No one likes to have "the talk" about how they want to die. It's really not a place any of us want to go for ourselves, or frankly for our loved ones. It's certainly not a topic any of us as employers want to have with our associates, yet we know it's a topic and a time that happens to us all affecting our lives, our work and our friendships. It's a painful thought – so it gets pushed aside and placed once again on the "to do" list for "another day." Until the day people most dread is upon them. Then they wish they hadn't put it off. At that point having had the conversations, asking the tough questions that it takes to put what's called an Advance Care Plan in place would have made all those overwhelming decisions a little clearer. "The talk" might have made the burden of choices not as heavy to bear. Read more.
When I took a delegation of UnityPoint Health – Cedar Rapids board and physician leaders to the United Kingdom nearly a decade ago we went to study a totally different health care system at a time of turmoil and anticipated reform of our American national health care policy. Months later the Affordable Care Act was passed by Congress and we embarked on this generation's version of health care policy reform. Looking back over the past century there has been some major effort of such reform virtually every decade. We are now in the midst of this decade's debate. Read more.
Access Close to Home
There's an axiom that all healthcare, like politics, is local. Or perhaps it's a cliché. At least in one local example it's playing out extremely well. In May Jones Regional Medical Center, a critical access hospital in Anamosa, dedicated a new wing designed to support offering additional physician specialty services to the people in their community. It's the kind of addition many rural hospitals in Iowa would like to be doing but that few can and the reason is pretty simple. Jones Regional is part of a system that encourages as much care being delivered as close to the patient's home as possible. The expansion, almost doubled the size of the hospital, and comes only seven years after the opening of their new facility in 2009. Read more.
The die is cast. On April 1st Iowa will officially transition to a "managed care" Medicaid program. The state, for all practical purposes, will exit the role of care manager and payer, handing those responsibilities over to three Managed Care Organizations (MCO's ) that represent some of the largest for-profit insurers in the country.
The program has been sold on the basis of cost savings to tax payers and better access and quality care to the 560,000 citizens on Medicaid. It is a massive transition, perhaps the largest in scope and speed of any of the thirty-nine states that have transitioned all or part of their Medicaid management from state employees to these managed care "experts", and it is unprecedented in Iowa for handing such a huge, $4.2 billion in annual state expenditures, over to outside contractors, all through administrative fiat versus vigorous public policy debate. Finish the article.
Iowa Caucus on Healthcare: A Silent Cacophony
Talk about much ado about fairly little. We took a call the other day from a national media reporter wanting assistance on getting a story together about how the Iowa Caucus campaigns were focusing in on healthcare as a national issue. We had little to share, primarily because the big healthcare issue in Iowa these days isn't national healthcare policy, but the conversion of our state Medicaid program from a single state-managed system to one parceled out to three (maybe four) private, for-profit "managed care" companies that are claimed to improve access and care coordination while tripling provider's administrative complexity and somehow reducing costs. Read more.
The Vulnerable Among Us
What I should be writing about this month is the impending conversion of Iowa's Medicaid program
to what's being called "Managed Care" as of January 1st, 2016, but I'm
not because there are simply too many unknowns about how this conversion
is actually going to work.
Making the Metal Dance
Picture this: driving down a street that looks like it could be out of an urban Mad Max movie. Concrete towers, steel pipes big enough to walk inside, a deserted horizon, then more asphalt, concrete and red hot molten ore pouring into the ground. Oh, and we're still in Cedar Rapids. Who knew?All that happened one day last month when several of us were invited to visit the local facilities of PMX Corporation. Find out what happens next.
The Sky Did Not Fall - January 2015
Fortunately for all of us the sky did not fall in 2014. A year ago at this time the nation in general and healthcare providers in particular were all in a tither about whether the rollout of the Affordable Care Act (ACA) was going to be a boon or a boondoggle. The answer, of course, was yes. After a chaotic start to new insurance sign ups through healthcare.gov, and the-world-is-ending-as-we-know-it prognostications from virtually all sides of the political spectrum, we survived. Find out how...
Why Mayo - July 2014
What is this new collaboration between UnityPoint Health - Cedar Rapids and Mayo Clinic all about?
I'll admit, this journey started out as a competitive advantage, but over the last year our motivation has matured and changed a hundred and eighty degrees. We knew this collaboration would offer a clinical advantage to our patients but what came as a pleasant additional surprise was the value it brought to our physicians. In the end, we did this because our physicians saw the advantage of the best of both worlds; full utilization of local physicians and specialists, with the added value of layering on the Mayo Clinic expertise, all while keeping our patients here in Cedar Rapids. The fact that we could do this at no additional cost to the patient made it even better. Finish the article...
Personally, I'm tired of hearing, reading and talking about the Affordable Care Act. Obamacare as it is colloquially known continues to roll through new phases of its implementation, with seemingly more glitches than selections and solutions, but roll forward it does. Most of the recent attention has gone to the foul-ups in the Healthcare.gov website where individuals were supposed to be able to find easy-to-use insurance options, prices, subsidies, and out-of-pocket costs. As ugly as that's been I don't think it comes close to what we're about to come to grips with in the new year. Whether you are a provider, employer, employee or patient, the biggest challenge will be sorting out who is covered for what and how any of the services people will want or need in 2014 will get paid for and by whom.
Health care in the United States is changing. It's no secret that the Affordable Care Act requires providers to stop doing business as usual. Its goal is to increase coverage and improve services while lowering costs. But that's not the only reason health care providers are quickly evolving the way we treat patients. For those of us with a lot of skin in the game - such as hospitals and networks of providers - creating a better model of care is necessary because the current fee-for-service system that drives volume is simply unsustainable. Read the rest of the article.