James A. Polo, MD, MBA

🏥 Extending Hospital at Home: A Bipartisan Initiative 🏥 Senators Tom Carper (D-Del.) and Tim Scott (R-S.C.) have introduced the Hospital Inpatient Services Modernization Act of 2024. This pivotal legislation aims to extend the CMS Acute Hospital Care at Home waiver program for five additional years. Here's what this means: - **Continued Success**: The program has shown to reduce healthcare costs, improve patient outcomes, and alleviate hospital burdens. - **National Reach**: Currently active in 37 states, including Delaware and South Carolina, with the program set to expire on December 31, 2024. - **Home Care Benefits**: Enables Medicare beneficiaries to receive hospital-level care in the comfort of their own homes. - **Bipartisan Support**: This extension builds on prior successes and bipartisan efforts to innovate healthcare delivery. - **Healthcare Evolution**: ChristianaCare has successfully admitted over 1,000 patients, showcasing the effectiveness and patient satisfaction with home-based care. 🗨️ "Our efforts aim to revolutionize healthcare by allowing vulnerable Americans to receive high-quality care at home, reducing traditional hospital risks," said Senator Scott. Take a look a the bill here: https://lnkd.in/ge4CMpx8 #HospitalAtHome #HealthcareInnovation #BipartisanHealthcare #Medicare #HomeCare #PatientCare #HealthPolicy #ModernMedicine #SeniorCare #CMS 👩‍⚕️🏡 Let's support the future of healthcare, where home is where the healing happens!

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Measuring Quality of Care Quality matters. Better health for everyone should be America’s goal. Where you live and receive your healthcare services makes a difference in your health.   Fortunately, objective understandable quality metrics are now easily available at https://lnkd.in/eVQyZ2E6. This easy-to-use website created by the federal government to help potential patients facilitate comparisons among hospitals is based on a variety of the more than 100 measures CMS publicly reports, divided into 7 measure groups or categories: Mortality, Safety of Care, Re-admission, Patient Experience, Effectiveness of Care, Timeliness of Care, and Efficient Use of Medical Imaging. Adding rationality to decision-making in determining where to go for care has the added benefit of improving performance for all hospitals because every healthcare system will have the extra motivation to improve its “grades.”   Better performance also translates system-wide to fewer complications, decreased waste, and lower costs. All these attributes contribute to a healthier America and the ability to transfer resources previously regarded as “waste” in healthcare to other worthwhile endeavors such as education, infrastructure, safety, and environmental protection.         Healthcare is the largest industry by far in America, consuming 18.3% of the GDP at $4.5 trillion dollars and growing. If the U.S. healthcare industry were considered a country, it would be the fifth largest in the world behind the U.S., China, Japan, and Germany. U.S. healthcare is larger than the United Kingdom. U.S. healthcare perennially ranks last in healthcare of the eleven most developed nations.     Healthcare systems living off a past reputation and perceived greatness, embellished and polished by extensive marketing, are no longer rational, effective, or fair to a naïve, stressed sick person. The most venerable institutions are now the most vulnerable.   Clear metrics such as heart failure, heart attack, pneumonia, and post-operative mortality rates objectively differentiate potential outcomes based on where you go for care. All this data is adjusted for age and severity of illness and, although the system is not perfect, it is the best we currently have, with all institutions having the same grading system.   Additionally, and arguably, even more important than being a repair shop, alert healthcare systems should be focused outside the four walls of their institutions. Sadly, our nation’s life expectancy has decreased in the last few years. This decline hasn’t happened since 1963.   Life has changed. Where you get care matters. Do your homework and add to your life expectancy. America can have better care for everyone now using accessible digital transparency.

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"A one-year analysis of 21 Kaiser Permanente Northern California Oncology practices presented at the 2023 American Society of Clinical Oncology Annual Meeting found that each of its oncologists respond to an average of 19 secure patient-physician portal messages per day, including weekends (Abstract 1503). The unseen value of these messages was estimated to be more than $11 million, including roughly $3.8 million in avoided out-of-pocket patent copayment costs and $7.7 million in missed billing. Major cancer centers are increasingly billing for some nonurgent patient portal messages, including Johns Hopkins Medicine, Michigan Medicine, Cleveland Clinic, and the Fred Hutchinson Cancer Center. In addressing the ethics of billing, Dr. Nazha said that health systems need to create an approach that, “1) is efficient and equitable, 2) ensures patients receive valuable and timely access to medical services, and 3) protects the well-being of healthcare providers.”" https://lnkd.in/eYgsKy_x

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Do you want to see who knows what we need to do and what is most important to fix health care? Listen to Sue Veer addressing this Committee. Hear from those who have a heart for serving most Americans most behind and are willing to sacrifice to address the next generation always ignored - and then we wonder why outcomes get worse. She was discussing 340B in about them most balanced and informative way possible. She noted how the CHC used 340 B "supports health care services that would otherwise be unavailable in many of the communities that we serve... the one that is near and dear to my heart are those early childhood services that are otherwise unfunded because we are building the health of the future generation" - Early Childhood Services - Sue Veer - More than a Hero - A leader for our nation and absolutely on target with her heart and her service and her testimony $600,000 margin lost and 0.6 FTE of labor to comply with 340 B - loss of nearly $700,000 in delivery capacity for those most in need! Did you hear this Congress, CMS, and others how you cut the lifeblood and distract the delivery team members time and time again over the past 40 years of design changes. Stop killing hospitals, practices, and delivery team members where most Americans are most behind. Start paying attention to Sue Veer and many others like her who can teach you how your designs fail and how they can work - for future generations. You do not fun health care where needed. You have forced a patchwork. Please don't kill the patches and pieces before you actually implement a plan for sufficient basic health access for 95% of the nation, not just 50 - 60%. Listen to the heart of health care delivery. Listen to those that you must fully fund who are the only ones that can be most and best for most Americans most behind.

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Fascinating new research from Dr. Jeralyn Bernier Jacobs, a physician research scholar at Mid-Atlantic Permanente Medical Group | Kaiser Permanente, shows a significant rise in the incidence of #prediabetes and #TypeIIDiabetes in children and adolescents early in the COVID-19 pandemic. As Dr. Jacobs says, “The pandemic's impact on our children’s health was notable and has potential longstanding implications.”   I look forward to Dr. Jacobs’ future research on pediatric diabetes. #PermanenteResearch https://lnkd.in/gfW2M2S5

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Fabulous webinar and conversation yesterday about AI in Healthcare cross-country from Mid-Atlantic Permanente Medical Group | Kaiser Permanente with my colleague from SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP Dr. John Rott, thank you Chris Corriveau and the entire team who helped organize. Sharing these apropos tips from our most recent Forbes Technology Council article on "19 Ways To Manage Different Stakeholders 😍" https://lnkd.in/eWymqdkg Top 19! 1. Strive For Collaboration 2. Prioritize Investments Based On Results 3. Communicate Openly 4. Embrace A Long-Term Portfolio Strategy 5. Prioritize With A Strategic Framework 6. Assess Dependencies 7. Develop A Transparent, Systematic Framework 8. Determine Needs And Wants 9. Use Outcome-Oriented Metrics 10. Consider The Value 11. Help Stakeholders Find Common Ground 12. Establish And Follow A Principle-Driven Approach 13. Let Data Drive Your Decision-Making 14. Implement Teams To Focus On Stakeholder Engagement 15. Prioritize Streamlining Workflows And Processes 16. Understand Your Customers’ Needs 17. Hold Stakeholder Meetings Regularly 18. Put A Governance Mechanism In Place 19. Encourage Empathy

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Once again, we see patients stuck in the middle of a payor/provider negotiation. The stakes seem to get higher and higher for both sides. This article puts out a couple of observations: Stremikis noted that as mergers occur in the health industry, patients are left with fewer choices. Any time there are disputes, disruptions are felt more widely. And such fights rarely result in lower costs for consumers long-term across California; and A KFF analysis found widespread evidence that consolidation of health providers leads to higher health care prices for private insurance. The same brief from 2020 found some evidence suggesting that large, consolidated insurance companies are able to obtain lower prices from providers, but that has not necessarily led to lower premiums for patients. Lets hope the pendulum swings back into equilibrium soon... https://lnkd.in/gwfkXFPt

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In my new piece, I will dissect this issue from various angles regarding the for-profit healthcare model and the debate, prompting stakeholders, from doctors to economists, patients to lawmakers, to voice their concerns and opinions. The notion of for-profit healthcare is like a surgeon's scalpel—capable of healing, but also, in the wrong hands, capable of inflicting severe harm. #valuebasedcare #innovation

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Medicare Advantage (MA) impacts patients and providers significantly. For patients, it involves hours wasted on prior authorization requests, limited access to physicians due to narrow network plans, and high healthcare costs for underinsured beneficiaries. Providers face challenges with the administrative burden of prior authorizations and negative outcomes for patients, including increased likelihood of death after certain surgeries for MA beneficiaries

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Articles on Late Adulthood Here is the second in my series of articles on Late Adulthood published by "Excellent Care, Decency and Optimal Living" (ECDOL.org): "Late Adulthood: Options and Guides for Choosing Where to Live (Part 1)" Please see the link below: https://lnkd.in/e2VVTT9m #AgeInPlace, #Boomers, #Retirement, #eldercare, #seniorliving, #caregiving

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Did you know 90% of our $4.5 trillion healthcare spending goes to chronic and mental health conditions? As healthcare costs continue to rise, physicians, group practices, and hospital systems need to focus on effective chronic care management (#CCM) strategies to coordinate care, improve patient outcomes, and create sustainable financial models that successfully navigate the future of #healthcare. My latest post, with good friend Greg Fulton, dives deep into the benefits of integrating CCM into value-based care models. We explore how new Centers for Medicare & Medicaid Services guidelines for concurrent reimbursement, the impact of care coordination on patient costs, and how implementing CCM can significantly enhance revenue and patient care quality. Discover how strategic use of #MIPS and ACOs can also significantly boost your revenue and strengthen your negotiation power with payers. Read on to learn why CCM is your key to a more profitable and sustainable healthcare practice. Let’s start building a healthier future today! Read the full article here => https://lnkd.in/eD5u9bww #CCM #RPM #TCM #BHI #CoCM #RTM #PCM #CPM #CEO #CRO #Strategy #Leadership #Growth #Innovation #JustinBarnes #HITAdvisor #StrategicPlanning #DigitalHealth #HealthTech #HIThinkTank #ServantLeadership Healthcare NOW Radio Answers Media Network SiriusXM Spotify

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📌 We need to identify and remove bad friction to simplify workflows in health care and improve the human experience for our care team members AND our patients. Imagine if all health systems invested in identifying and removing bad friction in EHR workflows doing these 6 things shared by the American Medical Association. 1️⃣ Identify the pain points 2️⃣ Ask the “why” of the current state 3️⃣ Prioritize the work 4️⃣ Change the EHR inbox workflow 5️⃣ Eliminate, automate, delegate, and collaborate 6️⃣ Remove items that don’t add value #RethinkAndRedesign #SimplifyTheEHR #HumanCenteredWorkflows

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Our work on differences in Home Health utilization and outcomes between Medicare Advantage and Traditional Medicare continues to inform the conversation in healthcare media: https://lnkd.in/gWY-9vYe

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🤖 Artificial Intelligence should be viewed as a tool to augment, not replace, human clinicians. The expertise and compassion of healthcare providers remain essential for delivering high-quality, resident-centered care.

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A while back I re-shared an article about the FFS and PMPM rates that would be needed to cover the costs of operating a community health worker (CHW) program by the Waymark research team. This article by the California Health Care Foundation describes how California's CHW program was developed and what they went through, including barriers (like merits of certification, CHW reimbursement rates). It also paints more context on the growing role (and need) of the CHW— a trained specialist with lived experience who helps patients in underserved communities navigate the health system and connect to social supports. The article highlights the key component best: "For generations, CHW/P/Rs have filled critical gaps in California’s health landscape and acted as liaisons between marginalized communities and mainstream systems. As trusted community representatives, they share cultural and linguistic backgrounds with their clients, many of whom are immigrants, people of color, and people with low incomes. And they provide accessible information and support in ways that resonate with their surrounding community." It would be pretty hard to replicate this connection and bridge with centralized care coordinators, discharge planners, customer service reps, etc., let alone AI, imho. As more closed loop referral systems are being implemented across city, county, state HIEs, and, systems, health plans, Medicaid agencies, etc., the increased effort on supporting whole-person care gives rise to more opportunity—and hopefully more funding pathways—for this kind of relevant, community-based work. Really great read by Robin Buller.

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Why big is bad in healthcare: Some interesting comments here on health system consolidation from Andrew Donahue, FHFMA, CPA, HFMA's director of health finance policy. Keep in in mind that this is someone who's extremely sympathetic to the hospital industry. First, he acknowledges that mergers "can lead to less competition, inferior service and higher prices" and goes on to say that the only driver of hospital mergers is private insurance companies giving better rates to bigger systems. In an accompanying interview on HFMA's "Healthcare Blame Game" podcast, Donahue goes even further: "Community healthy systems do not want to be megasystems...growth is not necessarily the strategic imperative...you lose local control." He talks about "megasystems" laying off local staff and cancelling contracts with local suppliers, both of which can be devastating to communities. "The corporate finger can slip off of the pulse of the local community when you have more bureaucratic layers, channels, and processes to navigate." This is a message that needs to be heard across the healthcare industry. Hospitals exist to serve communities, not corporate offices in distant locations. Corollary message: Private insurers, both for-profit and non-profit, have s***-ified the hospital industry with their contracting practices. #ethicalhealthcare #hippocraticcapitalism #hospitals #healthsystems #monopolies #antitrust

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Humanizing healthcare through collaboration. In my approach, I'm deeply committed to igniting change at its core. Challenging the status quo isn't easy, but as a bold leader, I'm always eager to embrace the challenge. My aim is to collaborate with the right great minds in the industry , like Alvin Gore, MD leading the charge at UM and collaboration in care through coding CDI and providers. In addition to Cesar M. Limjoco, M.D. , to revolutionize patient care through innovative practices and insights for Sepsis and quantitative fallacies in diagnosing. I am inspired by Zeev Neuwirth, MD "Reframing Healthcare," I'm driven to unravel the legacy framework that hinders efficiency and quality, aiming to reshape healthcare for the better. Dr. #Zeev puts it so well, “our brains are wired in a legacy framework that is engrained in higher cost, lack of efficiency and quality of care for our patients”. Together, let's embark on this transformative journey, rallying all clinicians, & all healthcare leaders, to join the movement towards a more compassionate and effective healthcare system. Vasanth Kainkaryam, MD, MSHI, CPE, ADS, FAAP, FACP, DABOM thank you for your dedication, passion,and contribution to this noble cause. Together, we can truly make a difference through education and thought driven solutions.

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HHS Releases Strategic Framework for a National Plan on Aging States have been developing multisector plans to better serve their older populations. Now, the federal government is enhancing these efforts with a national plan on aging. On May 30, HHS released “Aging in the United States: A Strategic Framework for a National Plan on Aging” to Congress. Developed by leaders from 16 federal agencies and departments through the ICC, this report outlines our nation’s approach to preparing for an aging population. It aims to improve the aging experience, create age-friendly communities, support family caregivers, and value the professionals providing in-home and community-based care. This effort includes the voices of older adults and stakeholders through the National Plan for Aging Community Engagement Collaborative, supported by West Health, The SCAN Foundation, and The John A. Hartford Foundation. Read the full report https://lnkd.in/eHkp2V6C 🌟 How do you think this national plan will impact our aging population? Share your thoughts in the comments! 🌟

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