BRIAN KLEPPER
Originally published on Care & Cost here.
The opening page of Siddhartha Mukherjee’s The Emperor of All Maladiesbegins with a quote by Susan Sontag that is so on-point, yet so rare and fresh, that one can’t help being excited by the prospect of what’s to come.
Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick.
Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.
You open the book with great expectations. It is weighty, yes – 570 pages, 100 of which are end notes – but beginning, you immediately find its expansive scholarship wrapped in a writing style so fluid and lyrically engaging that it instantly dispels any hesitancy, and you are captured.
Tuesday, December 7, 2010
Friday, December 3, 2010
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.
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.
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.
Originally Published 12/1/10 in Medical Home News
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.
Wednesday, September 29, 2010
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.
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.
Monday, September 20, 2010
Keeping An Eye On The Health Care Prize
Published on Kaiser Health News, 9/20/10
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.
Tuesday, August 31, 2010
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.
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.
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