Policy

Want Better Cardiac Outcomes? Just Follow the Money

The line between financial incentives and clinical outcomes just got a little straighter. A new study says money may have erased the difference in readmission rates between the top heart […]
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New Primary Care Provider, Same or Better Outcomes

Expanding the scope of practice for nurse practitioners and physician assistants may be a cost-effective way to manage the health of patients with chronic illnesses. That’s the market-based reform takeaway […]
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New Primary-Care Provider, Same Old Price

Patient office visits to primary care physicians are down. Patient office visits to nurse practitioners and physician assistants are up. But switching to NPs and PAs from doctors isn’t saving […]
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Amplifying Transformation: Addressing Medicare Advantage’s Disadvantages

The U.S. healthcare system will not change the way it delivers care until it changes the way it pays for care. Perverse incentives riddle fee-for-service payment (FFS) and lead to […]
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It’s Commercial Health Plans That Are Keeping Fee-for-Service Alive

Far from pulling the plug on fee-for-service medicine, commercial health plans continue to give it CPR. A new report says well over half of commercial health plan payments to providers […]
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Study Refocuses ER Coverage Debate on Patients

A new study reminds us that the squabble between providers and payers over coverage of unnecessary emergency room visits should be more about patients and less about who pays who […]
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Healthcare Worker Flu Vaccine Rates Offer a Lesson in Self-Policing

Short of making flu shots mandatory for healthcare workers, healthcare employers need to do much more to immunize their staffs from a virus that threatens their health and the health […]
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Against the Wind: Hospitals Challenge CMS’s Pro-Market Payment Reforms

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Over the past month, the Centers for Medicare and Medicaid Services (CMS) announced several pro-market policies that will enhance pricing transparency, stimulate competition (and fair prices) for routine procedures and eliminate burdensome reporting requirements. […]
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Kentucky HEALTH and Medicaid Work Requirements: A Behavioral Economics Lens Sheds Light

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On Friday, June 29, near the zero hour, a federal judge ruled [1] that Kentucky’s Medicaid waiver approved by the CMS could not go forward on Sunday, July 1 as […]
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CMS Misdirection: Two Troubling Decisions Damage Market Competitiveness

In well-functioning healthcare markets, governmental regulatory policies ensure access, safety, quality and privacy. The government’s most important role is creating level-field competition through balanced regulation, targeted enforcement actions and price/outcomes […]
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Pro-Market and Pro-Business: Not Always the Same, Particularly in Healthcare

Shortly after publishing Market vs. Medicine: America’s Epic Fight for Better, Affordable Healthcare in June 2016, I met with my former investment banking colleague, Jullia Quazi. Jullia arrived with a very funny story […]
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Reimbursement Follows Respect: Leading States Pay to Address Social Determinants of Health

For too long, the “Social Determinants of Health” (SDH) have been the big elephant in the exam room. While no one denies that a diabetic living alone in a food […]
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Is Tax-Exemption Necessary? Enlightened Health Systems Should Consider the Unthinkable

 In the mid-1800s, English philosopher and political economist John Stuart Mill developed “Utilitarianism,” a framework for making moral decisions. In Mill’s formulation, an action achieves optimal social utility when it […]
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Honey vs. Vinegar: Value-Based Pricing Wins Customers and Market-Share

Common wisdom holds that “it’s easier to catch flies with honey than vinegar.” That aphorism also applies to payers seeking lower prices for routine healthcare procedures. It “tastes” better when […]
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Taxing Consequences: House Republicans Target Tax-Exempt Hospital Bonds

Market Corner Commentary for November 21, 2017 Having failed to “repeal and replace” the Affordable Care Act, House and Senate Republicans have set their sights on reforming the U.S. tax […]
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Crony Capitalism Has Consequences: Opioid Distribution, Destruction and Death

Market Corner Commentary for October 25, 2017 – Special Edition Talk about bombshells. On October 15th, the Washington Post and 60 Minutes released a detailed and damning investigative report titled […]
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Senate Republicans Confront Their Healthcare Waterloo: Now What?

Last weekend Senators Jerry Moran of Kansas and Mike Lee of Utah announced they could not support Speaker Mitch McConnell’s Better Care Reconciliation Act of 2017 (BCRA). Their defections put […]
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40 Years in the Payment Reform Wilderness: DRGs to Nirvana

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Introduction In an ideal state, a well-functioning healthcare delivery system should provide the right care at the right time and the right place, while being accountable for clinical and financial […]
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“Indumbent” Healthcare Thinking: Prices Don’t Matter

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In a March 29th New York Times article, author Elizabeth Rosenthal chronicles America’s dystopian system for coding and billing medical treatments. Rosenthal concludes that the medical-billing system itself is a […]
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Trumpian Healthcare Reform: A “Silver Linings” Legislative Playbook

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Special Edition: Market Corner Commentary for March 29, 2017 Last Friday was supposed to be the shootout at the healthcare corral where Republican gunslingers were going to take the first […]
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The Rise and Fall of Academic Medicine: AMC Competitiveness in Post-Reform Healthcare

by David Morlock and David W. Johnson Rome wasn’t built in a day and didn’t collapse overnight. After centuries of growth, prosperity and domination, the Roman Empire began a long […]
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Healthcare’s Gettysburg Moment

Seven score and thirteen years ago this month (November 19, 1863), Abraham Lincoln delivered his renowned Gettysburg Address at the dedication for the Soldiers National Cemetery. With the ravages of […]
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Overturning Obamacare: A 5-Point Plan for President-Elect Donald Trump

Two weeks ago, I distributed a 5-Point healthcare plan for presumed President-elect Hillary Clinton. That was then. In a remarkable and unprecedented election surprise, Donald Trump defeated Hillary Clinton and […]
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HealthCare.Gov’s Death-Defying 2013 Launch: Implications for Government-Led Payment Reform

Enrollment for purchasing health insurance on public health exchanges began November 1st. Headlines for this fourth enrollment period include: 22% average price increases; major health insurers dropping coverage; and single […]
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Overhauling Obamacare: A 5-Point Plan for President-Elect Hillary Clinton

Absent a cataclysmic surprise next Tuesday, Hillary Clinton will become the 45th President of the United States. She will govern a divided electorate with highly-polarized elected officials. It’s no longer […]
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Value Quest: Capital Formation Challenges for Non-Profit Health Systems

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by David W. Johnson, James Moloney and Carsten Beith   There’s a battle outside and it’s ragin’ It’ll soon shake your windows and rattle your walls For the times they […]
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Market Evolution: Addressing Structural Flaws on Public Health Exchanges

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After two-plus years of operations, clear structural flaws have emerged in the design and function of public health exchanges. Health insurance cooperatives have largely failed. Many traditional insurers have suffered […]
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Epi(c) Pharmaceutical Market Failure

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It was hard not to feel sorry for Mylan CEO Heather Bresch as she sat for an extended CNBC interview on the morning of August 25th. Clearly on the hot […]
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Obama Speaks: A Presidential Assessment of Obamacare

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Market Corner Commentary for July 27, 2016 Earlier this month, President Obama took the unprecedented step of authoring an academic research article in The Journal of the American Medical Association […]
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Now You See It…. The Unreliability of Government Student Loan Forgiveness

Each October, the Association of American Medical Colleges (AAMC) publishes its “Debt, Costs and Loan Repayment Fact Card”. It surveys recent medical school graduates and details the amount and composition […]
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Dynamic Tension: Rethinking Health System Governance

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Market Corner Commentary- Health System Governance- for January 6, 2015 John Koster MD and David Johnson The winds of post-reform transformation are blowing through healthcare. Long-established health systems confront existential […]
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Of Metrics and Meaning: Making Sense of Healthcare Quality Ratings

Market Corner Commentary for September 9, 2015-Of Metrics and Meaning: Making Sense of Healthcare Quality Ratings As healthcare becomes more consumer-focused, hospital and physician rating systems are proliferating.  Yelp is […]
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Individual Mandate: Are You Up for N=1 Healthcare?

Market Corner Commentary for August 19, 2015 (disruption)-Individual Mandate: Are You Up for N=1 Healthcare? Yogi Berra famously observed, “The future just ain’t like it used to be.”   In N=1: How […]
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Supreme Court vs. Obamacare II: Decision Time

This article first appeared in Huron Perspectives on June 2, 2015-Supreme Court vs. Obamacare II: Decision Time The “Thrilla in Manila” in 1975 was Mohammad Ali and Joe Frazier’s second […]
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Supreme Court vs. Obamacare II: High Drama; Not the “Main Event”

The “Thrilla in Manila” in 1975 was Mohammad Ali and Joe Frazier’s second championship fight. In 1967, Ali refused conscription as a conscientious objector. He was convicted of draft evasion, […]
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