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Colorado Medicaid Bill Enables Important Value-Based Payment Reform

This week, Governor Hickenlooper will sign HB 1281, setting up 2-year payment reform pilots within Colorado’s Medicaid program. Brief pilot programs might seem like baby steps – but for a program as large and challenging as Medicaid, they are essential “proofs of concept.” And these pilots will likely have a big impact on how Medicaid takes shape in the coming years. This legislation is important both for the path it lays out for Medicaid’s future, and for the broad bipartisan and multi-stakeholder consensus it reflects.

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Retooling For the Information Glut Age: Five Things Physicians Should Do To Lead

In the last post, I talked about what physicians should stop doing if they wanted to have a leadership position in the rapidly evolving healthcare world. In the spirit of bringing solutions and not just problems, today’s list is five things that I think we as physicians collectively should start doing.

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CO Health Change Agent - HopeWest

Death is a taboo topic in America. In many cases, the reticence to discuss end-of-life concerns extends to serious diagnoses, such as cancer, which may not be terminal.

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Paramedics Save the Day...and Then Some

When asked to list types of primary care health care providers, the majority of people would probably say doctor or nurse. With prodding, perhaps pharmacists, public health providers, and medical assistants would come to mind. Paramedics and EMTs may not top the list, but Eagle County’s Community Paramedic program is starting to change people’s perceptions of paramedics.

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Staying Hopeful About Health Reform

 Originally posted on CCMU.org

Will we ever be able to stop “reforming” our health care system?

I’ve been working on health policy issues for more than 20 years, and from the beginning my efforts were framed around health “reform.” Indeed, neither the problems under discussion nor the thrust of the proposed solutions has changed much over that time period. But change is hard, particularly when agents of change are ranged against deep-pocketed industries, entrenched guilds and bureaucratic inertia.

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Specialist Health Reform Survival Tips

I was asked by a good friend who is an orthopedic surgeon to put together a list of action items that a forward-thinking orthopedic surgery group should be considering during these dynamic health care times. From my former experience running a successful orthopedic practice and my current work with CIVHC focusing on health care reform specific to paying for high-value health care, I have assembled a list of suggested “to-dos” that specialists should consider to remain vital in the upcoming years.

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CO Health Alliances: Leading Change Locally

Today's health care landscape is changing rapidly, and the action at the state and national level is receiving a lot of attention. However, much is happening at the local level, too. Local communities are coming together and taking the initiative to improve their own health care systems in exciting and innovative ways. Although certainly catalyzed by recent state and national health reforms, this movement has been gaining steam for years.

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Readmission Penalties Give Hospitals a Reason to Spend Money on the Right Things

There was a story in the Denver Post this week about Medicare’s penalty for readmissions being charged to 27 Colorado hospitals that participate with Medicare. On average, these hospitals were penalized 1/3 of one percent of their total Medicare reimbursement. In the case of one large hospital system, this amounted to about $300,000 out of a total revenue stream of $2.7 billion, or about 1/100 of one percent. At this level, one might wonder if it’s worth the trouble to administer, or if anyone is really paying attention.

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Obamacare: Hope, Fear and Misinformation

Recently I spoke about Obamacare to two different community groups. My expectations of each group were different given their locale – one was in well-to-do neighborhood that trends quite red at the voting booth (I was braced for anything up to and including a death panel discussion) and the other was in central Denver which I guessed would be more progressive in tenor. It turns out that the conversations were nearly identical and characterized by a striking polarity in which nearly everyone simultaneously viewed Obamacare with hope and fear.

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What's the Difference Between Palliative Care and Hospice Care? Part I in a Series of FAQs

Despite some interesting “discussions” at the federal level on end-of-life care over the last few years, CIVHC continues our commitment as a convener and leader to improve access to high-quality palliative care across Colorado. Along the way, we’ve received many questions from stakeholders about palliative care and our decision to focus on this topic, especially in the light of highly charged political rhetoric associated with end-of-life care over the last couple years. Over the course of the next few months, I will be answering some of the questions we get most often in an effort to demystify palliative care. Today's question focuses on a common misperception that palliative care and hospice care are one and the same.

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No Magic Bullet for Health Care Reform

Rarely does a day go by that I don’t run into another article arguing the efficacy of health care reform tactics such as medical homes, Medicare payment reform, and Electronic Health Records (EHR). A recent example is “Do Electronic Medical Records Save Money?” by the New York Times. The piece reveals the results of a 2008 federal survey showing that physicians using electronic records actually ordered more high cost tests than their peers who were still using paper medical records. This is contrary to the belief that EHR systems have the potential to save costs by reducing the number of tests being ordered.

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CIVHC Convenes Innovation Challenge Applicants with Foundation, Payers to Leverage Triple Aim Projects

The spirit of innovation is alive and well in Colorado health care. And, even as providers, patient advocates and health plans respond to local needs, they’re identifying many of the same problems. Even more striking: they agree that the changes they need to make to improve health, improve care and control costs can’t be done without radically transforming the way we pay for health care.

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Why Focus on Palliative Care to Achieve Triple Aim? Part II in a Series of FAQs

Considering the fact that CIVHC ‘s expansive charge is to improve the quality of care and bend the cost curve for health care across the state of Colorado, many people wonder why CIVHC has committed to an effort so specific as improving access to high quality palliative care, especially at such an early stage in our organization’s development. Perhaps an organization such as CIVHC should be more focused on “big picture” issues in Colorado, by identifying where we have the greatest opportunities to impact the quality and cost of care for the largest segments of our population. In 2008, the members of CIVHC’s planning committee took on that exercise, and identified palliative care as one of those opportunities.

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Filling a Void – EMS Providers Step Up To Address Community Health Care Needs

Last month I had the pleasure of representing CIVHC at the International Roundtable for Community Paramedicine (IRCP) conference in Vancouver, Canada. My friends and family were a bit surprised (and somewhat jealous!) to learn I was travelling out of the country for a conference. I explained that CIVHC identifies and promotes innovative solutions to address Colorado’s health care crisis, and the IRCP is the only conference that focuses exclusively on the up and coming community paramedic model. Community paramedic programs, although relatively new to the US, have proven successful in improving health and saving costs, and CIVHC is identifying how this model might fill gaps across Colorado.

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Aligning Delivery and Payment Reform for Maximum Impact

As one looks at the efforts to transform health care delivery and payment in Colorado, two overwhelming impressions emerge. The first is the sheer quantity of innovation underway in our state. To see what I mean, look at CIVHC’s Inventory of Payment Reform and Delivery Redesign Strategies and the graphic that accompanies it . While we’ve done our best to be comprehensive, we know we’ve left important initiatives off these documents (and please contact us if yours is missing). But even our non-exhaustive list requires nearly two dozen pages to describe.

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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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Watching Physician Culture Change

Originally posted on www.wanthealthcarellc.com.

I do a fair amount of work in payment and delivery system reform, in various communities around the country.  I have been speaking to physicians about change coming for over a decade. If you have done any of this work, you may have had this common experience: that change is hard, and people have to have a really good reason to change the status quo. I admit it sometimes seemed to me that change would never come. 

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