Author Archives: L. Gordon Moore, MD

Transitional care interventions: Evidence supports more intense interventions

Responding to value-based-purchasing, provider groups across the US are implementing or tweaking programs to reduce unnecessary hospital readmission or emergency department visits. Much of this is stimulated by Medicare’s plans to move the bulk of their payment into new models and the current incentives around readmission reduction for beneficiaries with certain conditions. Continue reading

Lifestyle improvement: An untapped resource in population health management

The recent report describing a decline in new cases of diabetes is good news. An article about it in The New York Times does a nice job describing the lifestyle changes individuals have made to reduce their personal risk. The article is informative on several levels: Continue reading

Good news and bad news: The cost of (partial) Patient-Centered Medical Home implementation

Magill and colleagues published a nice analysis of the staffing costs of a Patient-Centered Medical Home (PCMH). Compared to a regular practice that already has an electronic medical record, they looked at the incremental costs associated with meeting NCQA standards for Patient-Centered Medical Home recognition.

The investigators reported incremental costs in three ways: Continue reading

Strong patient-provider relationships drive healthier outcomes

Maybe there is a way to measure quality so that metrics better represent outcomes that matter.

Harvard Medical School’s Center for Primary Care has been studying exemplars in primary care through a series of case studies in the past two years. Their article in Harvard Business Review describes the finding that good outcomes are related to the strength of relationship between the primary care provider and patient. This finding is strong and consistent across all primary care exemplars in their study.i Continue reading

Working 22.6 hours a day: Alert fatigue, guidelines and “left of boom” opportunities in health care

Where do alerts fit in a physician’s 22.6 hour day?

When I’m travelling around the country interacting with healthcare leaders and health systems, I mostly see valiant efforts to improve outcomes through improved management of diseases. While improving disease management through guideline adherence is certainly a good thing, this is a problematic strategy given the current reality of our tools, the design of our workflow and our ability to recognize and address the multiple non-disease factors that weigh heavily on outcomes. Continue reading

Half of Primary Care Physicians Think Quality Metrics Have a Negative Impact on Quality

In a Commonwealth Fund/Kaiser Family Foundation survey, 50 percent of PCPs report that quality metrics have a negative impact on their ability to provide quality care to their patients.i

Quality Metrics Chart

Click to Enlarge

If you spend any time in a primary care office practice this should come as no surprise. PCPs tend to be deeply dedicated to their patients and want very much to do the right thing. Continue reading

The Logistics of Population Health Under the IHI Triple Aim

The Triple Aim is a construct developed to move past the trade-offs typical in health care improvement: improved quality at the expense of increased costs, decreased costs at the expense of quality or access, improved guideline adherence at the expense of patient experience of care, etc. The Triple Aim defines success as simultaneous improvement in population health and outcomes, patient experience of care, and cost trends. Continue reading

Why Primary Care Should Pay Attention to Continuity of Care

Reducing healthcare costs through better care delivery begs the question: “Where do we start?” When the goal includes something to the effect of “the greatest possible improvement for a population,” it is good to reflect on the body of evidence pointing to high performing population health outcomes.

The work of Starfield and others is instructive: High performing health systems have high performing primary care as their foundation. High performing primary care has four cardinal features:¹ Continue reading

Is Our Approach to Quality Measurement Getting in the Way of Quality?

The path to better population health outcomes is difficult–and our approach to quality measurement may be making it harder. Process measure improvement does not consistently lead to outcomes that matter, and narrow-focus outcome measures sometimes apply to a very small part of the overall population. Continue reading

Predicting Medical Resource Utilization with Patient Surveys

Success in population health management rests in part on being able to identify high cost/high utilization population segments and provide interventions that help achieve better outcomes.

With enough of a claims history (typically at least seven months), we can go from a simple “Who has diabetes?” to a much more nuanced understanding of total illness burden with a much better prediction of future medical resource utilization. Continue reading