Walter (Wally) Sackett MHA, FACHE

What does calling my cable company have to do with Medicaid? I had to call a certain notorious cable/internet provider recently. The one with customer service so bad that it was skewered in a classic South Park episode. I blocked out an hour and braced for my inevitable PCOM aneurysm rupture. Shockingly, it was a breeze. The rep was friendly, and my issue vanished in minutes—a far cry from their usual 'dial-one-to-scream-into-the-void' reputation. So, what changed? Competition happened. A decade ago, our choices for cable and internet were as limited as the soda options in a health spa. Now, thanks to a buffet of streaming services—even including live local TV—the old cable giants had to step up their game or step aside. Turns out, competition is more effective than caffeine at improving service quality. Why can't Medicaid beneficiaries get the same treatment? Currently, most Medicaid coverage is through Managed Care Organizations (MCOs), where the state pays a fixed monthly rate per patient. This model should spur cost-efficiency, but it often just limits the scope of care. Low payments to doctors, restricted access to necessary services—who does that help? Could strict government regulations guarantee better service? Maybe, but FA Hayek (and a basic reading of history) prove that bureaucracy alone can't engineer excellence. And choice for Medicaid patients? Virtually non-existent. Many areas offer just one MCO. If you're dissatisfied, too bad—there's no alternative. It's like being stuck with dial-up in the era of fiber optics. Long wait times for basic procedures, no freedom to seek better coverage... It's eerily reminiscent of the old cable monopoly days. In the private sector, at least there's a semblance of choice: HMOs, PPOs, HSAs... But for Medicaid recipients? Sorry, the state chooses for you. Hope you like it. Our Medicaid system desperately needs a dose of competition. Isn't it time we offer Medicaid patients the luxury of choice that drives quality up and costs down? https://t.co/C7XE6CpIIP Joe Grogan Lisa Grabert Joanne Spetz Cheerag Upadhyaya, MD, MBA, MSc, FAANS, FACS Brian R. Gantwerker, MD, FAANS, FACS Sanjay Dhall Larry Bucshon, M.D.

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On October 8th, U.S. News & World Report released its annual rankings of Children's Hospitals, called "Best Children's Hospitals". It is a 174-page report describing the methodology and data tables which I scanned through. Appendix C-10 has the data on Pediatric Pulmonology which I took a deep dive into. In the attached carousel, I have recreated two datasets that matter. If I were to shop around for a hospital for my care, what really matters to me is the outcome data for a particular condition I am seeking care for and not the reputation score. However what separates the top-ranked "Best Children's Hospitals" is their reputation scores, not the outcome scores for selected conditions as in asthma here. It's a different matter whether the outcome scores used in the rankings are good measures. We will discuss them in another post. What are your thoughts? Feel free to like, share, and comment. #healthcare #hospitals #physician

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The pandemic changed how many physicians viewed their practice and goals, and many decided that full-time clinical practice was not where they wanted to devote their energies. At Mid-Atlantic Permanente Medical Group | Kaiser Permanente, we knew we needed a concerted focus on recruitment and retention. By listening to our physicians and soliciting detailed, honest feedback, we were able to focus on removing as much logistical and administrative burden from our physicians as possible, with a simultaneous focus on enhancing patient care. Through those efforts, I’m proud to say we brought in more than 250 new physicians in 2023, and more than 150 so far this year. At the end of the day, it's up to us to make the practice of being a physician rewarding and sustainable. I recently spoke with the American Medical Association about our successful practices that can be replicated across organizations and industries: https://lnkd.in/gcp6kpXW

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As a new class of medical students begins school at the Kaiser Permanente Bernard J. Tyson School of Medicine, please join me in wishing them well on their journey. We’ll do everything in our power to support them. We hope policymakers will too.  The United States is facing a projected shortage of 139,940 physicians by 2036, which includes a shortage of 68,020 primary care physicians and 42,130 psychiatrists. This shortage is likely to be exacerbated by rising rates of physician burnout and early retirement following the pandemic.  The shortage is in part a result of a growing and aging (and more racially/ethnically diverse) population. And we have not done enough to grow the workforce. At Kaiser Permanente, we’re providing clinical education opportunities to address the workforce shortage, with a focus on health equity.  Our equity commitment is reflected in enrollment at the Kaiser Permanente Bernard J. Tyson School of Medicine, where students currently attend tuition-free, and we have one of the most diverse student bodies in the country.  Congress has a critical role to play in helping to grow and diversify the health care workforce, including the physician workforce. As the federal government, through the Medicare program, is the primary source of public funding for residency programs, Congress must act to expand the number of residency slots. Given the health care needs of the U.S. population, emphasis should be placed on expanding the number of slots in both primary care and psychiatry. There should also be emphasis on diversity and placing residents where they will care for historically underserved populations. Finally, Kaiser Permanente encourages Congress to extend the ability of teaching physicians to use telehealth to supervise resident physicians. This will be especially beneficial in rural parts of America. At Kaiser Permanente, we’re proud to train 2,444 medical residents and fellows each year. More residents will be needed and in the right fields to meet Americans’ health care needs.

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Health insurance companies Medicare Advantage plans subsidy and premium based EBITDA and Profits can only be guaranteed and expanded by taking from the physicians who manufacture preventive, medical, surgical and palliative outcomes with their patients and also taking from the hospitals in which clinical outcomes are manufactured and produced. #quadrupleaim, #medicare #medicareadvantage #healthcarecosts

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KH's most recent Flash Report unveils promising signs of financial performance, with a notable slowing of margin decline. The widening gap between lower and higher performing organizations highlights the focus on long-term investment and innovation in high-performing orgs. Lower performing organizations must focus on enhancing efficiencies and reworking key elements like their operating model and portfolio management. Explore the insights in the report here: [National Hospital Flash Report May 2024 Metrics](https://lnkd.in/ggUcyDPh). For resources to boost performance, visit us at https://lnkd.in/enBa3Tp

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According to this article in Modern Healthcare, discussing a report from the Center for Healthcare Quality and Payment Reform, we have 16 rural hospitals at risk of closing in Washington State, and another 8 in Oregon. It’s disheartening but not surprising when reimbursement rates don’t cover the cost to provide care and hospitals have been operating at a loss for much too long. Make no mistake, it is an issue of health equity when our neighbors in rural and underserved communities face hospital closure and risk further losing access to care.  #healthequity #healthcare #healthcareaccess https://lnkd.in/gHr4Qz-j

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Partnering for Health Equity: Rural Health Network Development Program As someone deeply committed to advancing health equity, I had the honor of serving on the Justice, Equity, Diversity, and Inclusion (JEDI) committee with the California Association of Healthcare Leaders. During that time, I contributed an article to their newsletter titled Equity & Access from the National Stage. You can read it here: https://lnkd.in/gyntYvfq Today, I’m excited to share an incredible opportunity to make a tangible impact on health equity. The Rural Health Network Development Program is designed to bring together diverse stakeholders to address the pressing challenges faced by rural communities. This initiative goes beyond incremental improvements—it lays the groundwork for lasting change. This program focuses on: Achieving operational efficiencies that allow resources to be maximized. Expanding access to quality care and improving health outcomes through better coordination. Strengthening the rural health system to create a more resilient and equitable future. With funding available through a grant (for which I will serve as the lead), this is the moment to step forward and collaborate on a transformative effort. By partnering on this program, organizations can be part of a movement that not only serves rural communities but also sets a benchmark for health equity nationwide. If you’re ready to be part of this impactful initiative—or simply want to learn more—please DM me directly. I’d be thrilled to share additional details or schedule a time to connect. Together, we can create meaningful change. #HealthEquity #RuralHealth #DiversityEquityInclusion #HealthcareAccess #PublicHealth #PartnershipsForHealth #CollaborativeCare #HealthcareInnovation #IntegratedCare #GrantOpportunities #HealthFunding #ProgramDevelopment #MakingADifference #TransformingHealthcare #EquityInAction #CommunityImpact

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I’m excited to share that I’ll be presenting at the upcoming Scottsdale Institute webinar, "The Business Case for Health Equity: The 3 Rs Approach," along with moderator Alan Roga, MD, FACEP, CEO of TruLite Health and panelists Edmondo Robinson, MD, Founder and CEO, Downeast Digital; & Julie Brown-Georgi, MS, CAHIMS, Founder & CEO, Digital Health Policy Strategies. This is an important topic because although the need for equitable healthcare is increasingly clear, often leaders struggle to garner support for investments in health equity initiatives. We'll discuss how to build a compelling business case for health equity, focusing on the “3 R’s"; Reimbursement, Results and Regulatory. SI members can register for the event here: https://lnkd.in/g8Ue-z64. If you're not a member of the Scottsdale Institute, please contact @TruLite Health to be added to the webinar. #HealthEquity #HealthcareLeadership #HealthIT #DigitalHealth #HealthcareInnovation #HealthPolicy #EquityInHealthcare #ValueBasedCare #HealthSystemLeadership #RegulatoryCompliance #HealthcareReimbursement #DiversityAndInclusion #HealthcareWebinar #ScottsdaleInstitute #LeadershipInHealthcare

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ACDIS Double Standard It has come to my recent attention the double standard ACDIS follows related to consultants participating as Board Members and active members of the Leadership Council. The association does not allow consultants to be an active Board member and will ask the Board member to resign if they become a consultants. The same holds for the Leadership council. Often consultants bring a unique perspective to the profession that can be shared with other board members, serving as the potential basis for shaping further educational offerings and direction of the association. On the other hand, the association willingly allows sponsorship from vendors to advance the vendor's interest and perspective of CDI, to some extent shaping the direction of the association and keeping the association from remaining true to the needs and desires of the association's members. This same phenomenon is what contributed to AHIMA losing direction and not being attuned to the pulse of its HIM Membership. Take note of AHIMA's membership roles, dropping every year and contributing to the current financial headwinds AHIMA is facing. No association, regardless of whether for profit or not, must remain cognizant of the best interest of its members. A balanced approach to revenue generation to sustain the association while meeting the interest of its members is the best recipe for advocating for the profession's advancement and relevance in the industry. Hopefully, the leadership of ACDIS will take note. Infomercials that are slanted toward the best interest of the vendor are not what the profession needs and wants. #membersinterest, #sponsorship, #ACDIS,

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Join the conversation! Our team is facilitating the strategy task force of a hospital client in Washington State this week. We're analyzing surveys, focus groups, market, and organizational data to develop a strategic plan framework for the next three years. What are your favorite and least favorite strategic working session activities? Do you hate ice breakers? Love SWOT analysis? Share your thoughts! #strategicplanning #healthcare #hospital #WashingtonStateHospitals #taskforce #dataanalysis

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As we commemorate Juneteenth, a day of profound historical significance, I’m proud to reflect on the diversity within our community at Mid-Atlantic Permanente Medical Group | Kaiser Permanente. One-quarter of our physicians and staff identify as Black or African American. This diversity is crucial, as 37% of our patients also identify as Black. Research consistently shows that diverse medical teams lead to improved outcomes for patients from various backgrounds. And in fact, studies have shown that our patients at Mid-Atlantic Permanente Medical Group | Kaiser Permanente who identify as Black live nearly 10 years longer than the national average for Black Americans. This statistic underscores the importance of culturally competent care and the powerful impact of a healthcare team that reflects the communities we serve. On this #Juneteenth holiday, let’s reaffirm our dedication to equity, diversity, and inclusion. Together, we can continue to build a healthcare system where everyone has the opportunity to thrive. #PermanenteMedicine #Juneteenth #DiversityInHealthcare #HealthEquity #Inclusion

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When used purposefully and responsibly, artificial intelligence improves equity in every part of a hospital, including the emergency department. Previous research found Black patients have a 20% greater chance of being mis-triaged in the emergency department, potentially delaying urgently needed care. Now, the Kaiser Permanente Division of Research is developing a clinical decision support tool that runs on machine learning to improve emergency department patient assessments. #AI #EmergencyMedicine #HealthEquity https://ow.ly/Rlz450Ub6NP

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Ketul J. Patel Thanks for raising awareness of the massive care disparities between rural and urban healthcare systems.  Having practiced in rural Washington for the past 15 years, I’ve seen a growing disdain for innovation and an intolerance of risk by our administration.  Rural healthcare systems can’t waste time trying to be the next Virginia Mason.  It’s just not a level playing field and the large system playbook won’t work for us.  We need leadership that values a different pathway, tailored to the communities we serve.  If we don’t reframe our approach, we will continue to see the collapse of rural healthcare.  I like to invoke Moneyball to better frame this.  Here in Wenatchee, we are the Oakland A’s to Virginia Mason’s New York Yankees.   If we are going to stay alive, then we need to play the game with more grit, strategy and innovation.  This is our reality.  If we accept it, then we can better serve our communities and create a winning rural healthcare ecosystem.

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Purchased services are vital to healthcare, but they can also become financial drains if not managed properly. A mature purchased services strategy includes insight into all expenses, reduction in unnecessary variation, and prioritized patient care, outcomes, and experience. By focusing on these areas, health systems can lower costs, improve clinical care, and enhance patient experiences. Learn more in Advantus Health Partners article about how to create a mature purchased services strategy: https://lnkd.in/g4UwCjCW #HealthcareSupplyChain #ValueBasedCare #SupplyChainManagement

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