And that progress is measured against outcomes. We don’t know exactly how it’s going to work, but we are going to just start doing these things and we’ll figure it out as we go. And we just said, we are just going to start and do it. We came up with ten and they go after the big cost drivers: unnecessary hospitalisations, unnecessary use of post-acute care, more use of home care and more use of primary care. And so, then what we did, is we, said how do we get from there to there? Well, the first thing we did, is we identified what we believe our largest opportunities, to save money and improve patient care, are.
And we want to achieve the quadruple aim. So, we are partners, health care, primary care, acute, post-acute and speciality care.
KING TOOL FERRIS SERIES
We had to have a whole series of retreats in our organisations to get to figure out what our strategy was.
They are just really cautious about someone else telling them, what better care is. I don’t know of any clinician who wouldn’t want to deliver better care. If you aren’t doing something difficult, you need to do something that is aspirational and appeal to the intrinsic motivation of the people who are actually with the patients. That means that when we design the delivery of primary care, we are designing them for risk contracts. That means that sixty per cent of our primary care patients are in risk contracts. And then we self-insure for our own employees. We have 350,000 people under commercial contracts. This is what you’re doing to actually change care. And then very specifically, the investment and population of management infrastructure. And so, the response back from the CFOs was how do you propose we do that? I’d say we have a direction, but we don’t have an answer.īut our work, falls into three basic buckets: network composition – who do we need inside this ACO in order to make progress? How do we flow the incentives? We call that the internal performance framework. Your performance is based on two spreadsheets, and by the way, if you’re doing better at one, you’re probably doing worse on the other. We signed contracts that said actually, volume is bad, and we were asking our chief financial officers at all the different organisations within our umbrella. We were organised right from the board, all the way down to the management structures, to deliver volume, because that’s how we got paid. When you sign a contract, that holds you accountable for money, like a lot of money, and spending it wisely, you’re thinking becomes a little clearer when next year’s budget actually depends on meeting a cost reduction target this year. And my job, is to balance those two competing forces and, by the way, I know what I’m doing okay, when I’m failing at both of those. When we turn around to the people delivering care, they say, you know, you can’t shut down, re-tool and then restart the factory, you’ve got to be delivering care as you change care. I would say the external pressures that federal government, the state government and the commercial insurers, would say to us, tomorrow is not soon enough for you to fix this problem. We need tactics that will successfully reduce the rate of growth of the costs of care. And everything else that a state does, is actually going down. So, this is the rate of inflation of acute medical costs in my state, Massachusetts. That program is mandatory for parents who enrol their children in hockey.We are laying off teachers and shutting down elements of public health and reducing our housing subsidies in order to pay, mostly for acute medical costs. The association adds it has created a Zero Tolerance submission tool for "anyone who witnesses an incident that may violate the Respect in Sport program." Simply put: the incident is far reaching to the children we are all trying to protect." "Furthermore, the comments that followed this on social media has also impacted other children on these platforms. "The incident was an embarrassing display of emotion from parents of both teams, the impact of which was felt by the volunteer coaches, the 10-year-old children playing a hockey game, the children refereeing the game, the children who were time-keeping and score-keeping and other spectators which also included other children," the association stated. However, it won't comment on its findings. In a release, the association says it has investigated and met with all the involved parties.
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