Author Archives: Kristine Daynes

Does anyone really believe quality scores change referral patterns or the doctors patients choose?

This question was posed by an audience member to speakers at the 3M Value-Based Care Conference. The answers were all “yes,” but not without qualification about how data transparency changes behavior.

Precisely, the question was, “Does anybody really believe that putting up a quality score changes referral patterns or makes a patient go someplace different?” The asker explained, “In New York, we’ve had the Cardiac Report Card forever and forever . . . I have never seen a badly reported cardiac surgeon come off that list or not do cases.” Continue reading

The seven habits of highly successful care programs—and six examples

Last month, David Blumenthal, MD, director of The Commonwealth Fund, addressed a 3M conference in New York City on value-based care. He mentioned soon-to-be-released recommendations from his organization on effective models for healthcare improvement.

What he didn’t say was that the recommendations would be accompanied by a media crusade. In the past several weeks, The Commonwealth Fund has released a range of multi-media content advocating new models of care. Continue reading

Healthcare execs weigh in on population health and value-based care

There is no common definition for population health. But if you ask enough healthcare executives, you’ll get a clear sense of what it means in terms of how it challenges them. That’s what I discovered at the Value-Based Care Conference hosted by 3M in New York City.

In a conference survey, I asked 42 leaders from health plans, government agencies, health systems, quality review organizations and consulting firms what they thought about population health. Their responses are a good gauge for where these organizations will be investing their efforts in the coming months. Continue reading

Value-based care is more than the new ICD-10

I’ve heard value-based care called “the new ICD-10.” I understand the comparison, at least in reference to regulatory disruption. But aside from the CMS willpower behind value-based care, I don’t see a lot of similarities.

I think of ICD-10 as a new language that requires translation within every system using ICD codes. All system users need some level of literacy training. Value-based care is this and more. It is like moving to another state—even another country—where the customs, geography and idioms of speech are entirely different. Continue reading

Why are we hoarding quality measures?

It’s hard to get rid of something you use but don’t like, even if it’s no longer practical. Things that are familiar have a lot of staying power. That may be why we can’t seem to shed ourselves of the suffocating layers of quality measures that have accumulated over the years.

There are over 4,600 healthcare quality measures and measure sets in the public repository set up by the National Quality Measures Clearinghouse. Granted, these measures represent all settings and aspects of care delivery and management. The numbers are still staggering: Continue reading

Why I get excited about APCDs (hint: also a memoir and album by Herbie Hancock)

I love hearing about multi-source or all-payer claims databases (APCDs). I’m not a data scientist, but I know enough about analytics to appreciate the possibilities within an APCD. Each announcement of a new state APCD (or private data alliance) feeds the expectation that someone will discover something new and useful and that maybe, sometime soon, the information will change the healthcare system for better.

I get excited about the possibilities. (Jazz musician Herbie Hancock chose “Possibilities” as the title for his memoir. It’s a tribute to those who aren’t afraid to explore in music and in life.) Continue reading

Do You Want a Healthcare House of Straw or Bricks?

Anyone who has renovated a home while living in it should relate to the challenges of shifting to value-based payment. It is takes time, money and grit to redesign a house and maintain any sort of normalcy for the occupants. The transition from fee-for-service reimbursement to value-based payment isn’t a tidy process either. As with home renovation, having a blue-print and a project plan makes it manageable. Continue reading

What Is Cost in Health Care?

Although cost is a common topic in health care, it is not commonly understood. As one man’s trash is another man’s treasure, similarly, in health care, one man’s cost is another man’s gain. Costs to a payer become revenue for a care provider, as do the co-payments and other shared costs paid by consumers. The perception of “cost” depends entirely on who is paying. Not only that, the definition of cost depends on who is measuring. And everyone measures it differently. Continue reading

Four SIM Projects Likely to Prove Truly Innovative and Worth Modeling

Thirty-eight states are developing State Innovation Models (SIM), or new models for multi-payer healthcare payment and service delivery, funded by grants from CMS. The SIM program tests ways to lower costs of caring for Medicare and Medicaid clients while maintaining or improving quality of care. It is an experiment in payment transformation, and, as with most experiments, some trials will perform better than others. Which SIM projects are most innovative? Which are most likely to succeed? Continue reading

Three Strategies to Fund Sustainable State IT Data Projects

Escalating healthcare costs have persuaded many states to redesign their Medicaid payment systems. Most of them are also developing innovative uses of their client data to help reduce Medicaid costs and improve health. The projects range from alternative payment models to all-payer claims databases, often funded by grants. Continue reading