Patrick Carroll

Many thoughts as Medicare Advantage continues to come under scrutiny. - MA has features of a value-based program, but most of the current "value" is being delivered through diagnosis capture and complexity payments. Ironically, much like FFS, it pays more to keep people sick (or make them look sick). Don't think that's anyone's definition of value. - To be fair, most doctors (especially specialists) don't do a great job of capturing diagnosis and patient complexity beyond their immediate area of expertise. (We're especially bad at this in MSK). We should have accurate representation of a patient's health in the medical record. Complexity and co-morbidities affect treatments and outcomes. We don't yet have a good way to account for this complexity -- and it's becoming clear the MA system isn't it. - EMRs make all of this worse. It's both too easy and too hard to record, change, or resolve diagnoses. EMRs should facilitate accurate complexity capture and treatment personalization. The goal shouldn't be to increase billing, it should be to increase sophistication and precision. - As MA scrutiny grows, the business model of many alternative care models (especially in primary care) will be challenged (potentially dealing another blow to retail healthcare). - CVS' purchase of Signify health is put into full context by this article. - It boggles the mind that CMS can develop and administer a program that nets billions for inscos (at the expense of taxpayers) while reducing physician reimbursement yearly and rolling out ineffective VBC programs for providers. CMMI should have an open-door policy for anyone delivering care and working on true value-based models. Ears, eyes, and minds should be wide open. h/t Mahek Shah MD, MBA Moby Parsons, MD #medicine #healthcare #vbc #valuebasedcare #health

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Independent physicians are the best value in healthcare

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Amazon's effect on physician consolidation Becker's Physician Leadership Review published this in early April- As physicians migrate to employed models and the healthcare industry consolidates, retail giant Amazon continues to double down on its focus on primary care and other physician specialties.  Amazon has 221 primary care offices in more than 20 markets. In February 2023, it finalized a $3.9 billion acquisition of virtual and in-person primary care company One Medical, which added more than 200 brick-and-mortar physicians offices and roughly 815,000 One Medical members. The One Medical deal has already "changed the landscape" of healthcare and altered the way hospitals do business, health system leaders told Becker's. "The acquisition of One Medical by Amazon should remove any lingering doubt that Amazon is serious about making a real and substantive move into healthcare as well as cementing the notion that any viable healthcare strategy must have at its foundation a robust primary care offering," Richard Zane, MD, chief innovation officer for Aurora, Colo.-based UCHealth, told Becker's.  Amazon has since launched One Medical for Prime, offering Amazon Prime members unlimited virtual visits for $9 a month. In January, Amazon Pharmacy integrated with One Medical to give patients and providers increased access to medication consultations. One Medical provides concierge primary care, with longer appointments and no wait times, as well as 24/7 virtual care for a yearly membership of $199 and has formed collaborations with 19 hospitals. The hybrid primary care company has specialty care referral agreements in the health systems' local markets.  The deals allow specialists from health systems to deliver care to Amazon's primary care patients.  Some of those health systems told Becker's in September the partnership improves access to primary care in their markets.  "This partnership with One Medical is a prime example of Mass General Brigham's commitment to working with world-class partners that complement our strengths," said Lynn Stofer, president of Mass General Brigham Community Physicians, part of the Somerville, Mass.-based health system. "One Medical offers a broad primary care network with tight connections to our entire team of Mass General Brigham specialists, providing outstanding services for our patients and increasing access to care at a time when demand continues to outpace supply." #healthcare #insurance #physicianleadership #disruptor #physicianshortage #ama

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Latest Kaufman Hall report: The hospital industry’s financial performance seems to be stabilizing, BUT there's a widening gap between the highest- and lowest-performing organizations. "The hospitals that have been able to maintain financial health throughout the last few years are the ones who have taken care to adopt a wide variety of proactive cost-saving and growth strategies." 🤔 Has your organization adopted innovative cost-saving strategies to maintain or improve its financial health? 💡Optimizing financial assistance with the help of technology creates a win-win for patients AND providers. #healthcarefinance #hospitalfinance #revenuecycle #healthtech

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Hmm. If these large companies are struggling to make a profit in healthcare--- with their economies of scale, strong market position and geographic locations, marketing savvy, and ability to treat patients like customers and funnel them to use a variety of their other profitable services (esp pharmaceutical, cold remedies)...... How can those in primary care survive? I know first hand-- my wife is in a small primary care private practice. They survive week to week paying their bills-- but provide great personalized care to their patients--- her wait time for new patients is 18 months which says a lot about her skill as a primary care (and she really 🏩 cares) physician and the state of primary care access (it is shrinking at an alarming rate). So it seems convenience for customers is not the answer. Well not enough smart people have tried to solve the healthcare finance dilemma--- I love this quote from the article-- “There’s no end of [executives] who have come in and said, ‘I think the problem in healthcare is that my genius and my business acumen hasn’t been applied to it yet,’” --- genius has yet to solve the problem--- Just ask Warren Buffet and Atul Gawande. So commoditizing healthcare does not seem to be working. The fee for service model continues us down this path of doing more, treating pathology, and not creating wellness to get paid. We need to create a reimbursement model that focuses and rewards high quality, team-based, patient outcome and experience driven healthcare. Maybe CVS and Amazon will solve the puzzle. Hmm, but is it a puzzle for patients, clinicians, or profits? #UsingWhatWeHaveBetter https://lnkd.in/g73tvrEZ

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Sometimes it isn’t about being first, but being better. That thinking helped fuel the entry of big players like Walmart, Amazon and Walgreens into the business of healthcare. But things aren't always as they seem from the outside looking in. As I shared in this piece for Modern Healthcare, health systems have the edge when it comes to creating long-standing relationships with patients and delivering the comprehensive care consumers need. But it's an advantage that's ours to lose if we fail to evolve. #healthcare #patients #consumers #disruptors #qualitycare https://lnkd.in/eAz4BQpu

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Recent court decisions have caused CMS to recalculate Medicare Advantage Star Ratings - which will generate increased bonus payments for some plans as extreme outliers are not discounted from the calculations. But note: this decision was made based on the Administrative Practice Act (a federal law governing how federal agencies do their work) rather than the substance of the action; smart money will expect future rulemaking to comply with the decisions and further modify the calculations. The takeaway for practices and plans is to take the win today but not rest on these decisions: Providers, do your absolute best to deliver the best care, and Plans, invest in practices doing the work with your patients now for long-term success. https://lnkd.in/gSRFcuMs

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The Congressional Budget Office recently released a report on Medicare ACOs. Here's a brief summary mixed with personal comments: ACO types associated with greater savings either a) were led by independent physician groups, b) had a larger proportion of primary care providers or c) had initial baseline spending higher than the regional average. One comment on that last factor I found interesting was that increased expense from post acute care tended to be an area of greater impact: “...postacute care, which includes skilled nursing care and rehabilitation services, is costly and has the potential to be overused or used inefficiently, making it a readily identifiable target for ACOs aiming to decrease spending.” ACOs led by hospitals performed less well because: “If hospitals reduced admissions, then they would earn less revenue to cover their fixed costs, weakening their incentive to generate shared savings.” Something they touched on that I think is a key weakness is that ACO benchmarks are updated over time to reflect the observed spending among that ACO’s attributed beneficiaries. “Because of that structure, ACOs that lower their spending are effectively penalized with lower subsequent benchmarks.” The CBO report also suggested ways to potentially improve the offerings. “Those approaches can be grouped into the following categories: those that would increase providers’ incentives to participate in ACOs, those that would increase providers’ incentives to reduce spending, and those that would increase awareness and engagement of beneficiaries.” One suggestion I called out above is the idea of eliminating “the rebasing of benchmarks using historical spending among an ACO’s beneficiaries and instead use administratively set benchmarks.” I have also found that, due to external impacting factors that occur each year, retrospectively looking at the rate of increase in expenses for the attributed population vs the actual rate of increase for a similar but not attributed population, is a much more fair assessment of the impact of the ACO than a prospectively projected target. Another key issue with ACOs is the lack of patient engagement. It is quite common for patients to a) not know they’re “in” an ACO and b) have no incentives to participate in the ACO’s offerings or services. This article notes “…strategies that rewarded patients for obtaining services from ACO providers could enhance communication and engagement between providers and patients and reduce Medicare spending.” The analysis goes on to say that “Without a clear financial incentive, beneficiaries tend not to obtain care exclusively from ACO providers. One way to strengthen that incentive would be by waiving Part B cost-sharing requirements for beneficiaries who obtain care from their primary care physician or another provider in the ACO.” Full CBO report here: https://lnkd.in/gEUaFZKV

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Here's a shocker -- the AHA and the FAH are pushing back against Medicare's mandatory hospital-based bundled payment program. The hospital associations are asking for more time to get ready for a program that will start in 19 months.... It's laughable, of course, but what else should we expect from the agents of the status quo? For those who hadn't kept up, Medicare announced the Transforming Episode Accountability Model several months ago and it's finally going through the end of the rulemaking process. So what's TEAM? A slimmed down version of the Medicare Bundled Payment Model (BPCI and its successor BPCIA) that has been in place for over a decade. There's nothing new about TEAM except that it only covers a handful of inpatient stays and the accountability is reduced to 30 days post discharge instead of 90. Four years ago a dozen or so highly respected leaders in the industry recommended that CMS institute a "DRG+30" across the board. Not just for five DRGs, but all DRGs. And here we are, four years later, and TEAM is set to start in 2026....yes, 2026, not 2025. The first cohort of the original program launched in April 2013, more than 11 years ago. By the time TEAM starts it will have been close to 13 years. Isn't that enough time to get ready Chip Kahn???? All of the published analyses on the Medicare Bundled Payment program showed the same source of savings -- post-acute care. And the savings never negatively impacted outcomes. So it's logical that Medicare makes this mandatory. What's not logical is that it's taken so much time to get to this decision. So let's just get on with it because the taxpayers deserve it and so do Medicare beneficiaries. #TEAM, #BundledPayments, #CMMI

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Key Strategic Insights = A Successful OP CDI Program The challenge of value-based care starts with a collaborative approach, when launching an Outpatient Clinical Documentation Integrity (OP CDI) program. Here are some key strategic insights to success: 1. Engage with Population Health Understand Pain Points: Begin by understanding the specific challenges faced. This fosters collaboration. Tailored Questions: Use customized questions to facilitate productive discussions and ensure alignment with needs. 2. Effective Software Implementation Manage Patient (Pt.) Volumes: Implement software solutions to efficiently handle pt. volumes. OP CDI Calculator: Utilize a calculator to determine Full-Time Equivalent (FTE) needs. Data Analytics and Reporting: Emphasize the importance of continuous improvement via data analytics. 3. Workflow Creation Establish Robust Workflows: Create strong workflows before integrating reviewers. 4. Collaboration & Communication Promote Strong Collaboration: Encourage robust communication between key stakeholders. Leverage Software: Use technology to reduce physician burnout & streamline communication. 5. Patient-Centered Approach Address social determinants of health (SDOH) & ensure accurate documentation of conditions and care plans. Patient Outcomes: Keep patient care at the center of all doc. & workflow processes. 6. Regulatory Compliance Adhere to Guidelines: Follow regulatory requirements such as CMS guidelines on Hierarchical Condition Categories (HCC) coding to avoid penalties and enhance credibility. 7. Measurable Outcomes Set Clear Goals: Aim for measurable outcomes like improved HCC recapture rates, enhanced RAF scores, better HEDIS measures, and addressing SDOH needs. 8. Stakeholder Engagement Involve All Stakeholders: Ensure that executives, clinicians, and other relevant parties are involved in planning and implementation process. Success Stories Recently, I helped several CDI directors validate their cases for OP CDI programs within Accountable Care Organizations (ACOs). By engaging with population health leadership, we identified key issues such as RAF gaps and HEDIS measures, and tailored processes to address them. For instance, a CDI director I guided successfully identified HCC and HEDIS recapture as their biggest pain points. With strategic solutions in place, they are now ready to implement the project for the 2025 budget yr., aiming to improve their HCC recapture rate by 20%, leveraging data analytics for outcomes and improvement needs. Benefits of Implementing These Strategies Align Risk Stratification: Properly align risk stratification with chronic conditions and healthcare needs. Quality Measures: Improve quality measures and address SDOH. Collaborative Team: Ensure success with a collaborative team supported by technology. Overall, these strategic actions will enhance patient care and operational efficiency. #Healthcare #Leadership #CDI #PatientCare #ValueBasedCare #HealthcareInnovation

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The April final rule on #supplementalbenefits in #MedicareAdvantage is a big deal requiring immediate action from #healthplans. The Centers for Medicare & Medicaid Services (#CMS) regulations have 3 major components: evidence, eligibility and member awareness. Beginning with the CY2025 bid process, CMS will deny a plan’s bid if it hasn’t demonstrated that its proposed supplemental benefits for the #chronicallyill (#SSBCI) is reasonably expected to improve or maintain the health or overall function of its chronically ill enrollees. CMS is also implementing annual review of SSBCI offerings for compliance. To comply with the final rule, plans must do the following: ▶️ Establish an evidence-based bibliography of clinical literature for each SSBCI offering, showing it can reasonably improve or maintain the health of chronically ill enrollees. All supporting evidence must be published within 10 years of the coverage year. ▶️ Use written, objective criteria to determine an enrollee’s eligibility for SSBCI, ensuring they meet the definition of “chronically ill enrollee” with complex conditions needing intensive care coordination. MAOs must also document when enrollees are deemed ineligible to ensure equitable access to benefits. ▶️ Include an all-channel disclaimer listing the chronic conditions required for eligibility and clarifying that additional criteria may apply. ▶️ Beginning January 1, 2026, MAOs must send mid-year notifications annually each July to each enrollee with unused supplemental benefits. CMS requires the mid-year notice to support #healthequity and inform enrollees about unused supplemental benefits. These new requirements impose huge new operational challenges for plans under tight deadlines. Get cracking now. Full rule: https://lnkd.in/e8GwBmCq

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Pssst, it’s not fee for service (ffs) that’s devastated American Healthcare access, outcomes or costs. The Bismarck Healthcare Modelused in several democratic capitalistic nations such as Germany, Japan, Switzerland and others enables private insured and private ffs manufactured medical care for all citizens at a fraction of the cost and with better outcomes and access than in America. Bismarck systems have more private hospitals and health insurers COMPETING per capita than in America. This is achieved simply by making health insurers profit-neutralized utilities instead of luxuries. Read about Bismarck: https://lnkd.in/ecUwsHWP

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🏜️𝗘𝗛𝗥𝘀 𝗔𝗿𝗲 𝗗𝗮𝘁𝗮 𝗗𝗲𝘀𝗲𝗿𝘁𝘀: 𝗪𝗶𝗹𝗹 𝗔𝗜 𝗣𝗿𝗼𝘃𝗲 𝘁𝗼 𝗕𝗲 𝗮𝗻 𝗢𝗮𝘀𝗶𝘀 𝗼𝗿 𝗮 𝗠𝗶𝗿𝗮𝗴𝗲? ⏱️As a physician, EHR's are frustrating. I find myself navigating vast data deserts every day within them. The majority of my time is spent aggregating and synthesizing data. This is a sentiment echoed by many in my field. ➡️According to a 2020 study by Cerner, physicians spend the majority of their EHR time on chart review, approximately 33% and another 24% dedicated to documentation. This significant investment of time highlights the inefficiencies currently embedded in clinician daily workflows. 💥𝗧𝗛𝗘 𝗛𝗬𝗣𝗘 The buzz around artificial intelligence (AI) suggests it could be the oasis we've been searching for, promising to streamline these processes. However, some recent publications urge us to temper our excitement. For instance, while AI can help summarize information, it also presents challenges, such as the generation of content by large language models (LLMs) that may actually increase the workload. Physicians now find themselves not only reading patient messages but also deciphering AI-generated content, which can sometimes be misleading due to the "hallucination" problem where AI fabricates or misrepresents data. ❌𝗧𝗛𝗘 𝗖𝗥𝗢𝗦𝗦𝗥𝗢𝗔𝗗𝗦 Despite these challenges, AI does hold promise. It has the potential to transform our interactions with data, provided it is implemented thoughtfully. It is crucial that we conduct careful objective, peer-review studies to ensure AI is used effectively, enhancing the lives of both physicians and patients without exacerbating current challenges. ✅𝗣𝗘𝗥𝗦𝗢𝗡𝗔𝗟 𝗘𝗫𝗣𝗘𝗥𝗜𝗘𝗡𝗖𝗘 𝗮𝗻𝗱 𝗖𝗛𝗘𝗖𝗞𝗣𝗢𝗜𝗡𝗧𝗦 For me, the jury is still out. While I have seen AI effectively summarize complex information, the ongoing issues of accuracy and reliability cannot be overlooked. As we move forward, our focus should be on understanding the appropriate use cases for this technology to ensure it serves as a true aid in our clinical decisions, not as a hindrance. ✅Here are my Personal Checkpoints for Useful AI 1️⃣ Accuracy➡️Trust: AI must demonstrate consistent accuracy and reliability, to earn my trust. 2️⃣Integration➡️Usability: AI should seamlessly integrate into existing my workflows, enhancing usability without complicating my already tedious workflow. 3️⃣Clinical Relevance➡️Impact: 𝗔𝗜 𝗶𝗺𝗽𝗹𝗲𝗺𝗲𝗻𝘁𝗮𝘁𝗶𝗼𝗻𝘀 𝗺𝘂𝘀𝘁 𝗵𝗲𝗹𝗽 𝗺𝗲 𝗺𝗮𝗸𝗲 𝗯𝗲𝘁𝘁𝗲𝗿 𝗱𝗲𝗰𝗶𝘀𝗶𝗼𝗻𝘀 𝗶𝗻 𝗹𝗲𝘀𝘀 𝘁𝗶𝗺𝗲. 𝗕𝗼𝘁𝘁𝗼𝗺 𝗹𝗶𝗻𝗲. 🤩Your thoughts and comments are appreciated. #artificialintelligenceinhealthcare #aiinhealthcare #ai #physicianburnout #healthcareinnovation #healthtech

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Embracing the Future of Telemedicine: The Path Toward Integrated and AI-Enhanced Care I fully concur with Spencer Dorn's recent post with a balanced perspective on the evolution and current limitations of telemedicine. While telemedicine has indeed not lived up to the initial sky-high expectations, its integration into our healthcare system still holds vast potential. Here are some additional points to consider: ·     Care needs to be multimodal: Effective healthcare should seamlessly blend in-person visits, telemedicine, and other forms of digital communication. This integration will cater to different patient needs and scenarios, enhancing accessibility and effectiveness. ·     Technology needs to evolve further to provide better comprehensive solutions: The current telemedicine platforms must evolve to offer more holistic healthcare solutions that are not only technologically advanced but also user-friendly for both patients and healthcare providers. ·     Adoption needs to happen: For telemedicine to truly become an integral part of healthcare, widespread adoption is necessary. This means not only by patients but also by healthcare providers who must embrace these new tools as part of their everyday practice. ·     Reimbursements need to improve: One of the major hurdles to the adoption of telemedicine has been the lack of adequate reimbursement models. As these improve, it will encourage both healthcare providers and patients to utilize telemedicine more extensively. ·     Future generations will likely be more attuned and comfortable receiving digital care: As digital natives age into needing more medical care, their familiarity and comfort with technology will lead to greater adoption of Telehealth services. Conclusion: The evolution of telemedicine is inevitable, though perhaps not immediate. With rapid technological advancements, particularly in AI, the future of integrated telehealth is promising and might arrive sooner than we think. The journey towards a technologically enhanced healthcare system is on its horizon, and it's only a matter of time before it becomes a new standard of care. That's why Idrees Mohammed and I @The Cloud Intelligence Inc are working tirelessly to bring solutions that not only foster change in our current healthcare landscape but will truly revolutionize it. #HealthcareEvolution #Telemedicine #HealthTech #DigitalHealth #AI

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I'm working with Lyssa Limbrecht-Moss from Optimal 340B and we've determined we don't need any files from the CP to do an audit. We just take one audit download of all NDCs from the TPA and one EMR download from the hospital and we can audit every NDC and dispense for ALL of a hospitals CP for $1,000 total (plus one 3K implementation fee).  Audit is just verifying valid patient status, eligible NPI and location.  No Medicaid check because the TPA isn't accumulating anything when the payor is Medicaid. Doesn't matter if chain pharmacies or all different because we don't get any data from CP directly.  And requires zero implementation or connection to CP. Be SURE (and cost effective) with 340Bsure

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In their new Forefront article, Alex D. Federman, Isaac O. Longobardi, Heidi W. Steinecker, April Diaz, David G. Stevenson, and Kathy Bradley from the Icahn School of Medicine at Mount Sinai, the Moving Forward Coalition, EY, Marquis Companies, Vanderbilt University, and OUR MOTHERS VOICE discuss how they have identified four ways to increase the efficiency of the CMS nursing home survey process without sacrificing survey quality. "In recent years, due to the COVID-19 pandemic and other factors, many state survey agencies are months, if not years, behind. According to a Senate Special Committee on Aging report, nearly one in nine nursing homes have not had a survey in two years. Delayed surveys enable poor conditions to persist or worsen, putting nursing home residents at risk for serious harm and death. They also undermine the timeliness and reliability of the Centers for Medicare and Medicaid Services (CMS) Five-Star Quality Rating System, which is based partly on survey results." Read the full article here: https://bit.ly/4cljrMh

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❓What happens to healthcare when the government fixes prices for a private business? I think we’re about to find out. Watch Closely 👀 🚨Massachusetts will start requiring urgent cares to accept all patients, even if out of network, to offload the overburdened Emergency Department (thanks to the collapse of Stewart Healthcare - another story) While I have my gripes about the urgent care model, especially when it’s used to replace primary care, one of the things that allows it to work better and be more efficient, is the pricing structure. Urgent care can turn patients away based on inability to pay or require payment upfront for services. This allows them to control their revenue to match the service they deliver. A healthcare business needs to be able to make enough money to pay for adequate staffing in order to give a quality experience. If an external body is setting the pricing structure, this could be a recipe for insolvency. Massachusetts will pay urgent cares at 135% of the Medicare rate. This is much lower than what most commercial plans will reimburse for urgent care fees. The urgent cares will NOT be able to balance bill (I.e. they cannot collect any additional payments to cover what insurance refuses to cover)📉 ⚕️Urgent care has been a reasonable back up for our failed healthcare system. If we start forcing urgent, cares to operate like the rest of the failed healthcare system, I see them collapsing pretty quickly. Let’s be vigilant.👀 Thank you Dr David Weinstock for sharing this important article. Please share your thoughts and predictions on what’s going to happen. #urgentcare #healthcarereform #healthcareshortages https://lnkd.in/eaTXrhJ9

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#Medicaid directors thoughts on #telehealth, supporting the flexibilities and what #reimbursement codes work. #Audio only telehealth is widespread and, in some cases, more popular. It is easier to do, more people can access it and has less barrier to entry. However, as we bring up in the #telehealthsuccess book and the authors bring up here, #video + #audio gives a broader picture and should be used. The entire premise of being able to do a telehealth physical exam is incumbent on being able to see the patient. Also great to see Medicaid data being shared. There has been more recognition of getting Medicaid reimbursement and patients - can't do #VBC without it. h/t to my fellow #DMPAG member Andrey Ostrovsky, MD, FAAP for authoring. https://lnkd.in/etFHKPcc #healthaccess #techquity #healthequity #digitialhealth —------------------------------------------------------ Telehealth Success: How to Thrive in the Age of Remote Care - the guide to telehealth and what it takes to be successful with telemedicine out now! Order now - link in bio and available on Amazon, Barnes and Noble and Target

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What does it say about our healthcare system when even the world’s largest retailer finds these ventures unprofitable? While we don't have all the details behind Walmart's decision, what we do know is telling: a retail giant couldn't align the numbers to make their healthcare services profitable or leverage them to drive sufficient business to their stores. If they can do it, how do independent physician groups do it? Walmart’s recent announcement to close its retail healthcare clinics marks a concerning trend in primary care. Alongside news of VillageMD closing their practices, it's evident that the business model underpinning healthcare, particularly primary and preventive care, is under severe strain. Revenues and Payor-mix, Inflation, and Expenses: CMS reimbursement rates for primary care and physician services have not kept pace with #inflation and expenses, placing immense pressure on these practices. Moreover, #revenue rates from payers are becoming ever more constrained, further squeezing the viability of such healthcare models. We must also explore how payor-mix and local economic levels play into practice viability. With rising operating expenses, practice operations become strained and unsustainable. Finally, when 51 clinics close, thousands of patients lose access to healthcare. Business decisions and economic drivers have real-world implications for healthcare access and outcomes. Based on Walmart's traditional store locations, these closures will impact many of our most vulnerable populations. More to come, but for now, watch this space. UNC Center for the Business of Health UNC Kenan-Flagler Business School Meroka ABIG Health #providers #patients #virtualhealth

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