The Role of Healthcare Systems in Supporting Social Safety Nets

Historically, healthcare systems and social safety net providers have worked in parallel to provide care to their constituents. There have been many instances of cross-pollination and mutual support, but this is not the norm, nor is it done in a manner that significantly enhances the value to all involved parties. The need for collaboration in a meaningful way… Read More »

Money Does Make A Difference

As we begin to reflect on policy changes and how they impacted people during covid, It’s of utmost importance that we assess what enhanced our wellbeing and what did not. We know that a significant determinant of health, especially in children, is access to healthy food and permanent food security. One of the many policies during Covid was… Read More »

Understanding Primary Care & Specialty Care Value-Based Models, Is One Better than the other?

Currently, a significant portion of value-based care payments has focused on primary care-based models. Whether Medicare Advantage, Medicare Shared Savings Programs, Direct Primary Care, or other value-based programs, they all center on primary care clinicians and services. Though there are a few unique specialty-based models such as BPCI, the vast majority are not. These models have had a… Read More »

Does Telemedicine Really Improve Access in All Neighborhoods?

For many of us, certain technologies, including telemedicine, are viewed in a highly positive light as a methodology to increase access in a consumer-centric manner. However, there are concerns that such technology will potentially increase health disparities because of the lack of broadband access, hardware, and functional literacy. As a result of the pandemic, access to office-based visits… Read More »

Pricing of Aducanumab Brings Out Flaws in Drug Payment Models

The recent approval of Medicare to extend insurance reimbursement for the new Alzheimer’s drug, only when taken as part of randomized clinical trials, highlights the various issues surrounding the FDA approval of Aducanumab for treatment. This approval process for trial usage only accentuates the necessity for further investigation into this new drug that received an expedited review and… Read More »

Looking into Diagnostic Excellence and Aligning Incentives

There is considerable discussion regarding aligning incentives to lower the total cost of care, and even more specifically, on the importance of diagnostic testing, the value it might bring, its accuracy, and the shared decision-making when ordering tests. Therefore, aligning incentives around appropriate diagnostic testing is critical to both diagnostic excellence and affordability of healthcare. Additionally, an important… Read More »

Determining the Effectiveness of Diagnostic testing

As clinicians, we spend a significant amount of our time attempting to diagnose what is ailing those we treat. And we have an armament of tests to select from and an extensive list of differential diagnoses, ranging from the probable, to the extremely rare yet, potentially fatal. Understanding the effectiveness of our diagnostic tests is important from multiple… Read More »

Physician Practices with Robust Capabilities Spend Less on Medicare Beneficiaries

As consolidation and integration of physician practices occur, especially within organizations that can wrap capabilities around ambulatory clinical care, we must examine the potential benefit to those we serve. This ideal is also the premise for a clinically integrated network where payment models are designed to allow for enhanced capabilities available to smaller groups of clinicians. These enhanced… Read More »

Understanding Why We Need Stratification of Hospitals for Readmission Penalties

There has been considerable debate concerning the value of the Medicare Hospital Readmissions Reduction Program. The program was designed to deduct up to 3% of Medicare payments for hospitals with higher-than-expected thirty-day all-cause readmission rates, after index admissions, for six conditions and procedures. One of the primary concerns regarding the program was the disproportionate impact on teaching and… Read More »