Accountable Care, ACO, population health

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.

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Accountable Care, population health, public health

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

 

 

Medicare, population health, Triple Aim, Uncategorized

[Re-post] The ‘Medical Aggregators’: Are We Entering Round Deux?

By Gregg A. Masters, MPH

[Originally written by @2healthguru on June 1, 2010 at 11:00 AM]

First a little historical context:

For those with a healthcare ‘event horizon’ slightly more seasoned than the current health reform ‘conversation’, you might remember the initial round of aggregation in medicine lead by disruptive nameplates such as MedPartners (now operating the PBM CareMark), PhyCor, FPA Medical Management, and their second or third tier physician practice management ‘me too’ copycats.

They all emerged from a robust round of venture capital backed industry determination tagged as ‘PPMC’s’, i.e., physician practice management companies. These ‘aggregators’ were the darlings of Wall Street for a while, though with some exceptions, i.e., US Oncology (formerly Physician Reliance Network), most witnessed relatively short life spans, from IPO to unwinding in perhaps a 10 year run (see: MedPartners collapse and Aftermath).

Yet, despite the promise outlined in the offering prospectus’, why did these entities fail so miserably as the ‘white knight’ consolidators or aggregators of a multi-trillion dollar ‘cottage medical industry’? Their business model proferred essentially three core benefits:

  1. Centralized, standardized and more efficient back office medical administrative management
  2. Scale of market asset concentration and therefore increased sophistication and leverage (improved pricing) with third party payor negotiation, and downstream contract management; and
  3. Serve as an ‘anchor play’ with respect to the broader design and implementation of rational though market based local delivery organization and financing, i.e., PPMC’s would harness and more effectively articulate a business culture among physicians that valued clinical integration, medical risk management, and ultimately the allocation of limited health care resources

At least this was the longer term expectation from a ‘win/win’, i.e., payor and provider perspective, of the more established players. Most however, in an effort to demonstrate value (i.e., earn their management fee) to their physician boards, focused on short term margin improvement (better rates, focus on more profitable services via improved payor mix, maximizing the contract revenue/recovery cycle, and reduced overhead, etc.), vs. the strategic focus of managing the risk (both quality and cost) of their local population (i.e., enrolled members).

So rather quickly the strategic basis of the PPMC appeal was subordinated to a short term focus (i.e., increasing net revenues) due to a rising chorus of claims that at its core the business model was merely a third party ponzi scheme which introduced another mouth to feed from an increasingly constrained health care supply chain.

Net/net, the PPMC industry flamed out big time and did not fulfill its ‘roll-up’ promise of the practice of medicine. Now many years later, we are at another tipping point. Witness the current round of promising vehicles with a similar vision of organizing physicians. These candidates include: hospital systems, health plans, integrated delivery systems, emerging ACOs, medical homes,  and even niche play organizers in the concierge, or direct practice space including SignatureMDMDVIPHealthAccess Rhode IslandCarePracticeQliance, and HelloHealth, as well as the rapidly emerging series of retail pharmacy sponsored primary care clinics, e.g., CVS/CareMark Minute Clinic, etc.

Too many docs are unwilling to risk the capital of private practice, and instead are looking to hook-up with one or more of these institutional or VC backed entrepreneurial sponsors. Will they succeed where their predecessors failed? If so, why?

From my perspective, it will clearly depend on the business model chosen to enable competition of the ‘right variety’, and the degree to which the venture embraces, nurtures and expresses physician culture that values collaborative group practice. Top down, corporate strategies dependent upon an over worked and out gunned medical director or VP of medical affairs will miss the mark. The more likely way for these ventures to succeed is by ‘baking’ the culture from the ground up. In other words, ‘seed it and they will come’. One of my mentors (Ernest Holmes) once wrote long ago:

the soil can’t argue with the seed.

Lets nourish the soil first, then make sure we plant the seeds with the right constitution and vision.