PODCAST: How Health Care Can Win by Adapting to Changes in Consumer Behavior

LESSONS FROM THE RETAIL SECTOR

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Discover how ProMedica uses customer feedback and a digital-first approach to consumers to achieve stellar results across more than 400 facilities in 28 states.

PODCAST: https://www.youtube.com/watch?v=861em_pJfVM&t=3070s

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PODCAST: “Un-Accountable” Healthcare Quality

BOOK REVIEW

By Dr. Eric Bricker MD

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MEDICAL ETHICS: https://medicalexecutivepost.com/2021/05/28/medical-ethics-managing-risk-is-a-component-of-caring/

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PODCAST: NCQA and HEDIS [Health Effectiveness Data Information Set]

90 NCQI MEASUREMENTS

BY ERIC BRICKER MD

The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of U.S. health plans to measure performance on important dimensions of care and service. More than 190 million people are enrolled in health plans that report quality results using HEDIS.

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HEDIS Explained - BHM Healthcare Solutions

CITE: https://www.r2library.com/Resource/Title/0826102549

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The National Committee for Quality Assurance is an independent 501 nonprofit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation.

CITE: https://www.r2library.com/Resource/Title/0826102549

MORE: https://www.dhcs.ca.gov/provgovpart/Documents/6422/NCQAAccreditationOverview-1-21-20.pdf

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Qualit8 | Pulse8 | Revolutionizing Healthcare Analytics Platform

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PODCAST: https://www.ahealthcarez.com/how-hedis-quality-scores-work

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What Exactly is a PONZI SCHEME; etc?

AND OTHER INVESTING SCAMS!

By Dr. David E. Marcinko MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

A Ponzi scheme (/ˈpɒnzi/, Italian: [ˈpontsi]) is a form of fraud that lures investors and pays profits to earlier investors with funds from more recent investors. Recall Bernie Madoff.

More: https://medicalexecutivepost.com/2010/06/04/the-madoff-circle/

The scheme leads victims to believe that profits are coming from legitimate business activity (e.g., product sales or successful investments), and they remain unaware that other investors are the source of funds. A Ponzi scheme can maintain the illusion of a sustainable business as long as new investors contribute new funds, and as long as most of the investors do not demand full repayment and still believe in the non-existent assets they are purported to own.

Link: https://en.wikipedia.org/wiki/Ponzi_scheme

A pyramid scheme is a business model that recruits members via a promise of payments or services for enrolling others into the scheme, rather than supplying investments or sale of products. As recruiting multiplies, recruiting becomes quickly impossible, and most members are unable to profit; as such, pyramid schemes are unsustainable and often illegal.

CITE: https://www.r2library.com/Resource/Title/0826102549

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How to Spot and Protect Yourself From Investment Fraud

Pyramid schemes have existed for at least a century in different guises. Some multi-level marketing plans have been classified as pyramid schemes.

And, there are MANY other schemes in the financial services sector.

MORE: https://www.msn.com/en-us/money/other/are-you-about-to-be-the-victim-of-a-ponzi-scheme/ar-BB1cqabu?li=BBnb7Kz

Front Running: https://medicalexecutivepost.com/2018/02/06/what-is-front-running/

Churning: https://medicalexecutivepost.com/2021/07/23/churning-front-running-and-pumping-dumping/

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MEDICAL RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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The HISTORY of Messenger RNA

A Tangled History of mRNA

Hundreds of scientists had worked on mRNA vaccines for decades before the coronavirus pandemic brought a breakthrough.

By Elie Dolgin

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Messenger RNA Medicines | Translate Bio | mRNA Therapeutics

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LINK: https://www.nature.com/articles/d41586-021-02483-w?utm_source=pocket-newtabBy

RELATED: https://www.msn.com/en-us/health/medical/pfizer-biontech-say-covid-19-vaccine-is-safe-for-young-children-generates-immune-response/ar-AAODfco?li=BBnb7Kz

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INTERVIEW: A Solution for Healthcare Financing?

HEALTHCARE FINANCING

Former: CEO and Founder
Superior Consultant Company, Inc.
[SUPC-NASD]

EDITOR’S NOTE: I first met Rich in B-school, when I was a student, back in the day. He was the Founder and CEO of Superior Consultant Holdings Corp. Rich graciously wrote the Foreword to one of my first textbooks on financial planning for physicians and healthcare professionals. Today, Rich is a successful entrepreneur in the technology, health and finance space.

-Dr. David E. Marcinko MBA CMP®

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Staff & Contributors - CHAMPIONS OF WAYNE

By Richard Helppie

Today for your consideration – How to fix the healthcare financing methods in the United States?

I use the term “methods” because calling what we do now a “system” is inaccurate. I also focus on healthcare financing, because in terms of healthcare delivery, there is no better place in the world than the USA in terms of supply and innovation for medical diagnosis and treatment. Similarly, I use the term healthcare financing to differentiate from healthcare insurance – because insurance without supply is an empty promise.

This is a straightforward, 4-part plan. It is uniquely American and will at last extend coverage to every US citizen while not hampering the innovation and robust supply that we have today. As this is about a Common Bridge and not about ideology or dogma, there will no doubt be aspects of this proposal that every individual will have difficulty with. However, on balance, I believe it is the most fair and equitable way to resolve the impasse on healthcare funding . . . .

CITE: https://www.r2library.com/Resource/Title/0826102549

Let me start in an area sure to raise the ire of a few. And that is, we have to start with eliminating the methods that are in place today. The first is the outdated notion that healthcare insurance is tied to one’s work, and the second is that there are overlapping and competing tax-supported bureaucracies to administer that area of healthcare finance.

Step 1 is to break the link between employment and health insurance. Fastest way to do that is simply tax the cost of benefits for the compensation that it is. This is how company cars, big life insurance policies and other fringe benefits were trimmed. Eliminating the tax-favored treatment of employer-provided healthcare is the single most important change that should be made.

Yes, you will hear arguments that this is an efficient market with satisfied customers. However, upon examination, it is highly risky, unfair, and frankly out of step with today’s job market.

Employer provided health insurance is an artifact from the 1940’s as an answer to wage freezes – an employer could not give a wage increase, but could offer benefits that weren’t taxed. It makes no sense today for a variety of reasons. Here are a few:

1. Its patently unfair. Two people living in the same apartment building, each making the same income and each have employer provided health insurance. Chris in unit 21 has a generous health plan that would be worth $25,000 each year. Pays zero tax on that compensation. Pat, in unit 42 has a skimpy plan with a narrow network, big deductibles and hefty co-pays. The play is worth $9,000 each year. Pat pays zero tax.

3. The insurance pools kick out the aged. Once one becomes too old to work, they are out of the employer plan and on to the retirement plan or over to the taxpayers (Medicare).

4. The structure is a bad fit. Health insurance and healthy living are longitudinal needs over a long period of time. In a time when people change careers and jobs frequently, or are in the gig economy, they are not any one place long enough for the insurance to work like insurance.

5. Creates perverse incentives. The incentives are weighted to have employers not have their work force meet the standards of employees so they don’t have to pay for the health insurance. Witness latest news in California with Uber and Lyft.

6. Incentives to deny claims abound. There is little incentive to serve the subscriber/patient since the likelihood the employer will shop the plan or the employee will change jobs means that stringing out a claim approval is a profitable exercise.

7. Employers have difficulty as purchasers. An employer large enough to supply health insurance has a diverse set of health insurance needs in their work force. They pay a lot of money and their work force is still not 100% happy.

Net of it, health insurance tied to work has outlived its usefulness. Time to end the tax-favored treatment of employer-based insurance. If an employer wants to provide health insurance, they can do it, but the value of that insurance is reflected in the taxable W-2 wages – now Pat and Chris will be treated equally.

Step 2 is to consolidate the multiple tax-supported bureaus that supply healthcare. Relieve the citizens from having to prove they are old enough, disabled enough, impoverished enough, young enough. Combine Medicare, Medicaid, CHIP, Tricare and even possibly the VA into a single bureaucracy. Every American Citizen gets this broad coverage at some level. Everyone pays something into the system – start at $20 a year, and then perhaps an income-adjusted escalator that would charge the most wealthy up to $75,000. Collect the money with a line on Form 1040.

I have not done the exact math. However, removing the process to prove eligibility and having one versus many bureaucracies has to generate savings. Are you a US Citizen? Yes, then here is your base insurance. Like every other nationalized system, one can expect longer waits, fewer referrals to a specialist, and less innovation. These centralized systems all squeeze supply of healthcare services to keep their spend down. The reports extolling their efficiencies come from the people whose livelihoods depend on the centralized system. However, at least everyone gets something. And, for life threatening health conditions, by and large the centralized systems do a decent job. With everyone covered, the fear of medical bankruptcy evaporates. The fear of being out of work and losing healthcare when one needs it most is gone.

So if you are a free market absolutist, then the reduction of vast bureaucracies should be attractive – no need for eligibility requirements (old enough, etc.) and a single administration which is both more efficient, more equitable (everyone gets the same thing). And there remains a private market (more on this in step 3) For those who detest private insurance companies a portion of that market just went away. There is less incentive to purchase a private plan. And for everyone’s sense of fairness, the national plan is funded on ability to pay. Bearing in mind that everyone has to pay something. Less bureaucracies. Everyone in it together. Funded on ability to pay.

Step 3 is to allow and even encourage a robust market for health insurance above and beyond the national plan – If people want to purchase more health insurance, then they have the ability to do so. Which increases supply, relieves burden on the tax-supported system, aligns the US with other countries, provides an alternative to medical tourism (and the associated health spend in our country) and offers a bit of competition to the otherwise monopolistic government plan.

Its not a new concept, in many respects it is like the widely popular Medigap plans that supplement what Medicare does not cover.

No one is forced to make that purchase. Other counties’ experience shows that those who choose to purchase private coverage over and above a national plan often cite faster access, more choice, innovation, or services outside the universal system, e.g., a woman who chooses to have mammography at an early age or with more frequency than the national plan might allow.  If the insurance provider can offer a good value to the price, then they will sell insurance. If they can deliver that value for more than their costs, then they create a profit. Owners of the company, who risk their capital in creating the business may earn a return.

For those of you who favor a free market, the choices are available. There will be necessary regulation to prevent discrimination on genetics, pre-existing conditions, and the like. Buy the type of plan that makes you feel secure – just as one purchases automobile and life insurance.For those who are supremely confident in the absolute performance of a centralized system to support 300+ million Americans in the way each would want, they should like this plan as well – because if the national plan is meeting all needs and no one wants perhaps faster services, then few will purchase the private insurance and the issuers will not have a business. Free choice. More health insurance for those who want it. Competition keeps both national and private plans seeking to better themselves.

Step 4 would be to Permit Access to Medicare Part D to every US Citizen, Immediately

One of the bright spots in the US Healthcare Financing Method is Medicare Part D, which provides prescription drug coverage to seniors. It is running at 95% subscriber satisfaction and about 40% below cost projections.

Subscribers choose from a wide variety of plans offered by private insurance companies. There are differences in formularies, co-pays, deductibles and premiums.

So there you have it, a four part plan that would maintain or increase the supply of healthcare services, universal insurance coverage, market competition, and lower costs. Its not perfect but I believe a vast improvement over what exists today. To recap:

1. Break the link between employment and healthcare insurance coverage, by taxing the benefits as the compensation they are.

2. Establish a single, universal plan that covers all US citizens paid for via personal income taxes on an ability-to-pay basis.  Eliminate all the other tax-funded plans in favor of this new one.

3. For those who want it, private, supplemental insurance to the national system, ala major industrialized nations.

4. Open Medicare Part D (prescription drugs) to every US citizen. Today.

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PODCASTS: Surgery Safety Checklists

ATUL GAWANDE MD

Medical Culture

BY ERIC BRICKER MD

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RISK MANAGEMENT TEXTBOOK: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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PODCAST: United States Health Spending by Race & Ethnicity (2021)

CULTURE IN HEALTHCARE

Culture is a factor to consider with healthcare. Depending on the culture they may seek alternative treatment such as homeopathic and treatment they have been raised with in their country Some cultures will get medications from their country because they believe in their medical system more then what is offered.

BY IHME

Creating a culture of health - Sedgwick

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Dr. Joseph L. Dieleman, Associate Professor in the Department of Health Metric Sciences at the University of Washington, is the lead author of the study “US Health Care Spending by Race and Ethnicity, 2002-2016,” published August 17, 2021 in the Journal of the American Medical Association

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PODCAST: https://www.youtube.com/watch?v=xbkSZmB-3f8&t=171s

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LONG Health Effects Post September 11th, 2001?

The Enduring Health Legacy

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As noted on this ME-P previously, surely 9/11 touched each and every American significantly. It was the end of American innocence, sending a powerful message about our place in the world.

Today, almost without exception, each of us can say that because of that bright September morning, we have been changed for life. Mothers were left without sons; brothers without brothers, and friends were taken from friends by this senseless act of violence.

Unfortunately, the ultimate legacy of 9/11 many still bear as they deal with the long-lasting health effects associated these terrorist attacks.

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RELATED: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors : Best Practices from Leading Consultants and Certified Medical Planners™ book cover

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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PODCAST: The Dartmouth Atlas of Healthcare

Geographic Variation in Spine Surgery

By Dr. Eric Bricker MD

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MORE: https://www.dartmouthatlas.org/

John Wennberg MD: https://tdi.dartmouth.edu/about/our-people/directory/john-e-wennberg-md-mph

CHECKLISTS: https://medicalexecutivepost.com/2009/01/20/a-homer-simpson-moment-of-clarity-on-medical-quality/

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On “FACE MASKS”

FACE MASKS

By Anonymous

I love freedom and personal liberty. But I also don’t want to contract or share COVID-19.

I wear a seat belt – I will comply with any mask  requirement.

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RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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PODCAST: What Exactly is a Human Sneeze?

All About “STERNUTATION”

Courtesy: www.CertifiedMedicalPlanner.org

A Silly Question Until Covid-19!

A “Sternutation” is a sudden involuntary expulsion of air from the lungs through the nose and mouth due to irritation of the nasal passage.

LINK: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

A sneeze is not always related to an underlying medical condition. It may be caused by:

  • Nasal irritants (dust, pepper, pollen etc)
  • Sudden exposure to bright light
  • Breathing cold air
  • Object struck in nose.

Self-treatment helpful in some less- serious cases include:

  • Change the furnace or air conditioner filters
  • Do not have pets in the house if allergic to animal dander
  • Wash linens in very hot water (at least 130 degrees Fahrenheit) to kill dust mites
  • Vacuum and dust frequently
  • Use a good humidifier especially at night, if the air is too dry
  • Drink plenty of water if suffering from flu/common cold.

See a doctor if you notice the following :

  • Fever greater than 101.3 F (38.5 C)
  • Fever lasting five days or more or returning after a fever- free period
  • Shortness of breath
  • Wheezing
  • Severe sore throat, headache or sinus pain
  • Allergy does not resolves in a few days.

See a doctor immediately if you notice:

  • Sneezing is continuous
  • Causes severe ear pain, drowsiness.

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PODCAST: https://www.bing.com/videos/search?q=sneeze&&view=detail&mid=C4DA4CD281B4AD36C2A5C4DA4CD281B4AD36C2A5&&FORM=VRDGAR&ru=%2Fvideos%2Fsearch%3Fq%3Dsneeze%26FORM%3DHDRSC3

VIDEO: https://www.msn.com/en-us/video/science/see-how-a-mask-affects-how-a-cough-travels/vi-BB13AQBH?ocid=SK2LDHP

Assessment: Your thoughts and comments are appreciated.

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BUSINESS, FINANCE AND INSURANCE TEXTS FOR DOCTORS

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HOSPITAL OPERATIONS: Organizations, Strategies, Techniques, Tools, Templates and Case Models

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RELATED TEXTS: https://medicalexecutivepost.com/2021/04/29/why-are-certified-medical-planner-textbooks-so-darn-popular/

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Management Strategies, Operational Techniques, Tools, Templates and Case Studies

FOR HOSPITALS AND HEALTHCARE ORGANIZATIONS

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BY DR. DAVID E. MARCINKO MBA

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

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PODCAST: Shareholder Activism in Healthcare

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BY DR. ERIC BRICKER MD

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PODCAST: The RAND Corporation Found that Commercial Health Insurance Plans Pay Hospitals 241% What Medicare Pays

The RAND Corporation Found that Commercial Health Insurance Plans Pay Hospitals 241% What Medicare Pays.

But Also That It Varies from 150% to 400%.

Dr. Boram (Kim) Park, MD - Dallas, TX | Internal Medicine

BY ERIC BRICKER MD

Health Insurance Companies Paid for Hospital Outpatient Services at an Even Higher Average Rate of 293% of Medicare.

A Detailed Look at the RAND Analysis Reveals that the ‘Basket’ of Services at Each Hospital Had Very Little Data.

For Example, the RAND Study’s Data for the Baylor Scott & White Hospital System in Dallas – Fort Worth Represented Only 0.4% of the Hospital’s Total Revenue.

For the Texas Health Hospital System Also in Dallas – Fort Worth, the RAND Study’s Data Only Represented 0.96% of the Hospital’s Total Revenue.

That Sample Size Is Likely Too Small to Make Accurate Comparisons from One Hospital System to Another Regarding their Commercial Insurance Prices Relative to Medicare.

ASSESSMENT: Your thoughts and comments are appreciated.

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ON RURAL HEALTHCARE PROVIDERS

Executive Order Expands Tele-Medicine to Ease Burden

By Health Capital Consultants, LLC

On August 3, 2020, President Donald Trump signed an executive order aimed at expanding access to care through two avenues: telemedicine and eased financial burdens on rural providers.

Health Disparities Continue to Plague Rural Areas

And so, our colleagues for this Health Capital Topics article will discuss the executive rule and the subsequent agency actions on these fronts.

READ: https://www.healthcapital.com/hcc/newsletter/08_20/HTML/EXEC/convert_executive_telemedicine_access_expansion_8.20.20.php

ASSESSMENT: Your thoughts are appreciated.

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ORDER [3rd. edition] TEXTBOOK: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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The Business of Medical Practice [3rd. edition]

SPONSOR: http://www.CertifiedMedicalPlanner.org

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SECOND OPINIONS: https://medicalexecutivepost.com/schedule-a-consultation/

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PODCAST: The Covid 19 Pandemic and Mental Health

Including Substance Use Issues

By Dr. David E. Marcinko MBA CMP© and staff reporters

The COVID-19 pandemic has spurred—and aggravated—a range of mental health and substance use issues in the United States.

In this episode of Critical Point, Milliman’s Stoddard Davenport discusses the rising demand for mental health services and how different populations are being affected. Stoddard also highlights recent statistics on the topic and what the road ahead may look like for mental health in America.

PODCAST LINK: https://www.healthcaretownhall.com/?p=10186

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Community Mental Health Programs and Resources: https://healthcarefinancials.files.wordpress.com/2019/05/mental-health-dr.-marcinko.pdf

Social Determinant of Health: https://www.healthsharetv.com/content/webinar-recap-social-determinants-health-turning-potential-actual-value

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NAACOS Recognizes Three ACOs for Health Care Improvement Efforts

Essentia Health, Ochsner Accountable Care Network, and Primaria Health win NAACOS Leaders in Quality Excellence Awards

[By David Raths]

At its Spring 2021 Conference, the National Association of Accountable Care Organizations (NAACOS) recognized three ACOs for their outstanding work to improve patient care in their communities.

DEFINITION: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO

NAACOS said the three inaugural winners exemplify how ACOs across the country are improving care by addressing food insecurity, making house calls to reduce preventable emergency department visits, and engaging patients in preventive services.

NAACOS 2017 Spring Conference - arcadia.io

LINK: https://www.hcinnovationgroup.com/policy-value-based-care/accountable-care-organizations-acos/article/21219825/naacos-recognizes-three-acos-for-care-improvement-efforts

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DICTIONARY: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

Your thoughts are appreciated.

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CDC Mask Update

President Biden Talks Up Benefits of Vaccines After New Mask Guidance

By Dr. David E. Marcinko MBA CMP®

It is time to practice smiling with your teeth again, because the CDC just updated its mask-wearing guidance yesterday from “mostly always” to “mostly just inside.” The agency said that fully vaccinated folks can do the following activities sans masks:

  • Dine outside with non-roommates
  • Go on walks, hikes, or bike rides alone or with household members
  • Attend small, outdoor events, even if some attendees haven’t been vaccinated.

Why now?

29% of Americans are fully vaccinated, and almost 43% have received 1+ dose. Plus, researchers’ understanding of Covid-19 has come a long way since every Amazon package was treated like an Area 51 special delivery, and public health experts say it’s rare for the virus to spread outdoors.

Chenue Her's tweet - "Helpful and easy to follow graphic from the CDC on  the new mask and vaccination guidelines. " - Trendsmap

MIT Experts Speak: https://www.msn.com/en-us/money/other/six-foot-social-distancing-rule-misses-bigger-risks-mit-experts-say/ar-BB1g7bx1?li=BBnb7Kz

Vaccines Need a Marketing Refresh

The pace of vaccinations has slowed down in the US, and the Biden administration hopes that FOMO from seeing vaccinated friends tandem-biking (as friends do) will spur the un-jabbed to act.

Assessment: In the words of President Biden, “For those who haven’t gotten their vaccine yet…this is another great reason to go get vaccinated now.”

Your thoughts are appreciated

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What is Your Teaching Philosophy?

 Here is My Teaching Philosophy

[By Dr. David Edward Marcinko MBA]

Although any learner-centered teaching philosophy, or Boyer Model of scholarship, is constantly in flux, the mission of a public or private educator is: [1] to promote positive learning; [2] to motivate students, staff and graduates; [3] to provide a strong foundation for lifelong learning; and in modernity [4] to enhance career and life-work opportunities; to [5] improve bottom-line financial metrics, and [6] to collaborate on a national and global basis.

However, because we are specifically operating in the rapidly changing healthcare, business management, investing, finance, economics and education milieu, even deeper experiential insight is needed.

Developing NEW Teaching AND Education Skills FOR Business and Healthcare 2.0

Medicine and healthcare business today is different than a generation ago, and all educators and healthcare professionals need new skills to be successful.

Traditionally, the physician – like the classroom professor – was viewed as the “captain of the ship”. Today, their role may be more akin to a ship’s navigator, utilizing clinical, teaching skills and knowledge to chart the patient’s, or student’s, course through a confusing morass of requirements, choices, rules and regulations to achieve the best attainable clinical or didactic outcomes.

This new teaching paradigm includes many classic business school principles, now modified to fit the PP-ACA, the era of health reform, and modern technical connectivity. Thus, a Professor, Chair or Dean must be a subtle guide on the side; not bombastic sage on the stage.

These, newer teaching philosophies must include:

  • Negotiation – working to optimize appropriate curricula, services and materials;
  • Team play – working in concert with others to coordinate education delivery within a clinically appropriate and cost-effective framework;
  • Working within the limits of competence – avoiding the pitfalls of the generalist teacher versus the subject matter expert that may restrict access to professors, texts and facilities by clearly acknowledging when a higher degree of didactic service is needed on behalf of the student;
  • Respecting different cultures and values – inherent in the support of the academic Principle of Autonomy is the acceptance of values that may differ from one’s own. As the US becomes more culturally heterogeneous, educators and medical providers are called upon to work within, and respect, the socio-cultural and/or spiritual framework of patients, students and their families; 
  • Seeking clarity on what constitutes marginal education – within a system of finite resources; providers and professors are called upon to openly communicate with students and patients regarding access to marginal education and/or treatments.
  • Supporting evidence-based practice – educators, like healthcare providers, should utilize outcomes data to reduce variation in treatments and curriculum to achieve higher academic efficiencies and improved care delivery;
  • Fostering transparency and openness in communications – teachers and healthcare professionals should be willing, and prepared, to discuss all aspects of care and academic andragogy; especially when disclosing problems or issues that arise;
  • Exercising decision-making flexibility – treatment algorithms, templates and teaching pathways are useful tools when used within their scope; but providers and professors must have the authority to adjust the plan if circumstances warrant;
  • Becoming skilled in the art of listening and interpretingIn her ground-breaking book, Narrative Ethics: Honoring the Stories of Illness, Rita Charon, MD PhD, a professor at Columbia University, writes of the extraordinary value of using the patient’s personal story in the treatment plan. She notes that, “medicine practiced with narrative competence will more ably recognize patients and diseases; convey knowledge and regard, join humbly with colleagues, and accompany patients and their families through ordeals of illness.” In many ways, attention to narrative returns medicine full circle to the compassionate and caring foundations of the patient-physician relationship. The educational analog to this book is, The Ethics of Teaching [A Casebook], co-edited by my teacher and colleague Deborah Ware Balogh PhD of the University of Indianapolis.

***

The Ohio State University
 Photo by Kevin Fitzsimons

***

Assessment

Finally, these thoughts represent only a handful of examples to illustrate the myriad of new skills that tomorrow’s healthcare professionals, and modern educators, must master in order to meet their timeless professional obligations of compassionate patient care and contemporary teaching effectiveness.

Dr. Marcinko Teaching Philosophy

CHAIR: Chair 3.0 Philosophy Dr. Marcinko

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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The Integrated Patient-Centered Medical Home Model

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Tools for Transforming Our Healthcare

By Matias A. Klein

[VP, General Manager, Clinical Quality and Collaboration, Portico Systems]

The patient-centered medical home (PCMH) continues to attract increasing attention from many industry stakeholders. The PCMH model has the potential to enhance the US healthcare system by rejuvenating primary care in a way that improves clinical outcomes, lowers costs, promotes wellness, and increases patient and physician satisfaction.

PCMH Pilot Programs

PCMH pilots are currently being tested in almost all states, including a 3-year Medicare medical home demonstration project overseen by the Centers for Medicare & Medicaid Services. However, few organizations have scaled the PCMH across their entire healthcare network, and the existing implementations appear to remain focused on care management at the expense of patient wellness. The value of focusing equally on promoting wellness (although an underappreciated nuance in the implementation of a PCMH) is a critical factor in effectively leveraging the PCMH model to improve clinical outcomes and the US healthcare system.

Centered on the Patient

The PCMH model, as its name suggests, is centered on the patient. The underlying thought is that if a comprehensive, longitudinal view of a patient is taken throughout a patient’s lifespan, the patient’s health could be better “managed” and better aligned with best medical practices. It is well documented that physicians do not consistently or frequently apply evidence based, recommended care to patients. Therefore, a major goal of the PCMH model is to improve the consistent application of evidence-based guidelines and best practices, by making longitudinal information about the patient available to providers and to patients – including any risks and recommended “intervention opportunities.” And although adherence to best practices in disease management is crucial, the PCMH model also focuses on preventing costly episodes by promoting and incentivizing wellness.

PCPs = Medical Homes

To effectively manage a patient’s health and promote wellness, primary care physicians – designated as medical homes – need to act as health “quarterbacks” or “coaches.” In such a role, these physicians will assist in aggregating a patient’s health information, making best practices transparent, offering health education and counseling, as well as coordinating the provisioning of any healthcare services the patient may need. With physicians spending significant time coaching and making critical clinical decisions, these services will be delivered with the support of care management nurses, who will handle the majority of the information processing and operational activity.

An Innovation in Care

The PCMH model is an important innovation in care delivery and has the potential to reduce medical and administrative costs, while improving the quality of care. However, how to implement the PCMH model within a care-delivery system remains unclear. Providers need the requisite infrastructure and capabilities at their locations to meaningfully participate in a PCMH. Patients must be engaged over long periods of time in proactively managing and improving their health. Outcomes and quality must be objectively measured to optimize the delivery of best possible patient care.

Potential Value

To realize the potential value of the PCMH, three distinct stakeholders – patients, providers, and health plans – must work in a collaborative way. Getting these stakeholders synchronized (i.e., aligned in their goals, using interoperable tools, and collaborating on an operational level) is no small feat but can be accomplished with the smart application of technology. Bringing these three stakeholder groups together on a common, collaborative technology platform results in what some are beginning to call the integrated PCMH. The integrated approach to the PCMH can best ensure that implementing a PCMH model does not create additional administrative burdens to health plans or provider organizations.

An integrated PCMH provides a framework for stakeholders to collaborate in a transparent fashion, and where quality, best practices, and outcomes are incentivized. The integrated PCMH also provides a pathway being awarded a medical home designation.

Vertical Integration Deployment

The key to deploying an integrated PCMH is an end-to-end vertical integration of the care-delivery process – that is, a process in which the provider network management, automation, information exchange, and analytics solutions are tightly integrated with patient and provider information. With so much complexity and so many “moving parts” in the delivery of the PCMH model, this end-to-end vertical integration is a practical solution that enables effective coordination of care and accurate measurement of quality: with such system integration, the provider network (e.g., the health plan) can bring economies of scale to even the smallest provider offices to optimize the quality of care delivery.

The 5 Keys

The five key components for such an integrated PCMH are:

  1. A source-of-truth for mapping medical home – designated providers, patients, as well as  the associated relationships with health plans and other medical professionals; a central medical home fact checking is critical for effectively identifying, managing, and communicating with medical home and their networks.
  2. A set of collaborative workflows that align stakeholders with best practices, incentives, and quality measures reporting; these collaborative workflows help each stakeholder understand where a given patient is in the care-delivery process, potential intervention opportunities, why certain interventions are being emphasized, and what incentives are available for executing specific interventions.
  3. An infrastructure for clinical integration and distribution of intervention opportunities, clinical reference content, education, alerts, and reminders. This infrastructure allows all stakeholders to have access to up-to-date, accurate patient information; it aligns stakeholders and helps reduce or eliminate duplication of procedures and tests.
  4. Interoperable clinical applications and collaboration tools to enable patients and physicians to engage in medical home processes; these tools – which include electronic medical records, e-prescribing, e-labs, secure e-mail, personal health records, and document management and exchange technology – can help manage health information, assist with decision-making, and improve communication between patients, providers, and health plans.
  5. Incentive management and analytics tools for modeling, setting, measuring, and rewarding incentives based on quality measures and outcomes; these tools must span the entire PCMH delivery process and are required for objectively evaluating and optimizing the performance of a medical home.

When considering the multiplicity of stakeholders, information, software systems, and knowledge that has to be coordinated in the context of a PCMH model, implementing a medical home pilot and scaling it to a full-blown network may seem a daunting task. The integrated PCMH offers a real-world solution for deploying a scalable and flexible infrastructure for the management of this emerging care-delivery model.

Assessment

Early evaluations of the PCMH model show promising, albeit inconclusive, outcomes. The integrated PCMH model offers a practical road map for deploying a management system that will enable objective measurement of PCMH performance and outcomes.

Conclusion

Although the jury is still out on the ultimate value of the PCMH, deploying an integrated PCMH system can help position PCMH pilots in a way that enhances their flexibility and scalability to support full-scale network transformation.

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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BOARD CERTIFICATION (Boarded, Diplomate): A doctor who is board certified has pursued advanced training in his or her specialty and has passed a qualifying examination; a doctor who is board eligible has received the training but has not taken or passed the exam.
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BOARD ELIGIBLE: Describes a physician who is eligible to take the specialty board examination by virtue of being graduated from an approved medical school, completing a specific type and length of training, and practicing for a specified amount of time. Some HMOs and other health facilities accept board eligibility as equivalent to board certification, significant in that many managed care companies restrict referrals to physicians without certification.
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PARSING “MEDICAL NECESSITY” IN HEALTH CARE

PARSING “MEDICAL NECESSITY” IN HEALTH CARE
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Terms and Definitions to Debate

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MEDICALLY NECESSARY CARE: The supplies and services used to diagnose and treat a medical condition within the standards of good medical care. The revenues from health insurance premiums spent to pay for the medical services covered by the plan. Usually referred as a ratio, such as 0.95, which means that 95% of premiums were spent on purchasing medical services. The goal is to keep this ratio below 1.00–preferably in the 0.75, range, since the insurance plan’s profit comes from premiums.

MEDICALLY NEEDY: Patients eligible for Medicaid whose medical bills and total income is below certain limits.

MEDICALLY UNNECESARY CARE: That part of a stay in a facility [case manager] determined as excessive to diagnose and treat a medical condition in accordance with the standards of good medical practice and the medical community. Excessive may be because stay was too long or available in a less costly or more efficient setting.

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How Does Herd Immunity Really Work?

Patterns of Virus Spread

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Top Child Health Concerns

Circa: 2020

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Pass Your Foot & Ankle Surgical Board Exams

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BEWARE – Medical Business and other Scammers

2021 Annual [Faux] Registration Letter

By Staff reporters

Below is a copy of a letter that some colleagues and clients have been receiving and asking us about.

This letter is not from a government agency and is not real. See the sections highlighted in yellow.

Please do not pay anything to this company. Thanks!

We recently received this notice.

It is untrue.

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VBC via CMS

By Staff Reporters

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Corona Virus [Pictorial] Update?

An Info-Graphic?

By Staff Reporters

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Election Day – A Medical Perspective

VOTE SAFELY

By Staff Reporters

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COACHING MEDICAL COLLEAGUES IN BUSINESS & FINANCIAL PLANNING

COACHING MEDICAL COLLEAGUES IN BUSINESS & FINANCIAL PLANNING
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The Pandemic “SAF[ER]” Classroom?

NOT Absolutely 100% Safe – But Much Saf[er]?

By Anonymous

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Inside the “Fall” of the CDC?

By Pro Publica

LINK:

https://www.propublica.org/article/inside-the-fall-of-the-cdc?utm_source=pocket-newtab

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Prevalence of Cardio-Vascular [Heart] Disease by Income level

CIRCA: 1999-2016

By http://www.MCOL.com

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The Economic Impact of Lung Diseases

Among US Workers

By: http://www.MCOL.com

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20 Cognitive Biases That Affect Decision Making

Screwed-Up Decision Making

[By Staff reporters]

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The COVOD-19 Vaccine Race?

Get Ready – Get Set – Go!

By staff reporters

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Some Perverse Incentives in the Healthcare System

Perverse Incentives in the Healthcare System

By Paul Thomas MD

There are perverse incentives in the healthcare system. As a part of my mission to provide affordable and accessible health care in Detroit and beyond, it needs to be said that the middlemen in healthcare inflate the cost of the care that you receive.Anthem Revenue $104 Billion (2019)

Cigna Revenue $154 Billion (2019)
United Revenue $242 Billion (2019)
Aetna Revenues $69.6 Billion (2019)

Cigna CEO salary $18.9 million (2018)
United CEO salary $21.5 million (2018)
Aetna CEO salary $18.7 million (2017)

The total annual healthcare spending in the US is over $3.6 trillion annually.

  • Healthcare spending on administration: 34%
  • Healthcare spending on physician salary: 8.6%

When your doctor can’t get you the tests/imaging/procedures/surgery/medication you NEED, remind yourself that the middle management, the CEOs, the lobbyists for health insurance company did NOT swear an oath to put your health above money.

Your doctor did.

************

Doctors are missing sleep, skipping vacation, answering calls on weekend and holidays, missing important family events, and otherwise working tirelessly to keep you healthy.

All of that’s to say that I firmly believe in the power of the doctor-patient relationship and removing the middlemen from this equation.

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UN-NECESSARY ANTIBIOTIC PRESCRIBING

In the USA

By http://www.MCOL.com

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CORONA VIRUS DEATHS [update]

Related Eco-Systems

By staff reporters

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What is the “Herd Immunity Threshold”?

What is the Herd Immunity Threshold = HIT?

By staff reporters

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How New Vaccines are Developed?

Approved and Manufactured [Phases 1, 2 and 3]

By staff reporters

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New Index Ranks Hospitals’ Community Benefit


N
ew Index Ranks Hospitals’ Community Benefit

By Health Capital Consultants, LLC

On July 7, 2020, the Lown Institute, a nonpartisan think tank, announced the initial release of its new ranking system for hospitals. Called the “Hospitals Index,” this ranking analyzes not just the quality of care and patient outcomes but also the hospital’s civic leadership and avoidance of overuse, ideas that harken back to the core mission and vision of the Lown Institute itself.

Founded in 1973, the Institute advocates for a healthcare system that “rejects low-value care, incentivizes healing over profits, promotes health equity, and honors the value of the clinician-patient relationship.” (Read more…)

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Ten Commandments of Logic

A List of 10 “Thou Shalt Nots”

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The AJPH Continues

AJPH 
Dear Dr. David Marcinko,

 

This month, AJPH continues to publish and promote COVID-19 papers that discuss the impact of the pandemic on the future of public health. Please visit the compiled list of our COVID-19 articles. The July issue also focuses on topics related to abortion, misinformation and structural racism and redlining. Here are a few of the many articles in the July 2020 issue:

 

·  Podcast: COVID-19: Are We In This Pandemic All Together?

·  The Public Health We Need

· Public Health Perspective in the Times of COVID-19

· COVID-19: The First Post-Truth Pandemic

· Accurate Statistics on COVID-19 Are Essential for Policy Guidance and Decisions

· Producing Independent, Systematic Review Evidence: Cochrane’s Response to COVID-19

· Will There Be an Epidemic of Corollary Illnesses Linked to a COVID-19–Related Recession?

·  Teaching Public Health Will Never Be the Same

·  Abortion Trends in Georgia following Enactment of the 22-Week Gestational Age Limit

· Structural Racism, Historical Redlining, and Risk of Preterm Birth in New York City.

 

Also, as we maintain physical separation, check out the June issue of AJPH via e-Reader or Kindle. The mission of AJPH is to advance public health research, policy, practice and education. Toward that goal, the journal also produces monthly podcasts available in English, Spanish and Chinese at ajph.org. The monthly podcasts also are on iTunes and Google Play. Be on the lookout for more timely research from AJPH, and consider subscribing or becoming an APHA member for full access.

Stay safe,

 

 

Alfredo Morabia, MD, PhD

Editor-in-chief, AJPH

@AlfredoMorabia

@AMJPublicHealth

Monthly Percentage Change in Health Care Utilization

By Specialty – CIRCA 2019-2020

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ENTER A HEALTHCARE ENTREPRENEURIAL BUSINESS “DISRUPTOR” FOR 2020

ENTER A HEALTHCARE ENTREPRENEURIAL BUSINESS “DISRUPTOR” FOR 2020
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A New Initial Public Offering [I.P.O.]

On January 30, 2020, 1Life Healthcare, Inc. (One Medical) went public, opening at $14 per share, and closing at $22.07 per share. The innovative San Francisco-based direct primary care organization more closely resembles a technology start-up than a traditional healthcare organization.

LINK: https://lnkd.in/eZxrhtp

Their membership model service provides “seamless access” to primary medical care services at “calming offices,” 24/7 virtual care, and 21st century technology (e.g., a mobile application that allows patients to schedule appointments and message their providers).


And so, here is a report from colleagues over at Health Capital Consultants, LLC.
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