It’s Still The Truth, Ten Years Later
Feb14

It’s Still The Truth, Ten Years Later

In the January 29th New England Journal of Medicine Foller, et. al. published an interesting article, “Population Health–A Bipartisan Agenda for the Incoming Administration from State Leaders.” The first paragraph said a lot.   The common goal of health policy leaders at the level of state government in the United States is promoting the health and well-being of all populations to the greatest extent possible within fixed...

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What To Do When You Don’t Know What To Do
Jan03

What To Do When You Don’t Know What To Do

Are you wondering what you and your practice or hospital should be doing while living in the ambiguity of “repeal and replace?” Focus on getting better. That is the short answer. With or without the ACA the challenge to create  Care better than we’ve seen, health better than we’ve ever known, cost we can afford,…for every person, every time…in settings that support caregiver wellness  …does not go away. The Triple Aim long...

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Old Fashioned Values Applied to Complex Times in Healthcare
Sep13

Old Fashioned Values Applied to Complex Times in Healthcare

  An “Interested Reader “ and friend recently sent me a eulogy that he delivered at his father-in-law’s funeral. Let me give it to you to read, and then invite you to think with me about Don Berwick’s recent call for Era 3, the “Moral Era” of healthcare.   I have been thinking about my nearly 50-year long relationship with Granddad, …Charlie to work colleagues, friends and neighbors. He brings to mind Churchill’s...

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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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Comments on the Future of Practice
Jun15

Comments on the Future of Practice

As we peer into the future and ponder what lies ahead for the practice of medicine we can be sure that the answer will vary across the spectrum of practice. To examine the potential changes for every type of practice would require a very extensive effort. If we focus on some of the high level issues that will be shared by all medical professionals then there is something to be learned. I recently attended a performance of Cirque Du...

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Concierge Medicine: Still Not a Good Idea
Mar04

Concierge Medicine: Still Not a Good Idea

A few physicians in my community began to try concierge medicine in the mid nineties. My first reaction was, “Harley Street has come to Beacon Street”. If you watch Downton Abbey, Lady Mary Crawley probably took her maid, Anna Bates, to Harley Street when they went to London to get the help of a gynecologist because of Anna’s recurrent miscarriages. Harley Street is synonymous with expensive private care. The English who want to avoid...

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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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