Headlines and opinions in healthcare

You’ve got questions, he’s got answers

Robert Betka Jr., a consultant with Catalyst Management Advisors in Grand Rapids, Mich., says federal authorities, private payors and ultimately ACOs themselves will have to answer some key questions on how the Accountable Care Organizations will operate. He analyzed five points, including how the ACO would divide up payments:

Initially, each component of the ACO would be paid on a fee-for-service basis and then would share a certain amount of the savings created by the ACO. How would that payment be divided? To determine this, Mr. Betka thinks clinical representatives from each component would have to identify the whole continuum of care for each condition and assign a value for each step in the continuum. For example, bypass surgery would involve surgery, imaging, nursing, rehabilitation and other services, depending on a variety of circumstances. While initially only the shared savings would be apportioned this way, eventually the whole payment would be broken down, Mr. Betka believes. The goal is to pay the ACO one lump sum for the entire episode of care, like a bundled payment, he says.


Money where his mouth is … if we knew who “he” is

Harvard’s initiative to improve primary care got a huge boost – to the tune of $30 million. As an anonymous gift, reports the Boston Globe.

Ultimately, Harvard — which some physicians believe has neglected primary care — wants to help fix the nation’s shortage of primary care doctors by raising their status among their peers and improving working conditions, said the dean, Dr. Jeffrey Flier.

He said the center will pay part of the salaries for 20 to 30 faculty, oversee expansion of the curriculum in primary care, and fund research and experiments to test new models of providing primary care. The school hopes to recruit a renowned national leader in the field to head the center, which Harvard planned to announce today. It will open over the next few months.

Speaking of Harvard, you can’t go wrong with the Harvard Business Review. Col. Bernard Banks, a faculty member in the Department of Behavioral Sciences & Leadership at West Point and a Colonel in the United States Army, offers some military insight into how companies can develop critical thinkers.


In industry, 90% of time is typically devoted to executing business actions, and less than 10% is allocated for increasing organizational and individual capabilities through training. The military, on the other hand, spends as much time training as it does executing — even in the midst of high stress/high risk operations. A unit in Afghanistan or Iraq will not suspend its experiential training program while involved in combat operations, because its ability to cogently and creatively address future challenges is enhanced by an enduring commitment to improving people’s competence and adaptability through experiential exercises, as well as actual experiences. But the real lesson for industry leaders is not simply that training is important. What’s really valuable is how the military crafts its training opportunities.

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