June, 2017 vol. 1 - In This Issue:
Everyone has a shiny new idea on how to transform healthcare. In my view, we already know the basic building blocks of transformation: patient-centricity, effective use of evidence, measuring outcomes, transparency, payment based on value and (at last!) the importance of tending to social determinants of health.  There are some gems in the articles in this issue, as well as a cautionary tale. Out-of-the-box thinking doesn't require something new; just the emergence of new leadership and political will to do it right.

Value over Volume
Measuring Value Based On What Matters To Patients: A New Value Assessment Framework
We spend 18 percent of our national gross domestic product on health care. As health care spending continues to grow and as we appropriately drive the health care system toward a payment system that rewards value instead of volume, it is imperative that we promote conversations on how to define value. To do this, it is critical that we first answer the question: value to whom?

Value in health care can mean different things to different stakeholders. Payer priorities may not match up with manufacturer concerns, and both may assess value entirely differently than public health entities. However, no matter which of these stakeholders is measuring value, it's important that value assessments always robustly consider and measure what matters most to the ultimate consumers of health care: patients.  

Building a Broader Consensus for Health Reform

Republican leaders in Congress are trying to pass legislation rolling back and replacing key features of the Affordable Care Act (ACA) without securing any Democratic support in the effort. On May 4, they succeeded in getting a bill known as the American Health Care Act (AHCA) through the House, but the prospects for passage of a bill in the Senate are unclear; there are many different points of view that make it difficult to reach a consensus. It is also not clear that a bill that can pass the Senate can also pass in the House.

In political terms, it might be best for Republicans if their effort stalls. The ACA was passed in 2010 with only Democratic votes, and that is a major reason the law remains politically and, to a degree, programmatically unstable. The Democratic Party has lost numerous seats at the federal and state levels of government since the ACA was enacted.
Finding Joy in Practice  

Cocreation in Palliative Care

Four years ago, after nearly 20 years in practice, I walked out of the familiar world of infectious disease and into the world of palliative care. In the world I left, I cared for hundreds of patients, educated countless learners, led dozens of infection prevention efforts. But that world felt increasingly superficial, fragmented, isolated, a hard place to find joy and meaning in my work.

I discovered a different world in palliative care, a world that-I think I can say-embodies cocreation. Spend a day with me and see what you think. 

time_for_change.jpg Dartmouth-Hitchcock CEO Dr. James Weinstein:
'If we had to redesign healthcare today, it wouldn't look anything like it does now'

9 Ideas for Change 

James Weinstein, MD, is set to retire from his role as president and CEO of Lebanon, N.H.-based Dartmouth-Hitchcock and Dartmouth-Hitchcock Health June 30, after six years at the helm of the only academic medical center in the state.
Speaking at the healthcare symposium Thursday at Northwestern University's Kellogg School of Management in Evanston, Ill., Dr. Weinstein's comments pertained to D-H but often spanned to cover the big picture of healthcare and its faulty system in America. He is a vocal advocate for change in healthcare delivery and payment, as well as macro-level improvements to improve access to care and reinforce healthy behaviors.  

The Next Generation of Episode-Based Payments

On December 20, 2016, the US Department of Health and Human Services (DHHS) announced the final models for the next group of mandatory episode-based payments. All hospitals accepting Medicare patients in 98 metropolitan areas will be required to accept bundled payments, which include a fixed payment for hospital care plus services for the 90 days following discharge of patients with acute myocardial infarction and coronary artery bypass graft surgery.  Even though the future of bundled payments remains uncertain, as illustrated by the recent delay in DHHS implementation of mandatory cardiac bundles until October 2017, episode-based payments are a fundamental component of alternate payment models currently being instituted by Medicare and private payers.  

In Washington state, a healthcare repeal lesson learned the hard way

Republicans in the state of Washington didn't wait long in the spring of 1995 to fulfill their pledge to roll back a sweeping law expanding health coverage in the state.

Coming off historic electoral gains, the GOP legislators scrapped much of the law while pledging to make health insurance affordable and to free state residents from onerous government mandates.   

Passion + Quality = Change That Matters
I embrace the powerful opportunities in our evolving health care landscape. I founded Momentum Health Strategies to be a catalyst for change through continuous learning, diverse engagement and thoughtful policy and practice initiatives. I deliver innovative, strategic thinking and a passion for improving the patient experience. My personal drive and dedication to high-quality results will help you navigate the competitive terrain you face and convert your vision to action.

Momentum Health Strategies

Jennifer L Bright, MPA
(703) 628 - 0534