Confessions of a Healthcare Super User
Confessions of a SuperUser This posting explores what Jeff Goldsmith learned about the health system he has worked in for over forty years as a patient. It examines his experience of five complex surgical episodes in four different health systems, and how theories of how the health system works match up against the patient experience.
The Scorecard: The Great Trump Health Policy Train Wreck
The Great Trump Healthcare Trainwreck This posting provides a scorecard to evaluate President Trump’s performance in managing the multiple unsuccessful attempts to repeal the Affordable Care Act, and provide some clues to this political defeat.
California’s Coverage Expansion: Fiscal And Political Risks
California’s Coverage Expansion: Fiscal and Political Risks This posting explores how California got the number of uninsured in its state down to 7% by dramatically expanding its MediCal progam and standing up Covered California, one of the most successful health exchanges in the nation. Can this expansion be sustained as Congress considers unwinding the Affordable Care Act?
Guest commentary: To profit from uncertainty, health enterprises must become anti-fragile
To Profit from Uncertainty, Hospitals Must Become Anti-Fragile This Modern Healthcare OpEd discusses Nasim Taleb’s book Anti-Fragile: Things that Gain from Disorder and its relevance to healthcare management. In particular, health systems actually become more difficult to manage and their business risks increase as they become larger, and diversify into unrelated businesses. How hospital managements can manage uncertainty is an increasing challenge as the industry consolidates.
Geisinger’s Transformation: Balancing Growth And Risk
Geisinger’s Transformation: Balancing Risk and Growth This posting in Health Affairs blog examines the unconventional turnaround Strategy which Glenn Steele pursued as CEO of the Geisinger Health System that led both to financial success and a remarkable clinical transformation that made Geisinger one of the national leaders in healthcare redesign.
The Rust Belt Is Burning: Republicans Lay Waste to their Base on Health Reform
“Repeal and Replace ObamaCare” was one of the slogans that powered Donald Trump’s upset victory in the November 2016 Presidential election. How ironic, then, that the actual proposals would have badly damaged both the states and working class voters that put the President in office. Read about the cruel paradox of Repeal and Replace and why it ultimately failed.
Oregon’s High-Risk, High-Reward Gamble On Medicaid Expansion
Oregon’s High Risk, High Reward Coverage Expansion This posting explores how Jeff’s home state of Oregon dramatically expanded health coverage under the Affordable Care Act, and its effects on Oregon’s health insurance market and care system.
Fail to Scale: Why Great Ideas In Healthcare Don’t Thrive Everywhere
Fail to Scale In winemaking, some wines only grow in highly defined localities. The concept is terroir. In US health policy, multiple examples of the same phenomenon exist: Kaiser, physician sponsored independent practice associations, hospital system sponsored health plans thrive in some parts of the US and wither in others. Why is this? Why do great ideas in healthcare repeatedly fail to scale up nationally? Read Fail to Scale:
All Risk is Local
All Risk is Local We all knew how this was going to go, or thought we did. Healthcare payment is moving from volume to value, led by the Medicare program’s historic ACO program, and private markets are going to be fundamentally restructured by ObamaCare. Well, it didn’t work out as we expected, and the shift to value is HIGHLY dependent not on the federal government, but rather state Medicaid programs, some of which pay at 65 cents on the dollar relative to cost. Private insurance markets are in turmoil as a result of ACA, and new payment models are taking a back seat to major underwriting losses. What difference does it make? Read All Risk is Local and find out.
The Tangled Hospital-Physician Relationship
The Tangled Hospital Physician Relationship Hospitals have employed tens of thousands of physicians in the past decade, a sixty percent increase from 2003 to 2014. Tens of thousands more depend on hospital subsidies of various kinds. And yet the private practice of medicine is far from dead, as single specialty physician groups increasingly dominate lucrative medical and surgical specialty markets. Power is shifting between hospitals and physicians with the growth in new payment models, but in which direction? How to make sense of this troubled and tangled relationship is discussed in The Tangled Hospital Physician Relationship.