Healthcare Reform and Healthcare Brand Management - A Conversation About Health Insurance Exchanges - What There Is To Know About Web-Based Health Insurance Access For Consumers
The document discusses Accountable Care Organizations (ACOs) and health insurance exchanges established under the Affordable Care Act. It explains that ACOs are groups of healthcare providers that agree to be accountable for quality and costs for Medicare patients. The exchanges allow individuals and small businesses to purchase qualified health plans. The document then provides details on how healthcare entities can become ACOs and considerations around participation, such as investments required and risks of not achieving savings. It also discusses perspectives of physicians, managed care organizations, manufacturers, and patients on ACOs.
How does Healthcare Reform and Accountable Care Organizations impact patients, clinicians and commercial stakeholders? Review the presentation, lead your own discussion and put your new insights to work!
Be sure to visit www.HealthcareMedicalPharmaceuticalDirectory.com for more clinical and business healthcare industry insights!
www.healthcaremedicalpharmaceuticaldirectory.com
John G. Baresky
https://www.linkedin.com/in/johngbaresky
#baresky
A "Conversation About Accountable Care" assesses Accountable Care Organizations (ACOs) and industry stakeholders including managed care, pharmaceutical manufacturers, managed care, physicians and patients. Patient care, hospital, provider and payer impact is discussed.
The Healthcare Medical Pharmaceutical Directory is an information resource for 15 metropolitan areas comprised of merger & acquisition updates, leading clinical and business entities and healthcare industry presentations. Atlanta, Cambridge, Chicago, Denver, Indianapolis, Minneapolis, Nashville, Philadelphia, Pittsburgh, Princeton, Raleigh-Durham, Salt Lake City, San Diego, San Francisco, Seattle.
www.healthcaremedicalpharmaceuticaldirectory.com
John G. Baresky
https://www.linkedin.com/in/johngbaresky
#baresky
A "Conversation About Accountable Care" assesses Accountable Care Organizations (ACOs) and industry stakeholders including managed care, pharmaceutical manufacturers, managed care, physicians and patients. Patient care, hospital, provider and payer impact is discussed.
www.healthcaremedicalpharmaceuticaldirectory.com
John G. Baresky
https://www.linkedin.com/in/johngbaresky
#baresky
A "Conversation About Accountable Care" assesses Accountable Care Organizations (ACOs) and industry stakeholders including managed care, pharmaceutical manufacturers, managed care, physicians and patients. Patient care, hospital, provider and payer impact is discussed.
www.healthcaremedicalpharmaceuticaldirectory.com
John G. Baresky
https://www.linkedin.com/in/johngbaresky
#baresky
How does Healthcare Reform and Accountable Care Organizations impact patients, clinicians and commercial stakeholders? Review the presentation, lead your own discussion and put your new insights to work!
Be sure to visit www.HealthcareMedicalPharmaceuticalDirectory.com for more clinical and business healthcare industry insights!
www.healthcaremedicalpharmaceuticaldirectory.com
John G. Baresky
https://www.linkedin.com/in/johngbaresky
#baresky
A "Conversation About Accountable Care" assesses Accountable Care Organizations (ACOs) and industry stakeholders including managed care, pharmaceutical manufacturers, managed care, physicians and patients. Patient care, hospital, provider and payer impact is discussed.
The Healthcare Medical Pharmaceutical Directory is an information resource for 15 metropolitan areas comprised of merger & acquisition updates, leading clinical and business entities and healthcare industry presentations. Atlanta, Cambridge, Chicago, Denver, Indianapolis, Minneapolis, Nashville, Philadelphia, Pittsburgh, Princeton, Raleigh-Durham, Salt Lake City, San Diego, San Francisco, Seattle.
www.healthcaremedicalpharmaceuticaldirectory.com
John G. Baresky
https://www.linkedin.com/in/johngbaresky
#baresky
A "Conversation About Accountable Care" assesses Accountable Care Organizations (ACOs) and industry stakeholders including managed care, pharmaceutical manufacturers, managed care, physicians and patients. Patient care, hospital, provider and payer impact is discussed.
www.healthcaremedicalpharmaceuticaldirectory.com
John G. Baresky
https://www.linkedin.com/in/johngbaresky
#baresky
A "Conversation About Accountable Care" assesses Accountable Care Organizations (ACOs) and industry stakeholders including managed care, pharmaceutical manufacturers, managed care, physicians and patients. Patient care, hospital, provider and payer impact is discussed.
www.healthcaremedicalpharmaceuticaldirectory.com
John G. Baresky
https://www.linkedin.com/in/johngbaresky
#baresky
This presentation from the 2014 ASHRM Conference analyzes the legal, regulatory and clinical risks related to meaningful consent and offers ways to mitigate them.
Learn some simple truths about how ACO's operate and function. Adapted from http://www.insight-txcin.org/post/why-accountable-care-organizations-succeed
Online Conference Takes “Deep Dive” into Affordable Care ActPYA, P.C.
PYA’s Martie Ross, Principal, joined three other panelists in a full-day, online conference sponsored by the American Institute of Certified Public Accountants to offer an in-depth look at healthcare reform under the Affordable Care Act (ACA).
Accountable Care Organizations: 4 Physician BenefitsGreenway Health
Why would physicians join an Accountable Care Oragnization (ACO)? This informative slide presentation gives a brief overview of ACOs, their benefits, and four reasons physicians may have for joining one.
Patient Centered Medical home talk at WVUPaul Grundy
To employers the cost of healthcare is now a business issue and this talk is about what one large buyer IBM did to drive transformation via broad coalition with other large employers to form the Patient Centered Medical Home movement and the covenant between buyer and provider away from the garbage we now buy episodic uncoordinated disintegrated care. In the change of convenient conversation we have worked with the Primary care providers to give us coordinated, integrated, accessible and compressive care with a set of principles know as the Patient centered medical home.
A Patient Centered Medical Home (PCMH) happens when primary care healers keeping that core healing relationship with their patients step up to become specialists in Family and Community Medicine. The move is to the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system. PCMH happens when the specialists in Family and Community Medicine wake up every morning and ask the question how will my team improve the health of my community today?
All over the world three huge factors are in play that is driving the concept of Patient Centered Medical Home. They are:
1) Cost and demography
2) Information technology and data (information that is actionable will equal a demand for accountability by the payer or buyer of the care)
3) Consumer demand to engage healthcare differently (at least as well as they can their bank- on line) have a question about lab results why not e-mail?
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
The healthcare reform debate is very heated and this presentation is our effort to cut through some of the misunderstandings and misinformation. We hope you find it helpful!
Trends From The Trenches : Adapting to Affordable Care Act: Provider and Heal...Andrea Simon
As the Affordable Care Act is implemented and healthcare expenditures continue to rise, providers and payers need to explore how to best set themselves up to succeed in an evolving marketplace. In this 5th webinar, Margaret Davino will discuss how the relationships between hospitals, physicians and other providers are changing and what structures are being used for providers and payers to work together, including accountable care organizations (ACOs). Margaret will also describe the different models of collaboration between hospitals and physicians, how these affect reimbursement, and what to expect in the future.
This presentation from the 2014 ASHRM Conference analyzes the legal, regulatory and clinical risks related to meaningful consent and offers ways to mitigate them.
Learn some simple truths about how ACO's operate and function. Adapted from http://www.insight-txcin.org/post/why-accountable-care-organizations-succeed
Online Conference Takes “Deep Dive” into Affordable Care ActPYA, P.C.
PYA’s Martie Ross, Principal, joined three other panelists in a full-day, online conference sponsored by the American Institute of Certified Public Accountants to offer an in-depth look at healthcare reform under the Affordable Care Act (ACA).
Accountable Care Organizations: 4 Physician BenefitsGreenway Health
Why would physicians join an Accountable Care Oragnization (ACO)? This informative slide presentation gives a brief overview of ACOs, their benefits, and four reasons physicians may have for joining one.
Patient Centered Medical home talk at WVUPaul Grundy
To employers the cost of healthcare is now a business issue and this talk is about what one large buyer IBM did to drive transformation via broad coalition with other large employers to form the Patient Centered Medical Home movement and the covenant between buyer and provider away from the garbage we now buy episodic uncoordinated disintegrated care. In the change of convenient conversation we have worked with the Primary care providers to give us coordinated, integrated, accessible and compressive care with a set of principles know as the Patient centered medical home.
A Patient Centered Medical Home (PCMH) happens when primary care healers keeping that core healing relationship with their patients step up to become specialists in Family and Community Medicine. The move is to the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system. PCMH happens when the specialists in Family and Community Medicine wake up every morning and ask the question how will my team improve the health of my community today?
All over the world three huge factors are in play that is driving the concept of Patient Centered Medical Home. They are:
1) Cost and demography
2) Information technology and data (information that is actionable will equal a demand for accountability by the payer or buyer of the care)
3) Consumer demand to engage healthcare differently (at least as well as they can their bank- on line) have a question about lab results why not e-mail?
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
The healthcare reform debate is very heated and this presentation is our effort to cut through some of the misunderstandings and misinformation. We hope you find it helpful!
Trends From The Trenches : Adapting to Affordable Care Act: Provider and Heal...Andrea Simon
As the Affordable Care Act is implemented and healthcare expenditures continue to rise, providers and payers need to explore how to best set themselves up to succeed in an evolving marketplace. In this 5th webinar, Margaret Davino will discuss how the relationships between hospitals, physicians and other providers are changing and what structures are being used for providers and payers to work together, including accountable care organizations (ACOs). Margaret will also describe the different models of collaboration between hospitals and physicians, how these affect reimbursement, and what to expect in the future.
Similar to Healthcare Reform and Healthcare Brand Management - A Conversation About Health Insurance Exchanges - What There Is To Know About Web-Based Health Insurance Access For Consumers
An in-depth discussion of the key clinical and financial concepts of healthcare reform and accountable care organizations. How does it affect clinicians, patients and payers?
www.healthcaremedicalpharmaceuticaldirectory.com
John G. Baresky
https://www.linkedin.com/in/johngbaresky
#baresky
Building Patient-Centeredness in the Real World: The Engaged Patient and the ...EngagingPatients
This paper examines the separate but intertwined ethical, economic and clinical concepts of patientcenteredness and how ACOs provide a structure for turning those concepts into a functioning reality.
Jay Crosson on integrated care - lessons from the USThe King's Fund
Jay Crosson, Senior Adviser for The Permanente Medical Group, shares his experience of integrated health care systems in the US and looks at incentives to support integration between primary and secondary care.
This is from a brief workshop we did at Arizona SkySong for local health care executives. All about the current state of value-based care, accountable care organizations, and general trends we're seeing within the health care delivery space.
Accountable Care Organizations (ACOs) are organizations of health care providers who provide care to a group of patients. Created in an attempt to decrease the cost of service delivery and increase efficiency, value and profit, these organizations are new territory for the CPA professional. This presentation was given to the Michigan Association of Certified Public Accountants at their Healthcare Conference on April 23, 2013.
Establishing a Community-based Framework for ACOs - slide-share 120116Jennifer D.
With the rapid growth of state Medicaid, Medicare, and commercial ACOs, now is the time to establish best practices for addressing the full spectrum of patient needs within an accountable care setting.
Imagine a healthcare system where people live long, healthy lives, receiving quality, affordable care, with clinicians nationwide collaborating to improve outcomes. That's Accountable Care! Learn the benefits of becoming an ACO in this insightful eBook.
Accountable Care Organizations and Physician Joint Ventures .docxAMMY30
Accountable Care Organizations and Physician Joint Ventures
Jeffrey P. Harrison
Chapter 9
“I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient.”
—from The Hippocratic Oath (modern version)
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
1
Learning Objectives
Demonstrate an understanding of the interparty relationships associated with healthcare joint ventures and accountable care organizations.
Understand some of the dynamics and controversies surrounding the concept of accountable care organizations as an alternative approach to the current marketplace.
Demonstrate a basic understanding of the patient-centered medical home with attention to how it supports network-based delivery systems.
Master the concept of physician–hospital alignment and health system integration including consumer, provider, and regulatory developments.
Assess the emerging role of medical groups and hospital-owned group practices across the continuum of healthcare services.
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
2
Key Terms and Concepts
Accountable care organization (ACO)
Clinical integration
Equity-based joint venture
Hospitalist model
Integrated physician model
Medical foundation
Patient-centered medical home (PCMH)
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
3
Introduction
A positive relationship between hospitals and physicians is important to the success of the US healthcare system, because hospitals and physicians can be both collaborators and competitors.
Many hospitals and healthcare systems have moved to various models of physician integration through which hospitals hope to capture market share and physicians seek financial security.
After the Affordable Care Act (ACA) was passed in 2010, physician–hospital alignment became driven by another factor: cost control and quality outcomes in the accountable care era (Reiboldt 2013).
Physicians work in a wide range of settings and serve in leadership positions that have significant responsibility for quality of care.
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
4
Clinical Integration
What Is It?
Coordination of patient care between hospitals and physicians across the healthcare continuum— e.g., an accountable care organization (ACO).
Provides an opportunity to coordinate services through centralized scheduling, electronic health records, clinical pathways, management of chronic diseases, and innovative quality improvement programs.
Clinical integration is necessary to delivering high-quality, affordable care in the current environment (Jacquin 2014).
Clinical.
Market Power, Transactions Costs, and the Entryof Accountabl.docxinfantsuk
Market Power, Transactions Costs, and the Entry
of Accountable Care Organizations in Health Care
H. E. Frech III.1 • Christopher Whaley2 •
Benjamin R. Handel3 • Liora Bowers4 •
Carol J. Simon5 • Richard M. Scheffler6
Published online: 15 July 2015
� Springer Science+Business Media New York 2015
Abstract ACOs were promoted in the 2010 Patient Protection and Affordable
Care Act (ACA) to incentivize integrated care and cost control. Because they
involve vertical and horizontal collaboration, ACOs also have the potential to harm
competition. In this paper, we analyze ACO entry and formation patterns with the
use of a unique, proprietary database that includes public (Medicare) and private
ACOs. We estimate an empirical model that explains county-level ACO entry as a
function of: physician, hospital, and insurance market structure; demographics; and
other economic and regulatory factors. We find that physician concentration by
organization has little effect. In contrast, physician concentration by geographic
Earlier versions of this paper were presented at the International Industrial Organization Conference in
Boston, the International Health Economics Association meeting in Sydney, the Allied Social Science
meetings in Philadelphia, the ACO Workshop in Berkeley, and the Bates White Health Care and Life
Science Seminar in Washington, D.C. Thanks are due to the participants of those meetings, especially
Martha Starr, Dean Rice, and Martin Gaynor for helpful comments. Thanks are also due to Sandra
Decker, Abe Dunn, Robert Obstfeldt, Jim Rebitzer, Michael Morrisey, Jessica Foster, and Lee Mobley
for helpful comments on earlier versions and to the referees and editor of this journal for more recent
useful comments.
& H. E. Frech III.
[email protected]
Christopher Whaley
[email protected]
Benjamin R. Handel
[email protected]
Liora Bowers
[email protected]
Carol J. Simon
[email protected]
1
Department of Economics, University of California, Santa Barbara, Santa Barbara, CA 93106,
USA
123
Rev Ind Organ (2015) 47:167–193
DOI 10.1007/s11151-015-9467-y
http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf
site—which is a new measure of locational concentration of physicians—discour-
ages ACO entry. Hospital concentration generally has a negative effect. HMO
penetration is a strong predictor of ACO entry, while physician-hospital organiza-
tions have little effect. Small markets discourage entry, which suggests economies
of scale for ACOs. Predictors of public and private ACO entry are different. State
regulations of nursing and the corporate practice of medicine have little effect.
Keywords Health care competition � Antitrust � Entry � Integration � Accountable
care organizations � Transactions costs � Obama plan
JEL Classification L 14 � I11 � L44 � I18 � L41
1 Introduction and Overview
The US health car ...
Edwina Rogers, executive director of Patient-Centered Primary Care Collaborative, began her presentation by highlighting the movement to advance medical homes.
With the U.S. being the number one in the world for the cost of healthcare and ranked number 37 in the quality category, something needs to change. Rogers discussed the broad stakeholder support and participation for the movement, as well as the incredible volunteer involvement. The four ‘centers’ include: the Center to Promote Public-Payer Implementation, the Center for Multi-Stakeholder Demonstration, the Center for eHealth Information Adoption and Exchange and the Center for Health Benefit Redesign and Implementation. Medical Homes will provide superb access to care, patient engagament in care, clinical information systems, care coordination, team care, patient feedback and publically available information.
Edwards explained that the Obama administration believes the medical homes concept is the best way to approach healthcare reform. The U.S. House of Representatives has showed great support for the movement and is helping develop and allocate funds for a five-year pilot program. She expressed her enthusiasm for the movement and her prediction that the medical home model is certainly the future of health care.
A complete version of Rogers’ presentation on the Patient-Centered Primary Care Collaborative is available online.
Perficient's physician loyalty program is designed to help health systems better connect and align with the physician community.
Similar to Healthcare Reform and Healthcare Brand Management - A Conversation About Health Insurance Exchanges - What There Is To Know About Web-Based Health Insurance Access For Consumers (20)
Early in August, President Trump issued an executive order focused on improving rural health. In response, the U.S. Department of Health and Human Services (HHS) is moving forward with a series of assertive measures featured in a formal strategic plan to remedy the significant healthcare challenges of farmers and others living in rural communities. It addresses access to quality care, medical staffing, technology, clinical innovation, reimbursement and sustainability.Read the story and contact John Baresky for further details.
Walgreens (NASDAQ: WBA) has signed on a second consumer home delivery service partner. Based in San Francisco, DoorDash will provide home delivery services spanning more than 2,300 items including over-the-counter (OTC) medications to consumers for Walgreens stores.
Read the story and contact John Baresky for further details
Authentic, fact-based healthcare content writing for medical, business, academic, patient and consumer audiences.
Review the presentation then go to the Bare Sky Marketing Healthcare Content Writing Services website. Visit the Examples page that features 2 portfolios and a satellite blog and visit the main Blog page on the website as well.
Both pages feature numerous examples of my healthcare marketing and healthcare content writing work.
The FDA has issued approval for Lynparza (olaparib) in the treatment of adult patients with deleterious or suspected deleterious germline or somatic homologous recombination repair (HRR) gene-mutated metastatic castration-resistant prostate cancer (mCRPC) who have progressed following prior treatment with Xtandi (enzalutamide by Pfizer/Astellas) or Zytiga (abiraterone by Centocor/Johnson & Johnson).
HRR gene mutations occur in approximately 20–30% of patients with mCRPC. Lynparza is a poly (ADB ribose) polymerase (PARP) inhibitor. The poly ADP-ribose polymerase (PARP) enzyme fixes DNA damage in both healthy and cancerous cells. Lynparza is available by prescription only and produced in 100mg and 150mg tablet strengths.
Read the story and contact John Baresky for further details...
Alexion Pharmaceuticals (NASDAQ: ALXN) has announced it is acquiring Portola Pharmaceuticals (NASDAQ: PTLA) for $1.41 billion in cash. Founded in 2003, Portola is based in South San Francisco and produces about $116 million in annual sales.
Closing rural hospitals are reducing access to care in multiple states
Between January 2010 and January 2020, 114 rural hospitals closed. More than 30 of these were critical access facilities. Data from the University of North Carolina Cecil G. Sheps Center for Research provides further insights showing that from 2005 to 2020 a total of 170 rural hospitals shut down. There seems to be no indication this trend is subsiding and a sizable portion of it has occurred during a time of record economic expansion. There is no telling how many more would have closed their doors had a weakened economy continued.
Read the complete story here and contact John Baresky for further details...
Learn about the 7 drivers of pharmaceutical television advertising. Television advertising for prescription drugs is a controversial practice but is an important component of the marketing strategy for many pharmaceutical manufacturers plus other healthcare product manufacturers. The FDA’s Center for Drug Evaluation and Research (CDER) and its Office of Prescription Drug Promotion(OPDG) closely monitor what pharmaceutical companies display and communicate within their television, print, radio or digital ads.
Get the complete insights through this article from Bare Sky Marketing Healthcare Content Writing Services
The World Health Organization has declared the Coronavirus 2019-nCoV a Public Health Emergency of International Concern (PHEIC). The declaration of PHEIC is rare. Upon its designation, various government agencies, healthcare institutions and other stakeholders are officially organized to act and escalate measures in collaboration with each other to combat the issue. The decision was made at a point as 171 persons in China have succumbed to the illness and the disease has spread to at least 18 other nations.
PHEIC events of the past: Ebola, H1N1 Swine Flu, Polio
WHO has deployed the emergency designation five times since the rules were implemented in the mid-2000s:
Ebola virus, 2019, Zika virus, 2016, Polio outbreak, 2014. Ebola outbreak, 2014, Swine flu, 2009
Learn more about the World Health Organization and the PHEIC designation by reading this article from Bare Sky Marketing
Alphabet / Google ( NASDAQ: GOOGL ) continue to build out their healthcare organization with distinguished leadership staff additions encompassing medical, commercial and government experience.
Dr. Karen B. DeSalvo, currently a professor at the Dell Medical School, University of Texas in Austin, will be the first person to have the title of Chief Health Officer for Alphabet / Google / Verily.
The company made the announcement as they progress through a steady workstream of healthcare-centered initatives involving Google Health and Verily Life Sciences. At Dell Medical School, she has two roles as Professor, Department of Internal Medicine and Professor, Department of Population Health. Dr. DeSalvo possesses exceptional medical, business and government experience.
Dr. DeSalvo’s academic and medical credentials include:
- M.D. — Tulane University School of Medicine
- MSc — Clinical Epidemiology — Harvard University
- MS — Public Health — Tulane University
- BA — Biology / Political Science — Suffolk University
In addition to medical academics, Dr. DeSalvo has worked in the commercial healthcare space ( Welltower and Humana ), the Federal Government ( Health and Human Services and Office of Health Information Technology ) and the Municipal Government Sector ( City of New Orleans ).
Alphabet clearly has long term, large scale plans for the healthcare industry. Their present enterprises span pharmaceutical research & development, medical device engineering, cloud computing, genetics, voice recognition technology ( VRT ), artificial intelligence ( AI ) and medical imaging (with advanced focus in oncology diagnosis and treatment).
The bandwidth of their ventures demonstrates the array of uses Alphabet’s growing technology innovation has throughout healthcare and life sciences industries.
Read the story to learn more about Dr. DeSalvo and Alphabet's plans ongoing healthcare initiatives...
Contact John Baresky with your questions and comments...
May Walgreens Boots Alliance be strategically signalling it is up for sale to the highest bidder by presumably going through the motions of taking itself private?
A consumer retail, pharmacy, healthcare services, supply chain leader...
Taking Walgreens private may involve an estimated range of $50 billion to $60 billion to execute the transaction. Most of the company’s global scope and scale are overlooked by consumers and even those in the healthcare sector:
• Founded in 1901, their present CEO, billionaire Stefano Pessina, owns about 16% of the company
• On a daily basis, Walgreens interacts with over 8 million customers in stores and online
• They operate more than 9,000 stores in the United States and more than 13,000 units worldwide in 11 countries.
• Walgreens owns 26% of AmerisourceBergen; one of the world’s largest drug wholesalers
• They are a minority share owner of Option Care Health, the largest home infusion and alternate site care provider in the nation servicing patients in all 50 states and administers over 2 million doses of various IV therapies per month; Option Care Health ( NASDAQ: BIOS ) was formed through the merger of Option Care and BioScrip in 2019
• The company has a pilot venture underway with grocery retail giant Kroger involving Walgreens health and beauty brands being sold in Kroger stores and Walgreens selling select Kroger grocery goods in their stores plus supporting Kroger online ordering consumer pickup services at participating stores
• Microsoft and Walgreens are collaborating on a suite of chronic disease management and patient engagement applications plus a portfolio of connected Internet of Things (IoT) devices for nonacute chronic care management, delivered by Microsoft’s cloud, AI and IoT technologies
• About 78% of the population in the United States lives within 5 miles of a Walgreens store or a Walgreens-owned Rite Aid or Duane Reed store.
• Walgreens has an active partnership with Blue Cross Blue Shield affiliated prescription benefit manager Prime Therapeutics known as AllianceRx Walgreens Prime)
Key Considerations:
• Boots Alliance ( WBA ) is reportedly consulting KKR, a leading global private equity firm, about its options to go private
• With an estimated market capitalization of $50 to $60 billion it would be one of the largest public to private deals in history
• The current debt load of Walgreens is about $15 billion and is a pivotal cost element undertaking such a deal
• If KKR were to orchestrate the public to private deal with Walgreens, it would likely enlist additional financial partners such as other private equity firms and investment bankers
Read the complete details on who may be interested in and most importantly, financially and organizationally qualified, to acquire Walgreens Boots Alliance... Contact John Baresky with your questions or comments...
Amazon has purchased a healthcare technology startup known as “Health Navigator”. Health Navigator, based in Chicago, Illinois, is a clinical healthcare information firm founded by an emergency medicine physician, Dr. David Thompson. Dr. Thompson is board certified in Emergency Medicine and Internal Medicine; his academic background includes the University of Illinois College of Medicine with a residency at McGaw Medical Center of Northwestern University.
Health Navigator encompasses a deep selection of features which account for the core elements of patient care interaction and documentation:
- After Care Instruction ( ACI ): provides health information and care advice for telehealth patients
- Clinical Documentation Support ( CDS ): a telehealth dialogue tool orchestrating patient visit details including initial patient intake, emergency screening and prioritization, consumer-facing health checker or health bot, CarePath ( formulates questions for patients based on their initial reasons for health visit to begin diagnosis ), consumer e-visit form and provider documentation checklist
- Coded Chief Complaints ( CCC ): supports definition, identification of patient’s primary reason for visit ( RFV ) seeking care
- Diagnosis Engine: a proprietary knowledge-based inference engine or processor generating a list of possible causes or pre-diagnoses for a specific symptom or problem that can be aligned with digital health assistants (health bots, diagnosis symptom checkers) and electronic health records ( EHR or EMR ).
- Natural Language Processing ( NLP ): a digital translator program used in patient and clinician dialogue for visit free-text into the Coded Chief Complaint clinical vocabulary
- Non-Commercial Resource Database: features over 25,000 Internet resources comprised of non-commercial websites linked to more than 2,800 clinical concepts (plus over 7,200 references of which many are directly linked through a PubMedIC )
- Triage Engine: calculates a triage score, level of care recommendation ( disposition ) for use in consumer health bots and triage symptom checker applications
As Amazon forges ahead, it will be interesting to see how its actions are reflected within the realm of Haven Healthcare, its healthcare management partnership initiative with Berkshire Hathaway ( NYSE: BRK.A ) and JPMorgan Chase ( NYSE: JPM ). The organization is seeking ways to improve quality of care while reducing cost.
Read the article for the complete details of Amazon's latest acquisition and contact John Baresky for further information...
Oncology initiatives in Women’s Healthcare have gained another valuable therapy to improve patient care and outcomes…
Merck & Co.’s ( NYSE: MRK )Keytruda and combination partner therapy Eisai’s ( OTCMKTS: ESALY ) Lenvima will keep their respective marketing and sales units very busy in the upcoming months. Regulatory agencies in the United States, Canada and Australia have concurrently approval to the Keytruda-Lenvima tandem for women with certain advanced endometrial carcinoma. It represents a significant accomplishment by Merck and Eisai and for government regulatory agencies working together to accelerate the process of advancing medicine whether it’s for completely new products or clinically strategic new indications.
Project Orbis: Improve accuracy and accelerate new drug and indication approvals across multiple nation government agencies...
The parallel decisions are the first made through Project Orbis ;a collaborative initiative of the Food And Drug Administration ( FDA ), the Australian Therapeutic Goods Administration ( TGA ) and Health Canada that seeks to reduce new oncology therapy review turnaround between nations. It champions concurrent submissions by drug manufacturers and collaborative assessments by each of the three government regulatory agencies, sponsors and collaborative reviews by all three agencies.
Project Orbis: A winning initiative for patients and clinicians
New drug approvals and the process of approving additional indications is a detail heavy exercise necessary to qualify performance and safety of medications. By improving the processes within nations and cultivating collaboration between them, patients and clinicians benefit from having access to approved therapies sooner. For advanced medication, payers are often reluctant to cover their costs without specific regulatory approval of precise indications. Project Orbis initiatives helps to overcome this hurdle.
Read the article for complete details and contact John Baresky for further information...
Walgreens Boots Alliance ( NASDAQ: WBA ) ranks at number 17 on the Fortune 500 list of largest firms. Reportedly they are exploring options to take the company private which may also be a strong signal to other industry leaders that it is open to takeover offers. Regardless of what their ultimate goals are, they remain a global force in retail, pharmacy, wholesaler and other sectors. The company’s CEO, Stefano Pessina, has communicated Walgreens is actively pursuing more partnerships as a business strategy that enable it to generate revenue by asserting its corporate, financial, clinical and operations resources to build market access and revenue while disrupting competitors — without having to deploy funding for complete acquisitions that contribute to further to debt loads.
Primary elements of Walgreens Boots Alliance financial profile:
- Market capitalization of $50 billion
- Annual sales: $136.86 billion ( 2019 figures which represented a 5.8% increase over 2018 )
- Earnings: $3.982 billion
- Debt: $15 billion
- Ownership stake of 16% held by CEO Stefano Pessina
Strategic global attributes of WBA
- Business operations in more than 25 nations
- Over 415,000 employees
- More than 18,500 stores located in 11 countries
- Over 390 distribution centers servicing pharmacies ( including pharmacies not owned by WBA ), physician offices and healthcare provider organizations
- Ownership stake of 26% in AmerisourceBergen ( NYSE: ABC ), a global leader in healthcare wholesaler operations ranked at number 12 on the Fortune 500 list; annual sales of $153 billion
Key Points:
- Leading companies seeking strategic alliances with Walgreens
Kroger, McKesson, Microsoft and Prime Therapeutics collaborating with Walgreens
- Brand marketing, pharmacy, market access and technology partnerships driving revenue for Walgreens and partners
- Global and domestic market access, commercial synergies and profit in strategic partnerships
Read the article for complete details on each of the strategic partnerships Walgreens has in place with Kroger, McKesson, Microsoft, Prime Therapeutics
Contact John Baresky for additional details
Amazon (NASDAQ: AMZN ) and its online pharmacy unit, PillPack, have a significant challenge. On the surface, it appears to involve only a small, Iowa-based healthcare and prescription data technology company, ReMyHealth, but drastically scales up and potentially involves some of the largest retail and mail order pharmacy, MCO / PBMs and pharmacy associations in the nation — and a somewhat ambiguous organization known as Surescripts.
Prior to being acquired by Amazon, PillPack had contracts in place with many managed care organizations, PBMs and other entities to be a providing pharmacy in their networks. PillPack’s success in building market access early as an integral part of their business model was just one of the reasons Amazon was impressed enough to acquire them.
As an online mail order pharmacy, PillPack is a competitor to the retail pharmacies represented by the NACDS and NCPA that have part ownership in Surescripts. These same retailers compete with PillPack’s parent company, Amazon, for other consumer product sales. CVS Health / Aetna and Cigna / Express Scripts, the two other ownership stakeholders in Surescripts, operate substantial mail order pharmacies PillPack would compete against.
Amazon has been entering into healthcare-focused partnerships and collaborations with such notable organizations as Accenture, Berkshire Hathaway, Carnegie Mellon, Cedars-Sinai, Cerner, Change Healthcare, JPMorganChase, Merck, National Institute of Health, University of Pittsburgh, University of Pittsburgh Medical Center and others. Amazon has steeply ramped up its understanding of the healthcare sector and identifying opportunities to develop and deploy commercial actions to succeed within it.
Read the complete story and contact John Baresky with any questions...
State Of Digital Healthcare In 2017 - HIMSS - • Healthcare Marketing Leadership Index
• Online and Digital Marketing Techniques Used
• CMS, CRM, and Marketing Automation
• ROI and KPIs
• Web Innovations
• Importance/Effectiveness of Digital Marketing Efforts
• Driving Digital Transformation of the Healthcare Brand
• Resources
• Key Take-aways
• Recommendations From the Research for Providers
My background is healthcare marketing; products (injectable & oral pharmaceuticals, IV pumps, disposables), healthcare services (market access programs, pharmacy benefits), managed care and healthcare digital marketing. Connect with me at LinkedIn and Twitter, visit my healthcare website -an industry resource since 2004...
Twitter: @johngbaresky
LinkedIn: https://www.linkedin.com/in/johngbaresky
My website: www.healthcaremedicalpharmaceuticaldirectory.com
Portfolio: https://www.clippings.me/johngbaresky
#IOT #digital #healthcare #marketing #medical #pharmaceutical #doctor #patient #consumer
... Healthcare Marketing Leader: Pharmaceutical, Medical Device, RPA, SaaS, Digital Marketing Strategy, Managed Care, Market Access - John G. Baresky
DELOITTE: 2017 Global Health Sciences Outlook Report - A global perspective on the healthcare industry and its strategic sectors. Deloitte efficiently delivers an uncomplicated but in-depth look at worldwide healthcare. Rising demand and associated spending are being fueled by an aging population; the growing prevalence of chronic diseases and comorbidities; development of costly clinical innovations; increasing patient awareness, knowledge, and expectations; and continued economic uncertainty despite regional pockets of recovery are just a few of the key issues and trends impacting the global health care sector.
Connect with me at LinkedIn and Twitter, visit my healthcare website -an industry resource since 2004...
Twitter: @johngbaresky
LinkedIn: https://www.linkedin.com/in/johngbaresky
My website: www.healthcaremedicalpharmaceuticaldirectory.com
John Baresky Healthcare Marketing Leader, Pharmaceutical Marketing, Digital Marketing Strategy, Content Marketing Strategy, Market Access Strategy, Healthcare RPA Software Marketing Strategy
These guidelines will enable you to develop assertively effective healthcare digital marketing initiatives with infographs. Launching a brand or seeking strategic options to promote an established brand?...Infographs have powerful attributes making them strategic assets to improve healthcare digital marketing performance, social sharing, brand awareness and ROI.
They can be strategically deployed across digital / social / mobile venues to engage clinicians (doctors, nurses, pharmacists), consumers / patients, managed care / payers, employers, employee benefit consultants and other stakeholders......
HMPD, AbelsonTaylor, Hospira, Takeda / Abbott (TAP), Walgreens and Pfizer. My experience spans advanced medical specialties and healthcare industry sectors. I am the interconnection of brand marketing, digital marketing, managed care marketing and sales...
My healthcare website:
www.healthcaremedicalpharmaceuticaldirectory.com
LinkedIn profile:
www.linkedin.com/in/johngbaresky/
Twitter:
@johngbaresky
Feel free to connect with me on LinkedIn and follow me on Twitter...
... Healthcare Marketing Leader: Pharmaceutical, Medical Device, RPA, SaaS, Digital Marketing Strategy, Managed Care, Market Access - John G. Baresky
These guidelines will enable you to develop assertively effective healthcare digital marketing initiatives with infographs. Launching a brand or seeking strategic options to promote an established brand?...Infographs have powerful attributes making them strategic assets to improve healthcare digital marketing performance, social sharing, brand awareness and ROI.
They can be strategically deployed across digital / social / mobile venues to engage clinicians (doctors, nurses, pharmacists), consumers / patients, managed care / payers, employers, employee benefit consultants and other stakeholders.
HMPD, AbelsonTaylor, Hospira, Takeda / Abbott (TAP), Walgreens and Pfizer. My experience spans advanced medical specialties and healthcare industry sectors. I am the interconnection of brand marketing, digital marketing, managed care marketing and sales...
My healthcare website:
www.healthcaremedicalpharmaceuticaldirectory.com
LinkedIn profile:
www.linkedin.com/in/johngbaresky/
Twitter:
@johngbaresky
Feel free to connect with me on LinkedIn and follow me on Twitter...
... Healthcare Marketing Leader: Pharmaceutical, Medical Device, RPA, SaaS, Digital Marketing Strategy, Managed Care, Market Access - John G. Baresky
Launching a brand or seeking strategic options to promote an established brand? These guidelines will enable you to develop assertively effective healthcare digital marketing initiatives with infographs...Infographs have powerful attributes making them strategic assets to improve healthcare digital marketing performance, social sharing, brand awareness and ROI.
They can be strategically deployed across digital / social / mobile venues to engage clinicians (doctors, nurses, pharmacists), consumers / patients, managed care / payers, employers, employee benefit consultants and other stakeholders. These guidelines will enable you to develop assertively effective healthcare digital marketing initiatives with infographs.
HMPD, AbelsonTaylor, Hospira, Takeda / Abbott (TAP), Walgreens and Pfizer. My experience spans advanced medical specialties and healthcare industry sectors. I am the interconnection of brand marketing, digital marketing, managed care marketing and sales...
My healthcare website:
www.healthcaremedicalpharmaceuticaldirectory.com
LinkedIn profile:
www.linkedin.com/in/johngbaresky/
Twitter:
@johngbaresky
Feel free to connect with me on LinkedIn and follow me on Twitter...
John Baresky Healthcare Marketing Leader, Pharmaceutical Marketing, Digital Marketing Strategy, Content Marketing Strategy, Market Access Strategy, Healthcare RPA Software Marketing Strategy
Get to know the mechanics of how deductibles work, how they are perceived and big data's role and impact. For healthcare marketers, pharmaceutical marketers, health insurance marketers and other healthcare / managed care stakeholders, the deductible feature in health benefit plans has wide reaching impact as does the data and analytics which support it.
... Healthcare Marketing Leader: Pharmaceutical, Medical Device, RPA, SaaS, Digital Marketing Strategy, Managed Care, Market Access - John G. Baresky
More from Bare Sky Marketing Healthcare Content Writing Services (20)
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Healthcare Reform and Healthcare Brand Management - A Conversation About Health Insurance Exchanges - What There Is To Know About Web-Based Health Insurance Access For Consumers
1. Healthcare Reform and
Healthcare Brand Management
“A Conversation About Health Insurance Exchanges”
Healthcare
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2. Healthcare Reform and
Healthcare Brand Management
“A Conversation About Health Insurance Exchanges”
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Pharmaceutical
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3. What is an Accountable Care Organization?
According to the Centers for Medicare and Medicaid Services(CMS)
an ACO is:
“An organization of health care providers that agrees to
be accountable for the quality, cost, and overall care of
Medicare beneficiaries who are enrolled in the
traditional fee-for-service program who are assigned
to it."
4. What are the Exchanges purpose?
The Affordable Care Act (P.L. 111-148 and 111-152) allows each
State to establish an Affordable Insurance Exchange (“Exchange”)
to help individuals and small employers buy health insurance.
They will allow individuals and eligible employers to
compare/select from qualified health plans (QHPs) for families and
their employees that meet benefit design, consumer protection
and other standards.
Exchanges will increase access to coverage by providing a single
source for consumers to determine enrollment eligibility, find
insurance affordability programs and select plans that suit them
By permitting consumers and employers to easily compare plans,
Exchanges will increase competition among issuers and improve
affordability of coverage.
Exchanges are integral to the Affordable Care Act’s goals of
prohibiting discrimination against people with pre-existing
conditions and insuring all Americans.
5. How may a healthcare entity become an ACO?
Collectively speaking they must:
Contract with CMS for 3 years and service 5,000+ Medicare beneficiaries
Be accountable for quality, cost and care of beneficiaries, feature a process for
evaluating their health needs, potentially operate under a capitated
payment/fixed funding pool
Have a defined administrative, clinical and legal structure, a certain number of
primary care providers and likely feature a hospital and other care facilities
Be responsible for issuing savings to providers and not service other Medicare
shared savings plans
Effectively assess, treat, measure and improve care/reduce costs
6. What else may they need?
They need accurate billing and clinical systems to continually
assess/tabulate patient care and costs.
Extensive information sharing conduits with doctors, nurses and
pharmacists to coordinate and deliver highly effective yet economic
care on a daily basis
Successful adoption/implementation of evidence-based medicine
measures
Have provisions in place to work with patients individually
7. How did the ACO idea come about?
Medicare and other payers have been looking for an alternative to
the Fee-For-Service model, which reimburses based on numbers of
patients but not the level of care or cost management of them
The ACO-model initiative originates from the 2003 Medicare
Prescription Drug, Improvement, and Modernization Act
It is part of the provisions to explore alternative ways to deliver high care/low
cost healthcare other than the current U.S. healthcare delivery system
8. What can they be compared to?
Geisinger, Intermountain Healthcare, Kaiser Permanente and Mayo
Clinic have served as “role models” in how optimum patient care,
physician accountability and economic performance can be
achieved
Pilot programs were conducted in Arizona, Kentucky, New Jersey,
Massachusetts, Vermont, Virginia and Texas to gather data and
working knowledge of the concept before it rolled out in 2012
9. Do all healthcare entities have to become ACOs?
No, the ACO initiative is optional
Academic, community and government healthcare facilities and
organizations are continuing to operate according to their individual
business models and may choose not to participate in the ACO
initiative during the initial 3-year run beginning 2012
32 Pioneer ACO plans were initially approved to operate in the
United States
10. Allina Hospitals & Clinics Michigan Pioneer ACP
Minnesota, Western Wisconsin Southeastern Michigan
Atrius Health Monarch Healthcare
Eastern and Central Massachusetts Orange County, California
Banner Health Network Mount Auburn Cambridge Independent Practice Association
Phoenix, Arizona Metropolitan Area Eastern Massachusetts
Bellin-Thedacare Healthcare Partners North Texas ACO
Northeast Wisconsin Tarant, Johnson and Parker counties in North Texas
Beth Israel Deaconess Physician Organization OSF Healthcare System
Eastern Massachusetts Central Illinois
Bronx Accountable Healthcare Network (BAHN) Park Nicollet Health Services,
New York City (Bronx) and Westchester County, New York Minneapolis, Minnesota Metropolitan Area
Brown & Toland Physicians Partners Healthcare
San Francisco Bay Area, California Eastern Massachusetts
Dartmouth-Hitchcock ACO Physician Health Partners
New Hampshire, Eastern Vermont Denver, Colorado Metropolitan Area
Eastern Maine Healthcare System Presbyterian Healthcare Services-Central New Mexico Pioneer ACO
Central, Eastern and Northern Maine 32 Pioneer Central New Mexico
Fairview Health Systems ACO Plans Primecare Medical Network
Minneapolis, Minnesota Metropolitan Area Southern California, San Bernardino and Riverside Counties
Franciscan Alliance Renaissance Medical Management Company
Indianapolis, Central Indiana Southwestern Pennsylvania
Genesys PHO Seton Health Alliance
Southeastern Michigan Central Texas , including Austin and 11 counties
Healthcare Partners Medical Group Sharp Healthcare System
Los Angeles and Orange Counties, California San Diego County, California
Healthcare Partners of Nevada Steward Health Care System
Clark and Nye Counties, Nevada Eastern Massachusetts
Heritage California ACO TriHealth, Inc.
South Central and Coastal California Northwest Central Iowa
JSA Medical Group, division of HealthCare Partners University of Michigan
Orlando, Tampa Bay and surrounding South Florida Southeastern Michigan
11. What’s the difference between Shared Savings and Pioneer Programs?
The Shared Savings Program implements a legislative obligation
established in the Affordable Care Act to create a structure for
groups of healthcare providers to become ACOs
The Pioneer ACO Model tests effectiveness of a payment plan:
If a plan is successful, they will show a profit and qualify for a share of the
savings they have earned through successful care/cost management of the
Medicare beneficiary patients they treated
Depending upon the minimum savings threshold (which may be from 2% to
3.9%),CMS will return some of the savings (as much as 60%) to the ACO to
reward its providers
12. Is it a good idea to become an ACO?
It could prove to be successful and be an important conduit for
providers and managed care to get focused access to the Medicare
patient population
Some ACOs may become stronger as inherent healthcare systems
by employing more physicians, caring for more patients and doing it
more cost effectively than other healthcare providers in their
marketplace
It may prove to provide better patient care and be the wave of the
future in the delivery of healthcare in the United States
13. Why would an organization not participate?
Significant investments are required to develop and implement an
ACO including:
Patient care/clinical protocol development and tracking
Physician group contracting and coordination of care between doctors,
nurses, pharmacists and other providers
Information technology
Risk-sharing capability and resources
There is no guarantee the ACO model will be effective or patient
care/savings will result in real financial return
14. What happens if an ACO is not successful?
They will not be eligible to earn additional funds through the
shared care/cost savings incentive
They will still be required to participate in the program for the
duration of their contract with CMS
Depending upon their arrangement with CMS, they may have to
pay a certain amount of the coverage costs back to the
government in a “risk sharing agreement”
15. What do physicians think of ACOs?
Some do not believe they will be fairly reimbursed for delivering
high levels of quality care and cost savings by the ACO they are
affiliated with
Certain physicians believe it may drive them to alter how they
normally treat patients and potentially under treat patients to keep
costs down
Physicians maybe engaged by the program if it suits their practice
management style and stabilizes their income/reimbursement
Other physicians may not have a choice if they are employed by a
healthcare organization participating in the program
16. What does managed care think of ACOs?
Conceivably, improved care means lower costs and in the long run,
MCOs could realize greater margins/less risk
If quality of care and cost reduction goals are not met, ACOs could
be overly burdened with clinical, financial and technical operating
structures unable to deliver results
Some managed care plans are concerned about the leverage
sizable healthcare systems have against them in an ACO
arrangement and in their commercial plans as well
17. What do healthcare manufacturers think of ACOs?
ACOs are another administrative/contracting structure for them to
strategically/tactically account for
If their product is part of the standard of care which an ACO
adopts, they are in a good position, if they are not, then they have
less access to the providers/patients in the ACO plan
For products to be considered as part of the standard of care, they
will have to clinically demonstrate they can deliver cost-effective
care and/or reduce their prices for a stronger economic position
within treatment protocols
18. What may Medicare patients think of ACOs?
It is still too early to tell as each of the pilot programs operates
differently and patient care experiences are in early stages
Conceptually:
If patients have access to physicians they prefer, receive better care,
experience less issues with medical records and incur less out-of-pocket
costs, they will embrace the ACO model and it will be expanded beyond
Medicare into commercial sector applications
If they experience restrictive access to care, administrative issues, increased
costs or confronted with overly cost-based treatment considerations , ACOs
will be associated with the unpopular, rigid staff model HMOs of the early
90s which fell into disfavor
19. What is the outlook?
Ongoing clarification of the legislation and enhancements made in
implementation/operation could steer ACOs in different ways
Those healthcare systems choosing not to participate may
selectively adopt certain ACO methodologies/principles to enable
themselves to operate more efficiently, then promote their
performance and eventually formalize their ACO status later
The limited number of ACOs participating will clearly and quickly
determine the success of the concept
The Federal government will closely assess progress and seek an
optimum, ongoing arrangement
20. What about Healthcare Brand Management?
There are a number of opportunities to engage the ACO initiative:
Professionally recognized prescribing/treatment protocols and key
indications may position a brand over another and achieve optimum access
Potential for Comparative Effectiveness Research (CER) and Health
Economics Outcomes Research (HEOR) applications present themselves but
will require additional funding by pharmaceutical manufacturers
Pull-through promotion and clinical presentations must champion the
brand’s ability to parallel the care/cost goals of the ACO’s protocols
Additional market segmentation and contracting strategies will be required
Fluid communication, web-based brand/clinical information sharing is key
21. For ongoing business and clinical healthcare industry resources, please go to:
www.HealthcareMedicalPharmaceuticalDirectory.com
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