Smoking, Exercise and Obesity – The Big Three

February 2, 2011 / Michael D. Miller MD / Economics & Financing, Health System Reform, Information & Communications, Public Health / No Comments

I’ve been working with a Midwestern community for the past 7 months to improve the quality, efficiency, and value of their healthcare – as measured by public health population status, and the cost and quality of medical services. This experience has reinforced what I’ve been hearing repeatedly for the 28+ years I’ve been working with healthcare challenges: The three most significant areas for improving quality and controlling costs related to illness and healthcare are reducing smoking, increasing exercise, and reducing obesity. (The latter two are connected, but they also have separate and important benefits.)

While I will be writing more about each of these health problems in the coming weeks, (along with many other health policy issues involving innovation, system transformations, and the ongoing debate about health reform legislation), I first wanted to lay out some top line perspectives on smoking, exercise, and obesity.…

Rise of the Tea Party Machine (and I Am Back)

November 14, 2010 / Michael D. Miller MD / Health Policy and Communications Blog, Health System Reform, Politics / 3 Comments

Interpreters of the recent election results have been pointing fingers in many directions about alleged successes and failures of policies and messaging. Having run a consulting business for more than 10 years I see a parallel between how people vote and how people and organizations making hiring decisions. That is, people voting for their elected officials are essentially making decisions about who they want to hire to run their government.

Politicians certainly want the people who voted for them last time to vote for them the next time. This is a fundamental tenant of business success, i.e., getting your current clients to become repeat customers. …

ACOs – Accountable Care Organizations: Now and in the Future

June 28, 2010 / Michael D. Miller MD / Delivery of Healthcare, Health System Reform / 1 Comment

Because Accountable Care Organizations (ACOs) promise to reduce costs and improve quality it seems like everyone is talking about them as the solution for what ails the US healthcare system.

What is an ACO?
ACOs are a generally described as entities consisting of care delivery providers and clinicians, (e.g. doctors, hospitals, clinics, labs, etc.), organized so that they can more effectively coordinate care and the ACO can accept and mange some type of global, bundled, capitated, or case-base payments for this care in a way that makes the ACO financially accountable for all – or nearly all – the care individuals receive. …

Health Reform’s Effects on Star Trek Medicine – Diabetes and Otherwise

May 11, 2010 / Michael D. Miller MD / Health System Reform, Innovation / 1 Comment

A long-time colleague recently asked me what effect the new health reform law would have on the use of the famous Star Trek Medical Tricorder.* I told him that provisions of the new health law will try to reduce the number of unnecessary imaging tests, and since the tricorder is a hand-held imaging scanner the new law might reduce its use – if it really existed.

Thinking about it later, I realized that if/when such hand-held scanners are developed they would replace much larger and more expensive devices. The impact of innovations like this on healthcare spending depends upon how health insurance pays for these tests.…

Making Health Reform Work

May 6, 2010 / Michael D. Miller MD / Delivery of Healthcare, Economics & Financing, Health System Reform, Quality of Care & Safety / No Comments

The May issue of Health Affairs focuses on Reinventing Primary Care – a topic that has been part of health policy discussions for at least 20 years. A few things have changed in that time: now there is better evidence about the importance of primary care providers in coordinating care to improve quality and reduce costs; the structural concept of this care coordination has been codified under the new term the “Patient Centered Medical Home,” (which has also been given precise parameters by NCQA); the complexity of medical care has increased so that the need for care coordination is greater; and electronic information storage, analysis, and communications technologies have been developed which – in theory – should make care coordination and the resultant quality improvement and cost control easier and more practical.…

Health Care Reform (PPACA): By the Numbers and Political Battles Over Numbers

May 3, 2010 / Michael D. Miller MD / Economics & Financing, Health System Reform / 1 Comment

A week ago I ran into a long-time Republican health policy expert who was very excited about the Memorandum the CMS Chief Actuary had released on April 22nd about the financial effects of the Patient Protection and Affordable Care Act (PPACA). He was very excited because he believes that the Memo has significant information that will support repeal of the new health reform law when the Republicans take over one or both houses of Congress next year. (FYI – Current credible speculation puts the House as a toss up for Republican control in 2011, but the Senate is less likely to switch party control.)…

Implementing Health Reform – The Long, Hard and Twisting Maze

April 13, 2010 / Michael D. Miller MD / Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Politics, State-Level Healthcare Reform / 3 Comments

Health reform is now the “law of the land,” and “written in law.” However, as people are quickly realizing, after a year of campaigning and more than a year of legislative action, implementing the new law will require navigating a long, difficult, and twisting path – even before any amendments are considered in this or subsequent Congresses.

Navigating the fast and slippery route to successfully implementing all the provisions of the PPACA will be daunting. Three relatively recent laws are examples of the time and steps required for such implementation – and each of these was much simpler than the PPACA:

The Medicare Part D law was signed in December 2003 and the new benefit started in January 2006.

…

Politics of Health Reform: Selling Anger or Catharsis

March 22, 2010 / Michael D. Miller MD / Federal Healthcare Reform, Health System Reform, Information & Communications, Politics / 3 Comments

With the health reform legislation process winding up, it is clear that going forward politics are – and will be – front and center, with the divide between the Democrats and Republicans as wide as the orbit of Pluto…… the planetoid, not the Disney character. This divide is depicted in black, white, and red in the National Journal’s March 13th Insiders Poll question, “If Congress enacts something close to President Obama’s latest health care reform plan, how would that affect your party in the midterm elections?” 87% of Democrats thought it would “help a lot” or “help a little,” and 100% of Republicans thought it would help them.…

How Long is the New Health Law?

March 21, 2010 / Michael D. Miller MD / Federal Healthcare Reform, Health System Reform, Information & Communications, Politics / 1 Comment

With the House of Representatives passing the Senate’s version of the health reform legislation tonight, it can now be signed by the President. An historic step by any measure. While one of the criticisms leveled against the bill has been its length – typically cited as 2,409 pages – I recently pointed out to someone that the 2,409 page length is because the bill is printed to make it easy to read by using a large font, leaving lots of space between the lines, and sequentially indenting subsections to make the overall structure clearer. (Below is one page from the printed version of the bill.)…

Regulating Insurance: States v. Federal Roles

March 18, 2010 / Michael D. Miller MD / Access to Healthcare, Economics & Financing, ERISA, Federal Healthcare Reform, Private-Employer Based Health Insurance, State-Level Healthcare Reform / 1 Comment

One of the fascinating issues within the health reform debate is how to improve the insurance market by changing government regulations. While large employers who self-insure are except from state regulations, (and must only conform to limited Federal rules under ERISA), individuals, small groups, and others who actually purchase insurance have their policies regulated by individual states.

Both Democrats and Republicans agree that the current system of insurance regulation creates job lock and other socially undesirable effects, and that insurance companies should be able to sell policies across states lines. However, their solutions are quite different.

Democrats favor national regulation to create a single playing field, and Republicans prefer permitting insurance companies to sell in multiple or all states if they are licensed and regulated in any state. …

Health Reform Without Health Reform

March 1, 2010 / Michael D. Miller MD / Health System Reform, Politics / No Comments

With a few weeks to go before the President’s March 26th deadline for agreement on a comprehensive health reform bill, the likelihood of that occurring is diminishingly small. However, even without a comprehensive bill, or even several incremental Federal laws passed this year, health reform will be happening in the States and the private sector, while the Federal government may also pull a few of the strings it has available to shift the operation of our healthcare system:

State Level Health Reform
“State-Level Health Care Reform” is the title of an article in the Feb. 20th issue of the National Journal. …

Missing Pieces of Health Reform

February 23, 2010 / Michael D. Miller MD / Delivery of Healthcare, Economics & Financing, Health System Reform / No Comments

At a briefing in Washington DC this morning, two very well respected and reasonable economists talked about how the increasing prevalence of chronic diseases and care delivery in outpatient settings are driving up costs in Medicare. They also asserted that a greater focus on real cost containment – and possibly cost reduction – should be the focus of health reform, and that this could be achieved by increasing team based care coordination and increasing personal responsibility for care and costs, among other focused initiatives that might require political courage…..which one of them noted appears to be currently in short supply.

Their conclusions and analyses are all well reasoned and reasonable, but having listened to these types of analyses and briefings for more than 20 years I was stuck by two things. …

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