5/ Four in every ten American adults say that they’ve delayed medically necessary care because of it
It’s a leading cause of bankruptcy.
Black Americans face more aggressive debt collection and higher rates of medical defaults
This is what “Social Determinant of Health” means
6/ The root causes are a gruesome dissection of our HC financing system:
lack of access to primary care
un/under-insurance
generational poverty/structural racism
surprise medical billing
cost-shifting to “consumers"
hospital consolidation
7/ Our action today isn’t attacking these upstream causes, but we’re going to try to ameliorate the pain
In partnership with @RIPMedicalDebt we @AledadeACO are abolishing the debt of more than 85,000 patients in MS & LA- the states with the worst health outcomes in the country
8/ The economics are astounding. @RIPMedicalDebt founded by former debt collectors has figured out how to purchase and abolish $100 of debt for about $1
This will cost us only a few hundred thousand dollars in donations – matched by RIP (thx to philanthropist @mackenziescott)
9/ Over 80,000 patients are going to get a letter than looks something like this
10/ It has particular resonance for me that we are doing this in Mississippi and Louisiana.
We've had the honor of working with some amazing practices and health centers in these states. They are doing heroic work, and they can use every bit of help.
11/ I recognize that this isn't going to help many of the patients we saw on the list that day.
The debt we are retiring has already wrought many years of toxic harm, and tends to be what could readily be purchased from health systems
We can do even better I think
12/ We are actively working with @RIPMedicalDebt to aggregate and eliminate medical debt for qualifying patients who are seen in community primary care practices
We will be going upstream
Each patient with their debt retired will be a patient who can reconnect with their PCP
13/ I hope that we can join forces with @aafp@MGMA@CMAdocs and others to reach out to community practices- particularly those in value-based care- to purchase and wipe out the debt held by them, and remove any barrier for their patients to return to them instead of the ED
14/ Their patients won’t have to be ashamed to go back to their clinics. They can get a wellness visit, or ask a doctor about a recurring pain they’ve had-- without waiting until it’s become so severe or complicated that an ER visit is their only option.
They can reconnect
15/ I'm proud to work at @AledadeACO where our values and mission are aligned with what's good for patients, good for doctors, and good for society.
I will never take that for granted.
16/ If you or someone you know is struggling with medical debt, there are resources that might be able to help.
(A former colleague literally reached out yesterday looking for help)
The Consumer Financial Protection Bureau is one place to start
You've read the headlines ("Medicare pay cuts partially averted") but to understand what led us here--and what's to come-- we need to go deeper
Also, some cool tangents on effective/ineffective financial incentives
2/ let's walk through the weeds of
"a temporary patch on an expiring pandemic patch for the unintended consequences of a good-will effort to fix pay imbalance between primary care & specialists, made worse by a failure to predict future inflation, w a sop to value-based pay"
3/ The "failure to predict medical inflation"
remember the annual "doc fix" scramble? it was because the "sustainable growth rate" was indexed to inflation, which was near zero for years. So Congress had to constantly step in to reverse its own past efforts to control costs. 😧
1/ Let's flip through the Physician Fee Schedule Final Rule just out, w shared savings focus
Here's a little trick to get past all the pesky comments (that people spent 1000's of hours developing and submitting), and right to the meat of the matter:
CTRL-F "we are finalizing"
2/ First up: we want to increase participation!
strong evidence for providing upfront capital, especially to rural, underserved, low income ACOs (see AIM)
Good idea to expand it 👍
Lots of comments about eligibility criteria, repayment, etc etc.
"finalized as proposed"
3/ We want to increase participation!
Let's allow folks to stay in one sided risk for longer, especially lower income (no hospital) ACOs
1/ Medical practices (and staff) are often damaged by hurricanes too, and the need for care will rise over the next few days to weeks
I'll summarize here some tips that our @AledadeACO Louisiana team have assembled to help others w the recovery process
(eg grab your diplomas)
2/ The needs - and the damage to care capacity- can persist for weeks
“I’m trying to caution [residents]. You do not want to get hurt now. There is not adequate services to take care of you if you cut your leg with a chainsaw, if you fall off a roof,.."
1/ there's been a lot of promise, but also disappointment in the influence of self-insured employers on improving the quality and cost of the healthcare they pay for.
I'm going to do a readout on what may go down as a seminal meeting last week
3/ The Purchaser Business Group on Health represents ~40 large public and private employers like CALPERS, Boeing, Walmart, Apple, GE that purchase health benefits for 31 million Americans
Do they think the $350B they spent last year improved the health of their employees?
1/ One of the best parts of the CMS Medicare Shared Savings Program is the transparency
Hot off the presses: Independent practices working with @AledadeACO generated over $390M in savings for in this flagship value-based program...while increasing primary care access and quality
Kudos to the physician groups with the highest savings rates in the country:
Top marks go to Aledade partner PMA in Pennsylvania.
Amazingly, the Mississippi COMMUNITY HEALTH CENTER ACO came in #4
3/ VBC can work in disadvantaged communities.
We are super proud @AledadeACO that >65% of the practices we worked with were in a Primary Care Health Care Professional Shortage Area and nearly half were in a Medically Underserved Area.
2/ To some crusty traditionalists (and the newly minted value investors out there), it might be "bottom line" - EBITDA
But if I'm CEO of a company with great fundamentals and a huge market ahead of me, shouldn't I be investing now in future growth/profits (vs stockpiling cash)?
3/ But everyone can say that! (and there used to be a lot of investors willing to fund them)
How can you actually distinguish between fundamentally great companies that are unprofitable because they are investing in R&D and sales, and those that are just ... unprofitable?