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What We’ve Been Reading – Week of August 25, 2014

by John Moore lll | August 29, 2014

If there was one thing on our minds this week, it was the launch of our most recent report, the 2014 Analytics for Population Health: Market Trends and Analysis. After months of research and writing, we are pleased to present our findings on a market still very much in early development, but catching the minds of some larger players that see the writing on the wall: VBR is less risky; it’s happening, and PHM is a key component of making it work. It is still a best-of-breed market, but the platform players are entering the fight more directly now. If you have any questions about the report, please reach out to us directly via Sean.

But that wasn’t the only thing worth reading this week (although we thinks it could be). Below are some articles and papers that captured our attention and which we thought might catch yours. If I had to pick a theme, this week’s would be “Uncertainty for the ACO Model.” Enjoy, and have a fantastic Labor Day weekend.

John III

Reform Update: Ascension deals signal new economic reality in healthcare
Melanie Evans in Modern Healthcare
While partnerships such as the ones Ascension is making that are detailed in this story are becoming more common, the devil is always in the details. How will these entities share patient data to support care coordination? Who will garner lucrative elective surgeries of shared patients? How might risk bearing contracts be structured and, ultimately, attestation? Partnerships always look good on paper but execution is a whole other ball game.” –John

The Long and Winding Road to Accountable Care: Beyond the Upcoming ACO Reg
Joshua Seidman in Morning Consult
“A nice review on some of the potential issues regarding the new rules for the MSSP ACO regulations the White House has been sitting on since early July. There is a lot of speculation about how the regs will be altered, including potential modifications to the patient attribution model, if the transition to the two-risk model will be disclosed, and alterations to governance and spending benchmarks.” –Matt

Open Letter from MedPAC to CMS about ACO/MSSP Initiatives (PDF)
Glenn Hackbarth, Chairman, MedPAC
“A wide ranging letter from MedPAC to CMS on lessons learned from Pioneer and MSSP ACOs points to the problems of attribution, uncertainty about financial goals the impact on investments in care management, and the challenges of data collection for quality reporting. It also describes the need for ACOs to have the flexibility to steer patients to high-quality, low cost post-acute providers.” –Brian

Sharp HealthCare Leaves Pioneer ACO Program
Jon Commins for HealthLeaders Media
“Yet another Pioneer ACO leaves the program leaving only 22 of the original 32 participants.  Sharp broke even on the ACO program in 2012 and wasn’t one of the 14 Pioneer participants to achieve any bonus payment.  Given the eight other Pioneer participants who received no bonus, and the increasing difficulty of the program, expect several more Pioneer participants to drop out of the demo program over the next year switching to the MSSP program or dropping out entirely.” -Matt 

Survey: CIOs Say ACOs Great On Paper, But Not In Practice
Kate Gamble for HealthSystemCIO.com
“While I always hold online surveys highly suspect, especially those that do not clearly state number of respondents, this survey from healthsystemCIO again points to the biggest challenge HCOs face today in moving to future VBR models: lack of interop across their community/partners. This issue, as it pertains to data aggregation, was also be a highlight of our recently released analytics report.” -John

Medicare Star Ratings Allow Nursing Homes to Game the System
Katie Thomas for The New York Times
“Can chasing care quality metrics undermine care quality? This New York Times article on Medicare Star Ratings in nursing homes describes a combination of substantive problems with patient care with self-reported, unaudited quality ratings.” -Brian

Commentary: Don’t confuse consumerization with patient empowerment
John Kelly in GovernmentHealthIT
A dense but thought-provoking overview of the shifting sands of consumerization in healthcare.  Health benefit design has begun evolving towards the individual, but we wont see true consumer empowerment until tech is applied to accommodate the retail shopping preferences we have become used to in other industries.” –Naveen

Leeds shared record suppliers named
Sam Sachveda for EHI
“With a different approach to healthcare outside the US, the longitudinal patient record includes social services data for a more complete view of the care needs of patients and populations. Other than this aspect, providers outside the US have some of the same challenges getting a comprehensive view of patient data.” -Brian

Nonprofit Hospitals’ 2013 Revenue Lowest Since Recession, Report Says
Reed Abelson in The New York Times
“Moody’s reports that NFP hospitals continue to experience serious fiscal challenges. This news (Moody’s report) puts increasing pressure on the hospital NFP sector and it will likely increase the rate M&A activity in the hospital segment which has been averaging a 3-5% annual rate the past 3 years.  One of the understated policy goals of PPACA was to increase horizontal consolidation in the hospital segment and it has been clear since its passage that has been occurring at an elevated rate.” –Matt

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