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  • Topic: Value-based Health Care

Does Medicare’s value-based purchasing model really create value in healthcare delivery?

December 2nd, 2019 / By Samuel Young, MD

Value-based reimbursement is the soup du jour in the medical industry these days. How value is defined, however, can vary depending on one’s perspective. Most experts in the field agree […]

Strategy weaving: Using HCCs, MACRA and readmission reduction requirements to strategize performance improvement

November 20th, 2019 / By Michael Malohifo’ou, RN, MBA

Far too often, healthcare organizations treat planning and execution as two separate processes which are intended to achieve a larger goal. Leadership makes plans and departments and workers are told […]

Doctors and hospitals: Not quite a love story

November 18th, 2019 / By Steve Delaronde

The relationship between physicians and hospitals has changed. Gone are the days of the hospital serving as the “physician’s workshop.” Advances in technology, different payment structures and the rise of […]

Searching for better outcomes and lower costs: The challenges facing state Medicaid directors

October 30th, 2019 / By L. Gordon Moore, MD

70 million people receive health coverage through Medicaid. These programs receive federal & state funding and are administered by state agencies that follow broad federal standards. Eligibility varies across states […]

The emergency room: Friend or foe?

October 21st, 2019 / By Steve Delaronde

Nearly one in five Americans visit an emergency room (ER) every year and one-third of them visit more than once. These proportions are the same as they were in 1997. […]

Sabbatical by bicycle: A healthcare listening tour across America

October 14th, 2019 / By L. Gordon Moore, MD

Dr. Paul Gordon rode a bicycle across the U.S. in 2016 asking people their thoughts on the Affordable Care Act. It was a true listening tour and he was not […]

What is most important to patients: convenience, cost or quality?

September 25th, 2019 / By Steve Delaronde

Does a patient prioritize convenience, cost or quality when it comes to taking care of his or her health? Do patients approach different conditions the same way—a sprained ankle, back […]

To lower readmission rates, focus on the intersection of cost and quality

August 28th, 2019 / By L. Gordon Moore, MD

A 55-year-old male is admitted to the hospital for an exacerbation of their chronic obstructive pulmonary disease (COPD). An 8-year-old child visits an emergency department with an asthma exacerbation. A […]

How well does the CMS-HCC risk adjustment model predict future expense?

August 26th, 2019 / By Samuel Young, MD

In my previous blog, “Demystifying Medicare Risk Adjustment,” I introduced the model that the Centers for Medicare and Medicaid Services (CMS) uses to predict future Medicare Advantage health expenditures—the CMS-HCC […]

Are we collapsing yet? Over-measurement is part of the hemorrhage in healthcare delivery

August 19th, 2019 / By L. Gordon Moore, MD

It should come as a surprise to no one that healthcare providers are frustrated (a significant understatement) by all of the requirements around documentation of their work with patients. I […]

Healthcare price transparency in 2020: Is it enough to control prices?

August 7th, 2019 / By Steve Delaronde

A proposal was issued by the Centers for Medicare and Medicaid Services (CMS) on July 29, 2019 stating that hospitals must make public the payer-negotiated price for 300 common shoppable […]

One health system’s approach to the opioid crisis is paying off

July 22nd, 2019 / By L. Gordon Moore, MD

What can health systems do to combat the opioid crisis? This is the kind of question that fascinates me as I think about how we can improve healthcare outcomes through […]