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When Doctors Get a Union Card

Saturday’s New York Times carried a front-page story about negotiations between administrators and the physicians’ union at the New York Health and Hospital Authority over a new pay-for-performance arrangement. Physicians’ raises will be tied to their performance on indicators such as patients’ assessments of physicians’ communication with them, how quickly ED patients are transferred to beds and how quickly patients are discharged, as well as quality metrics such as 30-day readmission rates for certain diagnoses.

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Tipping Point in Health Care?

I’ve been in health care for over 30 years and as I think about most of the problems with healthcare… access, quality, cost, safety, etc., many of the solutions to these issues were obvious even back in those early days of my career. We knew then that fee for service reimbursement created perverse incentives and that outcome based payments aligned incentives for better care and lower costs. In general, care was siloed, inefficient and demanded vertical and horizontal coordination along with tools such as electronic health records (EHR). The problem was that there was no pressure to change unless it was self-generated. Today, many of the same problems exist, but the impetus and external pressures to improve are upon us.

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Colorado Rises in National Health System Performance Rankings

Guest Blogger: Douglas McCarthy

In 2010, the CIVHC-led Data and Transparency Advisory Group set long-term goals for Colorado to move into the top tier of performance among states on key measures of health system performance. Thanks to the collaborative efforts of public and private stakeholders, the state has taken strides to realize these goals.

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Crunch Time in Health Care

This time of year is sports fan’s heaven but unfortunately I seem to have been born without the “sports fan gene”. Family, friends and colleagues exchange sad, knowing glances at my pathetic mixed sports metaphors and attempts to engage in post-weekend sports banter.  Despite that, as I write this first health care blog of 2013, all I have are sports metaphors floating in my head.  I apologize ahead of time to all sports fans out there.

Having crossed into 2013, the trigger date of 2014 for implementing the biggest elements of the health care law seems imminent...

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Full Speed Ahead for Accountable Care

With the President’s re-election, the concepts embodied in the Affordable Care Act will pick up steam. One of those is the Accountable Care Organization (ACO) model. ACOs are voluntary organizations that focus on coordination for patients across care settings, including doctors’ offices, hospitals, and long-term care; the coordination is made “accountable” through payment models that reward quality and share (potentially) both up-side and down-side risk. While the ACA enabled ACOs specifically for Medicare, this vision of coordinated, accountable care is being used for all populations and a variety of payers. So this seems like an opportune time to share some information and observations about ACOs—both nationally and within our state.

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Clinical Integration Versus Market Consolidation: An Important Distinction

What do we mean when we use the term “integrated care”?

This question struck me as I read about a health plan’s recent purchase of a network of providers in another state. The plan CEO and the reporter both used the phrase “integration” to describe the company’s strategy. But the vision of integration that emerged was less about clinical care and more about business share—a vision that differs markedly from that of CIVHC and many other stakeholders. And it’s important to understand that distinction.

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Reality Check in a Time of Uncertainty

Change brings opportunity. And judging from the amount of change underway in Colorado’s health care community right now, we’ve got lots of opportunity! Nonprofit organizations—including CIVHC—and state agencies are undergoing leadership transitions. Foundations are reconsidering their funding approaches. Colorado’s State health Innovation Plan lays out an ambitious, multi-year agenda for health system transformation.

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