The Search For a Better Future State
Apr04

The Search For a Better Future State

The failure of the president and House Republicans to launch a credible process to “repeal and replace” the ACA creates a moment of opportunity for those who would like to contribute to the search for a better future state for healthcare. The challenge of providing affordable, quality care to all Americans has flummoxed politicians, healthcare policy experts, clinicians, healthcare administrators, insurance executives, employers, and...

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Good Strategy in a Fog of Uncertainty
Feb07

Good Strategy in a Fog of Uncertainty

There is no challenge like the challenge of creating a strategic plan in uncertain times. What do you do when you do not know what to do? That is a question that frequently challenges leaders. Over eight years ago, after Lehman Brothers had failed and the value of the stock market had fallen by almost fifty percent and we did not know if we were facing a deep recession or the second coming of the Great Depression, I was asking myself...

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Thinking About ACOs Again For the First Time
Jan10

Thinking About ACOs Again For the First Time

I am proud to be a member of Whittier Street Health Centers Foundation Board and was delighted when our very able CEO, Frederica Williams, recently asked me to talk to the organization about ACOs at their Grand Rounds. Whittier Street is an exceptional example of a practice that will be sorely tested by the chaos that Jonathan Oberlander describes in his “Perspective” article, “The End of Obamacare”, in the January 5, 2017 issue of...

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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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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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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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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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Born Too Soon for Lean
May29

Born Too Soon for Lean

Lean arrived a little late for me. Even now, the Triple Aim is still more of a goal than a reality. When I think back over the system of waste in which I practiced medicine, I am left with the regret of the lost time spent licking envelopes, making calls for approvals, make calls to cajole a consult when the system had not been staffed to meet expected demands, and using my one-off problem solving skills to make it through the day. I...

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