Toward A Healthier America

BRIAN KLEPPER and DAVID KIBBE


Originally Published 12/1/10 on Care & Cost


Note: This article was published to frame the approach that David Kibbe and I have in developing our new national health care professional forum, Care & Cost.  

It’s not that we don’t know what’s wrong with health care or how to fix it. The problem, instead, is how to change a system rigged to protect industry excess over care and cost.


As we begin this forum, we see American health care edging closer to a cliff and dragging the larger American economy with it. The health care cost bubble, inflated by duplication and waste, is poised to pop. At the same time, the industry’s bloat has encouraged innovation, driving improvements in quality, safety and cost throughout health care.

Clinics As Health Care's Transformational Engines

BRIAN KLEPPER


Originally Published 12/1/10 in Medical Home News

The recent explosion of interest in onsite clinics - not just by employers, but by health plans, hospital systems, public health programs, and others - is anything but just another health care fad. At once, clinics’ growing popularity signals purchasers’ weariness with an intransigent, self-interested health system, as well as their guarded optimism about a better way.

If Employers Walked Away From Health Coverage

BRIAN KLEPPER & DAVID C. KIBBE

Originally Published on 11/24/10 on Kaiser Health News

What would happen if the rank and file of America's employers, financially overwhelmed by the burden associated with sponsoring health coverage, suddenly opted out?

It isn't so far-fetched. Enrollment by working age families in private health coveragedropped more than 10 percent over the last decade, as individuals and business were priced out of the coverage market. Others, victims of the downturned economy, have lost their jobs and access to subsidized coverage. Those who still have coverage have narrower benefits with higher out-of-pocket costs than before.

Healthy Eats For Data-Hungry Doctors

DAVID C. KIBBE and BRIAN KLEPPER

Imagine that an innovative health plan - aware that half or more of health care cost is waste and that physician costs to obtain the identical outcome can vary by as much as eight fold - hopes to sweep market share by producing better quality health care for a dramatically lower cost. So it begins to evaluate its vast data stores. It’s goal is to identify the specialists, outpatient services and hospitals within each market that, for episodes of specific high-frequency or high value conditions, consistently produce the best outcomes at the lowest cost. Imagine that, because higher quality is typically produced at lower costs - there are generally fewer complications and lower incidences of revisiting treatment - the health plan will pay high performers more than low performers. Just as importantly, it will limit the network, steering more patients to high performers and away from low performers.

Keeping An Eye On The Health Care Prize

Published on Kaiser Health News, 9/20/10

Many reformers undoubtedly believe that passage of the health overhaul law laid the issue to rest. But policy's wheels continue to turn, and the process is anything but over.

Decades of fee-for-service reimbursement became the health industry's article of faith, encouraging virtually everyone in the system to do as much as possible to every patient, with half or more of all expenditures wasted or unnecessary. But it was also a recipe for national disaster. Over the last decade, nearly all U.S. economic growth was absorbed by health care.

Beyond Meaningful Use: Three Five-Year Trends in the Uses of Patient Health Data and Clinical IT

DAVID C. KIBBE and BRIAN KLEPPER


Finally, we have a Final Rule on the Medicare and Medicaid EHR incentive programs. The rules and criteria are simpler and more flexible, and the measures easier to compute. But they are still an “all or nothing” proposition for physicians, who will have to meet all of the objectives and measures to receive any incentive payment. Doctors who get three-quarters of the way there won’t receive a dime. And a lot of uncertainty remains about dependent processes that CMS and ONC must quickly put in place, like accreditation of “testing and certifying bodies,” and the testing schemas for certification. All in all, we expect most physicians in small practices to sit on the sidelines until the dust settles, likely in 2012 or 2013.

Why The FMA Is Off-Base On Reform

BRIAN KLEPPER and DAVID C. KIBBE

First Published in the Florida Times-Union

At an Orlando meeting last week, Florida Medical Association (FMA) members fumed that their parent, the AMA, isn’t adequately representing Florida’s private practice doctors. After talk of secession and forming a new group, they settled for writing a stern letter urging the AMA to straighten up.

The FMA dustup began with a resolution written by Douglas Stevens MD, a Fort Myers cosmetic surgeon – you can’t make this stuff up – complaining that the AMA’s support for recent reforms was “a severe intrusion in the patient-physician relationship and allows government control over essentially all aspects of medical care.” He wrote that it will “relegate physicians to the role of government employees…and essentially end the profession of medicine as we know it.” A St. Petersburg neurological surgeon, David McKalip, added, “Without (AMA) support, the whole thing (i.e., reform) would have died."