An Accountable Care Organization Administrator Explains Why This Is A Good Idea to a Skeptical Patient

Oh you silly attributed ACO enrollee.....

Extormity EHR Hilarity

Extormity link here.

Why Appeals on the Constitutionality of the Affordable Care Act Will Not Be Fast-Tracked to the Supreme Court

The Disease Management Care Blog agrees with the spouse on one key observation about human and organizational behavior: if moms were put in charge, a lot of societal problems would be fixed - and pronto. For starters, war involving their children would end. Our nation's schools would work. 535 legislators would be looking for new employment. Taylor Swift's media ubiquity would cease.

If only.

The DMCB suspects the moms would also favor dismantling all of the lower court legal motions and appeals surrounding the constitutionality of the Affordable Care Act's individual mandate. It's going to end up at the Supreme Court anyway, so it'd be smart to just fast track it, right?

Alas, the moms aren't in charge. After researching the toxic legal issues and partisan undercurrents, the DMCB developed this handy decision tree posted above that amply demonstrates how our Republic can look forward to years of additional legal wrangling before we'll know for sure.

Email the DMCB if you want a pdf!

('’)

A Hippocratic Oath For Accountable Care Organizations (ACOs)

During it's post-Thanksgiving meal torpor, it occurred to the Disease Management Care Blog that it recited the Hippocratic Oath upon graduation from medical school. Since modern scientific policymaking has ascertained that goodly medicine should be a team sport, the agreeable DMCB wonders if other members of the health care community would want to demonstrate similar allegiance to the art. It is in that spirit that the DMCB offers up a version of the Oath for the newest member of the health care family: Accountable Care Organizations (ACOs):

I swear by CBO, the scorer, Hopefulius, Prayitworkius, and Panacea, and I take to witness all those who testify, publish and make presentations based on assumptions and made-up stuff, to keep according to my ability and my judgment, the following Oath and agreement:

To consider dear to me, as my parents, CMS who will regulate this art; to live in fear of its Administrator and, if necessary, to share upside risk with him or her; To look upon his or her regulations as my own siblings, to not rock the boat lest I be tossed under the bus or have to respond to a hostile letter from HHS Secretary Sebelius.

I will hustle for bundled payments for the good of my patients according to my ability and my judgment and avoid expensive MRI scans and other non-evidence based priceyness for everyone.

I will not give in to anti-trust allegations, nor will I document if I have made such a plan during meetings; and similarly I will not give an FTC lawyer any testimony to prompt scrutiny. But I will preserve the purity of my cash flow and my not-for-profit operating surplus.

I will not exceed my budget, even for patients in whom disease is manifest; I will meddle in all operations to be performed by practitioners, specialists in this art.

In every house where I come I will enter only for the good of gainsharing, keeping myself far from all appearance of any intentional ill-doing and all seduction and especially from the pleasures of finally controlling doctors, be they salaried or slaves.

All that may come to my knowledge in the exercise of my electronic records or in daily flow of information, which ought not to be shared with other competing providers appearing on area billboards as “Top 100,” I will keep secret and will never reveal.

If I keep this oath faithfully, may I enjoy my life and practice my art, be mentioned in glowing Congressional testimony or a State of the Union address and in all times; but if I swerve from it or violate it, may all my assets be absorbed by a for-profit investor owned health care system.

Once the regulations get published and the ACOs get selected for the national pilot program, the DMCB looks forward to seeing the Oath administered to the suits at an appropriate White House ceremony.

The Magnificent Carnac Speaks to Health Care Reform!

According to a TV documentary last night, "Karnak" is a temple complex used as a beacon to guide ancient astronauts. The Disease Management Care Blog knows better. It's really Carnac, and he was an all powerful and all wise soothsayer who, from time to time, would appear on Johnny Carson. He'd amaze and astound his viewers by divinating the answers to questions he hadn't even seen yet, because they were hermetically sealed in envelopes! And if the audience was insufficiently impressed with his all-seeing prowess, he'd condemn them with terrifying curses.

Was the DMCB a victim of an insomniac twilight sleep or was it the subject of a visitation by The Magnificient One? You be the judge:

Karnak's augury:

"The Obama Administration and American physicians."

The question..... Name two groups that will need to find another line of work by 2012.

More Karnak wizardry:

"A Perfect 10!"

The question..... How many thousands of dollars will independently practicing nurses soon pay for their malpractice insurance?

(If you groaned at that one, fear Karnak's curse: "May dozens of Mini-Me Pelosis and Boehners sprout from your computer screen and lecture you about 'the American people.'"

A last Karnak enchantment:

"The Matrix, Alice's 'Wonderland' and Avatar's Planet Pandora"

The question.... Name three settings where Accountable Care Organizations have been proven to save money.

Sis boom bah!

Suggested Disease Management Slogans for the Restore Sanity and/or Fear Rally

While the mainstream news media dissects the successful crossover mockery of Jon Stewart and Stephen Colbert from comedy to news to politics in their Restore Sanity and/or Fear Rally, it occurred to the Disease Management Care Blog that the phenomenon is hardly new. For example, Mark Twain and Will Rogers were the rock star satirist-pundits of their day. Yet, give those wacky Comedy Channel stars credit where credit is due. It takes real talent and judgment to simultaneously mock, be funny and score points. Just ask David "Palin-baitin'" Letterman, Don "nappy headed" Imus and Rick "the Jewish conspiracy" Sanchez.

The DMCB is jealous. If it weren't for some business, it might have been at the rally so it could have carried its own health care placards. To wit:

"We have nothing to fear except running out of my drugs for my chronic anxiety disorder that causes fear."

"Population health management nurses are hot."

"Kathleen Sebelius: not a witch, but one of us. Really."

"Health insurers need love too"

"Be nice. Share risk pools!"

"Man-up: read the DMCB"

"Anecdotes, not actuaries!"

"I want to be meaningfully used by the DMCB spouse!"

"I may be wrong, but you don't have health insurance."

"Everyone sort of likes disease management lots."

"Tea Partying: A chronic condition that can be positively managed with remote telephonic counseling"

"Shared decision making plus cookies: the cure for partisanship"

Primary Care - Hospital Negotiation Over the Formation of An Accountable Care Organization (ACO)

The Disease Management Care Blog recorded this exchange between a hospital administrator and a primary care physician over the terms of participating in an Accountable Care Organization. Chances of success seem high.....



This same physician is expert in the Patient Centered Medical Home.

Shared Decision Making to Aid in the Purchase of Health Insurance? Why Not?

The Disease Management Care Blog thought some more about the healthcare.gov site and yesterday's post. It looks forward to eventually reading a news release not unlike the one below in the not too distant future.....

HHS.gov
FOR IMMEDIATE RELEASE
Tuesday, Oct 4, 2014

HHS Announces Unique Three-Way Public-Private Partnership To Better Serve Purchasers of Health Insurance

The U.S Department of Health and Human Services (HHS) today announced that it has contracted with the National Committee for Quality Assurance (NCQA) and Amazon (AMZN) to help individuals and businesses make truly informed decisions about buying health insurance.

Thanks to relying on the NCQA's highly respected approach to the measurement of health insurer performance and using Amazon's track record of giving consumers tailored personalized purchasing choices, HHS has revamped its healthcare.gov site to aid consumers with shared decision making (SDM) when they are assessing their health insurance options.

"When the U.S. Congress demanded that HHS be subject to the same rigorous standards of health care outcomes measurement as doctors and hospitals, we quickly determined that the original http://www.healthcare.gov/ website was not exceeding the American people's expectations," said CMS Director Carolyn Clancy, formerly of AHRQ. "Consumers are interested in a host of complex features that include network physicians, keeping hassles to a minimum, time to answer a phone with a knowledgeable person, programs that promote wellness and prevention, web site usability and consumer satisfaction rates, among others. We decided it was time to let the experts discover what those interests are and get out of the way."

"I'm proud of CMS' efforts to meet the original intent of the Affordable Care Act of 2010" added HHS Secretary Donald Berwick. "Thanks to the leadership of President Meghan McCain, we are making important strides in combining the best features of federal and state oversight while simultaneously letting consumers reward the better insurers with their business in a fully transparent marketplace."

Shared decision making (SDM) is a process that relies on state-of-the-art and consumer-friendly media formats to provide unbiased information that allows consumers to rely on their own values and needs to make complex health care choices. Research funded by the newly named Agency for Healthcare Consumerist Research and Quality (AHCRQ) determined that if patients can use this to make informed choices about cancer treatment options, they could also use it in purchasing insurance.

According to the widely read and oft-quoted Disease Management Care Blog, once the NCQA announced the methodologies to isolate, measure and audit the key consumerist attributes of quality health insurance, it was a "no-brainer" to turn to Amazon's expertise in efficiently guiding consumers to find options to match their particular preferences. "Hit" rates from web-enabled cells phones on the HealthCare.gov site skyrocketed and taxpayers finally knew they were getting their money's worth.

For more information, visit our Facebook page at Facebook.com/HealthCare.gov, or the @HealthCareGov Twitter account.

To download a www.HealthCare.gov Insurance Finder widget – so that visitors to your website can easily start searching for health coverage options – visit www.HealthCare.gov/stay_connected.html.

The DMCB made several calls to the office of former HHS Secretary Kathleen Sebelius for comment at the headquarters of the National Coalition to Establish the Swedish Republic of Vermont. They went unanswered.

Shared Decision Making in the Patient Centered Medical Home

The Disease Management Care Blog couldn't resist.......





('’)

Taglines for the Patient Centered Medical Home

The Patient Centered Medical Home has achieved another stepping stone in its journey to mainstream respectability: it was featured on National Public Radio's All Things Considered. With that remarkable achievement, it's just a matter of time until this darling of health reform is into primary care thicker than meaningful on use. Knowing that the PCMH will also need to marketed to a grumpy public, the Disease Management Care Blog is pleased to help out by offering these taglines.

Your [insert name of chronic condition] is worse? Call our nurse!

Getting both you and your doctor home by 4 PM.

This ain't your grandfather's gatekeeping.

If your bones be groaning, give us a phone. If your entrails be failing, send us an email!

Turning your costs into our revenue.

Help us help you to help us help you to cut the government's costs.

Health insurers love us.... shouldn't you?

Our scheme is the team. Our cause is the costs.

Don't call it disease management.

Hey, it's primary care. We deserve it.

A cure for the common chronic care conundrum

Star Wars' Master Yoda Advises President Obama on Health Care Reform: Communicating, The Role of Experts & Top 100 Lists

The virtual Disease Management Care Blog has learned to navigate the duality that bridges particles and waves, channel dark matter and access the cosmic video game that governs humankind's Sim-like existence. It is in that polymension that the DMCB discovered that President Obama and Yoda have communicated.

This exchange was plucked from a bosonic mimetic string and is shared as a DMCB exclusive for your reading pleasure.....

Mr. Obama: Master, my poll numbers on health care reform are in the crapper. I've blamed the insurers and the conservatives again to try to generate better support, but it's not working. What is your advice?

Master Yoda: As wily Cato described has, using the Force is the product but the pitch not. To recognize the flaws in the Affordable Care Act and seek to correct them, you need, young knight!

Mr. Obama: But, Master, I don't have time for that. Midterm elections are a less than a parsec away. What do you think about giving some more speeches in a tour of the heartland, like the Great Communicator?

Master Yoda: The difference learn between communicating and oratory, you must. Yes, hmmm.

Mr. Obama: But President Reagan....

Master Yoda: Silence young one! Speak the name of the greatest Jedi Knight that ever lived, do not. A rare Gladwell Academy Outlier he became.... spent decades writing and giving speeches training his superb communication talent. Many thousand hours at Earth poultry dinner gatherings helped him his skills hone. Just a rookie novice you are. Yeesssssss.

Mr. Obama: Hey, let me remind you that you're just a mix of green latex and computer animation, while I'm President of the United States and Number 1 on this list of the 100 most powerful people in health care.

Master Yoda: Silly, are you. Other insider insurance execs, ivory tower policymakers, politicians and bureaucrats in a closed information loop on that list, see you, hmmm? A way to retread old news and generate web traffic, "Top 100" lists are. Little green droppings on them, I leave. Blah!

Mr. Obama: Hey, now you're sounding like the party of no that got us in this mess in the first place!

Master Yoda: Work on me, your tired rhetoric will not [whack with weenie cane here]. Advise to jettison your mistaken notions into deep space, you I do. Best find advisors who on that Top 100 list are not.

Mr. Obama: But my administration's policy making is being formulated by the brightest folks this country has to offer!

Master Yoda: Of great danger, over-reliance on experts is. Commune exclusively on Planet C-SPAN do they, pretending that Federal healthcare Jabba the Hut is not. Lack day-to-day understanding of patient care, they do! Publish in journals that are read by few. Instead, hologram message view you must from New York Times about the future of publishing, using the wisdom of crowds this is.

Mr. Obama: You are truly wise, Master Yoda. My last question is how I can get the First Lady to don Princess Leia garb.

Master Yoda: Ahhh, brazen young pilgrim. Eternally wise DMCB also frequently that asks. Thinks its spouse looks better than a new star drive when sport she twin buns of hair, says it. When the answer to that find, a true Force become, shall you!

March Madness and Health Reform: The Policy Brackets are Announced

March Madness is officially upon us and the Disease Management Care Blog is very excited - and not because it gets to simultaneously wear bright organge and root for a certain group of Wildcats from just north of Philadephia. It's also because the end of the beginning for health reform has an uncanny resemblance to the NCAA tourney. Sure, health reform may look like an unending and slow-motion care wreck, but there are also favorites, underdogs, hunches, winners, losers, rivalries, cheerleaders, media hoopla and bombast. The only thing that's really different is that it's not single elimination: U.S. health reform is more like double elimination to the fifth power involving a cast of thousands.

The un-information techie DMCB was stymied in its attempt to upload a landscape-style portrait displaying a 65 participant health reform tournament. So, the DMCB is making due by typing out two brackets of 32 key players/concepts. Note that the soothsaying DMCB has given "Health Reform Passes" a 1st seed position. Intrade now rates passage at greater than 50%. Apparently, bettors are thinking that it'd be unusual for Ms. Pelosi and Mr. Rahm to press toward a vote if they didn't think they could succeed. Who knows, they just may pull this off.

The East Bracket

(1) Health Reform Passes!

~vs.~

(16) Just What IS the Meaning of Meaningful Use?

(8) Integrated Delivery Systems Are Swell, Even If They Can't be Replicated

~vs.~

(9) Health Insurers Promote Living Wills to, er, Show A Commitment to Quality

(5) Reconciliation: Democracy in Action

~vs.~

(12) Health Cost Inflation Outlawed by Congress

(4) Caesarian Rates: Get What You Pay For

~vs.~

(13) Electronic Records: Stuck Eternally in the Future

(6) Insures: Love That Mandate

~vs.~

(11) D.C. Accounting Logic: Spend More, Reduce the Deficit

(3) Four ‘Ideas’ = Compromise!

~vs.~

(14) FDA Outlaws All Medication Side Effects

(7) Malpractice Reform Stillborn

~vs.~

(10) Primary Care: A General Motors Approach

(2) Accountable Care Organizations: PHO Redux

~vs.~

(15) CMS' Budget To Exceed Europe’s GDP

The More of the East Bracket

(1) Obama Cancels Another Trip

~vs.~

(16) Never Mind the Law: Here Come the Regulations!

(8) Cross POTUS Chief of Staff & Say Hello to Underside of Mr. Bus

~vs.~

(9) Academic Med Centers & CER's Outcome: Gravy Train

(5) HHS Secretary Appears in Dancing With The Stars

~vs.~

(12) Pay for wellness and disease management, please

(4) Pilots Fly, Demos Die, & Politicians Never Lie

~vs.~

(13) The United States of Greece

(6) Health Reform Polls Consistent with Any Preconceived Interpretation

~vs.~

(11) Sheryl Crow Gets Invite to Signing Ceremony

(3) Prez Gets Cadillac Check Up

~vs.~

(14) New Engl Journal of Medicine Wishes They Were Invited to Signing Ceremony

(7) CMS Administrator: AWOL

~vs.~

(10) Dems’ Health Care Information Loop Causes Death March

(2) Republicans: Scorched Rarth

~vs.~

(15) Blogs Glom onto Reform Like Blobs

The Health Care Industry Answers the Question Again: Why Did the Chicken Cross the Road?

It's been some time since the Disease Management Care Blog posted industry answers to the age old question. It's that time to ask again .......

"Why did the chicken cross the road?"

Health Insurance Industry: Crossing the road is not a covered benefit and, because we weren't informed about the bird's pre-existing tendency to cross roads, have issued a rescission effective three years prior.

Healthways: We regularly survey thousands of chickens with that question. We think this question can be applied to turkeys and guinea hens.

Lifemasters: Um, the chicken didn't make it across the road.

The PHI Institute: Compared to what?

The Dartmouth Atlas: We looked at regional variation involving the road-crossing patterns of dead chickens and can find no explanation for it. It must be preference sensitive.

Mainstream Media News: Fowl on Foul Road Prowl: Bird Defies Death, Seeks Safety From Evil Insurers!

The DMAA Care Continuum Alliance: If crossing the road was a desired outcome, our members' engagement strategies were responsible for it and that service should be covered by all health insurers and Medicare.

Academic Medical Centers: To find out, we'd like the government to fund large studies that randomly assign a valid sample of chickens to a road, another sample without a road and prospectively measure both groups over many years of comparative effectiveness research.

Medicare: So that we can be billed for it 10,000 times by a suppliers in Florida.

The Senate Confirmed CMS Administrator: blank

Bloggers: We don't know, but we'll be happy to speculate on why - or why not - for days on end.

The DMCB: To avoid having to watch the maudlin blubbering in The Biggest Loser

The DMCB Spouse: You have a ceiling to paint.

A Top Ten List of Medical Uses for the iPad: An Alternate Point of View

The Disease Management Care Blog is not surprised by the fawning adulation of the health information technology (HIT) minions over the illusory potential of Apple's iPad to 'transform' clinical practice. For example, this CIO posting examines its potential to 'revolutionize' healthcare, while this one says it can become the 'No. 1 tablet.' Toss in jargon like 'point of care tool' and 'personal health device' and add some lusty excitment over applications both real and imagined, and it's easy to succumb to the seduction of touching screens instead of patients, managing data instead of diagnoses and being digital instead of doctors. Never mind that a consistent link between electronic record use and health care quality remains as elusive as the CFO-like DMCB spouse's willingness to approve the expense of a dinner in the Circular Dining Room. It's still cool! It's still neat!

Of course, the iPad hoopla (including the Moses themed cover of The Economist) has only fueled that favorite of internet-media-bloggy punditry, the 'Top 10' list. For example, the Top 10 What You Need to Know and... well the list goes on, including a Top 10 list of Top 10 lists. Within the healthcare arena, the readers of KevinMD's blog were subjected to a dose of unreferenced and wholly speculative Top 10 healthcare iPadmania.

Not to be outdone, the DMCB - based on past experience with electronic records, their starry-eyed administrative support teams, questionable outcomes and the cold hard reality of actually taking care of patients - is pleased to offer its own Top 10 list of potential iPad uses in typical practice involving busy doctors and sick patients in a place unknown to many of the electronic record nobility. That place is called 'the real world':

1. Hot Beverage Insulator: The DMCB used to perch a prescription pad on top of its coffee cup to help retain heat between seeing patients. The disadvantage is that, as a result, the liquid often tasted from cardboard. The iPad case promises to be far more inert.

2. Instrument Tray: Office assistants can lay out scapels, scissors, swabs and other doo-dads on the screen for easy access. Compared to the price of medical equipment such as trays etc. in general, the DMCB suspects the iPad will be quite cost competitive.

3. Lunch! The DMCB learned from a wise colleague that no matter where you are in the day, lunch is always on the way. The iPad will be a boon to any physician who needs to place a lunch order during the tedium of patient care.

4. Tricorder: Remember Star Trek's Dr. McCoy and his multi-purpose diagnostic tricorder? If physicians are confident nothing is wrong with the otherwise dubious patient, point the iPad (or better yet, hold it up against the patient's body), peer intently at the screen and announce there is 'NOTHING WRONG.' Your patients will thank you!

5. Light Source: Surely the iPad's screen can be made to go white. When it does, aim that puppy at the patient and no mole, no body fold and no body cavity will not be amply and completely illuminated. All that's needed is a way to affix it to the doctor's forehead a.k.a. 'hands free mode.'

6. Timer: Most physicians and their administrators understand down to the second just how much time should be allocated to each patient to maximize practice income. The iPad will calculate current billings, cash flows, visit intensity and room-to-room pace to optimize maximum physician efficiency. When 30 seconds are left for that Level 4 visit, count on your iPad to buzz annoyingly.

7. Meaningful Use Standards: Like you, the DMCB doesn't really grasp CMS' Meaningful Use Standards' that will be linked to physician payment for EHR use either, but it thinks having an iPad will magically make it happen. Turn that baby on and wait for a check from Uncle Sam

8. Door Stop: Nothing annoys patients more than being put into a room ahead of time and being left to languish while the doctor is behind schedule. Not a problem, the iPad can be used to prop the door open so that patients can see out into the hallway.

9. Pass Time: Or, if patients prefer, they can leave the door closed and curl up with the iPad edu-tainment device, accessing functions like soothing music or really gross pictures of patients afflicted with weird medical diseases.

10. Cool and Cheap (relatively at least): OK, let's assume patients think you should use an electronic record, but you don't want to shell out the tens of thousands of dollars. Pretend to use an iPad during your patient encounters and you will give the appearance of being cool, connected and networked, even though what you're really doing is surfing and checking the Disease Management Care Blog.

('’)

The Movie Avatar as a Allegory: The Health Reform Debate and Good Versus Evil

The Disease Management Care Blog and the DMCB spouse saw the film 'Avatar' last night. About every decade or so, we can agree on a movie. It likes the cinematic eye candy of explosions, silly techno-fiction and lithe ferocious warrior babes, while she likes romance, romance and romance. While the DMCB almost spoiled things in the theater by pointing out the implausibility of the interspecies coupling that was rather virtual and was accomplished without the presence of any apparent.... er, equipment, both parties were not disappointed and pronounced the evening a dating success.

The plot was an intergalactic remake of Dances With Wolves: nice guy (Jake Sully) from an evil race (humans, a.k.a Sky People) that is attacking nature (the Planet Pandora) discovers the truth (an abiding reverence for all living things), attains innocence (thanks to communion with Eywa) and, (with the benefit of an uplink to a genetically engineered avatar), wins a woman, in this case a very blue ten foot woman (Neytiri).

Such is a classic theme of redemption that the DMCB thinks it can be extended to the health reform debate. All that remains is to take sides:

Jake Sully is a...

a) naive progressivist activist, or

b) soon to be former health insurance executive, who...

takes on the task of...

a) bringing a predatory corporate insurer to heel, or

b) is assigned the job of recissions for pregnant women who have just lost their job, because....

of 'unobtainium,' a substance...

a) that renders unparalled social justicium from the governmentium, or

b) can be turned into free marketium.

Jake's soul discovers the price of unobtanium is too high, thanks to mind-melding with Eywa,

a) a diety that uses the Tree of Blogs to help us discern the wonderful limitless goodness of all living things, or

b) a diety that uses the Tree of Blogs to help us discern the miserly selfishness of humans and, by the way, who cares about other living things?

Jake's evil people....

a) post provocative health reform videos on YouTube or

b) hold secret meetings in sumptuous hotels that are closed to the public, which causes great vexation and consternation of the...

Na'vi, an underdog group of ....

a) Republican leaning health insurance workers with families who go to Church, take out their neighbor lady's garbage and work hard to keep premiums down and pay providers fairly but as little as possible, or

b) politically agnostic and uninsured persons who never voted until President Obama came along.

Tens of thousands of Na'vi die, hundreds of thousands declare bankruptcy. Jake's guilt helps him to see The Truth because of a woman, because

a) according to the DMCB spouse, when they are heeded, great insights occur, or

b) according to the DMCB spouse, when they are heeded, great insights occur.

As a result, Jake leads a David vs. Goliath counterattack of the Na'vi by

a) appearing on Fox News with rabid denunciations of infringements on our liberty, or

b) appearing on MSNBC with breathless insider exposés.

As a result the Evil Ones

a) face loss of Federal funding support or

b) are brought before Congress for some uncomfortable questioning

leading to righteousness for all. Play inspirational music. Fade to credits. Leave theater knowing that there will be health reform sequel after sequel after sequel.

A Requiem for Joe and the Public Option....

Senator Lieberman has apparently succeeded in driving the final nail into the public option's coffin, earning him an eternal damnation from the Church of Universal Coverage. The Disease Management Care Blog agrees: oh, ease up on Joe already.

But the empathic DMCB feels your pain. And what better way to feel better than to break into some song? This one may be morose, but after a few verses, the DMCB guarantees that the suffering will ease and the work of influencing policy can begin anew....

With apologies to 0ne Eskim0 and their lovely and haunting version of Kandi

Joe’s made a scene for longer than you know
Reform thanks to you
Has been a big headache
Every day we stop
It’s make or break…..

And if we get things wrong
Don't want us to think we're running away
But we’ve heard from Joe about this plan
And we want to know

What did he say?
He said no way, no way no way all along
What did he do?
He said no way, no way all along…….

Why? Why? Why, do we need him?
Filibuster
Just how close are we to sixty?
Every smile he gave
Every pledge he made
Every word he said…..

And it hurts beyond hurt
A plan that Reid insists
And our base is pissed
When we heard from Joe about his “no”
And we want to know

(OK, everybody sing!)

What did he say?
He said no way, no way no way all along
What did he do?
He said no way, no way all along……

Do insurers ever touch you…..
Can Move-On ever reach you….
It’s never enough….

What did he say?
He said no way, no way no way all along
What did he do?
He said no way, no way all along…….

Air Passenger Travel and Population Based Health Care, Managed Care and Disease Management: Overlaping Terminology

The Disease Management Care Blog spent the day being victimized by our air transportation system and noticed many an uncanny resemblance between the healthcare and airline industries. So much so that some of the terminology used by the DMCB in past posts can be easily applied to the average passenger’s experience.

To wit:

System Inertia: What happens when a customer with a complicated itinerary has a flight delay with connection problems and hogs the attention of the gate agent.

Stakeholder: Anyone who plants or ‘stakes’ both elbows on the counter of a gate agent while dealing with a complicated itinerary. See ‘system inertia.’

Maximizing Outcomes: the jostling of the experienced travelers to get on the plane first so that they can be first to access the overhead bins with their generously sized carry-ons.

Disparities: the unfavorable ratio of available space to carry-on luggage volume for persons unable to maximize outcomes.

The Underserved Population: first time travelers who are baffled by garbled overhead announcements, opaque seating systems and how First Class passengers are always allowed to board ahead of everyone else - even when they get in line with them.

Outlier: the inexplicable tendency of underserved populations to remain in the aisle and not get in their seat while tending to the countless last minute details of traveling, like checking their ticket one more time, getting their food out, dealing with disparities and chatting it up with other underserveds.

Chaos Theory: the sudden and noisy unwinding of a toddler’s patience with being confined in a aluminum tube at 35,000 feet. More likely to manifest itself during descent thanks to narrow Eustacean tubes.

P value: the superior status of the lavatories in the front of the airplane thanks to the requirement that passengers restrict themselves to their ticketed cabin.

Regression to the Mean: the over-response of the DMCB spouse to the perfectly reasonable possibility that her frequent flying husband could get a coveted upgrade to First Class without her.

Withholds: the DMCB spouse’s solution to her husband’s continued willingness to go to First Class without her, despite Regression to the Mean.

Mmm Mmm Health Care (With Apologies to the Crash Test Dummies)

Once there was this Prez, who
Didn’t like the health care costs, and promised to re-tool
But when he did some Town Halls
His polls had turned from great into awful
He said that all those details
That small print’s sooooo haarrrdddd

Mmm Mmm Mmm Mmm

Once there was this Speaker who
Wouldn’t go and deal with any Blue Dog in the cloak rooms
But when they finally made her…
They saw spending out of control
She’s very good at explain’in it
‘The silly voters don’t care’

Mmm Mmm Mmm Mmm

But both Speaker and Prez were glad
‘Cause one pol had it worse than that…..

‘Cause then there was this Senator
Held all those secret meetings hidden from the press pool
And with opinion research
They looked n’ saw polls lurched down a big craphole
The voters had explained it
Don’t ever EVER go….. there

Mmm Mmm Mmm Mmm......

Health Reform Needs Villains: Here Are Three

Egads, promoting health reform is really hard work, especially for a U.S. President. Not only do you have to become expert in health economics, contend with others’ imperfect decision-making and settle for less than what you'd prefer, your family vacations have to be cut short. Since letting others do the heavy lifting isn't working out so well, Mr. Obama has turned to old-fashioned political rhetoric and generalities to garner support. Unfortunately, even that tried and true method is wearing thin.

But there is another approach that oten works: pin the blame on a villain. Yet, unbelievably, Mr. Obama gave up using that approach when, reproached by an insurance broker at a Town Hall, he answered:

'First of all, you are absolutely right that the insurance companies, in some cases, have been constructive. So I'll give you a particular example. Aetna has been trying to work with us in dealing with some of this preexisting conditions stuff. And that's absolutely true. And there are other companies who have done the same. Now... in some cases what we've seen is also funding in opposition by some other insurance companies to any kind of reform proposals. So my intent is not to vilify insurance companies. If I was vilifying them, what we would be doing would be to say that private insurance has no place in the health care market, and some people believe that.' (bolding from the DMCB).

Talk about a political blunder. Thanks to a deal with big pharma, a separate deal with the hospitals and breaking bread with the AMA, the only villain left standing was the health insurance industry. Now that’s gone.

The Disease Management Care Blog understands that finding someone to blame is a long-standing tradition in today’s ends-justify-the-means politics of partisan elbow throwing. What's more, half of the August recess is gone and big-bang health reform is in trouble. Knowing that it’s do or die time for the Administration, the DMCB is pleased to come to its rescue with three ready-made villains that are available to kick-start the health reform debate on the President's terms:

Global Warming: Can anyone doubt that the simultaneous warming of the planet and skyrocketing health care costs are more than just a coincidence? Their co-occurrence is not only clear proof than one is causing the other but fixing one will fix the other. The DMCB is thinking both ways: not only will cooling the planet preserve precious farmland (nutritious veggies) and halt the spread of bugs (like malaria and spiders), but vice versa: controlling health care costs will reduce our carbon footprint. Think smaller hospitals using less power, less use of internal combustion engines to access physicians thanks to the greater use of blue pills in lieu of red pills, fewer pacemakers and better preservation of both legs so that folks can bicycle to the organic Farmers' Market and the next Town Hall.

The Taliban: These enigmatic bad boys are behind a host of things that are wrong with our world, so why not toss in health care. Sure, they’re half a world away and their threat to the homeland is questionable, but that hasn’t stopped a prior President from successfully rallying the country to defeat these evil-doers. Time to dust off this template and say it out loud: unless health care reform passes, the terrorists will win.

Aliens: Why not leverage our country’s fascination with nefarious space beings. Case in point? How about the eerie resemblance between the wacky Sarah Palin and the space beings of Area 51? Is her bouffant hiding an unacceptably large head cavity? Are her spectacles making her eye sockets appear smaller than they really are? Can her behavior only be explained by orders beamed by some orbiting craft? While the DMCB wonders about this, it also thinks that implying that only a not-of-this-world entity could equate death panels with advance directives will resonate with a huge swath of gullible Democrats and Republicans. This will rally naysayers faster than managed care CEOs to an insurance mandate.

For the Disease Management Road Warriors

The Disease Management Care Blog understands the travails of the disease management consultant, sales, speaking and other-duties-as-assigned road warriors. It recalls an early posting on hotel water glasses, but now we know to not pack our guitars.....