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Hospitals' Physician Employment Conundrum

On May 30, Harvard Business Review posted a blog commentary Jeff Goldsmith wrote with his Navigant colleague Alex Hunter on whether it makes sense for hospitals to employ their physicians. According to the American Medical Association, roughly 25% of practicing physicians are in groups that are wholly or partly owned by hospitals and slightly more than 7% are direct hospital employees. For the physicians practicing in hospital based multi-specialty groups, direct financial losses of nearly $200 thousand per year per physician are the norm. How can hospitals quantify the benefits of employing physicians and manage the overall benefit?

Are State Medicaid Agencies Saving Money and Improving Health through their Medicaid Managed Care Programs?

On May 3 and 4, Health Affairs posted a Jeff Goldsmith research piece with Navigant colleagues David Mosley and Anne Jacobs on the wide prevalence of state Medicaid agencies contracting with managed care plans to care for their beneficiaries, Part 1 | Part 2 Medicaid agencies that contracted with MCOs showed a five fold variation in their agency administrative expenses and in health plan administrative costs, and a full thirty-seven point spread in their medical loss ratios (a crude measure of the amount of services provided their beneficiaries). There were also massive differences in the average amount of health plans’ reserves from state to state. These posts, the result of a nearly year long Navigant research project, raised questions about whether state agencies are contracting effectively and whether beneficiaries are seeing improvements in their health.

Call for a Revolution in the User Experience with Electronic Health Records

On March 30, with colleague Bob Wachter, Jeff Goldsmith posted a blog in the Harvard Business Review’s online Technology Forum on the need to Fix the Electronic Health Record. Physicians are in open revolt against new electronic tools that were supposed to help make medical practice more efficient and safer, but in some cases have done the opposite. Physicians cite their struggles with this complex new tool as a major source of physician burnout. Wachter is Chair of Medicine at the University of California at San Francisco, and author of the remarkable The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age (McGraw Hill, 2017), and was voted the #1 most influential physician executive in the US in 2015. This blog posting lays out a bold proposal for returning the patient to the center of the electronic health record.

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