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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Looking Forward with the Triple Aim
Feb25

Looking Forward with the Triple Aim

It is surprising that we have no good metrics to track our progress toward the Triple Aim. We have lagging numbers on what we spend as a nation and debatable public health indicators of gross population metrics. No one knows how many healthcare organizations have incorporated the Triple Aim into their strategic plans. We have very little to help us judge what organizations are accomplishing and no way of comparing their results to...

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Leaping Barriers to the Triple Aim
Feb17

Leaping Barriers to the Triple Aim

In  “The Triple Aim: Care, Health, And Costs” Berwick, Nolan and Whittington describe American healthcare as the most fragmented, most expensive and least effective care delivery system among all of the advanced economies of the world, and they identify the barriers to improvement. Their assertion remains a triple surprise for me. First, it was a true statement. Second, it did not disturb more people. Third, it is still true. The...

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Sustainable Universal Coverage
Sep09

Sustainable Universal Coverage

Last month CMS announced the results of the efforts of the Pioneer and MSSP (Medicare Shared Savings Program) ACOs for 2014. The headline made for compelling reading: Medicare ACOs Provide Improved Care While Slowing Cost Growth in 2014. This suggests that sustainable universal coverage is within our reach. Just in case you do not have the time to follow the link for yourself, let me help you appreciate the gist of the report. In 2014...

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The Older Americans Act
Aug14

The Older Americans Act

Recently the New England Journal of Medicine published a great article in the “Perspective” section, “The Older Americans Act at 50”.  Unfortunately the article is available online only to those who are subscribers, so I will try to give a very brief overview of its thoughtful content. I find that many physicians are totally unaware of the OAA program or–if they are aware–they do not know how to maximize its benefit for...

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Pioneer ACOs’ Successful Efforts
May21

Pioneer ACOs’ Successful Efforts

Recently the Boston Globe published the much-anticipated results of the independent actuarial accounting of the results of the first two years of the Pioneer ACOs program of CMMI.(Click here to read the whole article.) I find it impossible to read this without wanting to comment. Many may not remember that the first accountings of the Pioneer ACO program were somewhat different. In 2013 there was an article in the Globe and in papers...

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Fostering Healthcare Innovation in Vermont
May05

Fostering Healthcare Innovation in Vermont

In my recent encounters with leaders who are fostering healthcare innovation in Vermont, I have observed that leadership within the ACOs, The Vermont Medical Society, forward-looking and socially oriented members of Faculty at the UVM Medical School, the leadership of state health agencies, members of the legislature, the governor and the local leadership of the regional health areas all have a high degree of understanding of the...

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Healthcare Innovation in Vermont
Apr28

Healthcare Innovation in Vermont

I am now involved in a small way with the Vermont Healthcare Innovation Project that is the latest of several efforts in Vermont to move away from healthcare that is fragmented, inefficient and expensive. Despite efforts to move toward value-based reimbursement and the presence of three ACOs in the state (the largest, OneCare Vermont, sees about one hundred thousand Medicare, Medicaid, and commercial patients), the current system of...

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