PopHealth Week

We provide a weekly round-up of Accountable Care Organization (ACO) activities, in the run-up to the January 2012 'go live' date. For example, in November alone we witnessed: (1) the AMA Interim Meeting of House of Delegates publishing 'New Principles for ACOs', see: McDermott, Will & Emery summary here: http://bit.ly/hHryR1, (2) the Centers for Medicare and Medicare Services (CMMS) issued a request for information on ACO's, see: http://bit.ly/elTaNs, and (3) we reached the NCQA's deadline for comment submission, see: http://bit.ly/ddJFOW Our special guest for the inaugural program is J. Peter Rich, Esq., of McDermott, Will & Emery, LLP. Rich is a partner in the law firm of McDermott Will & Emery (MWE) LLP, and is based in the Firm’s Los Angeles office. Rich co-chairs MWE’s 'Insurance/Payors Affinity Group'. For more than 30 years, Rich has practiced almost exclusively in the health law field, and routinely advises hospitals, medical groups, health plans and other health insurers, as well as other health industry clients, in negotiating and structuring managed care and other health industry transactions, including major Medicare Demonstration Projects, and on a wide variety of other transactions and health regulatory matters. Consider joining us on our inaugural broadcast!

On the Tuesday December 7th 2010 program at 10AM Pacific and 1PM Eastern, my guest commentator is Kent Bottles, MD, aka @kentbottles on Twitter. Dr. Bottles is a compelling keynote speaker who grabs and holds the attention of his audience the moment he takes the podium. He has vast knowledge of healthcare systems, technology, change through conflict, and the future of healthcare. His ability to convey complex information in down-to-earth terms — combined with mind-opening delivery — promotes new ideas and attitudes while energizing listeners and facilitating transformation and growth. Dr. Bottles will discuss the role of physician leadership, and the 'culture of collaboration' imperative amidst a soon-to-be very competitive Accountable Care Organization (ACO) market. For more information on Dr. Bottles, see: http://kentbottles.com Please join us!

On the Wednesday, December 15th 2010 program at 11AM Pacific and 2PM Eastern, my guest commentator is L. Gordon Moore, MD, aka @lgordonmooremd on Twitter. Dr. Moore is a medical practice innovator, status quo disruptor, and thought leader in the field of direct medical practice, pioneering the 'exemplary primary care model' via Ideal Medical Practices. For more information, see: http://www.idealmedicalpractices.org/index.html. Dr. Moore is a compelling keynote speaker with a timely message, who previously directed the HelloHealth University, and selectively managed certain professional medical corporations. Much of the conversation around Accountable Care Organizations (ACOs) tends to focus on the intentions of the more mature integrated delivery systems, i.e., Kaiser, Mayo, Geisinger, et al, the establishment health plan community as well as hospital or institutional health systems, yet due to some modest language written into the Patient Protection and Affordable Care Act, there is room for niche or even 'marginal' players up to step up an organize direct primary care practices as participants in the ACO industry. Some call it the 'Qliance clause', but bottom-line, the issue is about gaining eligibility (as a patient centric, albeit alternative delivery system) to be listed as an option in the emerging health insurance exchanges (HIE's) - though not a 'insurance product' per se. Please join us!

On the Wednesday, December 22nd 2010 program at 11AM Pacific and 2PM Eastern, thought leader, blogger, lecturer and consultant Kent Bottles, MD, returns for an encore conversation. We'll highlight key points in several of the recent reports issued, here(http://bit.ly/idB1Fr), here (http://bit.ly/g2Lw3a) and here (http://bit.ly/hmH88S), by the Center for American Progress, the California Healthcare Foundation, and Health Affairs, respectively on ACOs, and provide somewhat of a primer for physicians who may not be familiar with the PPACA's ('ACA') provisions and the enabling language defining Accountable Care Organizations (ACOs) in the ACA. We'll highlight key points in several of the recent reports issued, here, here and here, by the Center for American Progress, the California Healthcare Foundation, and Health Affairs, respectively on ACOs, and provide somewhat of a primer for physicians who may not be familiar with the PPACA's ('ACA') provisions and the enabling language defining Accountable Care Organizations (ACOs) in the ACA. We'll also discuss the pros and cons of physicians working with or without a hospital partner. Please join us!

A preview and audio test strip for the Wednesday 12.29.10 broadcast segment with Mark Browne, MD, titled 'ACO 101: A Physician Primer'.

PROGRAM NOTE: We've re-scheduled Dr. Mark Browne for January 5th, 2010! On the Wednesday, December 29th 2010 program at 11AM Pacific and 2PM Eastern, my guest commentator and co-host is consultant, health innovation thought leader, and blogger, Mark Browne, MD of Pershing Yoakley & Associates. While in the pre-release period of the Centers for Medicare and Medicaid rule process, we'll focus on the known fundamentals of Accountable Care Organizations (ACO’s) of interest to physicians. Specifically we’ll address: (1) What are ACO's? Absent regulatory guidance, we have primarily a 30 thousand foot view with some pilot and demonstration exceptions. (2) What are the known or proximal models in operation to date? How are they structured? (3) How will ACO’s impact medicine and my practice in particular? Is this Medicare and Medicaid only? Or will its influence extend to the private or commercial (employer sponsored) market? (4) Why are ACO’s seen as a centerpiece in the Patient Protection and Affordable Care Act? Why the optimism? (5) What ‘go to’ resources are available, including related industry experience garnered from HMO’s, PPO’s and prior integrated delivery systems, to facilitate my education? (6) Why do ACO’s hold promise for taming the thirst of a seemingly insatiable health care financing and delivery ‘non’ system? (7) What does ‘physician leadership’ look like during the ACO consideration process? Your advanced comments and questions are invited and welcome, and can be posted on ACOwatch.com. In a post on ACOwatch.com, we supplied links to 3 timely and informative reports well worth your review. Please join us.

On the Wednesday, January 5th 2011 program at 11AM Pacific and 2PM Eastern, my guest commentator and co-host is Mark Browne, MD, of PYA (Pershing Yoakley & Associates). Dr. Browne is a consultant, health innovation thought leader, and blogger, and healthtweep in good standing via @consultdoc. While in the pre-release period of the Centers for Medicare and Medicaid rule process, we'll focus on the known fundamentals of Accountable Care Organizations (ACO’s) of interest to physicians. Specifically we’ll address: (1) What are ACO's? Absent regulatory guidance, we have primarily a 30 thousand foot view with some pilot and demonstration exceptions. (2) What are the known or proximal models in operation to date? How are they structured? (3) How will ACO’s impact medicine and my practice in particular? Is this Medicare and Medicaid only? Or will its influence extend to the private or commercial (employer sponsored) market? (4) Why are ACO’s seen as a centerpiece in the Patient Protection and Affordable Care Act? Why the optimism? (5) What ‘go to’ resources are available, including related industry experience garnered from HMO’s, PPO’s and prior integrated delivery systems, to facilitate my education? (6) Why do ACO’s hold promise for taming the thirst of a seemingly insatiable health care financing and delivery ‘non’ system? (7) What does ‘physician leadership’ look like during the ACO consideration process? Your advanced comments and questions are invited and welcome, and can be posted on ACOwatch.com. In a post on ACOwatch.com, we supplied links to 3 timely and informative reports well worth your review. Please join us.

On the Wednesday, January 12th 2011 program at 11AM Pacific and 2PM Eastern, my guest commentator is thought leader, author, blogger, lecturer and consultant on health care quality, and related transformational initiatives Michael L. Millenson. Millenson is president of Health Quality Advisors LLC, and a nationally recognized expert on improving the quality of American health care. He is the author of the critically acclaimed book, Demanding Medical Excellence: Doctors and Accountability in the Information Age, and he holds an adjunct appointment as the Mervin Shalowitz, M.D. Visiting Scholar at Northwestern University’s Kellogg School of Management. He also consults on Web-based interactive health care as a principal of Health 2.0 Advisors. For more information, see: http://www.healthqualityadvisors.com/ On this program we will discuss the state of the ACO development and deployment industry and particularly what lessons we need to carry forward in perhaps this final effort by the private sector to get a handle on the relentless expansion of the health care services industry. Please join us!

On the Wednesday, January 19th 2011 program at 11AM Pacific and 2PM Eastern, my guest commentator is thought leader, nationally known blogger, health care analyst, business development consultant, writer and speaker on health care cost and quality issues Brian Klepper, Ph.D. For more information, see: http://careandcost.com/ Over many years, Brian Klepper has developed a national reputation for thoughtful, reasonable perspectives on complex health care issues. Dr. Klepper consults with health care organizations and business groups to create market visibility that leverages performance, and to take advantage of emerging trends that promise to positively transform both health care quality and cost. Dr. Klepper serves as Editor for MedPedia, as Editor-at-Large for Community Oncology, and as one of only three non-physicians on the International Editorial Board of Medscape General Medicine, and is also a regular columnist on several of the best-respected and most widely-read expert health care blogs - The Health Care Blog, Health Care Policy and Marketplace Review, Health Commentary and Health Wonk Review. Klepper is a Principal in three firms. Healthcare Performance provides market analyses and strategic services to the industry. Health 2.0 Advisors counsels health care firms on ways to use the Web to facilitate knowledge exchange, patient engagement, pricing and performance transparency, transactional streamlining and decision support. WeCare TLC develops and manages onsite clinics for employers and other organizations. Please join us for an informative exchange!

On the Wednesday, February 2nd 2011 broadcast at 11AM Pacific and 2PM Eastern, my special guest commentator is Jaan Sidorov, MD, a self-described 'blogvocateur', publisher of the Disease Management Care Blog, and former medical director of the Geisinger Health Plan. We'll review several of Dr. Sidorov’s recent blog posts on the ACO market, and focus specifically on attracting 'independent physician' participation into ACOs. Other than mature IDN's such as Mayo, Kaiser and Geisinger, et al, who have risen to the head of the class when discussing ACO potential, there is a second tier of ACO candidates that includes the likes of Advocate Health Partners (see: http://bit.ly/gvJSeY) and Monarch Healthcare. We'll consider their cultural standing, nature and strategies to appeal to the independent physician market, while also exploring the ability of physician leadership sourced from voluntary medical staff culture to add value to the ACO development conversation. Please join us for an ACO exploration with some commentary along the way!

On the Wednesday, February 9th 2011 program at 11AM Pacific and 2PM Eastern, we are re-broadcasting portions of the February 1, 2011 Brookings Institution Event 'Achieving Better Care at Lower Costs through Accountable Care Organizations‘. The link reference for the entire program is: http://www.brookings.edu/events/2011/0201_accountable_care.aspx / The faculty include: Mark McClellan, Director, Engelberg Center for Health Care Reform, The Brookings Institution, Donald Berwick, Administrator, Centers for Medicare & Medicaid Services, Elliott Fisher, Director, Center for Population Health, The Dartmouth Institute for Health Policy & Clinical Practice, and Francis J. Crosson, Associate Executive Director, The Permanente Group, Inc., among other thought leaders. Additionally, we are blessed to also have access to a complete transcript of the conference via: http://www.brookings.edu/~/media/Files/events/2011/0201_accountable_care/20110201_accountable_care.pdf / NOTE: ACO Watch: A Mid Week Review is not affiliated, nor a representative of The Brookings Insitution. For commentary on the event and the ACO industry, see: ACOWatch.com.

On the Wednesday, February 16th 2011 program at 11AM Pacific and 2PM Eastern, my special guest commentator is Jeffrey L. Cohen, Esq. Jeffrey has over 20 years of healthcare law experience. He is board certified by The Florida Bar as a specialist in healthcare law and is a self decribed 'frustrated comedian'. As Founder of The Florida Healthcare Law Firm, he can be reached via jcohen(at)floridahealthcarelawfirm(dot)com. In this broadcast, we'll discuss the ACO industry in general and more particularly his recent blog post: 'ACO’s: Now We’re Just Being Silly' See: http://bit.ly/i9tWss, for context. Please join us for an entertaining and informative exchange!

On the Wednesday, March 2rd 2011 program at 11AM Pacific and 1PM Central Time, my special guest commentator is noted author, speaker and consultant William DeMarco, see: http://www.pendulumhealth.com/. DeMarco is the President & CEO of DeMarco & Associates, Inc., a national, independent healthcare consulting firm specializing in healthcare delivery system redesign and transformation. Mr DeMarco is recognized as a leader in the research , design and implementation of community based healthplans. Since his involvement in several startup health plans in Minnesota in the early 1970s Bill and his team of management consultants clinical specialists and reimbursement analysts have assisted employers and physicians in developing better relationships with insurers up to and including developing local solutions to deliver and finance care. Using Health Services Research from its affiliate Pendulum HealthCare Development Corporation, DeMarco and Associates assists both provider and employer clients in addressing prospective payment approaches in order to build Pay for Performance models to develop direct employer/provider contracting entities, benchmarking collaboratives under the new value purchasing legislation as well as single specialty centers of excellence. Mr. DeMarco is a well-known author having written or contributed to over a dozen books on managed care topics. He holds a master’s degree in organizational development from DePaul University. He a past faculty member of Loyola Law School’s graduate program and was recently awarded the Follomer Bronze award from the Healthcare Financial Management Association for his outstanding service and contributions to HFMA chapters and members. He is a regular presenter for such audiences as Medical Group Management Association, HFMA, VHA, AHA, Quorum, NMHCC and AHIP. Please join us for an informative exchange!

On the Wednesday, March 9th 2011 program at 12 Noon Pacific and 3PM Eastern, my special guest commentator is Steve Adams, Executive Vice President, Collaborative Care, and Health Improvement, Alere. Steve is a leader in the development and management of products and information systems in the converging Internet, healthcare, and personal computer industries. He founded ReachMyDoctor and RMD Networks, acquired by Alere in early 2010. RMD provides Collaborative Care Solutions® – a clinical groupware system that enables greater connectivity, clinical data transfer and collaboration among physicians, healthcare providers, patients and other business partners. RMD’s application is among the first to be labeled as a “Clinical Groupware” solution and Steve has been instrumental in the development of the Clinical Groupware Collaborative, a non-profit trade organization for Clinical Groupware Companies, where Steve serves as Chairman and President. Steve is an active participant in a number of national health initiatives and organizations. For an excellent presentation at HIMSS 2011 in Orlando, see: 'You Don't Need a Complete EHR: The Impact of Clinical Groupware' http://www.himssconference.org/docs/sphandouts/73.pdf/ Since connectivity both with physicians and other providers, as well as patients and the community is an essential component of an emeging ACO, we thought it would be of considerable interest to get some of Steve's thoughts on the record. Please join us for an entertaining and informative exchange with Steve Adams!

PROGRAM NOTE: Today, March 16th, 2011, we'll re-broadcast a prior segment on ACO Watch: A Mid-Week Review, featuring Jeffrey L. Cohen, Esq. There is some rumblings from an anonymous source that the eagerly anticipated but long delayed ACO proposed rules will be released by March 23rd, 2011 to coincide with the anniversary of the passage of the Patient Protection and Affordable Care Act. We'll see. It's getting rather late for a 1/1/12 go live date, and many are nervous. Given the House's efforts to block funding if not unwind the Act, we do live in interesting times! On the program, we may also poke around the news and drill into any interesting ACO headlines,a nd announce the upcoming schedule. On the Wednesday, February 16th 2011 program at 11AM Pacific and 2PM Eastern, my special guest commentator is Jeffrey L. Cohen, Esq. Jeffrey has over 20 years of healthcare law experience. He is board certified by The Florida Bar as a specialist in healthcare law and is a self decribed 'frustrated comedian'. As Founder of The Florida Healthcare Law Firm, he can be reached via jcohen(at)floridahealthcarelawfirm(dot)com. In this broadcast, we'll discuss the ACO industry in general and more particularly his recent blog post: 'ACO’s: Now We’re Just Being Silly' See: http://bit.ly/i9tWss, for context. Please join us for an entertaining and informative exchange!

On the Wednesday, March 23rd 2011 program at 11AM Pacific and 2PM Eastern, my special guest commentator is Wayne Pan, MD, Chief Medical Officer, Pacific Partners Management Services, Inc. (PPMSI); see: http://ppmsi.com/ for more information. Dr. Pan's background spans clinical medicine as an orthopaedic hand surgeon, basic science research in the field of molecular biology, and executive leadership in managed care and health information technology. As CMO, he is responsible for providing professional medical direction to PPMSI and the IPAs including, but not limited to implementing, maintaining, and refining approved quality improvement and utilization management programs and keeping up to date with and ensuring compliance with federal regulation and NCQA requirements. Please join us for a timely and informative exchange!

On the Wednesday, March 30th 2011 program at 11AM Pacific and 2PM Eastern, my special guest commentator is Jeffrey L. Cohen, Esq. Jeff is back for an encore appearance on ACO Watch. With over 20 years of healthcare law experience. Jeff is board certified by The Florida Bar as a specialist in healthcare law and is a self decribed 'frustrated comedian'. As Founder of The Florida Healthcare Law Firm, he can be reached via jcohen(at)floridahealthcarelawfirm(dot)com. In this broadcast, we'll discuss the ACO industry in general and more particularly his recent blog post: 'IPAs Again' See: http://bit.ly/figPnF, for context. Jeff gets straight to the point on the potential 'there's value in them hills' if only IPA morph into the very entities that the ACO conversation has hosted to date. Key claims made include the 'messenger model is dead' in the new and improved IPA. In a play on Jeff's reasoning, I tweeted today 'The 'messenger model' of contracting is 'dead'. IPA 2.0 = ACO 1.0' Please join us for an entertaining and informative exchange with counselor extraordinaire and ever present comedian, Jeff Cohen !

This is a rebroadcast of the context piece offered to the press prior to the release of the proposed rule on Accountable Care Organizations, published in the Federal Register, Thursday, March 31st, 2011. The call begins with Secretary Kathleen Sebelius, followed by Dr. Don Berwick, Administrator, of CMS, with participation from FTC, DOY, and Treasury. A very informative overview of what's inside the regs!

On Friday, April Fools Day, at 4PM ET/1PM PT, join us for a special edition broadcast of ACO Watch: A Mid-Week Review. We'll do a preliminary first pass, 'deep dive' into the hot off the press notice of proposed rules released, Thursday, March 31st, 2011 by the Centers for Medicare and Medicaid Services. For the complete published rule, see: http://bit.ly/i0YxhZ Roundtable guests to include 'fellow healthtweeps' Mark Browne, MD, @consultdoc, Vince Kuraitis, @VinceKuraitis, and David Harlow, @healthblawg. We'll dig into the regs and have some fun, too! Join us...

On the Thursday, April 7th broadcast, at 11AM Pacific and 2PM Eastern, my special guest commentator is health care industry analyst, Sheryl Skolnick, Ph.D., Senior Vice President of CRT Capital Group, LLC, a Stamford, Connecticut based institutional brokerage. Dr. Skolnick recently published as report titled: 'First Glance at Proposed Medicare ACO Rule: We Must Be Missing Something'. For a repost of her work, see: http://bit.ly/eAN3io  In Sherly's words: 'Our concern is this: we must be missing something major because, for the life of us, we can’t understand why any rational provider would incur the burdensome costs of establishing and operating an ACO, only to then be at risk for the major moral hazard inherent in the proposed ACO structure: providers who form ACOs (doctors, hospitals and post-acute providers) would be at risk for the cost of health care chosen by patients, yet would be expressly prohibited from requiring that patient to obtain that care within the ACO'.