healthcarereimagined

The path to value-based care in healthcare is becoming murky. After a few years of heightened promise and hope, the current and near-future reality is not necessarily so promising.

Results from innovation programs such as accountable care organizations, bundled payments and other ideas have not been as rosy as expected while bringing a number of attendant challenges. Those troubles are underscored by the findings from a recent survey conducted by Quest Diagnostics. In fact, the results are called “Stalled Progress on the Path to Value-Based Care,” which puts out the uncertain state without shying away from the perceived truth.

The survey reveals a slide among the viewpoints of physicians and, to a degree, health plan executives about the current state and viability of value-based care. On the whole, physicians are more skeptical. Some of the more interesting results are that a declining number of respondents believed the information necessary about patients to succeed with value-based care was in their hands.

Commentary frequently points to data as the lifeblood for being able to move ahead with value-based care. The dim view of data available in a physician’s electronic medical record helps provide color around falling assessment of whether sufficient data are available for success. Only 39 percent of responding physicians felt the EMR contained all the data needed for value-based care.

See Also: Shift to value-based care is slow, hampered by lack of IT, data

If so many physicians feel data are missing, where can that data be found? The cynical response would likely say in disparate systems that cannot talk to each other. While potentially overly cynical, the response is probably not without merit. The lack of interoperability, regardless of how it is defined, is not a myth within the system. While the technological means of remedying interoperability can probably be developed quickly or maybe even already exist, the will or incentive to put it into place is arguably missing.

Related to the data issue is the scope and applicability of quality measures. While this is an overused trope, if the quality measures in one value-based care plan are examined, then the reviewer likely only knows about one set of quality measures. Instead of developing and implementing a common set of quality measures, every value-based care program wants to come up with its own. This result can force providers into “focusing” on potentially hundreds of different quality measures that just sap time and energy from all involved.

Per the Quest survey, health plan executives more uniformly believe the measures can be helpful (80 percent) as opposed to a lower, though still majority, percentage of physicians (68 percent). While both areas of respondents leave a decent amount of room before all are on board, getting well over a majority for both suggests that quality measures are closer to hitting the mark than not.

Despite the potential usefulness of the measures being seen, both sides were very much aligned around the concept that measures are too complex. As noted above, it feels as though every value-based care program comes with its own measures. There could be five or more means of looking at blood pressure, diabetes management, smoking cessation or any other number of issues.

It is not clear why it is or should be so hard to come up with a common set of measures that can apply to any value-based care program. At some level, coming up with a proprietary program is more harmful than helpful.

One insight that can be inferred from the diverging views of physicians and health plan executives is that alignment between different aspects of the healthcare industry are still missing. Coming up with and putting into practice the means of getting the healthcare system into a more efficient, quality focused realm cannot be the work of any one segment of the industry. A fragmented approach will only lead to failure.

Could fraud and abuse regulations be a driver for the remaining gap between physicians, other providers, health plans and others in the industry? It is not a theory without merit. The fraud and abuse laws are arcane, convoluted and throw up a lot of barriers.

That is why the Centers for Medicare and Medicaid Services’ Request for Information concerning the Stark Law is important. The RFI squarely focuses on value-based care and how implementation and enforcement of the Stark Law can be changed to encourage value-based care. While exceptions arguably exist already that can be used to aid the creation of value-based care relationships, the law is rooted in a fee for service world and driven by concerns that may be alleviated and/or eliminated in a value-based care world.

Arguably CMS has already recognized that the Stark Law is incompatible with value-based care as a result of including numerous waivers with its different ACO models, bundled payment programs and other innovation models. The waivers, all self-certifying, provide fairly broad exemptions from the Stark Law for participants in order to more easily align workflows and divide shared savings. If the waivers were deemed necessary for the innovation models, it really begs the question of why the same waivers have not been expanded to encourage value-based car experimenting in other areas.

Leaving aside Medicare and other government-based programs, the private industry is not abandoning the value-based care world. Insurers such as UnitedHealth Group are, if anything, expanding such programs. Unlike Medicare, the private industry potentially has more freedom to adjust on the fly and account for issues such as those revealed by the Quest survey.

Ultimately, as has been noted before, the healthcare industry needed to change. The fee-for-service world could not remain rooted in place as costs were (and possibly still are) uncontrolled. The issue now is whether concerns about the ideas that have been put into place will be addressed and innovation allowed to occur, or will another misaligned system be allowed to pervade the industry.

Article link: https://www.healthdatamanagement.com/opinion/why-data-holds-the-key-to-value-based-care-perceptions

Pope Francis has made no secret of his intention to radically reform the administrative structures of the Catholic church, which he regards as insular, imperious, and bureaucratic. He understands that in a hyper-kinetic world, inward-looking and self-obsessed leaders are a liability.

Last year, just before Christmas, the Pope addressed the leaders of the Roman Curia — the Cardinals and other officials who are charged with running the church’s byzantine network of administrative bodies. The Pope’s message to his colleagues was blunt.

Leaders are susceptible to an array of debilitating maladies, including arrogance, intolerance, myopia, and pettiness. When those diseases go untreated, the organization itself is enfeebled. To have a healthy church, we need healthy leaders.

Through the years, I’ve heard dozens of management experts enumerate the qualities of great leaders. Seldom, though, do they speak plainly about the “diseases” of leadership.

The Pope is more forthright. He understands that as human beings we have certain proclivities — not all of them noble. Nevertheless, leaders should be held to a high standard, since their scope of influence makes their ailments particularly infectious.

 
The Catholic Church is a bureaucracy: a hierarchy populated by good-hearted, but less-than-perfect souls. In that sense, it’s not much different than your organization. That’s why the Pope’s counsel is relevant to leaders everywhere.

With that in mind, I spent a couple of hours translating the Pope’s address into something a little closer to corporate-speak. (I don’t know if there’s a prohibition on paraphrasing Papal pronouncements, but since I’m not Catholic, I’m willing to take the risk.)
Herewith, then, the Pope (more or less):
____________________
The leadership team is called constantly to improve and to grow in rapport and wisdom, in order to carry out fully its mission. And yet, like any body, like any human body, it is also exposed to diseases, malfunctioning, infirmity. Here I would like to mention some of these “[leadership] diseases.” They are diseases and temptations which can dangerously weaken the effectiveness of any organization.

1. The disease of thinking we are immortal, immune, or downright indispensable, [and therefore] neglecting the need for regular check-ups. A leadership team which is not self-critical, which does not keep up with things, which does not seek to be more fit, is a sick body. A simple visit to the cemetery might help us see the names of many people who thought they were immortal, immune, and indispensable! It is the disease of those who turn into lords and masters, who think of themselves as above others and not at their service. It is the pathology of power and comes from a superiority complex, from a narcissism which passionately gazes at its own image and does not see the face of others, especially the weakest and those most in need. The antidote to this plague is humility; to say heartily, “I am merely a servant. I have only done what was my duty.”
2. Another disease is excessive busyness. It is found in those who immerse themselves in work and inevitably neglect to “rest a while.” Neglecting needed rest leads to stress and agitation. A time of rest, for those who have completed their work, is necessary, obligatory and should be taken seriously: by spending time with one’s family and respecting holidays as moments for recharging.
3. Then there is the disease of mental and [emotional] “petrification.” It is found in leaders who have a heart of stone, the “stiff-necked;” in those who in the course of time lose their interior serenity, alertness and daring, and hide under a pile of papers, turning into paper pushers and not men and women of compassion. It is dangerous to lose the human sensitivity that enables us to weep with those who weep and to rejoice with those who rejoice! Because as time goes on, our hearts grow hard and become incapable of loving all those around us. Being a humane leader means having the sentiments of humility and unselfishness, of detachment and generosity.
4. The disease of excessive planning and of functionalism. When a leader plans everything down to the last detail and believes that with perfect planning things will fall into place, he or she becomes an accountant or an office manager. Things need to be prepared well, but without ever falling into the temptation of trying to eliminate spontaneity and serendipity, which is always more flexible than any human planning. We contract this disease because it is easy and comfortable to settle in our own sedentary and unchanging ways.
5. The disease of poor coordination. Once leaders lose a sense of community among themselves, the body loses its harmonious functioning and its equilibrium; it then becomes an orchestra that produces noise: its members do not work together and lose the spirit of camaraderie and teamwork. When the foot says to the arm: ‘I don’t need you,’ or the hand says to the head, ‘I’m in charge,’ they create discomfort and parochialism.
6. There is also a sort of “leadership Alzheimer’s disease.” It consists in losing the memory of those who nurtured, mentored and supported us in our own journeys. We see this in those who have lost the memory of their encounters with the great leaders who inspired them; in those who are completely caught up in the present moment, in their passions, whims and obsessions; in those who build walls and routines around themselves, and thus become more and more the slaves of idols carved by their own hands.
7. The disease of rivalry and vainglory. When appearances, our perks, and our titles become the primary object in life, we forget our fundamental duty as leaders—to “do nothing from selfishness or conceit but in humility count others better than ourselves.” [As leaders, we must] look not only to [our] own interests, but also to the interests of others.
8. The disease of existential schizophrenia. This is the disease of those who live a double life, the fruit of that hypocrisy typical of the mediocre and of a progressive emotional emptiness which no [accomplishment or] title can fill. It is a disease which often strikes those who are no longer directly in touch with customers and “ordinary” employees, and restrict themselves to bureaucratic matters, thus losing contact with reality, with concrete people.
9. The disease of gossiping, grumbling, and back-biting. This is a grave illness which begins simply, perhaps even in small talk, and takes over a person, making him become a “sower of weeds” and in many cases, a cold-blooded killer of the good name of colleagues. It is the disease of cowardly persons who lack the courage to speak out directly, but instead speak behind other people’s backs. Let us be on our guard against the terrorism of gossip!
10. The disease of idolizing superiors. This is the disease of those who court their superiors in the hope of gaining their favor. They are victims of careerism and opportunism; they honor persons [rather than the larger mission of the organization]. They think only of what they can get and not of what they should give; small-minded persons, unhappy and inspired only by their own lethal selfishness. Superiors themselves can be affected by this disease, when they try to obtain the submission, loyalty and psychological dependency of their subordinates, but the end result is unhealthy complicity.
11. The disease of indifference to others. This is where each leader thinks only of himself or herself, and loses the sincerity and warmth of [genuine] human relationships. This can happen in many ways: When the most knowledgeable person does not put that knowledge at the service of less knowledgeable colleagues, when you learn something and then keep it to yourself rather than sharing it in a helpful way with others; when out of jealousy or deceit you take joy in seeing others fall instead of helping them up and encouraging them.
12. The disease of a downcast face. You see this disease in those glum and dour persons who think that to be serious you have to put on a face of melancholy and severity, and treat others—especially those we consider our inferiors—with rigor, brusqueness and arrogance. In fact, a show of severity and sterile pessimism are frequently symptoms of fear and insecurity. A leader must make an effort to be courteous, serene, enthusiastic and joyful, a person who transmits joy everywhere he goes. A happy heart radiates an infectious joy: it is immediately evident! So a leader should never lose that joyful, humorous and even self-deprecating spirit which makes people amiable even in difficult situations. How beneficial is a good dose of humor!
13. The disease of hoarding. This occurs when a leader tries to fill an existential void in his or her heart by accumulating material goods, not out of need but only in order to feel secure. The fact is that we are not able to bring material goods with us when we leave this life, since “the winding sheet does not have pockets” and all our treasures will never be able to fill that void; instead, they will only make it deeper and more demanding. Accumulating goods only burdens and inexorably slows down the journey!
14. The disease of closed circles, where belonging to a clique becomes more powerful than our shared identity. This disease too always begins with good intentions, but with the passing of time it enslaves its members and becomes a cancer which threatens the harmony of the organization and causes immense evil, especially to those we treat as outsiders. “Friendly fire” from our fellow soldiers, is the most insidious danger. It is the evil which strikes from within. As it says in the bible, “Every kingdom divided against itself is laid waste.”
15. Lastly: the disease of extravagance and self-exhibition. This happens when a leader turns his or her service into power, and uses that power for material gain, or to acquire even greater power. This is the disease of persons who insatiably try to accumulate power and to this end are ready to slander, defame and discredit others; who put themselves on display to show that they are more capable than others. This disease does great harm because it leads people to justify the use of any means whatsoever to attain their goal, often in the name of justice and transparency! Here I remember a leader who used to call journalists to tell and invent private and confidential matters involving his colleagues. The only thing he was concerned about was being able to see himself on the front page, since this made him feel powerful and glamorous, while causing great harm to others and to the organization.

Friends, these diseases are a danger for every leader and every organization, and they can strike at the individual and the community levels.
____________________

So, are you a healthy leader? Use the Pope’s inventory of leadership maladies to find out. Ask yourself, on a scale of 1 to 5, to what extent do I . . .

• Feel superior to those who work for me?
• Demonstrate an imbalance between work and other areas of life?
• Substitute formality for true human intimacy?
• Rely too much on plans and not enough on intuition and improvisation?
• Spend too little time breaking silos and building bridges?
• Fail to regularly acknowledge the debt I owe to my mentors and to others?
• Take too much satisfaction in my perks and privileges?
• Isolate myself from customers and first-level employees?
• Denigrate the motives and accomplishments of others?
• Exhibit or encourage undue deference and servility
• Put my own success ahead of the success of others?
• Fail to cultivate a fun and joy-filled work environment?
• Exhibit selfishness when it comes to sharing rewards and praise?
• Encourage parochialism rather than community?
• Behave in ways that seem egocentric to those around me?

As in all health matters, it’s good to get a second or third opinion. Ask your colleagues to score you on the same fifteen items. Don’t be surprised if they say, “Gee boss, you’re not looking too good today.” Like a battery of medical tests, these questions can help you zero in on opportunities to prevent disease and improve your health. A Papal leadership assessment may seem like a bit of a stretch. But remember: the responsibilities you hold as a leader, and the influence you have over others’ lives, can be profound. Why not turn to the Pope — a spiritual leader of leaders — for wisdom and advice?

Gary Hamel is visiting professor at London Business School and cofounder of The Management Innovation Exchange. His latest book is “What Matters Now.”

Article link: https://hbr.org/2015/04/the-15-diseases-of-leadership-according-to-pope-francis

In an opinion piece for the Sunday Times in August 2018, Jeremy Fleming underlines the importance of partnerships in the new digital age.

News article – 12 August 2018

Director GCHQ, Jeremy Fleming, writes about the unparalleled opportunities and challenges we face as the world becomes ever more digitally connected. With the globalisation of technology, he explains how GCHQ will continue to work with businesses, technology companies, academia, and privacy groups, to protect the public from real-world and online harm.

The following was originally published in The Sunday Times on 12 August 2018.

Jeremy Fleming, Director GCHQ, 12 August 2018

Posted by Mary Butler on August 10, 2018

Health IT stakeholder groups are frustrated with what they see as lack of progress from the government in combating the practice of information blocking, according to a letter sent to the Office of the National Coordinator for Health IT (ONC).

One of the promises of the 21st Century Cures Act, which was passed by Congress at the end of 2016, was that it mandated the creation of regulations that prohibit providers and health IT developers from engaging in information blocking. Information blocking is one of the biggest hurdles to the free flow of health data from one organization to another—known as interoperability. According to Health IT Now, which is made up of 14 health IT stakeholder groups, the Cures Act required ONC to issue regulations halting information blocking, as well as create a standardized process where members of the public could report instances where health IT products are not interoperable or where other activities actively hamper information exchange.

“As the administration proposes and implements new rules related to open APIs and interoperability in Medicare’s payment rules for hospitals and doctors, the lack of clear rules of the road needlessly create uncertainty for vendors and providers alike,” they wrote.

The letter, which is dated August 6, 2018, notes that it’s been over 600 days since the law’s passage. “The administration has had 601 days to draft and publish clear information blocking regulations. We understand the nuance required, but feel that it is past time for a proposal to be made.” In a speech at ONC’s Interoperability Forum this week, ONC chief Don Rucker, MD, said that the information blocking regulations are a “work in progress,” according to Politico. Rucker said the timetable for releasing regulations has been pushed back to September.

ONC defines information blocking as “an act or a course of conduct that interferes with the ability to exchange or use electronic health information where permitted/authorized.” Examples include “implementing fees that make data exchange cost prohibitive, or technology designed or implemented in non-standard ways that inhibit the exchange of information.”

The 21st Century Cures Act provides a number of ways for the industry to challenge such practices, such as identifying reasonable and necessary activities that do not constitute information blocking, and allowing the Department of Health and Human Services Office of the Inspector General (OIG) to investigate credible claims of information blocking.

Health IT Now also addressed its letter to the OIG. To read it, click here.

Rucker previewed ONC’s actions on information blocking in a blog post for the journal Health Affairs.

Article link: http://journal.ahima.org/2018/08/10/onc-moving-too-slowly-on-information-blocking-say-health-it-stakeholders/

CMS is also seeking Blue Button 2.0 app developers, Verma says at second interoperability forum hosted by the Office of the National Coordinator for Health IT in Washington, D.C.

By Susan Morse  August 06, 2018  04:59 PM

The Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services are working together to realize a shared vision for a health ecosystem that sees the free flow of information between patient, provider and payer, CMS Administrator Seema Verma said Monday during the ONC’s Interoperability Forum in Washington, D.C.

Verma set a goal for digital health information to replace the current use of fax machines in physician offices to send patient information.

To this end, CMS is seeking developers, and already has an estimated 600, interested in building consumer-friendly applications for Medicare beneficiaries to connect their claims data to the applications, services and research programs they trust.

“If I could challenge developers on a mission, it’s to help make doctors’ offices a fax free zone by 2020,” Verma said to applause.

CMS is kicking off its inaugural Blue Button 2.0 Developer Conference on August 13.

Blue Button API has data for 53 million beneficiaries in Medicare Parts A, B and D.

“As head of CMS, one of my main missions is to break down barriers to interoperability,” Verma said.

While we live in an age of wonder at technological advancements such as fitness apps and precision medicine tailored to an individual’s genetic code, health information technology remains far behind all of the major industries, Verma said.

Healthcare remains in a 1990s time warp, she said.

Instead of making work easier for physician, electronic health records are contributing to their burnout, Verma said. Physicians are still recording their notes on paper.

Too often patients are told their data can’t be shared with another provider. But systems refused to share data because of the fear the patient will be poached, Verma said.

“We can keep data secure, while making it available to patients,” she said.

To avoid payment reductions, physicians and hospitals will have to give patients electronic access to their health records.

Verma said she’s also called on insurers to release their claims data so that health information is no longer locked in siloed systems.

Interoperability imagines a world in which medical decisions are fully informed by medical history; health history follows consumers wherever they go; third parties can leverage EHRs; data is used not only to treat, but to prevent illnesses; and researchers are using the information to develop cures.

Verma first unveiled new interoperability efforts at HIMSS18 in March, when she and Jared Kushner, director of The White House Office of American Innovation, promoted interoperability and the MyHealthEData initiative.

It’s about driving a new era of digital health, Verma said, liberating data to put patients in charge of their healthcare.

Article link: https://www.healthcareitnews.com/news/cms-administrator-seema-verma-calls-end-physician-fax-machines-2020

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

Posted on August 7, 2018 I Written By Anne Zieger

If anyone in healthcare needs to catch up on your records, it’s another provider who is treating mutual patients. In this day and age, there’s no good reason why clinicians at one hospital should be guessing what the other would get (or not get as the case is far too often).

Over the last few years, we’ve certainly seen signs of data sharing progress. For example, in early August the marriage between health data sharing networks CommonWell and Carequality was consummated, with providers using Cerner and Greenway Health going live with their connections.

Still, health data exchange is far more difficult than it should be. Despite many years of trying, hospitals still don’t share data with each other routinely, even when they’re treating the same patient.

To learn more about this issue, researchers surveyed pairs of hospitals likely to share patients across the United States. The teams chose pairs which referred the largest volume of patients to each other in a given hospital referral region.

After reaching out to many facilities, the researchers ended up with 63 pairs of hospitals. Researchers then asked them how likely they were to share patient health information with nearby institutions with whom they share patients.

The results, which appeared in the Journal of the American Medical Informatics Association, suggest that while virtually all of the hospitals they studied could be classified as routinely sharing data by federal definitions, that didn’t tell the whole story.

For one thing, while 97% of respondents met the federal guidelines, only 63% shared data routinely with hospitals with the highest shared patient (HSP) volume.

In fact, 23% of respondents reported that information sharing with their HSP hospital was worse than with other hospitals, and 48% said there was no difference. Just 17% said they enjoyed better sharing of patient health data with their HSP volume hospital.

It’s not clear how to fix the problem highlighted in the JAMIA study. While HIEs have been lumbering along for well more than a decade, only a few regional players seem to have developed a trusted relationship with the providers in their area.

The techniques HIEs use to foster such loyalty, which include high-touch methods such as personal check-ins with end users, don’t seem to work as well for some HIE they do for others. Not only that, HIE funding models still vary, which can have a meaningful impact on how successful they’ll be overall.

Regardless, it would be churlish to gloss over the fact that almost two-thirds of hospitals are getting the right data to their peers. I don’t know about you, but this seems like a hopeful development.

Article link: https://www.hospitalemrandehr.com/2018/08/07/hospitals-that-share-patients-dont-share-patient-data