This is worth a read!

Kaiser Health News' article today

Mass. Aims To Set First-In-Nation Health Care Spending Target 

is well worth the read.  It is interestingly juxtaposed with the article on how little consumers like the idea of expanding Medicaid budgets in their own states.  The absolute notion that leaders have to get their hands around is how quickly the game is changing from how do I squeeze out a margin on what I am now doing to how fast can I handle a global fee and still make a margin.  As the dollars continue to be constrained at the State levels, the message gets louder and louder: the federal constraints are going to come and they will stick...even in the current "leaderless" election cycles.

The perfect storm of aging babyboomers, slowing retirement accounts and slowing government spending really points to more and more risk based and data driven spending.  Massachusett's focus on global payments and data is by necessity going to hit all states and then the feds for those states that can't get their hands around it.

Check it out.

I have participated in my 10th (do I really know how many) on line debates on healthcare because a neighbor of mine loves to rile up his Republican colleagues and his Democratic neighbors and to watch the sparks fly.

It has been one of the few places that I have actually seen intelligent data being quoted with a few barbs thrown in, so I keep returning to the scene of the crime and get baited into participating.    Most discussions of healthcare, or Obamacare or ACA, are mostly barbs so this is kind of enlightening.  I have yet though to see anyone convince the other that they are right....isn't it interesting, no one believes anymore that facts are facts.  They believe that they can toss out an opinion (not their own but someone elses) as a fact, and because they know their facts are often wobbly, they challenge the facts of everyone else.  Its hilarious for adults to be throwing major reference data on a facebook discussion!  Or maybe not so hilarious....I really miss the days when facts were facts and you needed a professionally critiqued replicable study to dispute the facts.  Now all we need is one loony who says it just ain't so.

The only fact that I know is that everyone needs a doctor, or possibly surgeon or midwife or orthopedic specialist or trauma surgeon at some point in their lives.  They need them for immunizations (a nurse can give it I know), ear infections, stomach bugs, terrifying febrile seizures in 4 year olds, and broken hips in your 70s.  These are not life style or choice, these are terrifying or painful moments that affect all humans and the choices are to seek medical and other health attention or to suffer and possibly die.  That makes healthcare no more a commodity than the person who receives it and the person who gives it.  It is not a market but a need.  It is not a want but a necessity.  It is a requirement of most religions to provide it and its a mark of a civilized society to provide it equally to all citizens and visitors.  The good samaritan didn't ask for papers as you might recall.

Today healthcare is about money.  Huge whopping piles of money.  Money coming in and money going out.  Money paying for nurses to valiantly stand by your bedside all night long and hold your hand and money going in boatloads to pay for administrative rules and crazy systems.  Money that lines the retirement account of senior executives to the tune of the whole budget for a town of people and money that keeps some doctors squarely in the 1%.  Money to pay off ridiculously high costs of medical education and money to pay for overmedicating of children and seniors.  Nuns talking about margin. Millionaires talking about mission.  Money, money.  Everyone has a stake.  Do I get less or more.  Do I pay less or more.  Why do I pay for someone else.  Why do they expect to have what I get but don't pay for.  Its all about money and its so broken. 

I am not naive about money and the cost of healthcare.  Its the priority it has and the imbedded vested interest that is so difficult to move.  I have seen organizations put their best interest aside only to be slammed by their constituents.  We really don't understand what is at stake as a country.

So I keep jumping into the debate because it is about the foot that was lost to poor diabetic management or the women who decided living isn't so great when you're poor so she ignores pain. Its about the body, stupid, and that body just might belong to someone you know.

Twenty CCE/MCCN Projects submitted

The State of Illinois is reviewing 20 Care Coordination Entity project bids this summer to care for the most challenging Medicaid clients - the aged and disabled. 

I had the privilege of working with a great team to design and implement a health home network for these patients that is centered on a chronic disease management model as opposed to a family practice model.  This exciting approach to systemic change and patient management - patient partnership and patient engagement - could improve the value of care for thousands of patients.

Implementation that focuses on transition management and structural improvements is underway now.  This model has value for all patients.  Congrats to a great team.