When I was in high school, a national hardware retailer opened a new franchise down the street from the mom-and-pop hardware store that had served my neighborhood for many years. Since the new store had the advantage of larger volumes and lower costs, it seemed to be only a matter of time before it drove its smaller competitor out of business, the way that big bookstore chains and fast-food restaurants ...

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Around the country, doctors are leaving independent practice and joining large groups owned by health care systems. It’s a trend: the recruiting firm Merritt Hawkins predicts that if current growth continues, over 75% of newly hired physicians will be hospital employees within two years. There seem to be a number of reasons for this consolidation of physicians and hospitals into islands of care. One is the desire for larger groups to have ...

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American health care has become a gigantic game board with players of all sorts strategizing to win. Winning, of course, means getting more money from payers: government or private. It turns out this medical marketplace game is not all that new. It's just become wilier, as I have shared in a couple of posts over the summer. An obituary last week for Dr. Rashi Fein, an influential economist with a progressive stripe ...

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There’s been a lot of controversy recently about workplace wellness programs: Do they save money for employers on health care costs? Can they produce measurable benefits for employee health? Do they unfairly punish people who are unable to participate? Are these programs just a ploy to shift medical costs to unhealthy employees? Recently Austin Frakt and Aaron Carroll revisited these questions in a piece for the New York Times’ Upshot column, “
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1. Physician assistant (PA) growth will remain unprecedented. Demand is driving growth and PA program expansion.  The educational programs are charging students higher tuition costs for these coveted PA positions. PA students now acquire unparalleled debt, according to a recent Robert Graham Center report; one in four PA students owed more than $100,000. Although high student debt may impact PA graduates ability to go into fields like primary ...

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While there are plenty of valid reasons to be skeptical about the Affordable Care Act, regardless of where you fall on the political spectrum, it’s hard to argue that imposing an individual mandate to purchase insurance won’t result in more people obtaining coverage. According to the results of a recent survey conducted by the Centers for Disease Control and Prevention (CDC), that’s precisely what’s happened. Based on results of the National ...

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Part of a series. Patients need doctors that take time to listen which means a limited number of patients under care. Employers need programs that reduce costs and ideally improve the health of their staff. These apparently disparate needs can come together in a new model for effective company-sponsored primary care programs. Those of you who have followed this series know that I am an advocate for PCPs finding ways to ...

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In health policy circles (yes, those exist!), experts often refer to three aims for a modern health care system: to offer 1) universal access to 2) high quality medical care at 3) an affordable cost. Access, quality, and cost: a possibly unachievable set of goals, certainly in the U.S., where the quality of our care is decent (but uneven), while access to care and the high cost of our care compare dismally to ...

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Urgent care wont replace primary care. Heres why. About seven years ago, the California Healthcare Roundtable and Health Affairs sat down to prepare a white paper on the emerging phenomenon of urgent care centers, and what it might mean for primary care. At the time the group couldn’t agree that urgent care (UC) was a disruptive innovation, but it seemed clear to all participants that it represented a threat to primary care: ...

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This is what population health looks like It is a beautiful day here in my little college town. The sun is shining and at 11 a.m. it is about 78 degrees with a barely perceptible breeze. People are out walking on Main Street and riding their bikes. The mountain nearby calls: I can go for a hike today with my dog and still be within 20 minutes or so ...

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