Medicare recipients should be ecstatic about the potential to keep them out of the hospital.

The successfully managed patient will have a system of care called the Medical Home.  It is not one poor primary care person who has responsibility to know too much, but it is a series of information transfers to a single entity to capitalize on the expertise and data available to an array of providers in a system.  Your patient may be sending messages from home from his smart scale or may be managed and assessed by a number of protocols simultaneously and often remotely.

The Medical Home is much more than a primary care physician with a smaller panel of patients.  It is really a system of care that relies on effective transmission of data and implementaion of scientifically established protocols of care than can be deployed to every patient that enters the system.

AHA meeting...this should be fun!

Government shutdown, no budget for last year, no budget for next year, 20,000 people dependent on government money to run their hospitals sitting together, ACOs .

I am looking forward to the following at the meeting:
RISA LAVIZZO-MOUREY, M.D., Jonathan Perlin, MD, Mika (the only adult on cable TV), Leo Brideau and crew on insurance exchanges, and of course the parade of elected officials. 

A fresh (albeit tactless) take on ACOs!!

This is good for a Friday.  Enjoy.  Thanks to my friend Skip Fiordilis for sharing!
http://www.youtube.com/watch?v=lF8bK7AJyL0

ACO road to better outcomes: best practices

The road to ACOs may be paved with some broken hearts and dispirited warriors as they break new (or slightly new) ground on the road to a more perfect quality/cost equation.  On the other hand the learning curve doesn't need to be trial and error.  This is a time for consistent and unwavering application of known best practices.  Sounds impossible...not with the carrots that will be available for strong performance.  And the winners will be the first to understand that...because once the stragglers get on board, the incentives will begin to diminish by necessity ( Medicare cuts will not be a thing of the past).  So my message.  Jump in with both feet if you can maximize the size.

This appears to be a game about primary care but it really could be most effective if it is a game about leveraging the best in specialty care to the broadest set of patients.  What does that look like?  It looks like a CHF protocol for all chronically ill patients to guard against inevitable admissions from the side effects of chemo or radiation.  It looks like a coumidin clinic where nurses manage all patients on blood thinners and essentially take over from the primary care doctors the monitoring of lab results.  It means levels of care in the ER and a number of after hours options for all patients in the system from electronic to actual visits.  It could mean smart technology for patients in program categories.  It looks like each patient is no longer a series of diagnosis but a series of manageable processes and symptoms that trigger intervention.

For providers it means smart technology and reduction in redundancy.  It means comparative reporting to determine group and community standard norms.  It means aggressive risk management and interventions and rapid response, hospitalists and evidence based practice. It means patient navigation.

And you thought you were committing to an EHR and a medical group!