Perhaps an Explosion Would Be the Most Efficient Route to the Triple Aim
Apr25

Perhaps an Explosion Would Be the Most Efficient Route to the Triple Aim

After the failure of Paul Ryan’s American Health Care Act to get passed over the internal squabbling of House Republicans despite their forty four vote majority, David Brooks wrote an interesting tongue in cheek column entitled “The Coming Incompetence Crisis.” He articulated his concern:   …I worry that at the current pace the Trump administration is going to run out of failure. So far, we’ve lived in a golden age of...

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Is It Time For ACA 2.0?
Sep20

Is It Time For ACA 2.0?

Back in April when we were not absolutely sure who the nominees for president would be. Michael Cohen wrote “Obamacare: an unheralded success” in the Boston Globe. He  commented then that healthcare was not getting much discussion by Republicans beyond a flat out assurance that the ACA would be abandoned on the first day of a Republican presidency. Over in the Democratic Primary Bernie and Hillary were in a confusing debate about the...

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Dartmouth and Iora Health, Partners in Innovation
Aug30

Dartmouth and Iora Health, Partners in Innovation

I recently accompanied Dr. Rushika Fernandopulle on a visit to the Iora practice site in Hanover, New Hampshire which was created in partnership with Dartmouth College, King Arthur Flour (an employee owned company) , and the New England Carpenters Health Benefits Fund. The Hanover site opened in March 2012, a little over a year after the New Yorker article by Atul Gawande that introduced so many of us to Dr. Fernandopulle. I have been...

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Choices: Understanding Risk, Loss, Persuasion and Compulsion in Healthcare
May24

Choices: Understanding Risk, Loss, Persuasion and Compulsion in Healthcare

My wife had a simple mantra that she repeated each time our boys left the house to go out with their friends. She would say, “Make good choices!”. Her inference was that there was loss associated with bad choices. Never before have patients, families, doctors, other healthcare professionals and medical organizations had more important choices to make than now. Like the circumstances that potentially surrounded the choices that our...

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Money and Health; Relationships We Must Understand and Fix
Apr18

Money and Health; Relationships We Must Understand and Fix

Doctors and hospitals worry a lot about what they get paid. It surprised me several years ago to discover that a majority of the doctors and managers in our organization did not have an in depth understanding of the mechanisms and issues that really determined how we were paid. As I have traveled around the country I have discovered that our organization was not an exception. Misunderstandings about where the money comes from and the...

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Making the Triple Aim a Common Vision
Feb12

Making the Triple Aim a Common Vision

The core ideas of what the IHI calls the Triple Aim were articulated by Robert Ebert, Dean of Harvard Medical School in 1965. Our understanding of the Triple Aim was accelerated by two important books, To Err is Human (1999) and Crossing the Quality Chasm (2001), which  described safety, patient centeredness, timeliness, efficiency, effectiveness and equity as “systems properties” in high functioning systems of care. The Triple Aim is...

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