A "HealthTweep" Pulse Check

Exploring transformational potential of social media

Posts Tagged ‘Boutique Medicine

A Strategic Medical Group Algorithm To Assess ‘Social Media Readiness’

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So what is social media really all about in terms of its relevance and application to medical groups, whether single or multi-specialty? Is it really about a better way to push an often boring, ‘look what I/we can do’ PR messaging? Or is it a genuine offer of a transformational opportunity to re-engineer health care operations and practices in service of quality, access, cost transparency and patient engagement? I say one way to get closer to an answer is to walk through this initial set of questioning recently developed for a client.

ACO Medical Group (ACOMG) Strategic Questions

Is there a perceived need among the partners for a formal planned marketing and communications function at the Group level? Yes/No?

If no, end of conversation and on to the ‘next prospect’.

If yes,

Is the web viewed as a material source (actual or potential) for patient acquisition, business development, and connectivity with key ACOMG constituents? Yes/no?

If no, end.

If yes, should ACOMG invest in a coordinated and comprehensive ‘web presence’ that builds, positions and maintains real-time, interactive capabilities via a coordinated yet distributed set of both ‘push’ and digital interactive properties.

If no, end.

If yes, is ACOMG presently enabled to perform as a content development, publishing and management company that feeds and curates these content, keyword, market and niche rich community management properties?

If yes, end.

If no, are these core skill sets presently domiciled at ACOMG staff (whether via professional or administrative staff, consultants, etc.)?

If yes, end.

If no, how will ACOMG acquire, develop or otherwise embed the needed skill sets and core competencies?

Build, buy or do nothing?

If build, or buy is there a budget benchmarked to a formal marketing and communications program consistent with published management company guidelines as a percent of revenue or expenses? If yes, game on. If no, end of conversation or need for additional education (good luck!).

And while you consider this ‘social media readiness assessment’ do bear in mind that the world continues to spin and has minimally surfaced the following things to consider:

Additional strategic considerations to throw into the mix as market conditions and environmental context:

On the future of community medicine in general, or your version of community medicine via your specific specialty:

1. What alliances and/or networking arrangements should your group be considering?

2. What vehicles (legal entities or other forms of organizations) should your group be considering, e.g., single specialty IPA, or ‘super IPA’ (re-purposed specialty GPO), MSO, super MSO, associating with a 3rd party PPMC (i.e., US Oncology), linking with an hospital system (which one, might there be more, or even a multi-hospital vehicle to be created?)

3. What formal strategic positioning thought is underway given the relatively short horizon for ACO participation? Have you evaluated the range and wisdom of various participation options, i.e., as single sites; as an integrated group; with hospital participation or not ( a very key question)?

Basically [medical group leadership], do you have previous experience in dealing with these strategic issues (many of which seem to be re-cycling prior themes albeit with ‘new and improved’ acronyms)? Is there ‘institutional memory’ from the HMO, IPA, MSO, or PHO days? Is the ‘wisdom’ of the senior members of the group being shared with the younger generation, who carry the longitudinal stake in the practice’s sustainability? Or is the default position just to do nothing and see what happens?

Bottom line is it’s all about choice… and there is no ‘good’ or ‘bad’ here, only informed/uninformed choices and consequences; and inaction, denial or minimization is a firm choice, no doubt with inevitable consequences! Cheers!

‘Direct Practice’ Medicine Gaining Increased National Visibility

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A recent clip featuring Garrison Bliss, MD, founder of Qliance was profiled on NBC Nightly News under the title of ‘Flat-Rate Health Care A Viable Option?’

As this form of innovation is a niche, and largely unknown part of the Patient Protection and Affordable Care Act (PPACA), I include it, here.

Kudos to Dr. Bliss and the Qliance crew!

The ‘Medical Aggregators’: Are We Entering Round Deux?

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First a little historical context:

For those with a healthcare ‘event horizon’ slightly more seasoned than the current health reform and related social media data frames, you might remember the initial round of aggregation in medicine lead by disruptive nameplates such as MedPartners (now operating the PBM CareMark), PhyCor, FPA Medical Management, and their second or third tier physician practice management ‘me too’ copycats.

They all emerged from a robust round of venture capital backed industry determination tagged as ‘PPMC’s’, i.e., physician practice management companies. These ‘aggregators’ were the darlings of Wall Street for a while, though with some exceptions, i.e., US Oncology (formerly Physician Reliance Network), most witnessed relatively short life spans, from IPO to unwinding in perhaps a 10 year run (see: MedPartners collapse and Aftermath).

Yet, despite the promise outlined in the offering prospectus’, why did these entities fail so miserably as the ‘white knight’ consolidators or aggregators of a multi-trillion dollar ‘cottage medical industry’? Their business model proferred essentially three core benefits:

  1. Centralized, standardized and more efficient back office medical administrative management
  2. Scale of market asset concentration and therefore increased sophistication and leverage (improved pricing) with third party payor negotiation, and downstream contract management; and
  3. Serve as an ‘anchor play’ with respect to the broader design and implementation of rational though market based local delivery organization and financing, i.e., PPMC’s would harness and more effectively articulate a business culture among physicians that valued clinical integration, medical risk management, and ultimately the allocation of limited health care resources

At least this was the longer term expectation from a ‘win/win’, i.e., payor and provider perspective, of the more established players. Most however, in an effort to demonstrate value (i.e., earn their management fee) to their physician boards, focused on short term margin improvement (better rates, focus on more profitable services via improved payor mix, maximizing the contract revenue/recovery cycle, and reduced overhead, etc.), vs. the strategic focus of managing the risk (both quality and cost) of their local population (i.e., enrolled members).

So rather quickly the strategic basis of the PPMC appeal was subordinated to a short term focus (i.e., increasing net revenues) due to a rising chorus of claims that at its core the business model was merely a third party ponzi scheme which introduced another mouth to feed from an increasingly constrained health care supply chain.

Net/net, the PPMC industry flamed out big time and did not fulfill its ‘roll-up’ promise of the practice of medicine. Now many years later, we are at another tipping point. Witness the current round of promising vehicles with a similar vision of organizing physicians. These candidates include: hospital systems, health plans, integrated delivery systems, emerging ACOs, medical homes,  and even niche play organizers in the concierge, or direct practice space including SignatureMD, MDVIP, HealthAccess Rhode Island, CarePractice, Qliance, and HelloHealth, as well as the rapidly emerging series of retail pharmacy sponsored primary care clinics, e.g., CVS/CareMark Minute Clinic, etc.

Too many docs are unwilling to risk the capital of private practice, and instead are looking to hook-up with one or more of these institutional or VC backed entrepreneurial sponsors. Will they succeed where their predecessors failed? If so, why?

From my perspective, it will clearly depend on the business model chosen to enable competition of the right variety, and the degree to which the venture embraces, nurtures and expresses physician culture that values collaborative group practice. Top down, corporate strategies dependent upon an over worked and out gunned medical director or VP of medical affairs will miss the mark. The more likely way for these ventures to succeed is by ‘baking’ the culture from the ground up. In other words, ‘seed it and they will come’. One of my mentors (Ernest Holmes) once wrote long ago: ‘the soil can’t argue with the seed’. Lets nourish the soil first, then make sure we plant the seeds with the right constitution and vision.

From ‘Health Reform’ to ‘Delivery System Transformation’

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Well we made it! It’s over for now. Obama thrashed through the red zone and against all odds drove the football of health reform across the plane of the goal line. But no rest for the weary, since that drive was the ‘easy’ part. Congrats Mr. President, the ‘Patient Protection and Affordable Care Act‘ as amended by the ‘Health Care and Education Reconciliation Act of 2010‘ is now U.S. law. Yet, phase two, aka the ‘devil is in the details’ implementation challenge is now before an industry that has historically opted the path of least resistance, rather than risk true game changing innovation.

For an excellent recap and summary of the combined bills, see: Kaiser Family Foundation’s ‘Summary of Coverage Provisions‘. Yet, I am most interested in the quality, and payment provisions that will drive the innovators’ in the mix. Most of the applicable language can be found in ‘The Timeline for Accountable Care: The Rollout of the Payment and Delivery Reform Provisions in the Patient Protection and Affordable Care Act and the Implications for Accountable Care Organizations’.

While the law falls short of what I hoped for (I stood for a robust public option to ‘discipline’ the health plan community, and most certainly favored a ‘Medicare E’ option for the 55-64 demographic), it offers many needed incremental improvements to the U.S. health insurance industry practices, as well as the granular ‘patient’s first’ innovation imperative if the reform effort is to honor it’s coverage goals, and not bankrupt the country.

Bottom line, is we’re  entering the era of Managed Care 2.0, a do-over or ‘Mulligan’ – if you will. Since the failure of the grand HMO experiment, and subsequent risk ‘push back’ in the mid 90’s when the typical hospital sponsored integrated delivery system (a poorly equipped and improperly motivated first generation risk management vehicle) constituted mainstream efforts to manage care, we’re now hoping this time will be different. But will it? What’s changed to suggest we’ll have a different experience this go round, or are we just doing the same thing over (and over) again expecting different results?

To monitor and re-tweet these discussions, I’ve started a Twitter notebook and associated ‘managed care 2.0’ (#mc20) hashtag to pool tweets. I anticipate a robust discussion in both the blogosphere as well as on twitter, so get ready for a flood of activities on Patient Centered Medical Homes (PCMH), Accountable Care Organizations (ACOs), PHOs versions 2.0, and a re-invigorated IPA community including their Management Services Organizations’ (MSOs) as ‘infrastructure and strategy’ hosts.

Also add to this mix the growing membership (and buzz) into direct practice (boutique, concierge, retainer, etc.) medical models that offer access to basic medical care outside of an insurance or health plan context. This is a space that is likely to witness a clash of definitional interest as to what constitutes a ‘patient centered medical home’ and for what purpose, whether it be as defined by law as an ACO or PCMH vs. a primary care practice that opts out of Medicare or participating with health plans, to service their members as de facto equivalents of medical homes albeit of the ‘unregulated variety’.

May you live in ‘interesting times’ or so goes an ancient Chinese proverb or perhaps curse; and yes we do!

Written by 2healthguru

March 29, 2010 at 7:31 PM

Physician Participation in Social Media – What Up?

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On Tuesday, December 8th, 2009 I had the pleasure of speaking with Bryan Vartebedian, MD, a pediatric gastroenterologist, active in the social media space via Twitter @Doctor_V, his personal blog 33Charts.com, and periodic contributor to Get Better Health.

We spoke via Blog Talk Radio on his calling to medicine, pediatrics in particular and more recently his attraction to the social media space. Doctor_V has both interesting and witty insights on the medium. Some of his more recent tweets are noteworthy:

When I mention SM to other physicians they just giggle and look confused

LinkedIn may be a good first step for socially retarded physicians

Social media is the fancy awning that hangs from a building; human interaction is the bricks & mortar (a re-tweet)

For more of ‘Doctor_V’s insight, wit and early ‘do’s and don’ts’ for physicians considering a social media presence, listen in to the full interview here.

Written by 2healthguru

December 9, 2009 at 6:07 PM

The ‘Through-put’ Economy of Money Driven Medicine

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OK Tweeps in the movie ‘What the Bleep‘ do we know, the line transitioning to the theme of the flick proffers:

it’s time to get wise.

Well the same holds true with respect to the ‘resistance is futile’ health care borg aka ‘the tapeworm medical industrial complex’ economy. Our health care system is at risk of collapse; with 46 million uninsured, 25 million under-insured, primary care physicians bailing on the system daily, health care premiums sky rocketing, while benefits are being reduced and cost shifted from the plan to the employee. No one is happy with this status quo, quite to the contrary of some public opinion polls that tout we have the ‘best health care system’ in the world!

Surely we have the best high tech or ‘rescue care’ medicine that can be found. But when it comes to the ‘value proposition’ the story gets a little more complicated, and requires a bit more than sound-bytes or political grandstanding to get at the truth.

Money Driven Medicine is a primer for such a rational conversation. If we thought the Senate Finance Committee hearings followed by the debate of Chairman’s mark was exhausting, just wait for what’s in store from the special interests, and their ‘Quack-er’ proxies in the Senate during the impending floor debate of the merged bills.

So why not get current and be a part of the solution? Watch Money Driven Medicine and get WISE!

Written by 2healthguru

November 22, 2009 at 1:12 PM

The Names of the Dead

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While the political theater slogs towards it’s ‘battle fatigue’ finale in Washington, D.C., and elswhere in the United States of Amnesia, one American, who also happens to be a politician has decided to approach our health care conundrum in the spirit of the Cluetrain Manifesto and from the footprint of the human experience via a story telling process, i.e., the human narrative.

The name is Congressman Alan Grayson, and the site is Names of the Dead (dot) com. While some will immediately look to party affiliation, and standing with respect to the health reform bills before the Congress to position how they’ll ‘receive’ (or discount via an ideological filter) his message, I encourage you to watch some if not all of the videos.

They are personal stories of Americans who died directly as a result of delayed access to medical care. An empirical basis for the claim that lack of health insurance is associated with mortality is provided in the peer reviewed study Health Insurance and Mortality in US Adults.

The publishing of this report is a timely and top of mind topic, since as a male I am one of the 47 million Americans without health insurance, and a boomer in his 50s, who has occasion to think about the 1 in 6 prospects of prostate cancer in my future. Specifically I have pondered, and have avoided to date, submitting to a PSA test. And yesterday via virtual participation in the TEDMED hashtag stream (#tedmed) I came across a prostate CA piece from theVisualMD dot com, which only further affirmed my fear, and stoked a somewhat borderline despair.

Why ‘borderline’ despair? A few illogical and perhaps ‘magical thinking’ reasons come to mind:

  • I am avoiding the test since ‘ignorance is bliss, and I am uninsured?’ Ergo, if I or any lab for that matter doesn’t know, then it can’t be confirmed as a pre-existing condition, right?; and
  • If I am a positive, then what? I am not insured and can’t afford the treatment. So county here I come? No thanks, I don’t subscribe to the ‘John Goodman theory’ about the mythology of the uninsured in America.

So my choices are to sit with the 1 in 6 odds and continue as I am, pretending not to be concerned. After all, my history is disease free, and as a health care ‘insider’ I avoid interacting with the health care delivery system as a general rule, staying active and eating healthy for the most part.

Yet, I can’t help but think about those stories that Grayson is sharing with America and asking myself, will I be on the list soon?

So while we debate and more accurately obfuscate the nature of the problem we face vis a vis health reform solutions, people die daily. The ‘dead man walking’ queue witnesses some 122 new recruits each and every day.

The health reform imperative is real tweeps. Unfortunately the dividing line all to often seems to be between those who are employed, and have health insurance (aka, the I got mine crowd) and those who do not; many of whom are employed or self employed but none-the-less locked out of the system due to obscene health care costs or opportunistic underwriting and/or retrospective rescission schemes.

So what’s it going to be peeps? As a society, who will we value and install as the ‘anchor’ tenant in medicine? Will it be (generically speaking) a Mayo model, or the status quo, volume incented, quantity driven series of competitive fee-for-service sweat shops, dba ‘McAllen’s’ (generically speaking of course)?

Written by 2healthguru

October 29, 2009 at 10:47 AM

Towards a ‘Preferred Hospitals’ Manifesto

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So what’s a ‘preferred hospital’ anyway?  A fair question, since ‘beauty’ is for the most part in the mind of the beholder!

Preferred Hospitals remains a conceptual ‘on the come’ value proposition at this point; but when I first thought of the idea, I had in mind structuring a network of participating hospitals and physicians directed primarily to the 47 million Americans without health insurance. The network’s ‘secret sauce’ consisted of providers who contractually committed to a substantially discounted (equivalent to the best or “most favored nation’s”) rates, otherwise extended to ‘wholesale buyers’, i.e., health plans, with the greatest group purchasing leverage.

In the economics of managed care, the more members a health plan trafficked in a specific market, the greater provider discounts they could expect. Most favored nations rates often equated to 50 cents on the dollar (or less!) , i.e., a 50% discount. Thus, the value proposition (to the uninsured) was twofold: (1) the contract rates would be actually honored, and therefore the member would receive a benefit in exchange for the modest dues paid vs. told ‘we don’t participate with that plan’; and (2) the provider’s rates would be adjusted to ‘fair value’ at least as determined by the entities with the greatest purchasing power in that market.

The great irony is hospitals and physicians too often (whether by design or not) reserve their ‘retail book’, i.e., billed charges, for the least able to bear the burden of charge based ‘sticker shock’. Many offer cash discounts as a courtesy in the +/- 25% range, but too often fail to present that option upfront before the downstream litany of collection calls.

At the time I originally entertained the idea, the discounted medical plan marketplace (DMPO) was populated with flimsy players, many of whom where exposed by the Georgetown University Study ‘Discount Medical Cards: Innovation or Illusion?‘ So it appeared this idea would have traction in the marketplace. While I enthusiastically jumped in, I found myself banging my head on the wall, over and over again. The value proposition seemed so apparent to me; especially linking the emerging growth of retainer, concierge or micropractices to a targeted and under-served market that contrary to popular wisdom was not a indigent demographic per se. Further, I reasoned (incorrectly I might add) that many of the forward thinking, and compassionate hospital systems (especially the one I worked for in DFW), forged under benefit of tax exemptions would proactively embrace a solution designed to reach an underserved market, and thus make a material deposit into the ‘community benefit’ bank. With IRS and the Congress on the non-profit hospital trail (i.e., Chuck Grassley, et al) looking into the veracity of 990 filiings, certainly these hospitals would see the light and embrace the greater good this model so obviously afforded; not!

None-the-less, I began to negotiate ‘upstream’ with several national PPO network managers, who in search of incremental revenues, and fighting ‘silent PPO allegations’, were electing to ‘rent’ and private label their networks in exchange for a per member, per month (PMPM) fee that ranged at that time between $3.50 – $4.00. Yet, as a start up with no membership, it became solely a cat and mouse affair. The PMPM basis was a function of the membership base which at that time was zero. From their perspective, it was a pure play ‘on the come’ business model, and good intentions not withstanding, we could not come to terms.

I also approached several colleagues, and friends in the personalized, retainer model, or concierge medicine market, and attempted to interest them in the business model. Most notably the Society for Innovative Medical Practice Design (SIMPD) was a logical partner or sponsor (I reasoned) to which I ‘pitched’ the idea, though to no avail. They were just not interested in ‘marketing” their nascent member panel at the time, nor reaching out to this underserved market per se.

Thus, no traction developed, and after much time soliticing support, and partner participation, I elected to back off of the business model.

So fast forward a few years and witness the ‘health reform 2.0 moment’ we’re all having. Revived thoughts have surfaced as to what and how a preferred hospitals network might be structured?

Here are a few ‘indicia’ of an emerging preferred hospitals manifesto:

  • Commit to pricing, cost and quality transparency
  • Adopt social media guidelines to engage and empower patient utilization of the hospital’s services (pre-admission, during and post discharge; especially follow-up concerns)
  • Offer ‘members’ most favored nations’ rates via a credible discount medical plan(s)
  • Waive where possible, or otherwise, defer collection of all upfront fees, copays, estimated co-insurance, and/or deductibles
  • Participate in budget driven and consumer specific time payment programs (as determined by independent financial counselors) via auto-debit direct from the patient’s bank (interest free)

This is only a start. I welcome your thoughts.

HelloHealth’s Jay Parkinson on ‘New Age’ Medical Models

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Program Note: Due to ‘technical difficulties’ the interview with Jay was disrupted and will be rescheduled shortly! This live web is a continuing experiment and the tech gremlins do tend to appear now and then. My continued apologies to Jay.

Jay Parkinson, MD, MPH, of Hello Health, joins me for a conversation on emerging alternative medical practices from Concierge, Boutique to retainer based models, including the HelloHealth strain. Jay is a pioneer in the adoption, and integration of social media tools into medical practice; and will share his insights, and vision for the promise and pitfalls of social media innovation in medicine.

Amidst the current ‘fever pitch’ buzz of health reform, there is considerable conversation about lowering health care costs, while improving both quality and access. The US health care system is at risk of implosion. Whether we look at it from the underfunded programs of Medicare or Medicaid, or the cost prohibitive employer sponsored health insurance system – which has priced iteslf out of reach absent the planned cost shifting of so called ‘high deductible health plans’ – few are happy campers; and approximately 46 million Americans are without health insurance.

We will connect the dots of emerging medical practice models to the broader health reform agenda by considering the vision and value system of one of medicine’s clear innovator’s.

Join us on June 19th, at 11 AM EDT/ 8AM PDT for a live broadcast that will also archive for later broadcast or RSS subscription to Google Reader, iTunes or other feed aggregator.

Written by 2healthguru

June 18, 2009 at 9:21 AM

“Concierge, Boutique or Retainer” Based Medicine; Is This Good For American Healthcare?

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It seems not a day goes by without another announcement of this or that primary care medical practice electing to leave entirely, or in part, the traditional model of medical care. Yet, this is a trend most worthy of considerable exploration.

Absent effective health reform (minimally: primary care payment equity, and administrative simplification), the current drip, drip, drip outmigration of physicians from a traditional billing and collections medical practice into these ‘new age’ models has the potential to grow into an outright tsunami in the near term.

Movement by primary care physicians into the boutique, concierge or retainer based medical models is not without a downside. Some say that it is clear evidence of the emergence of an impending ‘perfect storm’ in medicine that will collapse the primary care safety net at the precise time when it anticipates its greatest demand (i.e., retirement of the baby boomer generation).

When one takes into consideration the overwhelming preference for medical students to opt for higher paying specialties vs. the primary care specialties of Family Medicine, Internal Medicine, and Pediatrics, the trend is quite disturbing – health reform incentives (to grow capacity) notwithstanding.

At one level, it is a rational response by physicians to a failed healthcare finance and delivery paradigm; while at the same time, extracting essential primary care infrastructure from a delivery system that completely relies on it’s availability.

There are many models in the retainer or concierge medicine market. Once you’ve seen one, you’ve seen only one; there is no standardization. From MDVIP, to Jay Parkinson, MD, at Hello Health, this is a dynamic and rapidly evolving industry.

We will feature this medical phenomenon from the inside out at one of our next programs. There is much to discuss.

Written by 2healthguru

June 14, 2009 at 11:45 AM