Smyrna Beach. They also manage a network of 32 affiliate providers throughout these six counties and around the Orlando area. Their mission is to promote health improvement to each and every patient that walks through their doors.

The practice focuses on improving their patients’ health and participates in numerous community events and health fairs including holding Diabetes Awareness Seminars several times per year. Island Doctors want each patient to achieve optimal health status through education, meal planning, exercise, smoking cessation and cholesterol management.

Dr. Hinman opened his first family practice office in 1991 on Anastasia Island in St. Augustine, Florida.

July 8th,12 PM ET/9AM PTStanding Up the ACO

Rushika Fernandopulle, MD, Iorahealth @IoraHealth

Dr. Fernandopulle is the founder and CEO of Iora Health, an innovative primary care practice that offers Team-based care that puts the patient first, a payment system based on care, not billing codes and technology built around people, not process.

July 15th, 3 PM ET/12 Noon PT 

<Tentative not yet confirmed>

Jay Lee, MD MPH aka @FamilyDocWonk 

Dr. Lee is board certified in family medicine. After leaving Stanford University with a degree in Human Biology, Dr. Lee worked for a non-governmental organization in rural northern El Salvador providing clinical support for local physicians and organizing public health projects before returning stateside for medical school at the University of Southern California and family medicine residency training at Long Beach Memorial. Prior to re-joining MemorialCare Medical Group he worked at community health centers in southern California and Boston, where he earned a Masters in Public Health at Harvard University.

Dr. Lee was recently honored and elected to the 2016 term as President of the California Academy of Family Physicians aka @cafp_familydocs

July 22, 3 PM ET/12 Noon PT 

Paul Grundy, MD Global Director of Healthcare Transformation IBM, President PCPCC and Ambassador Healthcare Denmark

Dr. Grundy, known as the “Godfather” of the Patient Centered Medical Home is one of the leading thinkers in the transformation of Primary Care and is the Founding President of the Patient-Centered Primary Care Collaborative (PCPCC).


Fred Goldstein is the President/CEO of Accountable Health, LLC, and the co-founder of PopHealth Week. This post originally appeared here

The ACA, ACOs and Health System Reform 5 Years Later

By Gregg A. Masters, MPH

In the relentless sound byte and laughable misrepresentation of facts proffered by ideologues intent upon diluting if not repealing the ACA, one consistent voice of reason and evidence mindfulness is that presented by the cogent and thoughtful reflections on the indicia of ACA implementation courtesy of ‘team Commonwealth Fund’ aka @CommonWealthFnd.aca_5 years out

Published recently in the New England Journal of Medicine by the Commonwealth Fund‘s CEO and former National Coordinator for HealthIT David Blumenthal, MD (@DavidBluementhal) is one to consume, one provision at a time.

The full NEJM article is posted here.

The relevant discussion to readers of this blog specific to ACOs is pasted below:

Accountable Care Organizations

The ACA encourages health care providers to form new organizational arrangements called accountable care organizations (ACOs) that are intended to promote integration and coordination of ambulatory, inpatient, and post–acute care services and to take responsibility for the cost and quality of care for a defined population of Medicare beneficiaries. Under the Medicare Shared Savings Program (MSSP) of the ACA, providers who create such organizations and who also maintain or improve the quality of care can share part of any savings they achieve.
Providers can also elect to become so-called Pioneer ACOs, which not only share savings but also accept substantial risk if expenses for Medicare patients are greater than expected. Recently, CMS announced still other variations on the ACO theme, including arrangements in which ACOs function very much like Medicare Advantage plans.17 Indeed, many observers see ACOs as a bridge from fragmented fee-for-service care to integrated, coordinated delivery systems that resemble the tightly organized Medicare Advantage plans.
The two existing varieties of ACOs have spread with considerable speed. The MSSP has 405 participating ACOs serving 7.2 million Medicare beneficiaries (14% of the Medicare population).18 Quality measures have generally improved for the 33 indicators tracked by MSSP, and patients report better care experiences in some respects than Medicare beneficiaries who are not part of ACOs.19 CMS estimates the savings at approximately $700 million, as compared with control populations not enrolled in MSSP. A total of 32 organizations started in the Pioneer program; 11 transitioned to the MSSP track, and 2 withdrew entirely. The secretary of health and human services reports that the Pioneer program saved $385 million in the first 2 years, as compared with fee-for-service Medicare beneficiaries.20 These cost and quality results are early and modest, and further evaluation is needed before definitive judgments can be made.

A most useful and interesting Appendix re-capping and categorizing the many moving parts of the ACA enabling payment and health system delivery reform is available here.

Big h/t to Blumenthal et al for this fact based and honest reflection of measuring the impact of the ACA five years out.

Three Reasons Your ACO Will Likely Fail

by Gregg A. Masters, MPH

I’ve seen this before, and many times at that, see: 6 Reasons Your ACO Will Fail (A Series), Any One Will Do.

While some continue to debate and attempt to repeal the Affordable Care Act, the underlying market dynamics on which the vision of ‘Accountable Care‘, the triple aim or a sustainable healthcare ecosystem has risen continues to spawn innovation and remains remarkably intact.

Yet ACO’s are the workhorse in the mix of this triple aim enabling ACA magic and will remain so (until and unless the Medicare Advantage special interests prevail in their advocacy of an ‘end-run’ from ACOs direct to ‘MA’s’ aka global risk bearing HMOs).

But back to my premise…

Reason One Your ACO Will Likely Fail

The first impulse is to put ‘form’ (vs. function or culture) at the top of the agenda. I like to call this the ‘O,G & E‘ (organization, governance and equity) card. Just vision a typical process which plays out over and over again. An entity (usually a hospital or hospital system with access to capital) retains ‘advisers’ presumptively qualified to educate and guide local leadership into focused consideration of a ‘journey’ away from if not antagonistic to their core operations and culture.

First up are the lawyers, then accountants and consultants who address the business risk profile, regulatory environment, competitive landscape and outline structural models or options of organizing and participating in this new line of business consistent the mission, objectives and tax status of the ‘host’ enterprise.

Right from the outset the focus becomes the form of the organization and not it’s vision nor underlying or enabling culture per se. While these considerations may be part of the mix, breathing life into this sensitivity and operational awareness is usually seen in the designation of one or more hospital or health system friendly physicians to represent the balance (ergo interests) of the medical staff tribe. We’ve seen this in PHO formation, or the underlying management services organizations (MSOs), JV’s, etc., to support their operations. But make no mistake the ‘deliverable’ is a timeline, top down, check the box type strategy where the meter is running and things need get done whether they’re layered on quicksand or ‘terra firma’ so to speak.

Reason Two Your ACO Will Likely Fail

It’s about the right kind of ‘leadership’. More often than not the DNA guiding these conversations and shortlist of implementation decisions are principally healthcare leadership typically sourced from ‘institutional’ (hospital, health system or more recently IDN circles) vs. physician leaders who ‘see the [arbitrage] light‘, i.e., principally those trained in leadership (whether at the level of MBA’s or a scheduled participation via off-site Estes Park like medical staff/administration co-management team building efforts), have historically participated in managed care v1.0 et sequelae, AND actively value the transformation imperative under consideration.

Add this to the fact that the most appropriate physician leaders in this volume-to-value transformation are primary care physicians, yet the true power brokers in the institutional setting are the cash cow volume based specialties including cardiology, orthopedics, and neurosurgery, and fill in the blank proceduralists. PCPs have for the most part been carved out of inpatient culture and stay relatively focused on the ambulatory or outpatient side of medicine. A trend that began a while ago as the credentialing process assured a growing economic turf war as to who got to do what in the hospital, and was sealed by the industry move to the ‘hospitalist’ as the go-to inpatient specialist.

Reason Three Your ACO Will likely Fail

Rick Scott the former CEO of the disgraced Columbia/HCA hospital system (and now sitting Governor of the State of Florida) who earned that system a record $1.7 billion fine and with whom I routinely and vehemently disagree with, best framed the volume-to-value shift as follows:rick scott quote

While this quote may be another carefully crafted (some may say devious) calculus as Scott continues to oppose the ACA and Medicaid expansion in the ‘Sunshine State’ (see: ‘Gov. Rick Scott officially convenes commission on hospital spending‘ ), it none-the-less accurately reflects why institutional leadership will neither proactively nor aggressively pursue a revenue cannibalization strategy. Disruption as he noted must come from ‘outside’, however in this case outside comes in the form of hospital asset untethered ACOs driven by prudent resource allocation, access and quality in their service area.

Until hospitals become ‘cost centers‘ (as in Kaiser Permanente) vs. the traditional revenue plays they’ve no doubt perfected while hospital based care drives the cost of healthcare UP, this is mostly rhetoric to buy time and sometimes exit packages of oft overcompensated senior executives both in the 501(c)3 sector as well as their more transparent though similarly for-profit oriented health system operators.

So don’t hold your breath until the Kaiser Permanente model becomes the defacto clinical integration and financing standard in the U.S., but do watch what former ONC Director for Health Information Technology evangelist turn healthcare disruptor and entrepreneur at Aledade (a physician led ACO management company (MSO) – see ‘Waiting For ACOcor) Farzad Mostashari MD is up to. That Venrock and Bob Kocher in particular are rallying behind this model says a lot to me.

Bottom Line

Your ACO will fail if it’s of the institutionally led, top down, corporate check the box variety, and not imbued with the full court press commitment (so eloquently espoused by Don Berwick) of the required culture of health values to achieve the triple aim. Your ACO’s DNA must truly be truly disruptive from the bottoms up AND willing to can·ni·bal·ize  traditional hospital cash cow revenue streams.

That’s a lot to ask. Building that bridge in a quarterly earnings per share mindset maybe a bridge too far. Just ask Greg Samitt, see; Eating Glass?': A DaVita Healthcare Partners Hiccup or Impending Physician Integration ImplosionHe tried to bring that bridge forged at Dean Clinic (scaled movement from production to value) at Healthcare Partners (Da Vita) but for reasons unclear to me was prematurely asked to leave.

For some of my experience on this journey, see ‘Some Context and Perspective on Standing Up The ACO‘.

A Fork in the Road: ACOs vs. Direct Practice?

by Gregg A. Masters, MPH

If you come to a fork in the road, take it.

In the run up to the passage of the Affordable Care Act (select milestones here), the Senate Finance Committee under the leadership of Chairman Max Baucus presided over a comical volume of amendments proffered by his colleagues on the other side of the isle, see: ‘Senate Democrats Lead Historic Passage of the Patient Protection and Affordable Care Act‘.

Senate Finance CommitteeHaving witnessed gavel-to-gavel coverage of this painful historical consideration (some may say exquisite political theater) I soon began to refer to this bunch as the ‘dis-ingenuous five‘ (Hatch, Grassley, Cronyn, et al) as all of their amendments had one thing in common – to dilute if not distract from the intent of the Act or any of its targeted provisions.

Fast forward some 5+ years and the ideological drama of a very complex piece of legislation still engenders varying degrees confusion, implementation complexity, litigiousness and its share of opposition often nested inside simplistic and dumber by the dozens sound-byte alternatives, witness this recent exchange between former Senator and Governor Judd Gregg and the journalist Chris Hayes.

Yet, forged from private market competitive ‘lessons learned’ experience, supported by tomes of sound bi-partisan health policy reasoning and enabling regulatory consideration two seemingly opposing remedies co-exist with relative degrees of market uptake success: ACOs and ‘DPCs‘ (direct practice‘) including it’s retainer and membership model medicine derivatives.

Some say direct primary care (DPC), still a trickle in terms of share of medical practice participation, is the way to ‘give the finger’ to the prevailing mangled care amended bill and chase model of American medicine (and by proxy the ACA) and exit the system in favor of a more simplified and patient centric model. Yet there is more to this story as few get the provisions in the ACA enabling the inclusion of DPC’s as potentially ‘qualified health plans‘ and thus eligible for listing on State or Federally Facilitated Health Insurance Exchanges, see: ‘DPC and Insurance, HDHP, HSAs‘; not to mention there are a range including ‘hybrid’ DPC models (from Qliance to OneMedical and many in between) that stay tethered to a claims filing and collections model of operations.ACO's: what's next if we fail? Jay Crosson, MD | 3rd National ACO Congress

ACOs are a statutory construction of the ACA via introduction of Section 3022: The Medicare Shared Savings Program and center core to the impact and efficacy of the law’s intent. To many this rules ACOs out as de-facto agents of change driving transformation of an excessively complex, silo-ed and provider centric healthcare financing and delivery system quagmire.

Another Way To Look At It

So for those willing to dive a little deeper into the chassis of both business models and services line extensions there may be more similarity between these two seemingly oppositional vehicles.

Both are variably tethered to the ACA and thus part of the implementation vision of the President and his then allies in the Congress. At its core the DPC model is a return to HMO roots of ‘pre-paid’ comprehensive primary care services though the DPC model is not in the business of health insurance while HMOs clearly are. While DPCs typically only include the range of primary care services they control, and exclude specialist referrals, lab and imaging services and hospital inpatient or outpatient services, they do leverage principles of ‘re-insurance’ via optional wrap around high deductible or catastrophic plans.

ACOs in the Medicare Shared Savings Program (MSSP) are seen by many especially those risk savvy medical group or integrated delivery system operators of Medicare Advantage health plans (aka ‘HMOs’) as too little too late (or ‘HMO-lite’) versions of the real deal and unlikely to steward the meaningful transformation from a volume-to-value based healthcare economy.Standing Up the ACO

Yet, the truth is they’re both part of the broad brush of initiatives included under the tenets and principles that gave birth to the ACA, see: ‘Obama-care 101: The president’s 8 principles‘.

Clearly this transformation of 1/5 of the U.S.economy will take time and there are many moving parts. The question is do we have enough time for pluralistic remedies to take hold before the ‘system’ collapses on itself? The nightmare scenario being non-risk bearing ACOs can’t deliver the shift to value and DPC led ‘exits’ create a perfect storm of declining supply at the precise time of peak demand for primary care services.

So one more time as I often say here: ‘…we shall see?’


‘Non-Profit IDNs': Where’s Da Beef?

By Gregg A. Masters, MPH

I have followed this narrative for quite some time albeit inside the industry contained debate of whether so-called ‘non-profit’ [501(c)3] hospitals or their parent systems (really more aptly characterized as “tax exempt”) actually earn this financial advantage via material ‘returns’ to the communities they serve.

NASI_Goldsmith studyAs can be expected you have the party line of the American Hospital Association (AHA) a trade group of predominantly non-profit members vs. that of it’s for-profit brethren The Federation of American Hospitals (FAH). You can guess which side of the argument each of them favor.

Now thanks to a recently published landmark study ‘Integrated Delivery Networks: In Search of Benefits and Market Effects’ by Healthcare Futurist Jeff Goldsmith, PhD et al, of the 501(c)3 cast of characters in the related but more often than not distinctly different ‘IDN culture’ we extend that line of inquiry into what has been a somewhat conversational ‘safe harbor of sorts’ – not any longer?

The Executive Summary notes both the rationale and basis to study the market ‘incident to’ a more focused pricing (via asset concentrations) power line of inquiry:

In January 2014, the National Academy of Social Insurance commissioned a study of the performance of Integrated Delivery Networks (IDNs), incident to its Study Panel on Pricing Power in Health Care Markets. The premise of this analysis was that any examination of the role that hospitals play in health care cost growth is complicated by the fact that in most large markets, the significant hospitals are part of larger, multi-divisional health enterprises. In these markets, hospitals may be part of horizontally integrated hospital systems operating multiple hospitals; vertically integrated health services networks that include physicians, post-acute services and/or health plans; or fully integrated provider systems inside a health plan (e.g. with no other source of income than premiums) like Kaiser Permanente. The latter two models are collectively labeled IDNs.

IDNs have very different stated purposes than mere collections of hospitals: to coordinate care across the continuum of health services and to manage population health. IDN advocates claim that these complex enterprises yield both societal benefits and performance advantages over less integrated competitors. The purpose of this analysis is to evaluate the evidence to support these claims.

And now for the less than surprising but wholly unacceptable answer albeit modestly caveatted by the limits of publically available information:

Despite more than 30 years of public policy advocacy on behalf of IDN formation, there is scant evidence in the literature either of measurable societal benefits from IDNs or of any comparative advantage accruing to providers themselves from forming IDNs. We have similarly found no such evidence in our analysis of 15 IDNs. Serious data limitations hamper anyone attempting to evaluate IDN performance based on publicly disclosed information. IDN financial disclosures obscure the operating performance of their hospitals and physician groups.

There does not appear to be a relationship between hospital market concentration and IDN operating profit [emphasis mine]. However, if the performance of the IDN’s flagship hospital is any indicator of overall systemic efficiency, the IDNs’ flagship hospital services appear to be more expensive, both on a cost-per-case and on a total-cost-of-care basis, than the services of its most significant in-market competitor.

This runs counter to the theoretical claim of IDN operating efficiency. Further, the flagship facilities of IDNs operating health plans or having significant capitated revenues are more expensive per case (Medicare case-mix adjusted) than their in-market competitors.

The authors would have greater confidence in these findings if they covered not only multiple years of information but also multiple institutions in the IDN portfolio (e.g. its suburban or rural hospitals, etc.). Further, the central question of whether IDNs have abused their market power in metropolitan markets can only be answered by examining actual service-specific payments to their hospitals by local health plans and by determining the profits generated by their hospital portfolio.

NASI_Goldsmith study_cohortI am struck by the reaction or better yet absence of a reaction in public discourse let alone in health wonk or big data evangelists circles particularly at time when there’s been so much mis-direction and battle fatigue surrounding the endless debate/efforts at repeal of the Affordable Care Act.

Such a profound observation and ‘counter intuitive’ result (i.e., ‘hey, there may not be a there, there insight’) based on frequent accolades and ‘innovation’ recognition extended to such trophy name plates as Kaiser Permanente, Geisinger Health, InterMountain Health and so little public debate (see complete list) causes me to question whether we’re paying attention to what matters?

How can we intelligently debate, discern and buildout the qualities and characteristics of financing and delivery system platform efficacy and business model innovation that delivers on the triple aim and lays a solid foundation for a sustainable healthcare economy if we do not understand their root DNA and the results (“community benefit”) they ostensibly generate?


Announcing the Launch of ‘PopHealth Week’

By Fred Goldstein

This week Gregg Masters (@2healthguru) and I (@fsgoldstein), along with Doug Goldstein (@eFuturist) are announcing the launch of PopHealth Week. This is a weekly Internet radio podcast (typically broadcast at 12 pm Eastern each David Nash MD MBAWednesday) with an associated website at We intend to focus on all things population health. Our shows will feature 1) people, topics, news and analysis as we will 2) present the broad spectrum of what is and is not population health and 3) how it fits into the changing health and healthcare landscape, what’s working, how and by whom.

Our first show this Wednesday, May 20 will feature David Nash, MD, MBA, the Founding and Current Dean of the Jefferson School of Population Health. This show will focus on Population Health and Population Medicine.

The last Wednesday show each month will feature a roundtable discussion of recent news. So join Gregg, Doug and me as we discuss what’s happening in population health on May 27.

Coming up in June:

June 3jennifer-drago-feb-2013

Jennifer Drago, Executive Vice President of Population Health with Sun Health. Among her many jobs, Jennifer oversees the Care Transitions program which is a CMS Community-Based Care Transitions Program (CCTP), focusing on reducing readmissions, a major issue for hospitals, ACOs and other provider groups.

kaveh_safavi-21June 10

Kaveh Safavi, MD, Managing Director, Global Health, Industry Lead, Accenture. Discussing his thoughts on population health and where providers should be focusing early on.

June 17blumberg_steven

Steven Blumberg, Senior Vice President – AtlantiCare and Executive Director – AtlantiCare Health Solutions, an ACO in New Jersey discussing ACO’s.

June 24

Join Gregg , Doug and me as we monitor the pulse of the population health industry revealing its best practices and biggest challenges. We’ll help you sort out the ‘wheat from the chaff’ in this emerging space ripe with marketing claims while often light on documented use cases or outcomes efficacy.

More to come.


Fred Goldstein is the CEO of Accountable Health, LLC, and co-founder as well principal co-host of PopHealth Week. This post originally appeared on Accountable Health, LLC.