Category Archives: medical-industrial complex

Models: Here We Go Again

My readers will remember that I have been critical of CMS’ multitude of models for health care payments and such from my articles, Models, Models, Have We Got Models!, Illogical!, or Regulation Strangulation.

So it comes as no surprise that CMS is unveiling another model for a voluntary bundled payment program.

The unveiling was reported today in FierceHealthcare. com. Called the Bundled Payments for Care Improvement (BCPI) Advanced model, it is the first model launched by CMS under the current political regime now occupying the White House.

As I have always maintained, the more models, the more complex, confusing and dysfunctional the health care system gets in the US. But it seems CMS never learns, and until the American people stand up to the medical-industrial complex and demand single-payer, damned the torpedoes to their profits and bottom-lines, the better our health care system will get.

Today, someone posted an article about single-payer on LinkedIn and most of the folks who responded did so with negative views about single-payer that indicated that they had drunk the kool-aid fed to them by the medical-industrial complex and their political allies.

They made the claim that countries that have single-payer have seen a decline in care, and that people hate it. So I asked the question, if it is so bad, why aren’t they adopting our system? It is because theirs works.

They don’t have too many models and regulations, and they get great quality of care. Yes, there are problems and they are not perfect systems, but nothing ever is. The truth is we are still the only Western country without single-payer, and CMS’ models are one reason why.

Here is the link to the article.

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EHR Vendor to Benefit from CVS/Aetna Merger

An article here from Healthcare IT News.com discusses how a CVS partner, Epic Systems, will benefit from the merger between CVS and Aetna.

The article reports that this signals a new era in analytics, interoperability, and population health.

According to Healthcare IT News.com, CVS is the biggest pharmacy chain in the U.S. by a number of locations and prescription revenue, Aetna is the nation’s third-largest insurance company. Epic Systems, which was not a party to the merger, but has been a CVS partner since 2015, is the largest electronic health record vendor.

The deal, according to the article,  stands to have a transformative impact on how healthcare is delivered in this country. Data, and lots of it, given that CVS has 9,700 retail locations and more than 1,100 walk-in clinics nationwide, was clearly a huge driver for the deal.

Epic’s vice president of population health, Alan Hutchinson, said that by using Epic’s Care Everywhere and Share Everywhere interoperability tools, CVA and Aetna could provide the rest of the community with information and insights to improve care.

“What’s really interesting about working directly with payers, providers, and patients is the ‘gray space’ – the opportunity that exists between traditional sites of care and all of the other organizations that are involved in the patient’s healthcare experience,” Hutchison said.

David Anderson, a research associate at Duke University Margolis Center, said in a recent blog post, “I can think of using the CVS retail data as a population health monitoring service, I can think of using the over the counter sales data tied to individuals to fuel predictive models for future opioid issues, or arthritis flares, or pulmonary hospital admissions or one hundred other things,”

He went onto say, “So from my former point of view as an insurance data geek, this merger offers an incredibly rich vein of data that can be mined and minted.”

The fundamental aim of the merger, is the management of chronic diseases through patient engagement, telehealth, and remote monitoring.

Aetna CEO Mark Bertolini said, “I think you have to think of it as keeping people away from the medical-industrial complex by offering better services in the home by meeting social determinants of health, which are big drivers of healthcare expenditures today, much bigger than people understand.”

Larry Merlo, CEO of CVS Health said the arrangement will enable the combined company to deliver services that many hospitals currently do not.

The Economist Explains it All: What the U.S, Needs to Do With Health Care

Thursday’s The Economist had the following article.

It explains what the U.S. needs to do to fix health care.

Our leaders in Congress, both Democrats, and especially Republicans should listen to what it has to say.

Medicare for All is not socialism, socialized medicine, or communism. But the status quo is health care capitalism, and has been a disaster.