Saturday, May 25, 2013

THR, Baylor Share ACO Growing Pains

Baylor Quality Alliance (BQA) President Carl Couch acknowledges his accountable care organization (ACO) is pursuing initiatives that are decreasing the health system’s revenue.
Baylor chief executive officer Joel Allison also noted at a Dallas conference earlier this month that the company’s quality efforts “are hurting the bottom line.”
“Why are we doing this?” Couch asked rhetorically. “Because we have to. It’s the only way to create value.”
Couch and Karim Kaissi, a Texas Health Resources (THR) director of business development, recounted the challenges and lessons learned at an Executive Health Network panel discussion in north Dallas Wednesday as the two large health systems develop their ACOs.
BQA was formed in August, with the Baylor Health Care System as its first client. THR and North Texas Specialty Physicians created DFW’s first ACO as one of the first crop of Pioneers in the Centers for Medicare and Medicaid program. It added commercial ACOs with Aetna and Blue Cross and Blue Shield of Texas in quick succession in January.
ACOs have spread rapidly in a little more than one year. As of February, there were 428 ACOs in 49 states.  More than half of Americans live in areas served by ACOs. Physician participation has tripled in one year. Nearly 9 out of 10 health-plan executives said they either had implemented or were planning to implement an ACO in the next 12 to 18 months, according to a recent survey.
Kaissi said the commercial ACO offers more leverage to negotiate. However, he insisted those negotiations are centered around programs rather than prices.
“We are trying to set up win-win situations for both sides,” he said. “Medicare is very restrictive. That (Pioneer) ACO allowed us to learn but there is more risk.”
Couch said today’s accountable care differs sharply from the health maintenance organizations of the 1990s.
“That was managed costs, not managed care. Also, you couldn’t measure quality back then. Now I say we have 50 percent lower mortality than seven years ago in (Baylor) facilities. We can also measure patient satisfaction now. If we can’t improve both at a lower cost, we are going to fail,” he said.
Kaissi said the ACO startups have underscored the importance of physician leadership to champion the effort. He pointed out THR recently created three geographical zones, each led by a clinical and operations executive at the same level.
An underappreciated challenge, Kaissi said, is patient accountability. THR is attempting several strategies to engage patients in their health to improve outcomes, including a patient advisory group. The system also has a 10-year agreement with Nashville-based Healthways to help physicians analyze and address patient health behavior.
Couch said winning the trust of physicians is critical to BQA’s success. He said he sees the ACO organizationally as a triangle, with the Baylor system, Baylor’s employed physicians and independent affiliated physicians as the key players.
“The independent physicians are fiercely independent, and they don’t trust hospitals. We need to win their trust by making promises that we can keep,” he said.
Couch said he believes ACO shared savings will be temporary. He said payers will “offload” risk to the providers, and then onto patients in the form of higher deductibles and benefit design.
“We can’t manage the (healthcare) system the way it is now,” he said.
Steve Jacob is editor of D Healthcare Daily and author of the book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at

10 Healthcare Innovations That Might Change The World

Guest Column | May 23, 2013

By Justin Boyle, originally published on
Take a look at 10 up-and-comers in the ever-changing space of healthcare tech. Innovation in healthcare is non-stop, and startups like these might offer the next big breakthrough in the way we look after our bodies and psyche. Some of these forward-thinkers and inventors were inspired by their personal experience as the family of patients or medical professionals. These innovations in healthcare join numerous other procedures, devices and services that have emerged recently to help providers give better care to patients, or help patients take better care of themselves:
  • 1DocWay wants to make it easier for you to see a doctor. Billing itself as "telemedicine," this New York startup intends to take some of the stress off of consumers as well as providers by making it possible to conduct psychiatric and medical business of a less serious nature by video-chat. Patients don't need to take time off work and make an extra trip for an appointment. The startup website AngelListnames the founding team as Samir and Mubeen Malik and Danish Munir, in charge of code.
  • Aidin, developed by Dogpatch Labs in New York, is a software application designed to streamline patient discharge from acute care. The app uses a search tool to match patient information with the indexed details of post-acute care providers. Aidin aids social workers and case managers in providing next-step options for discharged patients.
  • Axial Exchange, a Raleigh, NC, startup is led by healthcare and tech executives like Joanne Rohde, building on their collective experience at Red Hat and other high-tech firms. Software-based services target different aspects of healthcare: for example, hospitals can automatically notify primary care physicians when patients are admitted. Doctors and nurses can use Axial's Transition of Care software to send an organized batch of patient records to other providers; hospital admins can deploy a medical library or an extensive directory of contact information; and patients can stay on top of the outpatient care process.
  • BitGym and its developers want to make working out at the gym more fun. The team -- Alex Gourley, Clint Stevenson, Joshua McCready and Keerthik Omanakuttan -- found support from the Rock Healthaccelerator in San Francisco, the Reuters blog reports. This firm offers video games for the iPad, iPhone and iPod Touch that interface with exercise bikes, treadmills and elliptical running machines. BitGym wants to help you become more engaged with your cardio routine, hoping to make it more enjoyable so it might "stick" as a part of your lifestyle.
  • CampusMD, out of Bethesda, MD, makes telemedicine available to students at more than 1,100 colleges and universities. The program, co-advised by Kevin Kelleher, MD, and Duke University Vice President of Student Affairs Larry Moneta, is underwritten by a nationwide telehealth service called HealthNation. The service offers students 24-hour, 7-day access to physicians who can diagnose and recommend treatment for minor ailments.
  • Care Thread is a Providence, RI, company founded by CEO Scott Guelich, CTO Andrew Shearer and COO Nick Adams, who contribute years of experience in both high-tech and healthcare industry positions. With a goal of moving intra- and inter-facility communication away from pagers and whiteboards and toward today's multimedia devices, Care Thread's mobile messaging service focuses on connecting and organizing the multiple streams of patient information necessary for effective care.
  • EveryMove takes the "rewards program" concept that credit cards have been using for decades and applies it to the world of exercise: rewards for doing what's right for your body. Co-founders Russell Benaroya and Marcelo Calbucci -- a healthcare entrepreneur and an experienced technologist, respectively -- aim to connect exercisers with entities such as insurance companies, employers and brands that offer rewards.
  • Omada Health is a San Francisco startup specializing in programs to help prevent and treat type 2 diabetes through healthier habits and more wellness-conscious behavior. The firm's founders are startup veterans Sean Duffy, Adrian James and Andrew DiMichele. Omada makes use of personalized coaching, digital tracking, and support from family and friends to guide individuals with prediabetes or type 2 diabetes to build healthier lifestyle choices.
  • Slow Control, a French company started by inventor and biomedical engineer Jacques Lepine, takes a slightly unorthodox approach to boosting human health. Lepine's invention, a digital fork, measures the speed at which a user eats and shows personalized results online. Slow Control hopes to fight disease and prevent metabolic harm by encouraging people to take their time eating, rather than shoveling food into their mouths.
  • SmartWard is designed to reduce human error when transferring a patient from one healthcare department to another by reducing paperwork and enhancing staff communications. The app's features were devised by Michelle Teo, a doctor based in Nottingham, England, and built by a global team of designers and developers to work across platforms, on computers or mobile devices. The firm was founded at Startup Weekend London, a Silicon Valley Comes to the UK 2012 event.
Healthcare sees a continuous influx of new technologies aimed at enhancing our well-being and helping care facilities and other institutions run more smoothly. These 10 are just a few of the emerging developments on the horizon -- stay on the lookout for other healthcare innovations. The current standards for healthcare technologies had to start somewhere, and a quiet little startup flying under the radar might become the next industry standard.
About the Author
Justin Boyle is an experienced tutor and media technologist who works in video design for an ecology non-profit. He lives in Austin, Texas, and finds a lot of things interesting, especially food, finance, education, software, art and travel.

Medicare increasingly tough on doctors

Medicare increasingly tough on doctors

One physician says it's going to be impossible for her to remain in Medicare because of the new paperwork, regulations and costs associated with the program.

As doctors are faced with the expansion of Medicare, pay cuts, and red tape associated with the federal healthcare overhaul, some are thinking twice about remaining in the program.
Dr. Alieta Eck, the immediate past president of the Association of American Physicians and Surgeons (AAPS), says she enjoys taking care of her elderly patients, many who are forced to enroll in Medicare. Because of that, she has continued to cooperate with Medicare. But with new mandates added continually, she tells OneNewsNow she will soon be forced to make a tough decision.
"All that's required of me is becoming so burdensome that I will either see my patients, or fill out all the forms required," she laments. "But I probably can't do both."
Eck reports that Medicare has introduced another mandate called The Physician Quality Reporting System, or PQRS. By 2014, doctors must record patient illnesses or injuries using new digits and numbers. Current electronic medical records will be updated, which is costly for individual physicians, so Eck fears that only doctors who are part of hospitals or groups will be able to survive the changes.
"It's not clear at all why the government has a vested interest in such technology, but perhaps it's related to the fact that they want me to put my electronic medical records online," the physician poses. "That means the whole record, and that's a red line that I will not cross."
The New Jersey-based doctor concludes that patient records are for doctors to offer better care for their patients -- not for a federal bureaucracy to review and store.