Goodies to Download and Share

White papers, analytic briefs, presentations and links to resources.

 
 

Good Reads

Risk-Readiness® for Payers

Download our white paper to see how health plans and government payers use RowdMap’s Risk-Readiness® Benchmarks.

Risk-Readiness® for Providers

Download our white paper to see how hospital systems, provider groups, and post-acute care centers use RowdMap’s Risk-Readiness® Benchmarks.

Risk-Readiness® Use Cases

Download our white paper to see savings realized using RowdMap’s Risk-Readiness® Benchmarks.

Avalanche of Unnecessary Medical Care Is Harming Patients

Article in the New Yorker about how “no value” care is epidemic and unnecessary spend harms patients, their pocketbooks and stifles the delivery system. Thirty cents of every dollar goes to unnecessary spend and up to forty two percent of patients receive no value care every year dwarfing fraud, waste and abuse. An introduction to the concept with examples from Dr. Atul Gawande, Professor, Department of Health Policy and Management at the Harvard School of Public Health & the Department of Surgery at Harvard Medical School.

CMS Sunsetting Fee for Service

Article in Bloomberg from former Director of the Congressional Budget Office, Peter Orszag, explaining how CMS is sun-setting Fee for Service models. Most press follows the MSSP, ACOs and other CMMI programs, but the real power in what CMS is doing comes from new mechanisms to transform traditional FFS Medicare populations into pay for value models. CMS is starting with arguably the largest cost driver, orthopedics, as part of a controlled roll out to enforce phasing out 50% of FFS spend by 2018.

Doctors Need Help Moving from Fee For Service to Pay for Value

Study from the American Medical Association and RAND. "The Effects of Health Care Payment Models on Physician Practice in the United States." Dr. Mark Friedberg, study lead, explains to Forbes, “For many doctors and many physician practices, the desire to be paid a different way is there, but actually doing this is quite difficult." In a nutshell, "To do well with population health metrics, (doctors) had to develop a data infrastructure that they didn’t have. Those kinds of changes require major investments.”

More Good Reads

No-Value Care as Success Criteria for Value-Based Programs

Article in JAMA evaluating Accountable Care Organizations by comparing program participants to national benchmarks from Medicare in order to determine the amount of low-value services of program participants and whether the program mitigated low-value care. Success of the program is not the individual participant's performance against program's operational benchmarks or financial success in the program, but whether the program achieved success in mitigating underlying no-value and low-value care.

Incentivize Value-Based Participants Based on Low-Value vs. High-Value Care

Paper from Health Care Transformation Task Force, co-authored by major payers and providers and RowdMap, on creating sustainable economic value models. "Low-value care is the single largest driver of unnecessary costs, roughly three percent of Gross Domestic Product (GDP), so mitigating low-value care creates an immediate, demonstrable financial impact." "A provider may improve outcomes for a patient, but if a disproportionate amount of low-value care is generated in the process, there will be no savings."

CMS Data Releases Accelerate Transition to Value-Based Payment

Article from Managed Care on RowdMap using CMS data to create high-value networks. "CMS’s data-liberation movement is helping to accelerate the transition to value- and risk-based payment systems. For payers and providers, the trick is knowing what to do with the data." "The beauty of it all is that as fee for service fades into the rearview mirror, the road ahead is paved not only with good intentions but with data that are publicly available, waiting to be harnessed and not locked away in a proprietary database."

Regional Spending Variation and Physician Beliefs

2015 Working Paper from Harvard Business School entitled, "Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending." Article explores variation in spending across populations based on economic models, supply and physician preferences. Physician practice patterns are analyzed and individual physicians are bucketed into cohorts including "Cowboys," or, "those who consistently and unambiguously recommended intensive care beyond those indicated by current clinical guidelines."

Identifying Low-Value Care as Key to Value Based Success

Paper from the Health Care Transformation Task Force White Paper, comprised of 25 health insurances and 6 top health systems that have collectively committed to put 75% of their business into value based arrangements. RowdMap contributed to paper, which recommends identifying, quantifying and reducing Low-Value care as key to creating successful value based programs and risk arrangements.

"Why ‘Useless’ Surgery Is Still Popular"

Article in the New York Times on clinical evidence and market forces impact low-value procedures. "The studies were completed by the early 2000s and should have been enough to greatly limit or stop the surgery," says Dr. Richard Deyo, professor of evidence-based medicine at the Oregon Health and Sciences University. "It may be that financial disincentives accomplished something that scientific evidence alone didn’t."

“Cowboy Doctors" Identified by No-Value Care

Article in Harvard Magazine, presenting additional research in a more popular format. Hundreds of billions of dollars are spent with no additional effect by "Physicians who provide intensive, unnecessary, and often ineffective patient care, resulting in wasteful spending." These physicians are identified by their practice patterns using government benchmark data and labeled "Cowboys." Current incentives "often do not prompt doctors to ask the right questions, such as whether a proposed treatment truly benefits the patient."

How to Stop the Overconsumption of Health Care

Article in Harvard Business Review on low value care, its economic incentives and drivers. "Many of the choices are well informed by clinical evidence and expertise. But all too often they are driven by habit, hunches, or misaligned economic incentives, leading to substantial overuse of unnecessary, even harmful, services."

High Intensity Treatments Grounded in "Therapeutic Illusion"

A 2016 New England Journal of Medicine article on the Choosing Wisely campaign, in which medical societies have identified many tests, medications, and treatments that are used inappropriately. The article focuses on "Therapeutic Illusion" exploring how no-value care occurs "When physicians believe that their actions or tools are more effective than they actually are."

Stress Reduction Outperforms Traditional Care for Back Pain

A 2016 JAMA study looking at the leading cause of disability in the United States, low back pain and comparing the clinical efficacy of a low-intensity, non-traditional option: mindfulness-based stress reduction vs. usual care. In a double-blind study, stress reduction: "compared with usual care, resulted in greater improvement in back pain and functional limitations at 26 weeks."

A Population Health Approach to Risk Adjustment

Article published in the British Medical Journal showing how claims data suffers from observational intensity bias. In other words, cost is a function of supply and preference as much as sickness of a population and public data sets such as the BRFSS allow a more accurate way to adjust than traditional models. This data can be combined with traditional sets for additional visibility to project costs. Link includes an video interview with the authors including David Wennberg, MD, (Board of Advisers, RowdMap, Inc.).

A Population Health Based Approach to Pay for Value

Paper from the Health Care Transformation Task Force of payers and providers committed to putting 75% their business in pay for value risk arrangements. RowdMap, Inc. contributed to this paper, “Proactively Identifying the High Cost Population,” which discusses how to accurately risk adjust populations using new population health data from HHS including supply, demand, preferences and behaviors, to better project costs compared to traditional claims-based models, a key to succeed in pay for value programs.

More and More Good Reads

Experts Agree FFS Fuels Waste and Doesn't Promote High Quality

Article from the Harvard Business Review on which payment model reduces low-value care the most. Author Brent James argues that capitation reduces the most waste. The point is that: "Experts agree that the prevailing method—fee for service—fuels waste and does not promote high-quality care."

How to Pay for Health Care: Payment Models Judged by Reducing Low-Value Care

Harvard Business Review exploring medical economics around transformation from Fee for Service to Pay for Value models. Advocates for bundles as preferred economic mechanism to create "greater efficiency." Point is not the model but the goal of reducing "overtreatment" by reducing "ineffective or unnecessary therapies."

How the U.S. Can Reduce Waste in Health Care Spending by $1 Trillion

Harvard Business Review overview on reducing waste. Clinical waste accounts for $600BB direct and likely secondary impact in $340BB from administrative and demand and supply driven waste. Study highlights previous Institute of Medicine study on 30% of every dollar spend coming from low-value care, "leaving a significant opportunity for innovation in all areas of health care."

Health Care Needs to Practice Using Data to Overcome Resistance

Article in the Harvard Business Review on how to compete in health care. "Health care leaders have not learned how to achieve consensus quickly, overcome cultural resistance to change, or nurture high-performing teams. They have not mastered the principles of lean management or high-reliability cultures. And they have not gained experience in making tough, data-driven strategic choices in the face of powerful resistance, such as when and where to cut services in order to improve efficiency."

Practice Patterns across Lines of Business and Populations

Article in the New York Times exploring mysteries surrounding medicare. Despite many predictions and expectations that Fee for Service Medicare spending will continue to increase, FFS Medicare spending has been slowing. As more providers encounter Medicare Advantage and practice pattern management they change behavior and then apply those more efficient behaviors across their populations to FFS patients.

How Providers Practice across Different Patient Populations and Payment Models

Article in the Journal of Health Economics entitled, "How do doctors behave when some (but not all) of their patients are in managed care?" Explores how providers hold a dominant practice approach applied across patient populations, effectively avoiding cognitive bifurcation based on a patient's health issuance plan and related management protocols. Providers tend to practice with a similar intensity level across disparate patient populations.

Evolving Role of Primary Care in Pay-for-Value

Article from Urgent Care industry report featuring Anthem, Carolinas Healthcare System, American Family Care and RowdMap in the changing role of primary care. PCPs are increasing incentived to practice at the top of their licenses, coordinate care downstream, and intentionally refer to specific specialists in order to improve their value chains by reducing low-value care and succeed in pay-for-value economic models.

Even More Good Reads

Is Your Heart Doctor In? If Not, You Might Not Be Any Worse Off

NPR article summarizing JAMA study, which "found frail patients admitted to teaching hospitals with two common types of heart problems were more likely to survive on days when national cardiology conferences were going on. Heart attack patients who were at higher risk of dying were less likely to undergo angioplasties when conferences were occurring, yet their mortality rates were the same as similar patients admitted at other times."

Overused Medical Services Cost Medicare Billions Of Dollars

NPR article summarizing a JAMA study which "concluded that at least 1 in 4 Medicare beneficiaries received one of these 26 "low-value" services during 2009, and possibly significantly more." "There are hundreds of other low-value services," said McWilliams, a Harvard professor."

Variation in Individual Physicians Practice Patterns

Article on Health Affairs by Harvard professors and Sachin Jain, Chief Medical Officer of CareMore. Article summarizes variation not only in regional practices but among individual physicians. "Physician-level variation is not only pervasive, but substantially impacts the cost, quality, and value of care delivered across a wide spectrum of clinical services." "Creative application" of the benchmark data is called for along with corresponding payment and policy to identifying individual physician variation and incentive its mitigation.

Unwarranted Practice and Pricing Variation

A Health Affairs article, entitled "Making Sense Of Price And Quantity Variations." The article discusses the Zack Cooper study on pricing variation as reported by the New York Times. Both articles show that practice patterns remains stable across Medicare and Commercial populations but that pricing varies within a region as commercial payers often pay over the Medicare benchmark. Both articles call for pricing regulation. These are two different questions, is a surgery necessary and then how much does it cost. Putting risk-ready providers in risk arrangements solves both types of variation.

The Dartmouth Atlas of Health Care

Data, definitions, resources, research and informed decision information from decades of research. The project uses Medicare data to provide information and analysis about national, regional, and local markets, as well as hospitals and their affiliated physicians. This research has helped policymakers, the media, health care analysts and others improve their understanding of our health care system and forms the foundation for many of the ongoing efforts to improve health and health systems across America.

Choosing Wisely

Over 70 specialty societies, Consumer Reports, AARP and the National Partnership for Women and Families in an initiative with the goal of advancing a national dialogue on avoiding wasteful or unnecessary medical tests, treatments and procedures. Resources include evidence-based guidelines for low-value care and services with guides, conversation and information on informed decision making.

Low-Value Care as CMS Critique of Fee for Service Payment Model

Dr. Patrick Conway, Acting Principal Deputy Administrator for Innovation and Quality, Chief Medical Officer, Centers for Medicare and Medicaid Services (CMS) delivered presentation at the CAPG - Colloquium in October 2015. In his "Innovation Update on Risk-Based Payment Models," Conway delivered the CMS critique of Fee for Service payment models. The first slide, first point is "Excess use of low-value services."

Creating a Virtual Cycle: High-Value Networks to Succeed in Value-Based Care

Presentation of session at Health Datapalooza with Jon Blum, EVP of Government Programs at CareFirst (BCBS) and former CMS Deputy Administrator, Steve Ondra, Chief Medical Officer of HCSC (BCBS IL, MT, NM, OK, TX) Neurosurgeon, former Faculty Surgery Northwestern University & Bronze Star Combat Veteran and Ali Khan, Medical Officer of CareMore, an Anthem Company and former Yale Medical Faculty.

Payer-Provider Risk-Readiness®

RowdMap presentation from Health Datapalooza for a select audience of government officials, media, researchers and academics and payers and providers. Overview of how HHS and CMS data is being used by hundreds of millions of consumers, patients and members to make better decisions and receive the right care. Presentation focused on Risk-Readiness®, low-value and high-value care and how to use public, benchmark government data to identify, quantify and reduce low-value care to succeed in transition from Fee for Service to Value-based Care.

Whoa, Even More Good Reads

Are You Risk-Ready?

Presentation to the National Association of Accountable Care Organizations (NAACOS) on how to identify, quantify and reduce low-value care in order to succeed in traditional, next-gen and virtual ACOs.

No Value-Care Meets No-IT Needed

Presentation at HIMSS on how high-value care drives population health financial returns. Newly released government data means no IT integration and information that is ready the next day.

Capturing Your Hidden Value

Presentation at MGMA with RowdMap and Rothman Orthopedic Institute on Using Newly Released Government Benchmark Data to Select Value Programs and Negotiate Risk Arrangements.

Network as Strategic Advantage

Presentation at AHIP with RowdMap and HCSC (Health Care Service Corporation) on Curating a Risk-Ready Network to Succeed in a Value-Based Market.

Negotiate and Succeed in Value and Capitation

Presentation at CAPG, the Voice of Accountable Physician Groups, on how to use government benchmark data find the right value program or the right payer partner and negotiate the right arrangement.

Open Data as an Open Challenge

Presentation at South by Southwest (SXSW) with HHS Chief Technology Officer on Open Data and creating public and social good and market value in health care.

DATALAB HHS Showcase

Presentation at Health Datapalooza with the Department of Health and Human Services (HHS) showcase, DATALAB.

Open Gov Data and You

Trying Your Hand at Open Government Health Care Data; this is a guide with publicly available sources and taxonomy examples.

P0wning Your Risk

A notable event. Health Datapalooza's Risk-Owner Track. Public Data and Bottom Line Impact for Real World Payers, Plans and Risk-Owners. Organized by Kavita Patel of Brookings, former White House; Niall Brennan, Chief Data Officer of CMS; Jon Blum, former Deputy Administrator of CMS; Paul Wallace, Chair of the Board of AcademyHealth and formerly CMO of Optum Labs; Josh Rosenthal, CSO of RowdMap.

Data Science and Infrastructure

A notable event. Health Datapalooza's Data Science track composed of sessions answering key questions around how to use government data including building benchmarks, interpreting information, identifying outlives and best/worst practices. Organized by Niall Brennan, Chief Data Officer of the Centers for Medicare and Medicaid Services and Josh Rosenthal, Chief Scientific Officer, RowdMap.

Healthcare Entrepreneurs BootCamp

A notable event. Using government data to solve public and social good and create market value. An interactive bootcamp bringing together icons, industry experts and upstarts from the financial, academic, legal, clinical, operational and strategic rols across the health care delivery system.

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