Jamey Harvey

Like an unfazed young quarterback who keeps firing it downfield despite a spate of interceptions, CMMI keeps tossing around VBC models hoping something will connect. Contrary to its intent, CMMI's programs increased spending by $5.4 billion from 2011-2020 with another increase in net spending of $1.3 billion by 2030. Of the more than 50 models the Center has implemented, only 6 have generated "statistically significant" savings. Only 4 (Home Health Value-Based Purchasing, Prior Auth Model for Non-Emergent Ambulance Transport, Diabetes Prevention Program, and Pioneer ACO) were certified for expansion. CMMI points to the voluntary nature of the programs as a challenge to achieving cost savings. However, CMS hasn't done itself any favors here by aggressively ratcheting down payments and making downside risk >>> upside risk. (Notably, two upcoming programs -- TEAM and Inpatient THA/TKA PROMs are mandatory). Finding the VBC sweet spot was always going to require some trial and error. Perhaps CMMI has learned from the programs that failed or weren't chosen for expansion. TEAM doesn't seem to be all that different from CJR. Making Care Primary aims to closely integrate primary and specialty care (or, more likely, incentivize PCPs to take on more of this work). Not surprisingly, one of the criticisms is lack of provider input. The programs are too complex, too expensive to administer, and aren't transparent. CMMI should take note of several studies demonstrating the success of physician-led VBC efforts. Here are some other thoughts: - Offer financial grants in 5- or 10-year terms for any organization that designs its own VBC program and presents a reasonable and viable clinical/business model. CMMI would do itself a favor by partnering with or at least listening to innovators. - Medicare Advantage complexity and risk adjustment handwaving shouldn't be the only mechanisms by which advanced providers can profitably care for beneficiaries. That program isn't saving money either, but it's the only way many of these approaches can generate meaningful revenue (and most still aren't profitable). - Have regular meetings with those building VBC models, particularly those with strong physician leadership. Those meetings should be transparent and productive of action plans and iterative changes that increase model viability. - Be more open about what your goals and targets are. No one should be a victim of their own success, and if you keep moving the goalposts, you shouldn't be surprised when people get frustrated and drop out. I'm certain that, given fair incentives, a meaningful voice, and an equal seat at the table, healthcare innovators can design sustainable VBC programs. But there needs to be more collaboration and a willingness to listen and engage. Otherwise, you're just slowly adding to the alphabet soup of also-ran programs. #medicine #healthcare #health #vbc #healthcareinnovation #valuebasedcare

50

17 Comments

🚀Key Insights from the Release of ONC Common Agreement Version 2.0 The highly anticipated Common Agreement Version 2.0 was released on April 22, 2024, marking a significant milestone in advancing the directives of the 21st Century Cures Act. What's New in Version 2.0? Enhanced Data Exchange: Incorporation of HL7 Fast Healthcare Interoperability Resources (FHIR) enhances data sharing among participants and improves individual access. Streamlined Terms: A standalone document now outlines the Terms of Participation (ToPs), simplifying compliance and consistency across networks. Flexible Participation: Participants can now engage with multiple qualified health information networks (QHINs), offering greater flexibility in data exchange. Immediate Impact: The new version will be effective 60 days post-publication in the Federal Register, initiating a transition period for current QHINs and participants to adopt new ToPs. Although TEFCA participation isn't mandatory yet, the streamlined terms and improved interoperability provide compelling reasons for healthcare providers to consider joining. Strategic Considerations: Healthcare organizations should prepare for the transition by familiarizing themselves with the new framework and negotiating terms beyond the required ToPs, ensuring alignment with other regulatory requirements like HIPAA. 🔔 Why This Matters: Version 2.0 of the Common Agreement sets a new standard for nationwide interoperability, significantly impacting how healthcare data is exchanged across the U.S. It supports the broader goals of enhancing patient care, reducing administrative burdens, and moving the industry towards a more integrated and efficient healthcare system. #HealthTech #Interoperability #HealthcareInnovation #ONC #TEFCA #DataSharing #HealthIT

7

This is a great report from Mckinsey of what health system executives are prioritizing

14

Thank you for this comprehensive overview, Sam Pinson. The evolving landscape of AI governance in healthcare is critical for ensuring the ethical and effective deployment of AI solutions. Here are a few key takeaways and considerations: Regulatory Level Set 1. Data Stewardship: Compliance with HIPAA and FTC's Health Breach Notification Rule is essential for protecting patient health information (PHI). Ensuring robust data privacy and security measures is paramount for maintaining patient trust and regulatory compliance. 2. Consumer Protection: The recent FTC warning highlights the need for transparency in consumer privacy policies. AI developers must be vigilant in maintaining ethical data-sharing practices to avoid regulatory pitfalls. 3. Non-Discrimination: The new rule under Section 1557 of the ACA emphasizes the importance of mitigating risks related to AI and decision-support tools. Ensuring non-discriminatory practices in AI development and deployment is not only a regulatory requirement but also an ethical imperative. 4. Disclosures: The HTI-1 Final Rule from ONC underscores the necessity of comprehensive disclosure and risk management for predictive decision-support interventions (DSIs). Adherence to these regulations can provide a competitive edge for vendors integrating with certified EHR technology. 5. Medical Device Regulation: The FDA's regulation of software as a medical device (SaMD) remains a critical gatekeeping function. Navigating these pathways is essential for developers to ensure the safe and effective use of AI in clinical settings. 6. State Regulations: State-specific regulations, such as those in Colorado, Utah, and California, add another layer of complexity. Staying abreast of state-level requirements is crucial for comprehensive compliance. Best Practices and Compliance Developers and deployers should leverage industry roadmaps, federal agency guidelines, and emerging compliance structures to future-proof their AI governance strategies. The Executive Order 14110 and NIST Gen. AI Profile are valuable resources for developing robust governance frameworks. As we approach Q2, it will be important to continue monitoring regulatory developments and adapting governance strategies accordingly. Collaboration between industry stakeholders and regulatory bodies will be key to navigating this complex landscape and ensuring the responsible use of AI in healthcare. #AIgovernance #HealthTech #DataPrivacy #NonDiscrimination #Compliance #PatientSafety #Regulation

7

The healthcare system is broken, or at least hugely unoptimized, from any reasonable perspective (flatlined outcomes, falling patient/provider satisfaction, rising costs, etc.) The market for new health technology is framed around this flawed system. Almost all health tech innovation funding, private and increasingly public, is steered towards near-term product-market fit. The overall health ecosystem is incentivized to perpetuation decline and dilute transformative innovation. Perhaps it is time for a new approach at a systems level? AI MINDSystems Foundation #health #tech #science #research #outcomes #ecosystem

19

6 Comments

An analysis of the state of telemedicine in 2024. Abundance of opportunity remains, under the right constraints and with the right direction. The essence of clinical care is the transfer of knowledge and expertise between the providers and consumers. Telemedicine creates an optimal front door for value oriented clinical experience.

20

3 Comments

The i’s are dotted, the t’s are finally crossed… You now can register for my FREE Accelerator Webinar Series for Healthcare Change Leaders!🚀 This 3-part webinar series will run next week on 21st, 23rd, and the 25th May and will kick off the 3.0 version of my program Co-lab Academy: Project of Me (3 June - 26 July)🔥 There’s only 8 days to go until the opening session of Accelerator, so let me answer something you might be wondering… Why am I starting my third Co-Lab with a webinar series on deep mindset work and blasting through internal and external barriers to our success in healthcare?🤔 Well it all starts with Dr Dena long before she had the “Dr” - so just Dena, who dreamt of a thriving life and career where she could make a meaningful impact to the health system, love her work, and create financial stability for her and her one-day family. But oh my goodness, Dena was really weighed down by ways of working that kept her stuck. She worked so hard and had great ideas, but at the end of the day, yikes, she was keeping herself invisible as a leader, allowing perfectionism to halt her action taking, and worked alone (which severely limited what she could achieve)👎☹️ Because of this, nobody saw her as the leader she knew she was! Then she realised that if she could address these sabotaging patterns and barriers and prioritise her leadership as a “project” - it could change the whole trajectory of her career and how she could make a difference in her organisation and the health system🙌 Identifying, designing and implementing this combination of blasting these barriers plus “Project of Me” action taking was the first step to creating a career that brought “just Dena” to become me - Dr Dena van den Bergh, globally recognised leader and authority in change making and innovation in healthcare 🌍 In the 3 webinar sessions of the Accelerator, I’ll be teaching you my *exact* process for blasting the barriers that could be sabotaging your success so that you can move forward in bold action toward your highest dreams for your career and impact in healthcare🚀🚀🚀 Enrol now to avoid missing out! Head to the link in the comments below! If you previously attended my Accelerators last year, this Webinar Series contains never-before-taught original content from any previous events! You will need to re-enroll for this event to receive the new details🙏 I can’t wait to see you there! #healthprofessionals #accelerator #leadershipmentor

11

1 Comment