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."

Editor's inbox: Reader questions breadth of sources in article on onsite clinics

BRIAN KLEPPER


First published in Employee Benefit News, April 5, 2010

The article "Reconfiguring onsite health clinics" (EBN February) presented a remarkably limited perspective on modern clinics, resulting in statements like this one: "'In a tough economy, an initial clinic approach should probably employ mid-level practitioners, such as a nurse practitioner or a physician assistant, because they are most cost-effective when rendering basic medical services,' explains Mercer's [Bruce] Hochstadt."

Value Trumps Price In Onsite Clinics

BRIAN KLEPPER

First published in American City Business Journals (in Boston, Silicon Valley, Jacksonville, Nashville, San Jose and elsewhere.)

Onsite health clinics are new territory for most employers. It can be difficult to sort through the different approaches used by different vendors. Worse, in difficult economic times it’s tempting to “get in” as cheaply as possible.But like many purchases, you may get what you pay for with clinics, especially if you scrimp. Here are three reasons to favor value over price when considering an onsite clinic vendor:

Saving Health Care. Saving America

BRIAN KLEPPER, DAVID C. KIBBE, ROBERT LASZEWSKI and ALAIN ENTHOVEN

So far, Congress' response to the health care crisis has been alarmingly disappointing in three ways. First, by willingly accepting enormous sums from health care special interests, our representatives have obligated themselves to their benefactors' interests rather than to those of the American people. More than 3,330 health care lobbyists - six for every member of Congress - contributed more than one-quarter of a billion dollars in the first and second quarters of 2009. A nearly equal amount has been contributed on this issue from non-health care organizations. This exchange of money prompted a Public Citizen lobbyist to comment, "A person can reach no other conclusion than this is a quid pro quo [this for that] activity."

Will CIGNA Remake The Health Plan Marketplace

BRIAN KLEPPER

First published here on the Health Care Blog

America’s health plans are floundering. If their job has been to provide the nation’s mainstream families with access to affordable care (let’s leave quality out of it for the moment), they have failed miserably, though they were very profitable along the way, at least until Q1 2008. In 2008, the Milliman Medical Index – an estimate of the total cost for health coverage premium and out-of-pocket costs for a family of four – was $15,609. Now it is almost certainly above $17,000, more than the total income of more than one-third of American households.

To many health plan execs, these are simply market dynamics that must be accommodated through new product and service designs. I just attended a health plan conference where the overarching themes were the transition away from group to individual coverage, and the use of incentives and touch points like texting, email, and ergonomic Web interfaces to cultivate member competency, loyalty and retention.

Five Shovel-Ready Health Care Reforms

BRIAN KLEPPER and DAVID C. KIBBE

Microsoft Health Vault's leader Peter Neupert has a wonderful blog post that makes two important points really well. One message is that health care reform is about the outcomes, not the technology. We should think expansively about which technologies to invest in, based on the results we want to get.

The other message is the economic stimulus package is different than the reform effort. It is moving at hyper-speed through Congress, and it may be difficult for staffers and other advisors to sort through and incorporate what may seem like opposing Health IT views against a backdrop of traditional ideology and extremely forceful special interest lobbying.

Medscape Video: Re-Empowering Primary Care

Re-Empowering Primary care

Brian Klepper

A video-commentary that appeared - see here - on the Medscape Journal of Medicine.

Over the last couple decades, America's primary care physicians -- PCPs -- have been relegated to medicine's lowest caste.^[1] But many employers, who pay for the waste that results from tying PCP's hands, now see them as healthcare's most probable saviors.

Can Health Plans Explain Why They Aren't Re-Empowering Primary Care

BRIAN KLEPPER and DAVID C. KIBBE

First published on THCB.

Sometimes a whisper is more powerful than a shout. Here's a cartoon from Modern Medicine that shows a Medical Home counseling session between a primary care physician (PCP), a specialist and the health plan. The PCP looks forlorn, while the specialist and the insurer have their backs turned, fuming. It is perfectly true.

Health Care and the Broader Economic Crisis

BRIAN KLEPPER

First published on THCB.

I used to worry that the economic turmoil resulting from health care's relentless cost explosion would cascade into all other economic sectors. Now it appears that the credit crisis could push health care over the edge. The silver lining is that a sudden spike in the pressure on health care organizations could facilitate a transition to the meaningful reforms that are necessary to resolve the crisis.

Over at HealthLeaders, Dr. Richard Reece and I have an article, Will Primary Care Be Re-Empowered By An Ailing Economy?, arguing that the turmoil in the larger US economy – and particularly the tightening of credit – is going to significantly enhance the pressures on purchasers and industry players, and grease the wheels of meaningful change throughout health care.

Health Systems' Ferocious Challenges

BRIAN KLEPPER

First published on THCB.

 

America's health systems are facing an increasingly hostile marketplace. Keeping our hospitals intact will require changes in how we treat them and how they manage themselves.

Lately, I've had interesting discussions with a thoughtful exec. at a major Western health system about the ferocious challenges facing hospitals and health systems. Her organization's internal conversations at the moment are centered, in part, on what they should do to become "reform ready," not only for policy changes that could be in the wings, but more importantly, for emerging market dynamics that will change the ways hospitals work. She asked me to catalog some of the trends I think health system managers will have to deal with, along with five recommendations for action. Here's some of what I told her.

Rebuilding the Medical Home: What Walgreens Surely Sees

BRIAN KLEPPER

First published on THCB.

In March 2007, Walgreens suddenly acquired the two largest worksite clinic firms. Combined with their convenience care clinics, this gave them more than 500 primary care sites nationally. They estimate that there are 7,600 employer campuses in America with 1,000 or more employees onsite. Is this the beginning of the true corporatization of primary care. And if corporations come to own primary care's referral base, can't they capture all of health care?