Parsing Volume to Value, Proxy Measures, and the Streetlight Effect
Despite some concern that the migration from fee-for-service to value based payment (VBP) is being reversed, there remains strong momentum for VBP – both nationally – in the form of the bipartisan 21st Century Cures Act that was passed and signed into law last December, and many state and commercial initiatives, including the one I’m personally involved with, New York Delivery System Reform Incentive Payment Program (DSRIP). ?Defining value, of course, is not easy. ?I’ve often returned to Michael Porter’s short essay on this topic when I feel my definition meandering. Go read it now. ?Please.
...
Source: Docnotes - August 19, 2017 Category: Primary Care Authors: Jacobr Tags: Technology Value Source Type: blogs
Parsing Volume to Value, Proxy Measures, and the Streetlight Effect
Despite some concern that the migration from fee-for-service to value based payment (VBP) is being reversed, there remains strong momentum for VBP – both nationally – in the form of the bipartisan 21st Century Cures Act that was passed and signed into law last December, and many state and commercial initiatives, including the one I’m personally involved with, New York Delivery System Reform Incentive Payment Program (DSRIP). Defining value, of course, is not easy. I’ve often returned to Michael Porter’s short essay on this topic when I feel my definition meandering. Go read it now. Pleas...
Source: Docnotes - August 19, 2017 Category: Primary Care Authors: Jacobr Tags: Technology Value Source Type: blogs
Parsing eCW ’ s $155M payment to the government
UPDATE: ?Here are the public records for the case. ?More details there about the original complaint. ?Excerpt:
@eClinicalWorks to pay $155M fine: https://t.co/RngioK62SX
But what’s it mean?
Certification
The purpose of any certification program is to create a method for the purchasers of a product to have confidence that the product safely and reliably does what it is supposed to do. ?One example from USDA:
Turning Point for Meat Inspection ??In 1905, author Upton Sinclair published the novel titled The Jungle, taking aim at the poor working conditions in a Chicago meatpacking house. However, it was the fi...
Source: Docnotes - May 31, 2017 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs
Parsing eCW ’ s $155M payment to the government
UPDATE: Here are the public records for the case. More details there about the original complaint. Excerpt:
@eClinicalWorks to pay $155M fine: https://t.co/RngioK62SX
But what’s it mean?
Certification
The purpose of any certification program is to create a method for the purchasers of a product to have confidence that the product safely and reliably does what it is supposed to do. One example from USDA:
Turning Point for Meat Inspection In 1905, author Upton Sinclair published the novel titled The Jungle, taking aim at the poor working conditions in a Chicago meatpacking house. However, it was ...
Source: Docnotes - May 31, 2017 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs
National Coordinator 6.0: A Blueprint for Success
1.0 Brailer
2.0 Kolodner
3.0 Blumenthal
4.0 Mostashari
4.1?me
5.0 DeSalvo
5.1 Washington
5.2 White
6.0 Rucker
Now that it’s public, I’ll offer my thoughts on the next steps for Don and ONC. ?Don Rucker is a good pick for the nation, and will be a great National Coordinator. ?I’ve gone on record as saying that some others are not qualified, and as many of you know – I don’t mince words. ?Don is smart, focused, thoughtful, intentional, and will make good decisions for ONC and HHS. ?I have known Don for 20 years. ?He’s got a long track record of integrity, he’s a...
Source: Docnotes - March 31, 2017 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs
National Coordinator 6.0: A Blueprint for Success
1.0 Brailer
2.0 Kolodner
3.0 Blumenthal
4.0 Mostashari
4.1 me
5.0 DeSalvo
5.1 Washington
5.2 White
6.0 Rucker
Now that it’s public, I’ll offer my thoughts on the next steps for Don and ONC. Don Rucker is a good pick for the nation, and will be a great National Coordinator. I’ve gone on record as saying that some others are not qualified, and as many of you know – I don’t mince words. Don is smart, focused, thoughtful, intentional, and will make good decisions for ONC and HHS. I have known Don for 20 years. He’s got a long track record of integrity, he’s a nice person, he...
Source: Docnotes - March 31, 2017 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs
Career Transitions
I had lunch yesterday with an industry colleague who was recently let go from his job with a big company. ?He is now?doing what everyone told him to do: ?network, network, network – to find the next big thing. ?Our lunch was of course part of that networking. ?Who do I know? ?Which companies might be hiring people with his skills? ?His sense of urgency (despite the?generous severance package) was palpable.
Initially, I answered his questions: ?we brainstormed about?this company or that?company, and I offered to introduce him to some CEOs who may have interest in him.
But after the server brought our lunch, and the ca...
Source: Docnotes - January 28, 2017 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs
Career Transitions
I had lunch yesterday with an industry colleague who was recently let go from his job with a big company. He is now doing what everyone told him to do: network, network, network – to find the next big thing. Our lunch was of course part of that networking. Who do I know? Which companies might be hiring people with his skills? His sense of urgency (despite the generous severance package) was palpable.
Initially, I answered his questions: we brainstormed about this company or that company, and I offered to introduce him to some CEOs who may have interest in him.
But after the server brought our lunch,...
Source: Docnotes - January 28, 2017 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs
Why do I run marathons?
That’s me over there in the white shirt. ?Six days ago. ?It was a day that I had worked toward since ~ March. ?I’ve done this every year since 2010. ?For about 15 minutes after the marathon, I was sure that it was my last. ?I ran a 1/2 marathon about 3 weeks ago, and it was amazing. ?I loved it. ?I was downright gleeful afterward. ?Not so after 26.2 – especially NYC, which has a very difficult last 5 miles. ?Just walking the ~ 3/4 mile after the finish was painful. ? Why do I do this every year?
Resilience
Discipline
That’s it. ?If you know someone who has run a marathon, you know a person who has...
Source: Docnotes - November 12, 2016 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs
Why do I run marathons?
That’s me over there in the white shirt. Six days ago. It was a day that I had worked toward since ~ March. I’ve done this every year since 2010. For about 15 minutes after the marathon, I was sure that it was my last. I ran a 1/2 marathon about 3 weeks ago, and it was amazing. I loved it. I was downright gleeful afterward. Not so after 26.2 – especially NYC, which has a very difficult last 5 miles. Just walking the ~ 3/4 mile after the finish was painful. Why do I do this every year?
Resilience
Discipline
That’s it. If you know someone who has run a marathon, you know a per...
Source: Docnotes - November 12, 2016 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs
Service Innovation
?Shift the business models?
?Re-align the incentives?
?Fee-for-value?
These phrases are not new.
Nor are the concepts they represent.
Yet we?re starting to see new experiments from the federal government, from states, and even small communities that demonstrate a new willingness to deeply engage in understanding and overcoming the barriers to true change in how we improve health.
Notice that I said ?improve health.?? I didn?t say ?Improve health care.?? This not just an insignificant semantic nuance.? When we conflate care and health, we accept the fundamentally flawed assumption that in order for people to be healthy, we ...
Source: Docnotes - September 16, 2016 Category: Primary Care Authors: Jacobr Tags: Uncategorized Value Source Type: blogs
Service Innovation
“Shift the business models”
“Re-align the incentives”
“Fee-for-value”
These phrases are not new.
Nor are the concepts they represent.
Yet we’re starting to see new experiments from the federal government, from states, and even small communities that demonstrate a new willingness to deeply engage in understanding and overcoming the barriers to true change in how we improve health.
Notice that I said “improve health.” I didn’t say “Improve health care.” This not just an insignificant semantic nuance. When we conflate care and health, we accept the fundamentally flawed assumption that in order fo...
Source: Docnotes - September 16, 2016 Category: Primary Care Authors: Jacobr Tags: Uncategorized Value Source Type: blogs
Advice to the new National Coordinator
Two and a half years ago, John posted an entry with this title?- and I recall that it was a good summary of the state of the industry. ?While I didn’t agree with all of his suggestions, I enjoyed the review and it offered a good set of guiding principles. ?Since I was Acting National Coordinator for about the same duration as Vindell will serve, (Fall of 2013 – after Farzad Mostashari departed, and before Karen DeSalvo arrived) I’ll offer some thoughts?from?one who has been in his?position.
Certification. ?The health IT certification program is the core of ONC’s responsibility to the nation. ?Whil...
Source: Docnotes - August 15, 2016 Category: Primary Care Authors: Jacobr Tags: Electronic Medical Records Medicine and technology Uncategorized Usability Value Source Type: blogs
Advice to the new National Coordinator
Two and a half years ago, John posted an entry with this title – and I recall that it was a good summary of the state of the industry. While I didn’t agree with all of his suggestions, I enjoyed the review and it offered a good set of guiding principles. Since I was Acting National Coordinator for about the same duration as Vindell will serve, (Fall of 2013 – after Farzad Mostashari departed, and before Karen DeSalvo arrived) I’ll offer some thoughts from one who has been in his position.
Certification. The health IT certification program is the core of ONC’s responsibility to the ...
Source: Docnotes - August 15, 2016 Category: Primary Care Authors: Jacobr Tags: Electronic Medical Records Medicine and technology Uncategorized Usability Value Source Type: blogs
Self-Driving Health
Lots of news about this recently. Five years ago, you would shake your head and say “no way – not in my lifetime.” Now you know that this is our future. It will be safer, will save billions of dollars, and will be have positive consequences we can barely imagine. The kids need to go to soccer practice? Send them. Get the dog to the vet for his check-up? Plop him in the car and off he goes. It’s real. It will happen. Soon.
So why is it so hard for us to imagine self-driving health? Do we have a crisis of under-supply of primary care? Yes. Today we do . But I wonder if that...
Source: Docnotes - March 17, 2016 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs
