When a Doctor Is Always a Phone Call Away

By | Uncategorized

 

A 39-year-old truck driver was hauling through the Midwest in the middle of the night in 2011 when he began to feel a bit of indigestion. Then a lot of indigestion. He pulled over, recalling that his company had recently signed on with Teladoc, for which I was then the chief medical officer. The service allowed him to get a doctor on the phone within 15 minutes. He called and described his symptoms: nausea, chest pain, a little numbness in his left arm. He was having a heart attack, and his GPS guided him to the nearest emergency room. Getting that doctor on the phone saved his life, and potentially the lives of whoever his 10-ton rig might have plowed into had he keeled over behind the wheel. If efficient and affordable quality treatment is the goal, telemedicine should be the future of health care. Read more at The Wall Street Journal.

Join Boxer and many other industry thought leaders at the HCEG Annual Forum, October 25-28th, in Hollywood, Florida. This year’s theme “Healthcare Evolution Revolution, Inquire Within” promises to provide a compelling agenda and constructive dialog on Consumer Engagement, Payment Reform and Delivery of Care.Email us for additional information.


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Join thought leaders and industry experts for transformational dialog andpresentations at the HealthCare Executive Group’s Annual Forum.

Next Stage of Reimbursements

By | payer, payment, reimbursement

2015.07.28 - ReimbursementyTo those of us who have been in the healthcare industry for more than a few years, the perennial discussion about moving away from fee-for-service is getting a bit tiresome when do we stop talking and start doing on a broad scale.

When we look back at the 1960’s (Medicare and Medicaid were passed in 1965), the story was about getting more dollars into the system to pay for the care of elderly and disadvantaged populations. Today, we’re in a serious hunt to find ways to wring dollars out of the system. And the journey we’ve taken with Medicare tells us a lot about what has happened and will happen in the commercial sector.

When Medicare was implemented we paid providers based on submitted charges what seems like a quaint and na’ve approach, but alternatives didn’t show up until 1972 (the HMO Act), with the first reimbursement reform appearing in 1989 when the first step toward non-charge based reimbursement was legislated for Medicare a requirement that professional providers be paid according to a relative value scale. Medicare HMOs didn’t appear until 1997. Every few years another tweak in benefits or payments was legislated, with 2003 bringing the first prescription drug coverage. 2008 started Medicare, tracked in large part by commercial health plans, down the road to mandated reporting on quality measures, federally-incented investments in EHRs, and penalties + payments to drive better, more cost-effective care.

Finally we capped off the decade with the passage of the Affordable Care Act which included not only reforms to the insurance business but various permanent programs to reduce overall costs and improve outcomes. As we look to 2016, when HHS plans to make 30% of its fee for service payments through alternative models and 85% of payments tied to quality or value, growing in 2018 to 50% and 90% respectively, it’s clear we’re moving into a serious doing phase.

For some expert thinking on what this doing phase looks like already and where it’s headed, please join us for our panel discussion From Concept to Reality: Practical Considerations of Implementing Alternative Reimbursement Models. To understand the doing phase, we need to listen to expert doers, and we will be privileged to hear from three of them.

Dr. DiLoreto will talk about how delivery systems are responding to new reimbursement models and provide his perspective on ways payers can work more effectively with their networks.

2015.07.28 - Reimbursementy PromoDan Tuteur will share his lessons from developing innovative reimbursement methods in a startup health plan forging brand new provider relationships.

Craig Samitt will talk about actualizing the vision of changing physician behavior by aligning incentives based on his personal experience.

After their respective brief presentations the panel will take your questions and engage in a lively discussion. Please do not miss this opportunity to listen to and talk about the real world of alternative reimbursement.

Why is Healthcare Security Now More Critical?

By | Security

2015.06.07 - SecurityI’m not a security expert. I’m a strategy officer for a health plan. My job is to connect the dots on factors that could impact our strategic future. I have to say the dots related to privacy and security are threatening. Like many of you, I received emails from Marriott and American Express after the Epsilon breach years ago saying my credentials had been stolen. More recently, I’ve had similar messages from Sony, Target, Home Depot and others.
2015.06.07 - Security Webinar PromoThis year these dots directly impacted healthcare. My daughter, business colleagues and neighbors, along with 90 million other people, received Anthem and Premera letters giving them credit tracking and fraud insurance. CareFirst just had a 1.1 million member breach. And the OIG claims to have warned one of them that their information was at risk. This problem is not new. It has been on the MCEG/HCEG Top 10 issues 3 of the last 6 years, but keeps getting bumped by other priorities, such as ICD-10, the ACA and others. I’ve just finished the day at AHIP’s pre-conference forum on Cybersecurity, Technology and Infrastructure. It was excellent but disturbing as to where we are at in cybersecurity as an industry.

Why is healthcare security now more critical The financial world doesn’t have a security system they have a remuneration system. Money goes missing from my account and they put the dollars back no harm, no foul, I’m secure, right It is different in healthcare. Unconscious in an ER after an accident, if my blood type or medications comes up in an EMR because someone used my identity for a fraudulent procedure, it just might cost me my life. No one can put that back in the account. Finding out I’ve exceeded my dental plan deductible because someone already had a root canal and crown using my stolen Dental Plan ID makes me acutely aware that my personal information is not secure.

Attempting to connect these dots reminds me of Whack-a-Mole at the circus. We have a mallet in both hands and are pounding down the goffers (cybercriminals, in this case) just as fast as we can. The problem is that there are a lot more dedicated and financially rewarded cybercriminals (as banks just keep reimbursing their fraudulent transactions) than we have mallets. Risk management versus risk avoidance continues to feed the beast. RSA’s President, Amit Yoran, said recently the threat landscape has changed and we have to constantly challenge the existing thinking to get ahead of our adversaries. RSA should know as they had their own significant security breach a few years ago affecting dozens of governments around the world and almost every major defense contractor.

This is a serious trend in healthcare with serious implications. And, it is a battle we are obviously losing. I suggest that we need to do more than challenge our existing thinking we need a whole new way of thinking! Without a whole new approach and focus on security, the credibility and future of healthcare could be in serious jeopardy. The HealthCare Executive Group is accelerating the dialogue on critical issues like security with the launch of the HCEG Webinar Series. Join in the open discussion on June 17th by registering at ww.hceg.org/webinars. We will pick this discussion back up then.