An excerpt from the CEO's Guide to Restoring the American Dream: How to deliver world class healthcare to your employees at half the cost. I often think about a question that should make us all step back a bit. Why are millennials—the largest American generation in history—the first generation to think life won't be better for them than their ...

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Historically, the “do more, bill more” fee-for-service model of healthcare measured success by increased billings. In the fee-for-value era, we need a new framework for assessing healthcare results. Quality indicators are logical but they  are mostly geared towards measuring actions taken. We can borrow a concept from the energy sector for an additional metric.  We need a concept for removing waste and unnecessary care that could be inspired by a concept ...

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”Email is the killer app of patient portals.” I heard a variation of that quote when interviewing people for the patient-provider communication chapter of the book I’ve been co-editing and writing for HIMSS with Jan Oldenburg, Brad Tritle and Kate Christensen. For the organizations who’ve pushed patient portals the furthest into their patient base, email is always the place where things started. In other words, email is the gateway drug for ...

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As both the private and public sector aggressively shift healthcare incentives from a “do more, bill more” to a value and outcome based model, healthcare providers ignore patients role in driving outcomes at their own peril. It is generally understood that patients forget 80-90% of what they are told at the doctor’s office. As incentives no longer reward outcome over activity, this is a disaster financially for health professionals. This ...

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The New Yorker's Dr. Atul Gawande outlined how, at the turn of the 20th century, more than forty per cent of household income went to paying for food and food production consumed nearly half the workforce. Beginning in Texas, a wide array of new methods of food production were piloted. Today, food accounts for 8% of household budgets and 2% of the workforce. As a wide array of small innovations ...

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There's a great deal of planning and testing of new models of care and delivery to respond to healthcare's ever increasing costs. We've all heard about Accountable Care Organizations (ACO) and medical homes. The common concern is that they become a repeat of HMOs with the accompanying misaligned incentives undermining their effectiveness. An exciting new medical home model is rapidly expanding that avoids the dreaded "gatekeeper" that was the undoing of ...

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More and more providers see the value of providing patient portals. In an attempt to be responsive, EMR vendors are providing patient portals that have some limited capabilities (get lab results, email your doctor and possibly fill out a form requesting an appointment). However, just as the ability to design an airplane cockpit is radically different from a car dashboard, so to is designing an EMR geared towards medical professionals ...

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Matthew Mintz, MD recently shared how primary care doctors are set to lose more than half of their salary. It's well documented how primary care has faced a number of challenges with half of primary care physicians saying they'd leave medicine if they could as was mentioned in an earlier piece. There's talk of a "doc fix" as physicians believe the debt ceiling deal is ...

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The federal health reform bill included a little-noticed clause allowing for Direct Primary Care (DPC) models to be a part of the state health exchanges. I believe this will fundamentally alter the health insurance market and is leading to what I call a "Do it Yourself Health Reform" movement. That little-noticed clause (item #3 in 1301(a) of HR 3590) should have the effect of massively ...

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At a time when half of primary care doctors say they'd leave medicine if they had an alternative and the NY Times reports on a family physician who can't give away his practice this hardly seems like the obvious time to claim that primary care is positioned for a renaissance. However, if there's one thing savvy investors have demonstrated, when everyone says to invest in something that is usually the time to ...

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Over 1.5 million Americans travel abroad each year for medical procedures. Services typically sought by travelers include elective procedures as well as complex specialized surgeries such as cardiac surgery, dental surgery, joint replacement, and cosmetic surgeries. However, virtually every type of health care, including alternative treatments, psychiatry, convalescent care and even burial services are available. U.S. based healthcare providers have taken notice as have self-funded employers and health plans. The ...

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In an age of family physicians literally not being able to give away their practices, Brian Forrest has built a successful model that is similar to the age of Marcus Welby where there was a direct relationship between a patient and their doctor. Practices such as Forrest’s Access Healthcare in North Carolina run unencumbered by insurance hassles. As word of Dr. Forrest’s direct pay ...

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The insurance middleman has taken a toll on the family doctor. New practice models plan to change that. Physicians in Seattle, Silicon Valley and Boston are proving what the rest of the world already knows. When you have a high function primary care system, there's less money spent and better health outcomes. Before House, M.D., ...

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Now that I'm well out of my reckless youth phase of my life, I try to preserve the efficacy of my brain. With my lifestyle, there's three actions I take to ensure the integrity of my brain.

  1. Always wear a bike helmet when I bike
  2. Avoid over-consumption of alcohol
  3. Avoid looking at doctor bills and insurance "statement of benefits"
The first two ...

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With my extensive health care background, many people have asked for my opinion during the health reform debate. My response has been that the only way to really "reform" the system is to blow it up and start over, which isn't politically feasible. After delving deeper into the current legislation, I believe that we are going to see something ...

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