Showing posts from March, 2016

Lack of Accountability for Accountable Care

Is it possible that another era of health reform has been wasted in the 2010s as in the 1990s? Many of the failures have been in the same areas - too much increase in administrative cost, too much for too few for too little in outcome improvement, too much too fast, too much focus on innovation and not enough practicality, and failures specific to access to care. Could it be that designers, their designs, and the implementations all fail to consider local people, local needs, and those who care for people locally?

ACA was squeezed between some of the largest corporations in America (health insurance), those who purchase health care (major corporations), health care associations, and academic innovators. Meaningful reforms were lobbied away before the landmark Accountable Care Act was passed. For an accounting of who is doing well under ACA, try Health Care Who Is it Good For? Not listed are the software corporations that have found their way to hundreds of billions starting with 16 b…

Health Care Who Is it Good For?

Fortune 500   Top 10 in Health, Overall Rank, CEO Salary 2015 CVS - 10thMcKesson - 11thUnited Health Group - 15th  15 million for CEO salaryAmerisource Bergen - 16thExpress Scripts - 22nd      13 million for CEO salaryCardinal Health - 26thWalgreens Boots Alliance - 35thJohnson and Johnson- 25thAnthem (was Wellpoint) - 38th   14 millionAetna - 49th  15 mCEO Salaries Health care been very good to insurance company CEOs with salaries at 7 to 30 million. Health CEOS lead all industries in salary 5 of 6 years in one ranking and fall behind finance and telecommunication in other rankings. Isn't it great to see your health care dollars well spent, or your cable payments diverted?
Others by rank Pfizer Humana - 10 million CEO salary Merck - 25 m Cigna - 15 m Rite Aid Gilead Sciences - 19 m Abbott- 18 m Community Health Systems - 26 m Amgen - 14 m Tenet Healthcare - 18 m Baxter International - 15 m Bristol Myers Squibb - 27 m
DaVita HealthCare Partners - 14 m
Wellcare Health Plans - 5 m Health Net - 13 mi…

Innovation Incapacitation

Americans Can Always Be Counted Upon to Do the Right Thing... Churchill knew us well. He knew that we would eventually do the right thing, but knew also that it could take forever to get to the right thing. There is no deficit of innovative proposals to help address primary care delivery capacity woes. It is as if the deficits have helped to multiply the numbers and types of innovative proposals. Medical schools for over 50 years (all failed save 1), NP and PA programs, payment designs, types of specialties, rearrangements, consultants, measurements, definitions, determinations - all are just a few of the innovations. Does anyone really want to address access barriers for those with low or no access?
If it has not yet become obvious, primary care does not need more distraction from what must be done. Yet we have created more foundation proposals, more government innovations, more primary care associations, more sources of primary care workforce - and we still have 80 to 100 million that…

Safety Net Should Sunset and Front Line Access Must Rise

The right wording is important to communicate important concepts such as health access. After decades of marginalization, health access must arise. New terms are required.

Front line is the proper term to combine with access. Front line access communicates the challenges met head on and in the most dimensions.

We do not have "safety net" soldiers, or police, or teachers, or nurses. We have front line human infrastructure active and strong in serving person to person. To protect and serve fits across the front line.

Nets have gaps, are passive, reflect the past, and include some of the largest and most impersonal facilities in the nation. Those largest and with the most lines of revenue benefit from "safety net." Critically important primary care must rise as the front line that it is.

"Safety net" must sunset. 
Front Line Health Access
CHCs, RHCs, FQHCs, and FPs all represent the front line of health access. New reports continue to reinforce what we have kn…

Experimental Innovation or Basic Infrastructure?

Almost daily we see some promotion of health care innovation - a foundation grant, a research study, a primary care association communication, a government statement... 
Wouldn't it be nice if we actually funded infrastructure and basics
instead of trying to substitute innovation or other distractions? 

Innovation focus has actually caused significant dysfunction in health care and beyond.

Why not value basic nutrition, housing, clean water, sanitation, public health, and basic health services? When we fail to achieve the basics, we ignore the most important contributors to health outcomes. Current estimates by civil engineer experts indicate that our water supply alone needs over 1 trillion to return to a basic infrastructure. 
No one appears to value infrastructure until it is lackingNo one does anything until the privileged feel the pinch of lack of infrastructureIn other words, Flint Michigan is only the tip of the iceberg. Health care designs are just as bad.

Why value expanded in…