Brent Asplin, MD, MPH

Shifting the financial model alone is not sufficient for the transition - the care delivery, workforce, and many other pieces of the ecosystem with which PCPs interact also need to adjust accordingly. Funding to allow for the startup costs of transformation must be made available. A comprehensive analysis from The Commonwealth Fund: To encourage participation, practitioners say upfront payments, investment in the primary care workforce, and less emphasis on simplistic quality measures are needed, as well as more support for practices to provide accessible, comprehensive care. #primarycare #integratedcare #teambasedcare #healthcare #healthcareonlinkedin

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It's wild to think in 2024 we're FIRST seeing the DOJ accuse telemedicine conglomerates of criminal drug distribution. How long have we known about these practices in brick and mortar care...? Answer: decades! Take it from someone who prescribed stimulants and other psychotropics to kids over the years - painstakingly measuring and documenting the need and impact - these appalling abuses by Done and Cerebral mean we need more calls for thoughtful pause when it comes to working with startups. Particularly about funding's role - my favorite topic! 🤑 How did we end up with venture capital and PE financing in healthcare that risk the safety of kids in the name of exorbitant returns? Not that all VC or PE dollars are bad, of course, but they're certainly key drivers who shouldn't be in that seat. Did we underestimate these funders as 'barbarians at the gate', much like the pharma reps of the 90's and early 2000's heyday? Have we not learned from Purdue Pharma's aggressive and deadly Oxoycontin marketing? Purdue pleaded guilty to criminal charges and paid $600 million in fines in 2007. Or TAP Pharmaceutical Products's Lupron kickback scheme for the prostate cancer drug? TAP also pleaded guilty to criminal charges and paid $875 million in fines in 2001. Or Pfizer marketing Neurontin, an anti-seizure drug, for off-label uses, such as treating pain and bipolar disorder, even though the drug was not approved for these purposes, and paying physicians kickbacks. In 2004, Pfizer pleaded guilty to criminal charges and paid $430 million in fines. Cerebral and Done's playbooks were practically the same thing, just with a modern mid-pandemic, low-regulatory scrutiny, digital-platform twist. Will appropriate regulation ever outpace American venture greed? Is it even possible to ensure patient safety AHEAD of tragedies driven by the intersection of innovation and venture funding? If you're keeping score, healthcare regulatory reactivity: 1 million. Healthcare ounces of smartly preventive policy: 3. Blech. 😖 When will we finally own that prevention in-house? #healthcare #overdoseprevention #suicideprevention

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100% satisfaction in birth metrics! What is the secret? Cleveland Clinic achieved 100% satisfaction across five birth metrics, a notable feat that Becker's Hospital Review highlighted. Cleveland Clinic adopted TeamBirth in October 2022. TeamBirth is a care delivery model jointly created in 2021 by Harvard Pilgrim Health Care, Ariadne Labs and UMass Memorial Health. It emphasizes routine check-ins with all patient care team members and family at key points to streamline communication about birth preferences and patient status, using a whiteboard as a key tool. Since adopting it, the health system saw the rate of C-sections for Black mothers go down from 41% to 22%. Rates also improved for white mothers, dropping from 27% to 23%, bringing the outcomes for its patient populations to a more equitable level. ▶ Satisfaction went up across five categories in 2022 to a perfect 100% for: ➡ Friendliness/courtesy of the unit — up 10% from 2022. ➡ Staff concern, information about progress and baby’s condition — up 12% from 2022. ➡ Nurse promptness in responding to patient call — up 12% from 2022. ➡ Nurse's attitude toward patient requests — up 13% from 2022. ➡ Doctor and staff working together during birth — up 15% from 2022. Patient satisfaction grew by 23% — from 72% in 2022 to 95% in 2024 — for how well they felt Cleveland Clinic managed their pain during labour. Transparent communication is important to promoting safety and reliability in high-risk organizations. ♻ How is the communication in your organization? #healthcare #communication #reliability

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Walmart joins so many others in quickly entering and leaving or scaling back in healthcare after ambitious plans to scale. This morning, Walmart said it will close all 51 of its health-care clinics, as well as shut down their telehealth virtual care services. This is right after an announcement in March that they wanted to double the size of their clinical operations by opening up over 20 more locations this year and more next year. The reasons they cited? “Like others, the challenging reimbursement environment and escalating operating costs create a lack of profitability that make the care business unsustainable for us at this time.” As a physician, it’s been fascinating to watch over the past few years as so many non-medical companies try to get their bite of the huge percentage of the GDP that is healthcare. They pour money into trying to deliver healthcare at scale, ignoring the many concerns that hospital systems and physician private practices have been citing for years: declining reimbursements, shortages of clinicians, and expensive labor costs. Healthcare is broken, and those that are in it understand why. Patients need - and deserve - quality health care. This requires safe staffing practices, skilled clinicians who can feel good about what they do, and insurance companies that pay their bills. We can’t have a system where insurance companies can get away with record profits while finding more and more reasons not to pay for care and eroding away at the heart of healthcare. You cannot scale your way out of America’s healthcare problem. You actually need to fix the incentives, regulate insurance companies, pay clinicians appropriately, prioritize clinician well being and retention, and focus on the patient. The days of paying lip service to physicians leaving medicine and physician burnout are numbered. Supply and demand forces will necessitate real solutions that move the needle. Companies will come and go in the healthcare space when they realize how hard it is on the ground in healthcare these days. The question for patients and legislators is, who will be left to pick up the pieces if there’s no support for physicians, other healthcare workers, and hospital systems?  The percentage of clinicians leaving healthcare annually because they no longer recognize the heart of why they joined the profession is astounding, with over 1/4 of clinicians looking to leave within the next few years. Relying on the altruism of clinicians and the erosion of quality healthcare to support profits for corporations is just not a sustainable business model in healthcare - not to mention terrifying for public health. #HealthcareOnLinkedIn #PhysicianBurnout #PhysicianShortage #Walmart

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CarePoint Health System's most recent bankruptcy reflects years of financial struggles, legal disputes, and attempts to salvage its healthcare operations. Ironically, it was formed in 2013 when three hospitals—Bayonne Medical Center (BMC), Hoboken University Medical Center (HUMC), and Christ Hospital— were purchased out of bankruptcy. Financial strain and management controversies plagued the network, particularly after reports surfaced in 2019 that former CEO Vivek Garipalli and other leaders funneled millions through shell companies, casting a shadow over CarePoint’s financial integrity. In recent years, CarePoint’s financial troubles deepened, with operating losses reaching 14% and significant debt accumulation, prompting the state to appoint a fiscal monitor. CarePoint repeatedly requested state subsidies to maintain operations, cut employee hours, and faced over $11 million in lawsuits from unpaid vendors. An intense rivalry with Secaucus-based Hudson Regional Hospital and its owner, Yan Moshe further complicated CarePoint’s stability. Moshe acquired the land beneath BMC in 2019, spurring legal battles over property control. Bayonne’s city council attempted to safeguard BMC’s future as a hospital through zoning protections, leading to a prolonged court dispute that recently concluded with a ruling in favor of preserving the hospital's function. Despite their adversarial history, CarePoint and HRH recently forged a tentative partnership to create a unified healthcare network, a deal brokered by Jersey City Mayor Steven Fulop. However, just weeks after this announcement, newly appointed CarePoint CEO Dr. Jawad Shah abruptly resigned, leaving CarePoint without a clear leader and triggering renewed uncertainty. Following Shah’s departure, HRH promptly offered $25 million in interim funding to help CarePoint avoid liquidation. HRH proposed to integrate HUMC, Christ Hospital, and BMC into its network, which includes its existing facility in Secaucus, with hopes of forming a stable, regional healthcare system. The Hudson County community and union representatives have since called for a state investigation into CarePoint’s financial management. To keep this story very "New Jersey" its also worth noting that HRH’s recent public image suffered a blow due to the arrest of its marketing director, Reuven Alonalayoff, who was found with an arsenal of weapons and ammunition in an unlocked hospital office. This prolonged crisis raises a pressing question for New Jersey’s state leadership: why wasn’t more done to prevent this unfolding catastrophe? For years, warning signs were not only apparent—they were glaring. Mismanagement, spiraling debt, and questionable practices were well-documented. As a critical safety-net system, CarePoint’s facilities serve some of the most vulnerable populations in Hudson County. When we have a crisis in leadership, patients and communities suffer. Full stop. Kevin Lyonsjeff lestonJohn TozziAnna Mathews

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Radiologists are achieving payments 500% above the Qualified Payment Amount (QPA) in surprise billing disputes, thanks to the No Surprises Act. This figure is staggering and highlights an important reality: many providers might not realize the tremendous potential of this opportunity. When the No Surprises Act (NSA) was enacted in 2022, the rates at which providers were reimbursed took a major hit, often cut in half. Payors exploited the QPA to justify lower payments, essentially giving themselves the green light to underpay claims. If a provider disagreed with the payment, they had to navigate the cumbersome claims process to recover what they deserved. But here’s the good news: By participating in the IDR process, radiologists are claiming up to 5 times their initial payments. This result is a powerful incentive for payers to engage in a meaningful negotiation and ensure fair compensation. Providers should leverage the NSA to their advantage - and capture every dollar they’re owed.

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How Much Variation Should There Be in the Pricing of a CT Scan, from the *Same​* Provider in Michigan? Here's a real life example of from one of finHealth's clients. The names have been changed to protect the innocent (until proven guilty).   This is the actual distribution of CT scan of the abdomen and pelvis with contrast in the Michigan region – all from the same provider. Typical cost at this facility is $400, but here we also see this same provider exceeding $2,700 on multiple occasions. Why does the contract allow much significant pricing variation for the same service from the same provider? Is your BUCA contract allowing for this? Do you know? 𝑯𝒐𝒘 𝒘𝒐𝒖𝒍𝒅 𝒚𝒐𝒖 𝒌𝒏𝒐𝒘? #healthcare #cost #fiduciary #howwouldyouknow

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View of U.S. Healthcare Quality Declines to 24-Year Low Americans' rating of U.S. healthcare coverage is below average; most say the system has major problems This is not surprising, maybe there will be some improvement in 2025 #healthcarequality, #opinionofhealthcare, #sentimentofhealthcare https://lnkd.in/eRJAFgSh

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I hole heartedly agree Benjamin Schwartz, MD, MBA. Anywhere else in an economic system, innovators who can deliver a better product at lower costs are almost always rewarded with greater market share, and frequently set the direction for the future of a product or industry. Not so in healthcare. I think that Terry Adirim, MD, MPH, MBA (below) hit the nail on the head when she references for-profit health insurers in the mix. Although policies have been enacted with the idea of providing better healthcare at lower costs, they have always given the job of administering those policies to a middleman (insurance companies) whose motives are at odds with the objective they claim to be administering. Profit! Innovation is not in the best interest of the payer. They profit through the inefficiency of the system. Until this lack of alignment between quality patient care at low costs and for-profit health care plans is addressed, process innovation and improvement will only be able to nibble at the edges.

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I’ve been given advice that the fastest way to monetize HER Heard without charging the end user (woman) is trackers and selling data. Instead, I’d like to build something more trustworthy. I don’t want to be in a headline like this. If you are not paying, then you are the product (you/your data are being sold). There are newer ways to deindentify data or even to aggregate things women search for that can be of interest to various stakeholders. In theory that could be okay to sell, but in a post-Roe world with laws encouraging bounty hunting, I am vetting the choices ahead. I am all for moving fast, without breaking things.

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A brief thread on how MLR is often a stat that is juked (h/t to The Wire) in the “value-based” care world. The medical loss ratio (MLR) is a financial metric used in health insurance and managed health care to measure how much of a premium dollar an insurer uses to pay medical claims and quality improvement activities. The MLR is also known as the medical care ratio, medical cost ratio, or medical benefit ratio (cite: Healthcare.Gov). Many so-called value-based care models cite their impact in the form of medical loss ratio improvement. Most innocently assume that such improvement is generated by better medical management (I did when I first started working in the field). While this may be the case in some models—it is importantly to note that another way to improve a medical loss ratio is be increasing revenue capture in the form of coding. Said another way, to improve MLR, one can reduce the numerator or increase the denominator. Therefore, when someone cites a major medical loss ratio improvement—the key question to ask is: did the MLR improve because of true medical utilization reduction or because of better revenue capture? Most will glibly (and sometimes dishonestly) say “both.” At which point it’s important to ask, what fraction of Medical Loss Ratio improvement arose from better medical management and what fraction from better revenue capture. Usually, what we will find is that most dramatic improvements in MLR are a function of improvements in revenue capture—and only marginal improvements in medical cost-management. In that way, the so-called “value” produced by many value-based care models isn’t true value. It’s better revenue capture. And many “value-based” care models have been granted undue recognition for medical cost management—citing filthy MLR improvements—that are associated with minimal true improvement in medical expense. This kind of short-cut taking sets back the whole value-based care movement which (while appropriate revenue capture is necessary) should be about overall better cost management and reducing total cost of care—not better revenue capture alone.

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We all know managed care was a scam for the corporatization of health care.. it has cost billions of dollars to adapt to the insurers wishes - which was aimed at maximizing profits. It is not hard to realize that taking care of people is not the same as building cars. The attempt at controlling surgical time is just another idiotic attempt to make/keep more money. So why not send out that balloon and see if it gets shot down. And now to waste the time of the Congress. With any luck positive changes will and should occur on how health care financing is done in the United States. Let us hope so. Bottom line - what a stupid arse idea -

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Sg2's 2024 Impact of Change report has been released, and projects that the aging population will drive increased ED and Inpatient volumes over the next decade. In addition to a 3% increase in inpatient discharges, the report projects a 9% increase in inpatient days, indicating that length of stay will continue to rise. This will have a significant impact on a health system's patient flow, all the way back to the ED, where there will be a projected 4% increase in volume compounding the impacts of patient flow bottlenecks. The report also projects a significant uptick in home health, with 22% growth, as well as a 14% increase in Outpatient and Ambulatory Surgery volume. Health Systems should be making investments in efficient patient flow NOW to prepare for the growth anticipated over the next decade. Payers should be thinking about how we enable a greater offset from EDs and Inpatient, whether through investments in remote patient monitoring, mobile integrated health, or transportation to support the rarely-covered outpatient use cases.

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For part of your fiduciary duty, self-funded plans, you should be asking your carriers about #medicaldrug rebates, or under Medicare, these are considered "#PartB" drugs. These are not drugs you pick up at the corner drug store. These are the drugs that are infused as an outpatient at an infusion center, doctor's office, or even sometimes at home. Chemotherapy, drugs like infliximab, or any drug that you need to have infused are likely in the medical plan benefit, NOT the pharmacy plan or benefit. And, spoiler alert - they're often the most expensive drugs to hit plans....ever. ✅ The next time you're with your medical carrier, ask them about medical drug rebates. ✅ Then ask them about medical drug rebates as they apply to your plan, specifically. ✅ Last, ask them when you should be expecting a check on your medical drug rebates. If you get South Park blank stares, that means you're on to something. Keep asking....hold them accountable. There ARE medical drug rebates, and if your plan is paying for medical drugs, your plan should be getting drug rebates back. #pharmacy #medicaldrugs

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What would it take for CMS to actually have sufficient primary care by 2030. Spending in primary care would need to go up, not down as in 5.8% to 4.6% of total spending as indicated by the Milbank Scorecard 2010 to 2020 (purple squares at bottom). Flat lined 250 billion in primary care spending with cuts and new types of costs added can only decline capacity by about 20 - 30 billion or 10% of capacity year after year due to less workforce and other team members supported (green line). Worst case orange line reflects cuts, higher turnover costs, even worse retention, and higher costs of delivery. Primary care delivery capacity should have continued to increase slightly faster than population growth (purple line), ideally at 2% annual increase (turquoise) to cover population increases and increases in a number of complexities. Fewer and fewer primary care years per class year indicate declines, not advances. Primary care retention would need to increase. It continues to decline for all 5 sources decade after decade. CMS would have to prioritize delivery team member numbers and quality while decreasing metrics, micromanagement, and team member burdens. CMS would have to focus on volume increases rather than volume to value. In primary care, volume is what enhances access. In particular the cost cutting and overutilization focus must go away for 40% of the nation with half enough primary care and basics where underutilization and inappropriate utilization worsen by the financial design. The nation would have to address the fatal flaw of employer based health insurance - payments lower than cost of delivery where the weaker employers are concentrated. CMS would have to increase payments to 110% of the cost of delivery, up from 60 - 85% CMS would need to audit its plans and discipline them such that lower payments are not associated with lower levels of workforce - as in 15% lower office payments for primary care where it is half enough for 40% of the population in 2621 counties across vast regions. Primary care year production since the class of 2010 needed to exhibit regular annual increases in the numbers of primary care years from IM NP FM PA and PD (blue line) CMS would have to look back historically and see that the only major increase in primary care was 1965 to 1980 with the new billions from the original Medicare and Medicaid design (blue line left) CMS would need to understand that no training design, especially graduate medical education funding, can address deficits of primary care and basics where the public plans and worst private employer based plans are concentrated. CMS would need to see that its designs prevent improvements in PC delivery capacity including regulatory capture, RBRVS, budget neutrality, and better payments and more lines of revenue for those larger - especially when CMS votes its 1.4 trillion annual budget against basic health access.

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Home healthcare providers face increasing pressure from Medicare rate cuts and rising operational costs and unfortunately, the nurses and care team often feel the brunt of this pressure. "The Centers for Medicare & Medicaid Services (CMS) has proposed cuts to home health payments three years in a row. Though its last two final payment rules have not been as harsh as its proposals, they have still come with permanent cuts to payments. Providers have multiple gripes with these cuts. The first is over the payment methodology that CMS applies, which most providers and advocates strongly disagree with. The second is the rising costs that home health agencies have recently faced. While CMS is cutting home health payment in traditional Medicare, the cost of providing services has skyrocketed – namely due to the cost of labor." If you're a home healthcare provider trying to do more with less while also wanting to support your clinical team, please reach out. We're happy to help! #coordinista #HomeHealthCare #Efficiency #ClinicalOptimization #HealthcareInnovation #nurses #fieldcaredelivery https://lnkd.in/gS5z3-Jj

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Title: Bridging the Gap: Public and Private Healthcare Collaboration On June 11, we hosted a pivotal meeting with key voices from both private healthcare providers and public healthcare regulators and providers. The consensus was clear: collaboration between the public and private sectors is essential to create a robust and sustainable healthcare system. Here’s how we can achieve this: 1. Unified Vision:Establish common goals like improving patient outcomes and increasing accessibility. 2. Leverage Strengths:Public systems excel in broad coverage and preventive care, while private providers lead in innovation and efficiency. 3. Data Sharing:Integrate data to enhance diagnosis, treatment, and preventive measures. 4. Joint Investment:Collaborate on funding for advanced medical technologies and telemedicine. 5. Policy Harmonization:Align policies to reduce bureaucratic hurdles and foster innovation. 6. Public-Private Partnerships: Pool resources to tackle infrastructure and rural healthcare challenges. 7. Continuous Improvement: Regular feedback and communication to adapt to changing needs. Our meeting highlighted the potential of collaboration in transforming healthcare. By working together, we can build a more efficient, equitable, and responsive healthcare system. Let’s commit to this collaborative journey for a healthier future. #UHC #medicalai #health #PPP

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