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.
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.
The C Word
The C Word: Why Calling Patients “Consumers” Is an Insulting Caricature: That patients are becoming consumers of healthcare implies both discretionary purchasing power and leverage that, in most real world situations does not accurately reflect either their powerlessness or their priorities. Why we need to find better language to describe the patient role in the health system.
2014 National Health Spending: The Great Moderation Likely Is Not Over
2014 Health Spending: The Great Moderation is Likely Not Over: Health spending growth spiked upward in 2014, after a decade of moderation.
In this posting, Jeff Goldsmith argues that the factors leading to the 2014 spike are one time costs related to the Affordable Care Act’s implementation and does not alter the trajectory of core costs.
Moral Failure And Health Costs: Two Simplistic Spending Narratives
In attempting to explain the seemingly endless rise in health costs, politicians and the health policy community have evolved two explanations of the root cause: moral failure by either care providers or by patients. Read why both conservative and progressive policy narratives are flawed, and should be replaced by a broader and more nuanced explanation, leading to different remedies. Read Moral Failure and Health Costs: Two Simplistic Spending Narratives
Commentary: Shift to population-health payment unlikely to come anytime soon
Population health-based payment (e.g. capitation) is expected by many in the health industry to replace the current fee-for-service methods of paying doctors and per admission or per procedure payment of hospitals. Read why this is unlikely to happen: Shift to Population-health payment unlikely to come anytime soon
Commentary | Integrated delivery networks: Is the whole less than sum of the parts?
Is it inevitable that most care in the US will be delivered by so-called Integrated Delivery Networks, that span hospital, physician and post-acute services and offer these services through their own health plans? This model of care organization was felt to offer less expensive care at higher quality than less integrated enterprises. In a comprehensive review of the economics literature as well as a preliminary look at new data, Jeff Goldsmith and Rob Burns of the Wharton School of Finance at the University of Pennsylvania found no evidence either of savings or improved quality from these complex care models. Read Integrated Delivery Networks: Is the Whole Less than the Sum of the Parts?