I am an health care analyst, advisor and commentator. Principal of Worksite Health Advisors and Moderator of the Healthcare Benefits Hackers Listserv.
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Articles by Brian Klepper
Are doctors' emotions fueling the opioid crisis?
It should be obvious by now, but somehow it is not: Physicians are not immune to the same emotions that govern human behavior everywhere else. We like to imagine that our white coats and years of training somehow grant us a protective immunity to fear, to shame, to the raw surge of emotion that can stop us in our tracks. The truth is, physicians and other medical professionals are just as subject to the power of affect as anyone.
The opioid crisis in wealthy zip codes
To be honest, I never imagined myself treating A-list celebrities and professional athletes in Manhattan. As a young physician in Juárez, Mexico, I spent my earliest years working in community clinics and even pharmacies on the city’s impoverished peripheries. Back then, the idea of practicing at one of the most prestigious hospitals in the United States (let alone as a pain management specialist) was unthinkable.
Why the system is collapsing from within
The Pitt was compelling TV. As an emergency nurse educator for a Stanford campus in Northern California, there is one thing that is required viewing for my new graduate nurses: The Pitt. The ambitious series did an admirable job portraying the complex world of the emergency department. The procedures were clinically accurate. The spectrum of patients and social issues was nuanced and believable.
a key to solving America's opioid crisis
In 1736, Ben Franklin famously advised Philadelphians that preventing fires is better than fighting them. Mr. Franklin’s advice is just as applicable today in addressing America’s opioid crisis. Billions of opioid settlement dollars are being distributed to every state, and a portion of those funds should be allocated to preventing opioid addictions, not just buying fire extinguishers (Narcan) and fighting fires (medication-assisted therapy or substance use disorder treatment).
Health care's Great Resignation will cost employers
It is reasonable to anticipate that, in the near future, providers will demand rate hikes to cover their increased overhead. Four months ago, a Morning Consult poll reported that, since February 2020, almost one in five (18%) health care workers had quit their jobs due to the pandemic. Then a USA Today/Ipsos Poll found that 23% of health care workers say they’re likely to leave health care soon. As it turns out, these figures are misleading.
Where Health Care Value Can Lead
Health Policy Mar 15, 2022• By BRIAN KLEPPER It seems inevitable that, in the near future, an innovative health care organization – Let’s call it The Platform – is going to seize the market opportunity of broader value. It will cobble together the pieces, and demonstrate to organizational purchasers that it consistently delivers better health outcomes at significantly lower cost than previously has been available.
Healthcare reform's deeper problems
Congress' healthcare reform debate has highlighted how American governance is broken and the difficulty of addressing our national problems. Take, for example, whether healthcare is in crisis at all. Conservative commentators argue that America's health system is fine, that our excellent care simply costs more than other countries' poorer quality, and that most uninsureds can afford coverage. They ask why we should revamp a great system for the two or three percent of Americans who get less.
Is the Healthcare Economy Rightsizing?
More than at any time in recent memory, powerful forces are buffeting the health care sector. We are in the midst of profound upheaval, driven by market and policy responses to the industry's long-term excesses. We can already see evidence that the dysfunction of our traditional health system is accelerating. It also seems clear that the center cannot hold indefinitely. Dog Eat Dog It is useful to remember that the health care industry's different stakeholders are adversaries.
Will CIGNA Remake The Health Plan Marketplace?
America's health plans are floundering. If their job has been to provide the nation's mainstream families with access to affordable care (let's leave quality out of it for the moment), they have failed miserably, though they were very profitable along the way, at least until Q1 2008. In 2008, the Milliman Medical Index – an estimate of the total cost for health coverage premium and out-of-pocket costs for a family of four – was $15,609.
Stifling Primary Care: Why Does CMS Continue To Support The RUC?
Last October, the Wall Street Journal ran a damning expose about the Relative Value Scale Update Committee (RUC), a secretive, specialist-dominated panel within the American Medical Association (AMA) that, for the past two decades, has been the Centers for Medicare and Medicaid Services’ (CMS’) primary advisor on valuation of medical services. Then, in December, Princeton economist Uwe Reinhardt followed up with a description of the RUC’s mechanics on the New York Times’ Economix blog.
Can the Relative Value Scale Update Committee (RUC) be defended?
Recently, 47 American medical specialty societies sent Rep. Jim McDermott (D-WA) a letter, with copies to all members of Congress, containing a detailed defense of the American Medical Association’s (AMA’s) Relative Value Scale Update Committee (RUC). For 20 years, the RUC has exclusively advised the Centers for Medicare and Medicaid Services (CMS) on physician procedure valuation and reimbursement. On its face, the letter responds to a seemingly minor piece of legislation introduced by Rep.
Tying Health Care Investment to Performance
Health Tech Oct 16, 2020• By BRIAN KLEPPER and JEFFREY HOGAN recently made the news, notable because the company, launched in 2011, has been profitable since 2016. Evidently, it’s become unfashionable for investors to demand proof of performance, so GoodRx’s results shone like a beacon. By contrast, most health care firms seeking funding convey bold aspirations and earnest promises. Investors throw in with them and hope for the best.
Health Plans Need to Go Farther To Get Us Through the COVID-19 Crisis. Employers Can Encourage Their Cooperation.
COVID-19 Apr 9, 2020• By JEFFREY HOGAN and BRIAN KLEPPER Among its less appreciated but more worrisome impacts, COVID-19 threatens to destabilize America’s health care provider infrastructure. Patients have largely been relegated to sheltering at home and, to avoid infection, are avoiding in-person clinical visits. The revenues associated with traditional physician office visits have been curtailed. Telehealth capabilities are gradually coming online, but are often still immature.
KLEPPER: Business leaders can save NC health care
The North Carolina State Employees Health Plan’s (SEHP) proposal to pay network hospitals less than in the past has been blocked this year by the state’s hospital community, precipitating a visible, high-drama dispute that promises to percolate into the future. State employees will have stable benefits for now.
How a Value Focus Could Change Health Care
Health Policy Aug 14, 2019• By BRIAN KLEPPER, PhD How will the drive to health care value affect health care’s structure? We tend to assume that the health care structure we’re become accustomed to is the one we’ll always have, but that’s probably far from the truth. If we pull levers that incentivize the right care at the right time, it’s likely that many of the problems we think we’re stuck with, like overtreatment and a lack of accountability, will disappear.
Why EHRs Really Haven’t Made Us Healthier: A Response To Glen Tullman
Why EHRs Really Haven’t Made Us Healthier: A Response To Glen Tullman Posted on March 19, 2013 by Brian Klepper Brian Klepper Recently-fired Allscripts CEO Glen Tullman waxed progressive in a self-promotional Forbes article last week, describing the ways past and forward for electronic health records (EHRs) and health information technology (HIT).
When Health Care Organizations Are Fundamentally Dishonest
Health Policy Mar 19, 2019• By BRIAN KLEPPER A class action legal ruling this month, on a case originally filed in 2014, found that UnitedHealthCare’s (UHC) mental health subsidiary, United Behavioral Health (UBH), established internal policies that discriminated against patients with behavioral health or substance abuse conditions.
North Carolina’s brewing battle over health care value
State Treasurer Dale Folwell speaks at a Council of State meeting in Raleigh in 2017.
Saying No to the Drug Crisis
By BRIAN KLEPPER In a recent essay, VIVIO Health’s CEO Pramod John guides us through four sensible drug policy changes and supporting rationales that could make drug pricing much fairer. Reading through it, one is struck by the magnitude of the drug manufacturing industry’s influence over policy, profoundly benefiting that sector at the deep expense of American purchasers. As Mr. John points out, the U.S. has the world’s only unregulated market for drug pricing.
Quality is the Key to Healthcare Value
At its core, America’s healthcare value crisis is rooted in our system-wide failure to focus on managing quality. Health outcomes for specific conditions and procedures vary wildly across providers, health plans, and markets. A highly regarded 2008 PricewaterhouseCoopers study estimated that Our health system optimizes revenues, in part, through excessive care, meaning that many clinicians largely disregard quality, ignoring whether treatment pathways are right or founded in evidence.
How Value Can Save Us
Posted 8/19/2018 on The Doctor Weighs In as “High Value Health Care: Is It the Wave of the Future?” The most consequential health care question of our time is whether the iron grip on policy and the marketplace exerted by the industry’s dominant players – a grip that continues to favor volume-based care, opaque quality and cost information, widespread information blocking, and little in the way of quality or safety management – can be broken in favor of value-based services.
New Approaches to Delivering High-Value Healthcare
The most consequential healthcare question of our time is whether the iron grip on policy and the marketplace exerted by the industry’s dominant players – a grip that continues to favor volume-based, opaque quality and cost information, widespread information blocking, and little in the way of quality or safety management – can be broken in favor of high-value healthcare.
New Approaches to Delivering High-Value Healthcare
The most consequential health care question of our time is whether the iron grip on policy and the marketplace exerted by the industry’s dominant players – a grip that continues to favor volume-based care, opaque quality and cost information, widespread information blocking, and little in the way of quality or safety management – can be broken in favor of value-based services.
A Whiff of Market-Based Health Care Change
Tuesday’s announcement about Amazon, Berkshire Hathaway and JPMorgan (A/BH/JPM) was short on details. The three mega-firms will form an independent company that develops solutions, first, for their own companies’ health plans and then, almost certainly, for the larger health care marketplace. But the news reverberated throughout the health care industry as thoroughly as any in recent memory.
Far better health care value is coming
One of health care’s most corrosive myths is that nothing can be done about exorbitant costs. But there are alternatives, if they can make their way into the marketplace.The health care policy arena has become a tug-of-war between ideologues and special interests, and offers few solutions.
Quit The RUC | Kaiser Health News
Recently, a Wall Street Journal expose and a New York Times column by Princeton economist Uwe Reinhardt detailed how vast health care resources are steered by the American Medical Association’s Relative Value Scale Update Committee — or RUC, a secretive, 29 person, specialist-dominated panel. Since 1991, the RUC has been the main, if unofficial, adviser on Medicare physician reimbursement ?
To Promote Health Care Excellence, Let’s Recognize Approaches That Assure Value
A challenge for health care purchasers is choosing vendors whose performance matches their cost and outcomes claims. A 2015 Mercer survey found that only 41 percent of worksite clinic sponsors think that they’re saving money. As Al Lewis and Tom Emerick have detailed, many wellness and disease management companies simply overstate their results. In many cases employers may not realize that they, not the vendor, take the risk for results.
Key Mechanisms That Define Health City Cayman Islands’ Value Innovation
Health City Cayman Islands (HCCI), less than three years old and located in the Caribbean just an hour’s flight south from Miami, is a 104-bed hospital outpost of Bangalore, India-headquartered Narayana Health (NH). HCCI has caught the attention of US health care professionals not just as a nearshore health care destination, but for having extremely high quality despite pricing that is a fraction of that in the US, as well as careful attention to the patient’s experience.
The Ethical Stain on U.S. Medical Care | Care And Cost on WordPress.com
Posted 11/02/16 on The Doctor Weighs In Bill Bestermann, MD, Medical Director at QualityImpact (COSEHC) Practice Transformation Network in Greenville, South Carolina, has spent the past few years training other physicians to optimize the care of patients with cardiometabolic disease. In a project sponsored by Louisiana Blue Cross, Dr. Bestermann worked with 700 primary care physicians to improve care and outcomes for patients with multiple risk factors.
Why U.S. Prescription Drugs Prices are the Highest in the World | Care And Cost on WordPress.com
It was hard to contain my outrage as I made my way through a special communication in the August 22/23, 2016 JAMA written by Aaron Kesselheim, Jerry Avorn, and Ameet Sarpatwari. The article is titled “The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform.” In this comprehensive review of the issue, the authors provide examples of drug pricing that will make you grind your teeth.
Pink Ribbons (Trailer)
The timing couldn’t be better (or worse, depending on your perspective) for this film. In the wake of Susan G. Komen for the Cure Foundation’s politically-motivated withdrawal (and now reinstatement) of funding to Planned Parenthood for breast screening exams for low income women, today is the film release of Pink Ribbons, a documentary about the corporate machinery and motivations behind the pink ribbon breast cancer campaign.
The Gold Standard for Current Cancer Treatment
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Florida’s Governor Scott and the Public’s Trust
Originally Posted 1/17/16 on The Doctor Weighs In A CNN investigation by Elizabeth Cohen and Katherine Grise asserts that Florida Governor Rick Scott’s administration has scuttled longstanding state hospital quality standards after two Republican political groups received large contributions from Tenet. A for-profit hospital firm, Tenet, operates St. Mary’s Hospital in Palm Beach, which has been scrutinized recently for a high death rate in its pediatric cardiology program.
How the RUC Escaped a Challenge to Our Deeply-Flawed Reimbursement System
By On January 7, a federal appeals court rejected six Georgia primary care physicians’ (PCPs) challenge to the Centers for Medicare and Medicaid Services’ (CMS) 20-year, sole-source relationship with the secretive, specialist-dominated federal advisory committee that determines the relative value of medical services.
Why medical management is critical to health reform
Several years ago I had dinner with a woman who had served in the late 1990s as the national Chief Medical Officer of a major health plan. At the time, she said, she had developed a strategic initiative that called for abandoning the plan’s utilization review and medical management efforts, which had produced heartburn and a backlash among both physicians and patients. Instead, the idea was to retrospectively analyze utilization to identify unnecessary care.
Why CMS should settle with primary care plaintiffs
By mid-November, the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) must respond to the legal complaint filed in a Maryland federal court by six Augusta, Georgia family physicians. These doctors are not asking for money, but for relief from the negative effects brought about by CMS’ twenty year reliance on the American Medical Association’s Relative Value Scale Update Committee (RUC) for valuing doctors’ work.
Why I Am an Information Flaneur
Kent Bottles First published 6/13/11 on Kent Bottles Private Views While reading the New York Times Sunday Book Review (in a hard copy format that got my fingers dirty with ink) I came across this quotation in a Evgeny Morozov book review of The Filter Bubble by Eli Pariser: [Citizens] should not be content as mere passive recipients of tweets, pokes and bytes; they should aspire to become what some Internet scholars call “information flâneurs,” treading the unbeaten paths in cyberspace and...
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