L. Gordon Moore, MD

A neighbor of mine is undergoing her third round of chemotherapy this week. As we head into the end of the year, she was relieved that she had already passed […]

This is the question behind a publication from Dr. Will Bleser and colleagues at the Duke Margolis Center for Health Policy. Anyone doing or contemplating work similar to this has […]

Physicians go through a lot of training: pre-med, medical school, internship, residence and some go on to further specialization in fellowships. It used to be that a physician would finish […]

Everywhere you look in health IT news, you’ll find headlines announcing the latest amazing (potential) results of artificial intelligence (AI), machine learning (ML), etc. As we explore these new horizons, […]

How can we reduce health care cost trends while improving access and quality? The answer is staring us in the face. Maybe we need a new app that tracks every […]

U.S. health care costs are too high and are continually getting worse. This is especially galling considering the ongoing decline in life expectancy, the low ranking of the U.S. compared […]

Like most people (I hope), I can get caught up in the details of my work and life to the point that I’m in back-to-back meetings, dashing from one task […]

Best selling author, inventor and technologist Nick Webb describes the trends he sees that are disrupting the current state of health care. He says our previous changes have been too […]

As early as 1992, JAMA published a randomized control trial (gold standard for studies of impact) of telephone care. Patients liked it, doctors liked it, outcomes improved and costs went […]

A physician is billed $10,000 for a COVID-19 test by his own organization, and the insurer paid the full amount (it costs about $8 to perform the test). A nurse’s […]

There is good evidence that waste is abundant in health care. Inefficient care delivery is one source of waste, where inefficiency is defined as variability in the way we care […]

As part of a clinical improvement project, I was reviewing charts in a hospital and was dismayed by how much junk I had to wade through to find out what […]

If primary care is the foundation of high performing health systems, Advanced Primary Care (APC) is what primary care looks like when it is fully resourced. An efficient health care […]

Imagine I have two patients with diabetes. Person A has very mild disease and does well with a treatment plan of self-directed diet and exercise. Person B has more severe […]

Families USA 1—a nonprofit, nonpartisan consumer health advocacy organization—pulled together a coalition called Consumers First, 2 which issued a Call to Action: “Consumers First has issued A Call to Action […]

Health care payment is about how we write the checks. Health care finance is about how we design the way money flows.  We’re living in a system built by good […]

If we want better health care outcomes in the U.S., we need to change the way we finance health care. Policies flowing from Medicare are a strong signal to the […]

The work of Advanced Primary Care (APC)1 is different from what most primary care practices do today. In addition to using queueing theory and technology portals to provide access and […]

Health care outcomes improve and unnecessary spending declines when we can get ahead of problems rather than reacting to them after they have spiraled out of control. For a woman […]

“Primary care is the foundation to a high value, high functioning system that meets the needs of people and communities.” – Elizabeth Mitchell, president and CEO of the Purchaser Business […]

State budgets have been pushed to extremes driven in part by ballooning Medicaid costs and ballooning Medicaid rolls. According to the Kaiser Family Foundation:  “Early estimates indicate that states are […]

Current payment models are inadequate for the full scope of work in primary care. Last month, the Purchaser Business Group on Health (PBGH) and the California Medical Association (CMA) addressed […]

When asked to reflect on what inspired their career choices most doctors and nurses will speak about the professional satisfaction and joy in helping people. They will talk about making […]

People with chronic health conditions face many challenges as they work to manage those conditions to the best of their ability. A 2018 survey of certified diabetes educators asked how […]

We’ve had months and months to plan. We have expert guidance on how to prioritize COVID-19 vaccine distribution in ways most likely to benefit all Americans, and yet in the […]

With all of the data we have on diagnosis, comorbidity, age and sex, we still only access a small subset of factors that predict a person’s likelihood of experiencing complications […]

We’re in somewhat uncharted territory when it comes to measuring health care outcomes. Given the radical shifts in elective procedures, people avoiding care due to COVID-19 exposure concerns, and of […]

Emergency departments provide an essential role in the health care ecosystem, but a significant proportion of visits to the emergency department are for care that might have been delivered in […]

In some estimates, medical care accounts for approximately 11 percent of a person’s health and wellness; the rest is made up of individual behaviors as well as environmental factors.  When […]

Telemedicine has been around for a long time. “In 1906, the inventor of the electrocardiogram published a paper on the telecardiogram. Since the 1920s, the radio has been used to […]

These times of uncertainty and stress press us to rethink what we are doing and where we are headed in terms of health care. I had a chance to speak […]

The COVID-19 pandemic continues to have a massive impact on health care around the globe and in the U.S. in particular. Health insurers expect a tsunami of pent-up demand once […]

Health care payment in the U.S. is the outgrowth of decades of policy decisions that were not all thought out in advance and thus have become a mess. We pay […]

Telemedicine has exploded during the COVID-19 pandemic with expanded access guidelines from the CDC and others.[1]  How much of this is a good thing? Should we continue the new rules […]

Not just during the current COVID-19 pandemic, but for a long time, doctors and nurses have expressed concerns and frustration with the administrative work of clinical documentation. An article from […]

Medicaid budgets are under extraordinary stress with increased enrollment, increased direct and indirect costs and declining state revenues. What can be done to mitigate these budgetary cliffs? Reducing unit prices […]

Julio Ayala died at home of COVID-19. I don’t know if he would have survived if he had gone to a hospital, but he might have. Nobody wants to be […]

State budgets are often challenged by healthcare costs. An increasing number of states are exploring ways to reduce these costs through policies aimed at the intersection of healthcare costs and […]

There are thousands of wellness apps, hundreds if not thousands of devices, apps and tools that can be used for chronic disease management, all of them adding their streams to […]

How might a health ministry, insurer, or health system use existing health information to inform a data-driven prioritization model in response to COVID-19? In the movie Contagion, countries distributed the […]

During a pandemic, healthcare information is gathered, studied, and published rapidly by scientists, epidemiologists and public health experts without the usual processes of review. Our understanding is rapidly evolving and […]

What does “severe” mean? I know this sounds like a specious question, but it provides a window into the complex world of clinical documentation. As a palliative care physician, Dr. […]

A 15 percent increase in value is a compelling reason for business and industry to consider investing in the health of communities. Another? How to reverse the trend of new […]

Medicaid spending accounts for about three percent of annual U.S. GDP and more than 20 percent of most state budgets. With a ten-year run of a strong economy, we may […]

Physicians and nurses are experiencing burnout and are committing suicide at unprecedented rates. When asked, healthcare professionals tell us they are pulled away from meeting their patients’ needs to fulfill […]

70 million people receive health coverage through Medicaid. These programs receive federal & state funding and are administered by state agencies that follow broad federal standards. Eligibility varies across states […]

Dr. Paul Gordon rode a bicycle across the U.S. in 2016 asking people their thoughts on the Affordable Care Act. It was a true listening tour and he was not […]

A 55-year-old male is admitted to the hospital for an exacerbation of their chronic obstructive pulmonary disease (COPD). An 8-year-old child visits an emergency department with an asthma exacerbation. A […]

It should come as a surprise to no one that healthcare providers are frustrated (a significant understatement) by all of the requirements around documentation of their work with patients. I […]

What can health systems do to combat the opioid crisis? This is the kind of question that fascinates me as I think about how we can improve healthcare outcomes through […]

So much is happening with artificial intelligence in health care; thank goodness for experts who provide clear explanations. I can barely turn around at healthcare conferences without “bumping into” another […]

Dr. John H. Wasson has decades of research digging into what is important to people vis-à-vis health care. He has published in all the big journals, testified in the big […]

We’re living in a time of paradox in health care. With the increasing capacity to identify people at risk for bad outcomes, some are exploring fascinating innovations in healthcare delivery, […]

“…overcrowding is a hospital-wide problem that requires a hospital-wide response.”[1] Overcrowding seems to be an ongoing problem for many hospitals in the U.S.[2] Overcrowding adds stress to physicians, nurses and […]

How long will it take until health plans catch up with the evidence? Non face-to-face visits can: be done well provide excellent care improve outcomes improve satisfaction reduce healthcare costs […]

Dr. Rebecca Resnik tells me that the rate at which clinicians can recognize that a person is suicidal has not changed in 50 years. Regardless of the type of clinician—primary […]

Good ideas can morph into problematic policies that drive up costs and erode quality. Take diabetes as an example.  We could pose the ultimate goal of effective diabetes management is […]

Dr. John “Rick” LeMoine has an interesting role at Sharp HealthCare. He’s Chief Medical Information Officer but is not in charge of a large staff.  In fact, when he describes […]

The way we use language says something about us. Disordered thought can manifest as disordered language use—a signal that might mean the person has schizophrenia. Pressured speech could be a […]

In a Health Affairs blog and an Inside Angle podcast discussion, the health policy expert, physician and self-styled contrarian, Bob Berenson explains why the Evaluation and Management (E/M) coding guidelines […]

I think it’s reasonable to say that most people working in health care are motivated to deliver high quality care to the people they serve. Because humans are complicated organisms, […]

Consumer-directed health care is the idea that a person armed with good information will select the right services from the best provider of that service and this will translate to […]

Okay, so the title of this blog reads like an obscure academic paper, but here’s the point: For computers to aid us in finding needles in haystacks, we have to […]

That’s the tagline for the Patient Care Intervention Center (PCIC), a nonprofit working with people living on the streets in and around Houston, Texas. It started with family medicine physician […]

Why would an orthopedic surgeon develop expertise in documentation and coding? Eugene Christian, MD, Chief Medical Officer for St. Mary’s Bon Secours Hospital in Richmond Virginia describes his work on […]

Healthcare delivery is under extreme pressure to improve costs and outcomes. One reliable pathway is by improving efficiency. One aspect of efficiency is to better match interventions to people most […]

Dr. Alan Glaseroff developed Type I diabetes as an adult.  As a family medicine physician, he was surprised by the work involved in really understanding the condition and the best […]

The pressure to improve healthcare outcomes and reduce unnecessary use of healthcare resources weighs heavily on hospital and health system administrators working with tight margins. Success under value-based payment requires […]

Dr. John Cromwell is a colorectal surgeon interested in computers and machine learning. He believed that computers could sift vast amounts of data to inform surgeons on ways to reduce post-operative infection rates.

People with asthma have many fewer emergency room, urgent care and doctor office visits when their primary care practices link symptom survey results to care guidelines according to a recent […]

Physician burnout has a negative impact on quality of care, patient safety, operational efficiency and of course on the burned-out individuals. In a new episode of the Inside Angle podcast, Christine Sinsky, MD, vice president of professional satisfaction at the American Medical Association, discusses how we can improve the work of care.

Does the “more is better” approach to quality measurement create a burden on healthcare delivery? Does it distract attention from actual care and consume resources that might be used to […]

When it comes to the health of the healthcare workforce, how can we help caregivers care for themselves? Dr. Gordon Moore describes the work of SEIU 775 Benefits Group to improve the health of homecare workers in Washington State. Read the blog and listen to the podcast.

One of the “truisms” of value-based programs is that these programs align the incentives of the health care delivery system and the insurer, such that better care results in better […]

One of the best parts of my job is the opportunity to interact with thought leaders and innovators from across the spectrum of healthcare delivery in the U.S. Given the […]

Sometimes science upends what we think of as common sense.  We might believe that a degenerative tear in the meniscus (cartilage in the knee) ought to be fixed. Then some […]

In a representative survey of 300 hospitals and health systems, the Deloitte Center for Health Solutions discovered that: “80 percent of hospital respondents reported that leadership is committed to establishing […]

Recent research has shown that the cost of clinician burnout appears to be significant: “Clinician burnout is prevalent across health care settings and may impair clinicians’ ability to maintain safe […]

“The Medicare Payment Advisory Commission is pushing for the immediate repeal and replacement of a Medicare payment system that aims to improve the quality of patient care.” – Modern Healthcare […]

We have lots of opportunities to improve primary care access so that people have a viable alternative to an ED visit for non-emergent care. As anyone who has ever worked […]

With the unrelenting pressure to reduce unnecessary costs in healthcare delivery and despite (or maybe because of) the lack of clear direction from the federal government, Medicaid plans across the […]

As a physician, I am responsible for coding certain diagnoses that will trigger certain payment and risk adjustment. Risk adjustment scores are important in terms of quality measures and they […]

Every year, most health plans are rated on quality by the National Committee for Quality Assurance (NCQA) with Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS gets most of its […]

An interesting convergence of articles flowed over my laptop recently: 1:  Becker’s ACS Review: The 11 things payers, providers really think about value-based care:[1] Seventy-five percent of health plan executives […]

Doctors work really hard to take care of their patients, but find the technology at their fingertips is more of an obstruction and friction than a resource. Natural language processing […]

Implantable cardioverter-defibrillators (ICDs) can save a person’s life when they detect a dangerous heart rhythm and correct it by delivering a shock to the heart. For another person it might […]

Value-based purchasing and population health management are supposed to change aspects of the relationship between insurers (health plans) and providers (accountable care organizations, health systems, etc).  New contracts are supposed […]

One premise of improving population health outcomes rests on the idea that we can be more pro-active in healthcare delivery. In addition to reacting to the “reason for visit” we […]

With HIMSS17 around the corner, I’ve been thinking about advances in technology and data and the history of silos and systems in healthcare delivery. Optimizing a part of a complex […]

The Missouri Hospital Association’s exploration of the impact of poverty on readmission rates leads them to suggest, “Before Penalizing Hospitals, Account for the Social Determinants of Health.”[1] Here’s an example: […]

“Readmission rates apply to hospitals.  As a primary care physician, I don’t have control over hospitals so why should I be on the hook for this?”  This is a question […]

Health professionals should not have to choose between doing what’s right for their patients and doing well. Health care in the U.S. is undergoing significant changes in the way we […]

MIPS is coming and physicians are unsettled.  Programs with the best of intentions can have unintended side effects. Healthcare providers across the U.S. have justified complaints regarding the multiple reporting […]

If you are interested in improving population health outcomes and by so doing reduce the trajectory of cost increases, it is useful to reflect on the foundations of high performing […]

Let’s assume you’re about to sign a contract to manage a population of several thousand. The goal of the contract is to improve care delivery, improve outcomes and reduce the […]

Achieving Triple Aim outcomes is more likely when interventions reach people who are likely to have better outcomes because of those interventions.  This has been described as Impactability: “[B]y stratifying […]

I’m often asked by health system leadership “How do we improve X?” where X is a specific quality or utilization metric.  This blog is a description of one (not the […]

Populations served by good primary care have – on a risk-adjusted basis – better health outcomes at lower per-capita spending on health.1  Recognizing the need to better resource the work […]

Electronic records are a boon in many ways, but failures and frustration in the field are too common. Jean Antonucci is a family physician in Farmington, Maine – northwest of […]

Return on investment (ROI) is driven in part by our payment decisions, and many of our current choices stack the deck against the possibility of achieving ROI through population health […]

Improving the rate of mammography or colorectal cancer screening for appropriate individuals is a good thing. I suspect that my experience in practice was similar to others: Our group would […]

Responding to value-based-purchasing, provider groups across the US are implementing or tweaking programs to reduce unnecessary hospital readmission or emergency department visits. Much of this is stimulated by Medicare’s plans […]

The recent report describing a decline in new cases of diabetes is good news. An article about it in The New York Times does a nice job describing the lifestyle […]

Magill and colleagues published a nice analysis of the staffing costs of a Patient-Centered Medical Home (PCMH). Compared to a regular practice that already has an electronic medical record, they […]

Maybe there is a way to measure quality so that metrics better represent outcomes that matter. Harvard Medical School’s Center for Primary Care has been studying exemplars in primary care […]

Where do alerts fit in a physician’s 22.6 hour day? When I’m travelling around the country interacting with healthcare leaders and health systems, I mostly see valiant efforts to improve […]

In a Commonwealth Fund/Kaiser Family Foundation survey, 50 percent of PCPs report that quality metrics have a negative impact on their ability to provide quality care to their patients.i If […]

The Triple Aim is a construct developed to move past the trade-offs typical in health care improvement: improved quality at the expense of increased costs, decreased costs at the expense […]

Reducing healthcare costs through better care delivery begs the question: “Where do we start?” When the goal includes something to the effect of “the greatest possible improvement for a population,” […]

The path to better population health outcomes is difficult–and our approach to quality measurement may be making it harder. Process measure improvement does not consistently lead to outcomes that matter, […]

  Maybe solo primary care practices are dying, but so what? This question led some folks at Mathematica Policy Research to look into solo primary care practice and the results […]